BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total ga...BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.展开更多
BACKGROUND Early oral feeding(EOF)is an important measure for early recovery of patients with gastrointestinal tumors after surgery,which has emerged as a safe and effective postoperative strategy for improving clinic...BACKGROUND Early oral feeding(EOF)is an important measure for early recovery of patients with gastrointestinal tumors after surgery,which has emerged as a safe and effective postoperative strategy for improving clinical outcomes.AIM To determine the safety and efficacy of early oral feeding in postoperative patients with upper gastrointestinal tumor.METHODS This meta-analysis was analyzed using Review Manager version 5.3 and Stata version 14.All clinical studies that analyzed efficacy and safety of EOF for postoperative patients with upper gastrointestinal tumor were included.RESULTS Fifteen studies comprising 2100 adult patients met all the inclusion criteria.A significantly lower risk of pneumonia was presented in the EOF compared with TOF group[relative risk(RR)=0.63,95%confidence interval(CI):0.44-0.89,P=0.01].Length of hospital stay was significantly shorter in the EOF group than in the TOF group[weighted mean difference(WMD)=-1.91,95%CI:-2.42 to-1.40;P<0.01].Cost of hospitalization was significantly lower(WMD=-4.16,95%CI:-5.72 to-2.61;P<0.01),and CD4 cell count and CD4/CD8 cell ratio on postoperative day 7 were significantly higher in the EOF group than in the TOF group:CD4 count(WMD=7.17,95%CI:6.48-7.85;P<0.01),CD4/CD8 ratio(WMD=0.29,95%CI:0.23-0.35;P<0.01).There was no significant difference in risk of anastomotic leak and total postoperative complications.CONCLUSION EOF as compared with TOF was associated with lower risk of pneumonia,shorter hospital length of stay,lower cost of hospitalization,and significantly improved postoperative immune function of patients.展开更多
Objective To identify the target behavior in the process of behavioral intervention for children with feeding difficulty and relevant factors that may contribute to more effective intervention.Methods Children aged fr...Objective To identify the target behavior in the process of behavioral intervention for children with feeding difficulty and relevant factors that may contribute to more effective intervention.Methods Children aged from 1 to 6 years with feeding difficulty randomly received interactive behavioral intervention(245 cases)or routine primary care(217 cases).By the end of the 1,3,6,and 9 months,the rating score of feeding difficulty and the body mass index(BMI)were assessed.The target behavior was determined based on the selecting criteria that simultaneously satisfied two conditions:①it was relevant to improving children's nutritional status;②it changed fast during intervention.Moreover,the relevant factors of target behavior were analyzed by multivariate analysis(Multi-Way ANOVA).Results Among nine behaviors of feeding difficulty,"eating slowly"was identified as a target behavior because it was closely relevant to the BMI z-score increment and had the biggest score reduction at early stage during intervention.Various factors were relevant to improving the target behavior,including parents acting as caregivers,caregiver's education level equal to and above junior college,and caregiver's concern about their children's feeding difficulty.Conclusion"Eating slowly"should be selected as the target behavior for early intervention for children with feeding difficulty and some social factors should be considered for optimizing the intervention.展开更多
Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life ...Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.展开更多
Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the del...Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.展开更多
文摘BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.
基金Supported by Danone Nutrition Research and Education Foundation,No.DIC2020-03.
文摘BACKGROUND Early oral feeding(EOF)is an important measure for early recovery of patients with gastrointestinal tumors after surgery,which has emerged as a safe and effective postoperative strategy for improving clinical outcomes.AIM To determine the safety and efficacy of early oral feeding in postoperative patients with upper gastrointestinal tumor.METHODS This meta-analysis was analyzed using Review Manager version 5.3 and Stata version 14.All clinical studies that analyzed efficacy and safety of EOF for postoperative patients with upper gastrointestinal tumor were included.RESULTS Fifteen studies comprising 2100 adult patients met all the inclusion criteria.A significantly lower risk of pneumonia was presented in the EOF compared with TOF group[relative risk(RR)=0.63,95%confidence interval(CI):0.44-0.89,P=0.01].Length of hospital stay was significantly shorter in the EOF group than in the TOF group[weighted mean difference(WMD)=-1.91,95%CI:-2.42 to-1.40;P<0.01].Cost of hospitalization was significantly lower(WMD=-4.16,95%CI:-5.72 to-2.61;P<0.01),and CD4 cell count and CD4/CD8 cell ratio on postoperative day 7 were significantly higher in the EOF group than in the TOF group:CD4 count(WMD=7.17,95%CI:6.48-7.85;P<0.01),CD4/CD8 ratio(WMD=0.29,95%CI:0.23-0.35;P<0.01).There was no significant difference in risk of anastomotic leak and total postoperative complications.CONCLUSION EOF as compared with TOF was associated with lower risk of pneumonia,shorter hospital length of stay,lower cost of hospitalization,and significantly improved postoperative immune function of patients.
基金Science and Technology Commission of Shanghai Municipality(14411969200,10DZ2272200,09DZ2200900,10PJ1407500,10PJ1403500,10231203903,10JC1411200)Ministry of Education of China(NCET program)+4 种基金National Natural Science Foundation of China(81000592,11001084)Shanghai Municipal Education Commission(11ZZ103)Shanghai Municipal Health Bureau(2010004)Morning Star Rewarding Fund of Shanghai Jiao Tong University(Category B,2011)New Bairen Plan of Shanghai Jiao Tong University School of Medicine,and Shanghai Health Municipal Bureau Three-year Action(GWⅢ-27.3)
文摘Objective To identify the target behavior in the process of behavioral intervention for children with feeding difficulty and relevant factors that may contribute to more effective intervention.Methods Children aged from 1 to 6 years with feeding difficulty randomly received interactive behavioral intervention(245 cases)or routine primary care(217 cases).By the end of the 1,3,6,and 9 months,the rating score of feeding difficulty and the body mass index(BMI)were assessed.The target behavior was determined based on the selecting criteria that simultaneously satisfied two conditions:①it was relevant to improving children's nutritional status;②it changed fast during intervention.Moreover,the relevant factors of target behavior were analyzed by multivariate analysis(Multi-Way ANOVA).Results Among nine behaviors of feeding difficulty,"eating slowly"was identified as a target behavior because it was closely relevant to the BMI z-score increment and had the biggest score reduction at early stage during intervention.Various factors were relevant to improving the target behavior,including parents acting as caregivers,caregiver's education level equal to and above junior college,and caregiver's concern about their children's feeding difficulty.Conclusion"Eating slowly"should be selected as the target behavior for early intervention for children with feeding difficulty and some social factors should be considered for optimizing the intervention.
文摘Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.
文摘Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.
