A large-scale study integrating nutritional indicators and clinicopathological parameters to evaluate prognosis, follow-up, and postoperative chemotherapy decisions in rectal cancer patients

OBJECTIVE

The aim of this study was to evaluate the role of nutritional indicators and clinicopathological parameters in predicting the progression and prognosis for pathological stage II-III rectal cancer (RC) patients without neoadjuvant radiotherapy. In addition, we sought to explore the high-risk population who may require postoperative chemotherapy.

METHODS

A total of 894 consecutive RC patients were enrolled in this study. Univariate and multivariate Cox analysis were performed to identify the independent risk factors for PFS and OS. The nomogram and calibration curves were conducted according to multivariable analysis result. Kaplan-Meier survival curves and log-rank tests were performed for different groups. Finally, random survival forest (RSF) model was developed to predict the probability of progression.

RESULTS

Our results revealed that CEA level, pathological stage, tumor deposit, and PNI were independently associated with PFS in RC patients. Similarly, the results indicated that CEA level, pathological stage, tumor deposit, PNI, and NRI were independently associated with OS. RSF model revealed that group 1 had the highest risk of progression at the 12th month of follow-up, group 2 had the highest risk of progression at the 15th month of follow-up, while group 3 had the highest risk of progression at the 9th month of follow-up. Besides, subgroup analysis suggested that the high-risk group needs postoperative adjuvant chemotherapy, while patients in the low- and moderate-risk groups may not need postoperative adjuvant chemotherapy. Finally, we validated our results with the SEER database.

CONCLUSIONS

In conclusion, we demonstrated that preoperative nutritional indicator and clinicopathological parameters could act as auxiliary prognostication tools for RC patients without neoadjuvant radiotherapy. We also established follow-up strategies for different groups of patients. Collectively, incorporating nutritional assessment into risk stratification for RC resection is crucial and should be an integral part of preoperative planning.

Nomogram based on nutritional and inflammatory indicators for survival prediction of small cell carcinoma of the esophagus

OBJECTIVES

Small cell carcinoma of the esophagus (SCCE) is a rare type of esophageal cancer, and the parameters for prediction of SCCE outcome are unclear. This study aimed to construct a nomogram to predict the outcome of SCCE.

METHODS

Patients who underwent treatments at the Sun Yat-Sen University Cancer Center were recruited and divided randomly into training and validation cohorts (61 and 32 patients, respectively). A Cox regression analysis was utilized to identify independent prognostic factors to establish a nomogram and predict overall survival (OS) and disease-free survival (DFS).

RESULTS

Information on pretreatment nutritional candidate hemoglobin and inflammation-related neutrophil-to-lymphocyte ratio and platelet count were entered into the nomogram. In the training cohort, the concordance index of the nomogram for OS was 0.728, higher than that obtained by tumor/node/metastasis staging (0.614; P = 0.014). A significant difference was observed in the nomogram for DFS (0.668 vs tumor/node/metastasis stage: 0.616; P = 0.014). Similar results were found in the validation group. The decision curve analysis, net reclassification improvement, and integrated discrimination improvement showed moderate improvement of the nomogram in predicting survival. Based on the cut point calculated according to the constructed nomogram, the high-risk group had poorer OS and DFS than the low-risk group in both cohorts (all P < 0.05). Moreover, the DFS of patients receiving surgery in the high-risk group was better than that of patients receiving single radiation therapy or chemotherapy (P = 0.0111).

CONCLUSIONS

A nomogram based on nutrition- and inflammation-related indicators was developed to predict the survival of patients with SCCE.

Effect of targeted nutrition intervention on defecation and postoperative complications in patients undergoing radical resection for rectal cancer

AIM

To investigate the effect of targeted nutrition intervention on defecation, nutritional indicators and postoperative complications in patients undergoing radical resection for rectal cancer.

METHODS

One hundred and thirty patients who underwent radical resection for rectal cancer at Zhejiang Hospital were selected from January 2015 to December 2016. They were randomly divided into a control group and an observation group, with 65 cases in each group. The control group underwent routine nutritional intervention, and the observation group was given targeted nutritional intervention. Defecation function, nutritional indexes, postoperative recovery and postoperative complications were compared between the two groups.

RESULTS

Excellent recovery of defecation function was achieved in 23 (35.38%) patients and good recovery of defecation function was achieved in 27 (41.54%) patients in the observation group. The rate of excellent and good recovery of defecation function was significantly higher in the observation group than in the control group (76.92% vs 60%, P < 0.05). Time to postoperative exhaust (1.83 d ± 0.68 d vs 2.75 d ± 0.84 d), time to postoperative defecation (2.81 d ± 1.06 d vs 3.95 d ± 1.38 d), time to intake of semiliquid diet (9.84 d ± 1.26 d vs 11.72 d ± 1.58 d), and postoperative hospitalization time (16.27 d ± 1.53 d vs 18.49 d ± 2.14 d) were significantly shorter in the observation group than in the control group (P < 0.05). Serum total protein, albumin, prealbumin, hemoglobin and transferrin levels at 1 week after surgery were 68.35 g/L ± 13.63 g/L, 36.17 g/L ± 5.62 g/L, 0.29 g/L ± 0.08 g/L, 124.75 g/L ± 28.14 g/L and 1.97 g/L ± 0.51 g/L, respectively, in the observation group, which were significantly higher than those of the control group (56.32 g/L ± 10.66 g/L, 26.12 g/L ± 4.25 g/L, 0.18 g/L ± 0.04 g/L, 100.26 g/L ± 23.86 g/L and 1.56 g/L ± 0.35 g/L, respectively; P < 0.05). The incidence of pulmonary infection, urinary tract infection, wound healing, and anastomotic leakage was similar between the two groups (P > 0.05). The total complication rate in the observation group was 7.69%, which was lower than that of the control group (20%; P < 0.05).

CONCLUSION

Targeted nutrition intervention can significantly improve the defecation function and nutritional indicators in patients with rectal cancer undergoing radical surgery, promote postoperative rehabilitation and reduce the incidence of complications.

Correlation between clinical and cognitive aspects and nutritional indicators of elderly patients with new-onset epilepsy

OBJECTIVE

Nutritional indicators were correlated with cognitive and clinical aspects of 25 elderly patients with new-onset epilepsy (EPWE). The nutritional indicators of the EPWE were compared with those of a similar control group at a significance level of p < 0.05.

RESULTS

There was lower cognitive performance, greater risk of malnutrition and muscle tissue depletion, and higher waist circumference (WC) in the EPWE. Longer epilepsy duration was correlated with loss of muscle mass (Pearson's correlation: 0.433; p = 0.044). Performance in the verbal fluency test, in the clock-drawing test, and in the immediate memory test was negatively associated with body fat. Better performance in the image recognition test was negatively associated with the indicators of muscle reserve.

CONCLUSION

There was lower cognitive performance, higher risk of malnutrition, and high abdominal obesity in EPWE. Cognitive performance was related to adiposity. Cognitive impairment and longer disease duration are related to increased nutritional risk.

Prevalence of severe acute malnutrition and associated sociodemographic factors among children aged 6 months-5 years in rural population of Northern India: A population-based survey

Introduction

National Family Health Survey (NFHS)-3 documented that nearly 57 million children are undernourished in India, which is one-third of the world's share. We planned a study to identify the prevalence of severe acute malnutrition (SAM) among children aged <5 years in a rural population of Northern India.

Materials and Methods

A cross-sectional study was conducted at 2 blocks of District Meerut during 2012-2014. A total of 70 villages were identified and all children in the age group 6-60 months were approached through house-to-house visits. Data on sociodemographic profile and anthropometry were collected utilizing standards methods and equipment. The Z-scores for weight-for-age, height-for-age, and weight-for-height (WHZ) were calculated using the World Health Organization (WHO) reference data as standard. SAM (severe wasting) was defined as per the WHO criteria (WHZ score <-3 standard deviation or severe visible wasting or bipedal edema).

Results

A total of 19,449 children were screened and 18,463 children (age, 32.6 ± 15.4 years, and 53.4% males) were enrolled, and 466 were excluded due to erroneous age estimation and physical deformities. The prevalence of SAM was 2.2%, 95% confidence interval (CI) 2.02-2.44%, (409/18,463). Multivariate logistic regression documented age (odds ratio [OR]: 0.97, 95% CI 0.96-0.98), nuclear family (OR: 1.25, 95% CI 1.01-1.54), lower occupation of head of family (OR: 1.29, 95% CI 1.05-1.59), and lower paternal education (OR: 1.49, 95% CI 1.16-1.91) as independent predictor of SAM.

Conclusion

The prevalence of SAM was lower (2.2%) in this Northern district of India as compared to national prevalence (7.9%). Younger age, nuclear family, lower parental education, and poor occupation of the head of the family predispose a child to SAM.

Effects of tea saponin on growth and development, nutritional indicators, and hormone titers in diamondback moths feeding on different host plant species

The diamondback moth (DBM) is an important worldwide pest. This insect has been studied for several decades; however, its control remains problematic. Numerous chemical insecticides have become ineffective and chemical residues constitute an important problem. In the present study, we determined the mortality of 3rd instar DBM larvae feeding on three different host plant species and exposed to various concentrations of tea saponin (TS). In addition, we evaluated growth and development parameters, nutritional indicators, and juvenile hormone (JH) and molting hormone (MH) titers in 2nd instar larvae exposed to LC20 and LC50 doses of TS. We found that treatment of DBM larvae with LC20 and LC50 doses of TS led to lower growth rates, decreased feed consumption, reduced frass production, lower pupal weights, reduced percentage pupation, slower adult emergence percentages, and diminished fecundity, but prolonged durations of the larval and pupal periods. The efficiency of conversion of ingested and digested food increased, but the approximate digestibility did not differ significantly between treatments and controls. JH and MH titers were higher after TS treatment; these increases varied according to the host species and TS concentration. Our results indicate that TS represents a potential new alternative insecticide based on its natural origin, low cost, and minimum environmental impact.