Effects of double-tract reconstruction versus total gastrectomy on nutritional status in patients with gastric cancer / 第二军医大学学报

Objective: To explore the influence of different reconstruction methods of digestive tract on postoperative short-term nutritional status of patients with early malignant tumor in upper gastric body. Methods: Retrospective analysis was conducted on 109 patients with early upper gastric cancer who underwent surgical treatment in our hospital from Jun. 2016 to Jan. 2018. Double-tract reconstruction was performed in 59 patients (double-tract reconstruction group), and total gastrectomy was performed in 50 patients (total gastrectomy group). Nutritional indexes (hemoglobin, total protein, albumin and prealbumin) were compared between the two groups during hospitalization (at admission, 1, 3, 5 days after operation, and at discharge) and one year after operation. The changes in body weight were observed in the first year after operation. Results: There were no significant differences in age, gender, body weight or nutritional indexes (hemoglobin, albumin, total protein, prealbumin) at admission, operation time, operation method, tumor location, tumor maximum diameter, or tumor differentiation between the two groups (P>0.05). On the 3rd day after the operation, albumin in the total gastrectomy group was significantly lower than that in the double-tract reconstruction group (t=2.30, P=0.023). There were no significant differences in the hemoglobin, total protein or prealbumin between the two groups on day 1, 3 and 5 after operation, and at discharge (P>0.05). The levels of hemoglobin, total protein, albumin and prealbumin were significantly decreased in both groups at discharge as compared with that at admission (P0.05). But the body weight loss in the double-tract reconstruction group was significantly lower than that in the total gastrectomy group (- 10.45%[- 17.11%, - 5.19%) vs - 17.83%[- 22.06%, - 13.10%], Z=4.31, P<0.01). Conclusion: In comparison to total gastrectomy, double-tract reconstruction surgery can effectively improve the nutritional status of patients with early upper gastric cancer.

Preliminary Establishment of a Scoring System Based on Medical History,Vital Signs,and Routine Blood Test for Prediction of the Prognosis of Esophageal Cancer / 中国医科大学学报

Objective To screen predictors for the prognosis of patients with inoperable locally advanced esophageal squamous carcinoma (LAESC) who are undergoing concurrent radiochemotherapy and establish a preliminary scoring system. Methods The data of 75 patients with inoperable LAESC who were undergoing intensity-modulated radiation therapy and concurrent chemotherapy were collected and analyzed to determine whether the prognosis was associated with medical history,vital signs,and the results of routine blood test and liver and kidney functions test before and at the end of radiochemotherapy. The prediction efficacy of the model was assessed using the receiver-operating characteristic curve. The degree of fitting was tested using the Hosmer-Lemeshow goodness-of-fit test. Results Seventy-five patients with LAESC were included. The univariate analysis indicated that the prognosis of the patients with LAESC who were undergoing concurrent radiochemotherapy was associated with weight loss of more than 5％,poor dietary habit,and significant decrease in white blood cell count (P = 0.047,0.074,and 0.074). The multivariate Cox model was conducted,and a scoring system for prediction of prognosis was established. The scores were 1.5 for weight loss of more than 5％,1.0 for poor dietary habit,and 1.0 for a significant decrease in white blood cell count (more than 2.0×109/L). A total score of more than 2.25 indicated a high mortality risk,with a sensitivity of 0.559 and a specificity of 0.805. Conclusion The simple and practical scoring system for prediction of prognosis of patients with LAESC in this study could generally predict the mortality risk of patients with inoperable LAESC who are undergoing concurrent radiochemotherapy.

Risk Factors of Emergency Hospitalization in Japanese Nursing Home Residents / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The purpose of this study was to investigate the risk factors for emergency hospitalization in Japanese nursing home residents.</p><p><b>Methods: </b>Our retrospective cohort study included 170 nursing home residents who had stayed in two nursing homes in Saitama for more than one year by May 1, 2013. The association between emergency hospitalization within one year and 17 factors was examined initially by univariate analysis. Putative factors with P-values <0.05 on univariate analysis were considered in the multivariate analysis.</p><p><b>Results: </b>A total of 70 (41.2%) of 170 nursing home residents were hospitalized emergently at least once within one year. In a logistic regression model, diagnosis of chronic heart failure (OR: 5.73, 95%CI: 1.37-23.84), presence of a decubitus ulcer (OR: 16.70, 95%CI: 1.89-147.41), and 5% loss of body weight over a one-year interval (OR: 2.47, 95%CI: 1.07-5.68) were associated with emergency hospitalization.</p><p><b>Conclusion: </b>Diagnosis of chronic heart failure, presence of a decubitus ulcer, and a 5% loss of body weight over a one-year interval were risk factors for emergency hospitalization in Japanese nursing home residents.</p>

Importance of Lean Muscle Maintenance to Improve Insulin Resistance by Body Weight Reduction in Female Patients with Obesity

BACKGROUND: It has recently been suggested that skeletal muscle has an important role in insulin resistance in obesity, in addition to exercise tolerance and the fat index. The aim of this study was to identify body composition factors that contribute to improvement of insulin resistance in female patients with obesity who reduce body weight. METHODS: We studied 92 female obese patients (age 40.9±10.4 years, body mass index 33.2±4.6 kg/m2) who reduced body weight by ≥5% after an intervention program including diet, exercise therapy, and cognitive behavioral therapy. Before and after the intervention, body composition was evaluated by dual-energy X-ray absorptiometry to examine changes in skeletal muscle mass. Homeostasis model assessment of insulin resistance (HOMA-IR) was measured as an index of insulin resistance. Cardiopulmonary exercise was also performed by all patients. RESULTS: There were significant improvements in body weight (-10.3%±4.5%), exercise tolerance (anaerobic threshold oxygen uptake 9.1%±18.4%, peak oxygen uptake 11.0%±14.2%), and HOMA-IR (-20.2%±38.3%). Regarding body composition, there were significant decreases in total body fat (-19.3%±9.6%), total fat-free mass (-2.7%±4.3%), and % body fat (-10.1%±7.5%), whereas % skeletal muscle significantly increased (8.9%±7.2%). In stepwise multiple linear regression analysis with change in HOMA-IR as the dependent variable, the change in % skeletal muscle was identified as an independent predictor (β=-0.280, R2=0.068, P<0.01). CONCLUSION: Improvement of insulin resistance in female obese patients requires maintenance of skeletal muscle mass.

Efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes internados com obesidade severa / Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

OBJETIVO: Descrever os efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes obesos severos internados. MÉTODOS: Um total de 728 adolescentes obesos extremos, incluindo 249 meninos (15,25±1,56 anos) e 479 meninas (15,34±1,59 anos), recebeu terapia multidisciplinar durante um período de 3 a 9 meses. A terapia consistiu de redução da ingestão energética, orientação dietética, exercícios físicos e terapia psicológica. A composição corporal foi analisada pela bioimpedância elétrica, e a aptidão física foi avaliada pelo teste em ciclo ergômetro multiestágios. O tipo e duração de cada atividade foram avaliados através de recordatório diário de atividade física. RESULTADOS: Foi verificada redução significante (p < 0,05) na massa corporal (27,84±12,49 kg para meninos e 21,60±9,87 kg para meninas), índice de massa corporal (9,19±3,88 kg/m² para meninos e 7,72±3,98 kg/m² para meninas) e da gordura corporal. Além disso, a porcentagem de massa magra aumentou significantemente (p < 0,05) nos meninos (de 58,8±6,41 para 69,98±7,43 por cento) e nas meninas (de 51,86±4,96 para 60,04±5,65 por cento). CONCLUSÃO: A terapia multidisciplinar de longo prazo permite reduzir acentuadamente a obesidade severa, preservando o crescimento e a porcentagem de massa magra.

OBJECTIVE: To describe the effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. METHODS: A total of 728 extremely obese adolescents, including 249 boys (aged 15.25±1.56 years) and 479 girls (aged 15.34±1.59 years) received multidisciplinary therapy during a period of 3 to 9 months. The therapy consisted of reduced energy intake, dietetic education, physical exercises and psychological therapy. Body composition was assessed by bioelectrical impedance analysis, and physical capacity was assessed by the multistage cycle ergometer test. Type and duration of each activity were recorded using a daily controlled activity diary. RESULTS: There was a significant decrease (p < 0.05) in body mass (27.84±12.49 kg for boys and 21.60±9.87 kg for girls), body mass index (9.19±3.88 kg/m² for boys and 7.72±3.98 kg/m² for girls) and fat mass. In addition, the percentage of fat free mass increased significantly (p < 0.05) in boys (from 58.8±6.41 to 69.98±7.43 percent) and in girls (from 51.86±4.96 to 60.04±5.65 percent). CONCLUSION: Long-term multidisciplinary approach allows significant reduction in severe obesity, preserving growth and percentage of fat free mass.

Recognition of Body Weight Loss according to Age and Gender

Among current health-related issues, obesity is considered one of the foremost, and the importance of this subject has fostered a national interest in body weight loss. In this study, the differences in recognition of body weight loss according to age and gender are investigated. The subjects of the study were 720 (male: 360 and female: 360) aged between 10 - 60 years, who had experienced to try body weight loss during 6 months prior to this study. Anthropometrics, general characteristics, personal reasons for body weight loss, comprehension of body weight loss, and a knowledge of diet-related issues were assessed through a questionnaire. The anthropometric measurements showed significant differences in height, body weight (present and desired) and BMI (p < 0.05) by age and gender. The difference between desired body weight and actual body weight was greater for younger subjects or female, regardless of whether they had under- or normal body weight (p < 0.05). Reasons for body weight loss varied; younger subjects and female tended to lose body weight "to enhance their appearances", whereas the older subjects and male desired "to improve their health" (p < 0.05). Subjects had different concepts concerning body weight loss; younger subjects and female considered body weight loss as "maintenance of a slender figure, or becoming more lean". On the other hand, older subjects and male thought body weight loss to be "effects approaching normal body weight" (p < 0.05). From our studies, it can be concluded that attitude on concerning body weight loss varied according to a age and gender. Thus, consideration of this individual differences would be vital in developing contents of a particular nutritional education program for body weight loss.

EFFECT OF EXERCISE TRAINING ON SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN CONCENTRATION IN HEALTHY MIDDLE-AGED AND ELDERLY SUBJECTS / 体力科学

High-sensitivity C-reactive protein (CRP) is a novel risk factor for coronary artery disease. It is well known that body weight loss is effective in reducing serum CRP concentration ; however, the effect of exercise training on serum CRP concentration has not been fully elucidated. The purpose of this study was to examine the effect of a 24-week exercise training program on serum CRP concentration in 169 healthy middle-aged and elderly subjects (65.9±6.4 years). Each subject underwent baseline testing (peak oxygen uptake, daily physical activity, body weight, and serum CRP levels), and repeated these tests on completion of the training program. The subjects were classified into 2 groups based on initial CRP levels : normal<1.0 mg/L, n=139, and high≥1.0mg/L, n=30. On completion of the program, both daily physical activity and peak oxygen uptake increased significantly (+33.9±72.4%, p<0.0001, +5.4±14.7%, p=0.014, respectively). However, body weight did not change significantly. In addition, CRP levels of the entire group did not change significantly. However, CRP levels significantly decreased among the high baseline CRP group (from 1.82±0.81 mg/L to 0.98±0.59 mg/L, p<0.0001). It was concluded that serum CRP levels are reduced without body weight loss in response to exercise training in healthy middle-aged and elderly subjects with high initial CRP levels.

Effects of drinking on sweating and body cooling during exercise / 体力科学

To examine the effects of water replacement on sweating and body cooling during exercise, We studied the sweat rate, changes in body weight and body temperature during exercise with or with-out drinking various amounts of water. The subjects had been dehydrated or normally hydrated prior to exercise.<BR>1. Rectal temperature increased significantly with body weight loss.<BR>2. Sweat rate during exercise was constant (968-996 g/h) regardless of whether the subjects were dehydrated or hydrated.<BR>3. Body weight loss was negatively correlated with the amount of water intake, but was not correlated with the total amount of sweating.<BR>4. Total heat loss increased with increased water intake, and corresponded to 1345% of heat storage during exercise without drinking.<BR>These results suggest that although water replacement during exercise dose not affect the sweat rate, it has physiological significance in the maintenance of body fluid, and a physical effect in terms of body cooling.