Comparison of the Global Leadership Initiative on Malnutrition and the Patient-Generated Subjective Global Assessment for diagnosing malnutrition in patients undergoing surgery for hepatobiliary and pancreatic malignancies.

OBJECTIVE: to analyse the differences in malnutrition assessment between the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Patient-Generated Subjective Global Assessment (PG-SGA) among patients with hepatobiliary and pancreatic malignancies. METHOD: this study was a cross-sectional study and included 126 hospitalised patients who underwent surgery for hepatobiliary and pancreatic malignancies between November 1, 2019 and August 1, 2020. The patients' clinical data were collected, and malnutrition assessments were completed using the different nutritional assessment tools. The consistency of both tools was analysed using Cohen's kappa coefficient. RESULTS: the prevalence of malnutrition showed a difference in diagnosis results between the GLIM criteria (36.51 %) and the PG-SGA (55.56 %). The two methods had moderate consistency (kappa = 0.590, p < 0.01). The sensitivity of a malnutrition diagnosis using a combination of GLIM and PG-SGA was 65.7 % (53.3 % and 76.4 %, respectively), and specificity was 100 % (92 % and 100 %, respectively). When malnutrition was evaluated using only PG-SGA, sensitivity was 88.9 % (95 % confidence interval (CI) 63.9 % to 98.1 %), whereas when only the GLIM score was used for malnutrition evaluation, sensitivity was 98.2 % (95 % CI, 92.8 % to 99.7 %). In addition, the PG-SGA score and the GLIM score had significant correlations. CONCLUSION: GLIM performed better than PG-SGA in the correlation analysis of nutritional indicators. GLIM is more suitable for patients with hepatobiliary and pancreatic malignancies than PG-SGA.

Design and application of the intraoperative protective device for patients undergoing interventional therapy via the femoral artery approach.

BACKGROUND: Femoral artery puncture is still the most used surgical approach. Because the operation requires local anaesthesia, the patient may not be able to exert full self-control, and their upper and lower limbs and trunk need to be constrained by a protection device. OBJECTIVE: To explore the safe application effect of a new type of anti-movement protection device for upper and lower extremities, shoulders and chest in patients undergoing interventional therapy via the femoral artery approach. METHODS: This is a prospective randomised controlled study. A total of 230 patients were randomly divided into two groups: the study group (n= 115) and the control group (n= 115). The time needed to implement the restraint operation and the loosening of the restraint device in the two groups was recorded, and the satisfaction of surgeons and nurses was investigated. RESULTS: The time needed to perform restraint operation in the study group was significantly less than that in the control group (4.06 ± 0.61 min vs. 7.01 ± 0.76 min, P< 0.05). The satisfaction of surgeons and nurses with the use of the new protective device was significantly better than that of the conventional restraint band (P< 0.05). CONCLUSION: The new anti-movement protection device for upper and lower limbs, shoulders and chest can conveniently and quickly achieve effective protection and braking of patients, ensure the safety of surgery and improve satisfaction.

Malnutrition accelerates the occurrence of infectious complications in patients with chronic kidney disease: A cross-sectional survey of 682 patients with chronic kidney disease.

BACKGROUND: To investigate the influencing factors of infectious complications in patients with chronic kidney disease (CKD) and provide a basis for clinical diagnosis and prognosis evaluation of CKD. METHODS: A total of 682 patients with CKD were selected and divided into CKD stage 1-5 subgroups according to their glomerular filtration rate. Infectious complications, length of hospital stay, and total cost of hospitalization were recorded. The Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool was used to assess the detection rate of malnutrition among patients. Univariate and multivariate analyses were performed in patients with and without infectious complications. RESULTS: The incidence rates of infectious complications in CKD stages 1-5 were 45.6%, 22.7%, 28.3%, 30.8%, and 40.4%, respectively. The overall detection rate of malnutrition among patients based on the GLIM criteria was 16.7%. The total detection rate of severe malnutrition was 14.2%, with all patients with severe malnutrition in CKD stages 3-5. The incidences of infectious complications in patients with and without malnutrition were 62.3% and 29%, respectively. Binary multivariate logistic regression analysis shows that malnutrition is a risk factor for infectious complications in patients with CKD, who are at 2.41 times higher risk than patients without malnutrition. There were significant differences in length of hospital stay and hospitalization costs between the patients with CKD with and without infectious complications (P < 0.01). CONCLUSION: Infectious complications are relatively common in patients with CKD. As CKD advances, the incidence of infectious complications increases. Moreover, malnutrition accelerates the occurrence of infectious complications in patients with CKD.

Factors influencing the prevalence of frailty in older adults with fractures: the association of nutritional status with frailty.

BACKGROUND AND OBJECTIVES: To investigate the association between frailty, malnutrition, comorbid medical conditions and activities of daily living (ADL) in older adult patients with fractures, and to analyse the influential factors of frailty. METHODS AND STUDY DESIGN: The FRAIL scale including five components: fatigue, resistance, ambulation, illness, and loss of weight, was used to evaluate frailty. Participants were divided into frailty, pre-frailty and non-frailty groups. The ADL was assessed using the Barthel Index, while the nutrition risk screening tool, NRS-2002, was used to assess the nutritional risk, and the Global Leadership Initiative on Malnutrition diagnostic criteria were used to diagnose the nutritional status. Statistical analysis was performed using univariate and multivariate logistic regression to determine the factors associated with frailty. RESULTS: A total of 166 patients were included in the study, and the incidences of frailty, pre-frailty and non-frailty were 39.2%, 33.1% and 27.7%, respectively. The severe dependence rate (ADL scale of <40) in the frailty, pre-frailty and non-frailty groups was 49.2%, 20.0% and 6.52%, respectively. The prevalence of nutritional risk was 33.7% (56/166), including 56.9% (31/65) in the frailty group and 32.7% (18/55) in the pre-frailty group. Of the 166 patients, 45 (27.1%) were diagnosed with malnutrition, including 47.7% (31/65) in the frailty group and 23.6% (13/55) in the pre-frailty group. CONCLUSIONS: Frailty in older adult patients with fractures is widespread, and the prevalence of malnutrition is high. The occurrence of frailty may be related to an advanced age, increased medical comorbidity and impairment in ADL.

An analysis of nutritional risk factors in older adults with gastrointestinal tumours.

INTRODUCTION: The aim of this study was to investigate risk factors for nutritional risk in older adults with gastrointestinal tumours. MATERIALS AND METHODS: A total of 170 eligible hospitalised older adults with gastrointestinal tumours were included. Their clinical characteristics were collected, their nutritional risk was screened by NRS 2002, and then patients were divided into a nutritional risk group and a non-nutritional risk group. The observation indicators included body mass index (BMI), muscle mass, muscle strength, and calf circumference. The third lumbar skeletal muscle index (L3 SMI) was calculated using abdominal computed tomography (CT) scan results, and grip strength/muscle strength, 6-m walking speed and calf circumference were measured. Sarcopenia was diagnosed according to the criteria of the Asian Sarcopenia Working Group (AWGS). Finally, we analysed the relationship between nutritional risk and sarcopenia and other related factors (BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed) in older adults with gastrointestinal tumours by multivariate logistic regression analysis. RESULTS: Older adults with gastrointestinal tumours who were at nutritional risk accounted for 51.8% of patients in this study. The differences between sex, tumour stage, age, BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed, and prevalence of sarcopenia were statistically significant in two groups (all P < 0.05). Multivariate logistic regression analysis showed that age, BMI, grip strength/muscle strength, and sarcopenia were risk factors of nutritional risk in older adults with gastrointestinal tumours (all P < 0.05). DISCUSSION: Older adults with gastrointestinal cancer had a higher proportion of nutritional risk, and L3 SMI, grip strength/muscle strength were independent risk factors for nutritional risk. In clinical practice, attention to nutritional risk screening and sarcopenia development in older adults with gastrointestinal cancer is warranted.

Investigation and analysis of frailty and nutrition status in older adult patients with hip fracture.

BACKGROUND: To analyze the current situation of frailty and the main influencing factors of frailty of older patients with hip fracture. METHODS: Using a fixed-point consecutive sampling method, we investigated older adult patients with hip fracture aged ≥60 years who were hospitalized in an orthopedic ward of a tertiary hospital from January 2021 to March 2022. We also assessed the prevalence of frailty and malnutrition by trial of the fatigue, resistance, aerobic capacity, illnesses, and loss of weight (FRAIL) scale and the Global Leadership Initiative on Malnutrition criteria to analyze the factors influencing frailty. RESULTS: A total of 216 older adult patients with hip fracture were collected, 106 (49.08%) were frail, 72 (33.33%) were prefrail, 38 (17.59%) were nonfrail, 103 (47.69%) were at overall nutrition risk, and 76 (35.19%) were malnourished. The results of bivariate correlation analysis showed that frailty score was correlated with age, the Activity of Daily Living Scale (ADL) score, body mass index (BMI), C-reactive protein, hemoglobin (Hb), serum albumin (ALB), and serum prealbumin, and was negatively correlated with ADL score, BMI, Hb, and ALB (r = -0.399, -0.420, -0.195, -0.283, respectively; P < 0.05). The results of multiple linear regression analysis showed that age, number of underlying diseases, ADL score, BMI score, and nutrition status were important influencing factors of frailty (P < 0.05). CONCLUSION: Older adult patients with hip fracture are frail and prefrail, with a high prevalence of malnutrition. Advanced age, combined underlying diseases, and a low BMI score were risk factors for preoperative frailty.

Prevalence and Management Recommendations for Disease-Related Malnutrition in Chronic Kidney Disease Patients with and without Diabetes.

Objective: To investigate the nutritional risk, malnutrition, severe malnutrition, and malnutrition prevalence of different stages in chronic kidney disease (CKD) patients with and without diabetes mellitus using the Global Leadership Initiative on Malnutrition (GLIM), and to analyze the causes of malnutrition and to improve the clinical outcomes of patients for early intervention. Methods: A total of 683 patients with CKD who were hospitalized in our hospital from January 2020 to January 2021 were enrolled and divided into subgroups 1 to 5 according to whether they were complicated with diabetes and glomerular filtration rate. Using the second step of the malnutrition (GLIM) diagnostic tool and 2 previously commonly used malnutrition assessment methods (body mass index <18.5 kg/m2 with poor general condition, 3 points for nutritional deficiency in nutritional risk screening), combined with clinical research on the main causes of malnutrition, the intervention measures were discussed. Results: The prevalence of malnutrition was 16.7% (114/683) in the patients included in the survey using the diagnostic criteria of malnutrition (GLIM) (excluding whole body muscle mass index). The prevalence of malnutrition in CKD patients with and without diabetes was 23.7% and 12.6%, respectively. The overall prevalence rate of severe malnutrition was 14.2%, and the prevalence rates of those with and without diabetes were 19.0% and 11.4%, respectively; the results of the two methods of malnutrition assessment showed that the prevalence of malnutrition in CKD patients with diabetes was higher than that in the uncombined group. There was no severe malnutrition in patients with CKD stages 1 and 2. From CKD stage 3 onwards, the severe malnutrition in the diabetic group was significantly higher than that in the uncombined group. Conclusion: With the progression of CKD, the incidence of malnutrition also gradually increased, indicating that malnutrition is related to primary diseases and concomitant diseases. Attention should be paid to the malnutrition of CKD patients with diabetes, and clinical medical staff need to pay early attention to various diseases that lead to the progression of CKD, such as diabetes, primary nephropathy, and other factors, to prevent complications and delay the progression of CKD.

The efficacy and tolerability of sports drink versus water in bowel preparations: a randomised controlled study.

BACKGROUND: An optimal bowel preparation can result in an improved colonoscopy. This study was to compare the effectiveness and safety of the use of a sports drink (Mizone) plus polyethylene glycol (PEG) solution with a water plus PEG solution in bowel preparations. METHODS: This was a randomised controlled study. All of the included patients were randomly divided into the following two groups: the PEG + Mizone group and the PEG + water group. The palatability of the solution was measured through the use of questionnaires. Additionally, bowel cleanliness was evaluated according to the Ottawa Bowel Preparation Scale (OBPS, 0-14, with higher values indicating worse cleanliness), as well as with the aid of colonoscopy videos. RESULTS: A total of 270 patients were enrolled. The rate of adequate bowel preparation was 74.8% in the PEG + Mizone group and 68.9% in the PEG + water group, with a risk difference of 5.9% (95% CI: - 4.8-16.6%), which indicated noninferiority (noninferiority margin: - 9.5% < - 4.8%). However, patients rated the palatability (65.9% vs 44.4%, P < 0.001) and willingness to recommend or repeat (88.9% vs 75.6%, P = 0.004) the administration of the PEG + Mizone preparation as being better than those of the PEG + water preparation. The rates of adverse events during the bowel preparations were not significantly different between the two groups, except for bloating (PEG + Mizone vs PEG + water, 4.4% vs 13.3%, P = 0.010). CONCLUSION: The concomitant use of PEG + Mizone was a well tolerated and effective bowel preparation, compared with the PEG + water treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04247386 . Registered on 30 Jan 2020.

Cytosolic Nudix Hydrolase 1 Is Involved in Geranyl ß-Primeveroside Production in Tea.

Geraniol is a potent tea odorant and exists mainly as geranyl glycoside in Camellia sinensis. Understanding the mechanisms of geraniol biosynthesis at molecular levels in tea plants is of great importance for practical improvement of tea aroma. In this study, geraniol and its glycosides from tea plants were examined using liquid chromatography coupled with mass spectrometry. Two candidate geraniol synthase (GES) genes (CsTPS) and two Nudix hydrolase genes (CsNUDX1-cyto and CsNUDX1-chlo) from the tea genome were functionally investigated through gene transcription manipulation and gene chemical product analyses. Our data showed that in tea leaves, levels of geranyl ß-primeveroside were dramatically higher than those of geranyl ß-glucoside, while free geraniol was undetectable in this study. A tempo-spatial variation of geranyl ß-primeveroside abundance in tea plants existed, with high levels in young and green tissues and low levels in mature or non-green tissues. Cytosolic CsNUDX1-cyto showed higher hydrolysis activity of geranyl-pyrophosphate to geranyl-monophosphate (GP) in vitro than did chloroplastidial CsNUDX1-chlo. A transgenic study revealed that expression of CsNUDX1-cyto resulted in significantly more geranyl ß-primeveroside in transgenic Nicotiana benthamiana compared with non-transgenic wild-type, whereas expression of CsNUDX1-chlo had no effect. An antisense oligo-deoxynucleotide study confirmed that suppression of CsNUDX1-cyto transcription in tea shoots led to a significant decrease in geranyl ß-primeveroside abundance. Additionally, CsNUDX1-cyto transcript levels and geranyl ß-primeveroside abundances shared the same tempo-spatial patterns in different organs in the tea cultivar "Shucha Zao," indicating that CsNUDX1-cyto is important for geranyl ß-primeveroside formation in tea plants. Results also suggested that neither of the two candidate GES genes in tea plants did not function as GES in transgenic N. benthamiana. All our data indicated that CsNUDX1-cyto is involved in geranyl ß-primeveroside production in tea plants. Our speculation about possible conversion from the chemical product of CsNUDX1-cyto to geranyl ß-primeveroside in plants was also discussed.

Corrigendum: Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors.

[This corrects the article DOI: 10.3389/fonc.2021.697699.].

Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors.

PURPOSE: This study intends to explore the safety and effectiveness of the concept of enhanced recovery after surgery (ERAS) in the perioperative care of patients with supratentorial tumors. METHODS: A total of 151 supratentorial tumor patients were enrolled in this study, and they were divided into control group (n = 75) and observation group (n = 76) according to the random number table method. Patients in the control group received routine neurosurgery care, and patients in the observation group received enhanced recovery after surgery care. The incidence of perioperative complications, postoperative hospital stays, early postoperative eating time, catheter removal time, and time to get out of bed were observed for the two groups of patients, and the quality of postoperative recovery was evaluated. RESULTS: There was no statistically significant difference in the basic data of the two groups of patients, such as age, gender, lesion location, and condition (P>0.05), and they were comparable. The observation group's postoperative eating time, catheter removal time, and time to get out of bed were significantly earlier than those of the control group. Postoperative hospital stays and hospitalization expenses were less than those of the control group. There was a statistically significant difference in postoperative hospital stay between the two groups (P<0.05). CONCLUSION: Applying the ERAS concept to implement perioperative care for patients with supratentorial tumors is safe and effective. It can not only reduce after-surgical stress and accelerate postoperative recovery, but also shorten hospital stays and reduce hospital costs. It is worthy of clinical application.

Feature-Based Molecular Networking Analysis of the Metabolites Produced by In Vitro Solid-State Fermentation Reveals Pathways for the Bioconversion of Epigallocatechin Gallate.

Dark teas are prepared by a microbial fermentation process. Flavan-3-ol B-ring fission analogues (FBRFAs) are some of the key bioactive constituents that characterize dark teas. The precursors and the synthetic mechanism involved in the formation of FBRFAs are not known. Using a unique solid-state fermentation system with ß-cyclodextrin inclusion complexation as well as targeted chromatographic isolation, spectroscopic identification, and Feature-based Molecular Networking on the Global Natural Products Social Molecular Networking web platform, we reveal that dihydromyricetin and the FBRFAs, including teadenol A and fuzhuanin A, are derived from epigallocatechin gallate upon exposure to fungal strains isolated from Fuzhuan brick tea. In particular, the strains from subphylum Pezizomycotina were key drivers for these B-/C-ring oxidation transformations. These are the same transformations seen during the fermentation process of dark teas. These discoveries set the stage to enrich dark teas and other food products for these health-promoting constituents.

Family support is beneficial to the management and prognosis of patients with obstructive sleep apnoea.

BACKGROUND: This study aimed to explore the correlations between continuous positive airway pressure (CPAP) treatment-related self-efficacy and family support among patients with obstructive sleep apnoea (OSA) to provide a basis for improving patients' CPAP treatment compliance. METHODS: From May to Dec 2017, a cross-sectional study was conducted in the emergency wards, otorhinolaryngology wards, respiratory wards, and outpatient clinic of our hospital. A total of 112 patients with OSA treated with home ventilators were administered with the Self-efficacy Measure for Sleep Apnoea (SEMSA) and Perceived Social Support from Family (PSS-Fa) Scale. RESULTS: On the SEMSA, participants had a disease risk perception score of 2.61±0.31, an outcome expectation score of 2.44±0.17, and a self-efficacy score of 2.55±0.13. Mean total score on PSS-Fa was 10.15±2.73, with 10.7%, 45.5% and 43.8% of participants showing a low level, a medium level, and a high level of family support, respectively. Outcome expectation and self-efficacy were positively correlated with family support. CONCLUSIONS: The self-efficacy and outcome expectation of patients with OSA are positively correlated with their level of family support.

High Performance Liquid Chromatography and Metabolomics Analysis of Tannase Metabolism of Gallic Acid and Gallates in Tea Leaves.

Tannase (E.C. 3.1.1.20) is hypothesized to be involved in the metabolism of gallates and gallic acid (GA) in pu-erh tea fermentation. In this work, we measured tannase in Aspergillus niger fermented tea leaves and confirmed the production of fungal tannase during pu-erh tea fermentation. A decrease in catechin and theaflavin gallates and a significant increase in GA content and the relative peak areas of ethyl gallate, procyanidin A2, procyanidin B2, procyanidin B3, catechin-catechin-catechin, epiafzelechin, and epicatechin-epiafzelechin [variable importance in the projection (VIP) > 1.0, p < 0.05, and fold change (FC) > 1.5] were observed using high performance liquid chromatography (HPLC) and metabolomics analysis of tea leaves fermented or hydrolyzed by tannase. In vitro assays showed that hydrolysis by tannase or polymerization of catechins increased the antioxidant activity of tea leaves. In summary, we identified a metabolic pathway for gallates and their derivatives in tea leaves hydrolyzed by tannase as well as associated changes in gallate and GA concentrations caused by fungal tannase during pu-erh tea fermentation.