简介：Enteralnutritionhasbeenstronglyrecommendedbymajorscientificsocietiesforthenutritionalmanagementofpatientswithacutepancreatitis.Providingsevereacutepancreatitispatientswithenteralnutritionwithinthefirst24-48hofhospitaladmissioncanhelpimproveoutcomescomparedtoparenteralnutritionandnofeeding.Newresearchisfocusinginonwhenandwhattofeedtobestimproveoutcomesforacutepancreatitispatients.Earlyenteralnutritionhavethepotentialtomodulatetheimmuneresponses.Despitethisconsistentevidenceofearlyenteralnutritioninpatientswithacutepancreatitis,clinicalpracticecontinuestovaryduetoindividualclinicianpreference.Achievingtheimmunemodulatingeffectsofenteralnutritionheavilydependonproperplacementofthefeedingtubeandmanaginganytubefeedingassociatedcomplications.Thecurrentarticlereviewstheimmunemodulatingeffectsofenteralnutritionandpro-andprebioticsandsuggestssomepracticaltoolsthathelpimprovethepatientadherenceandtolerancetothetubefeeding.Properselectionofthetypeofthetube,closemonitoringofthetubeforitsplacement,patencyandsecuringitsproperplacementandroutinecheckingthegastricresidualvolumecouldallhelpimprovetheoutcome.Usingpeptide-basedandhighmediumchaintriglyceridesfeedingformulashelpimprovingfeedingtolerance.

简介：Theuseofenteralfeedingaspartofthemanagementofacutepancreatitisdatesbackalmosttwodecades.Thisreviewdescribestheindicationsforandlimitationsofenteralfeedingforthetreatmentofacutepancreatitisusingup-to-dateevidence-baseddata.Asystematicreviewwascarriedouttoanalysecurrentdataontheuseofenteralnutritioninthemanagementofacutepancreatitis.Relevantliteraturewasanalysedfromtheviewpointsofenteralvsparenteralfeeding,earlyvsdelayedenteralnutrition,nasogastricvsnasojejunalfeeding,andearlyoraldietandimmunonutrition,particularlyglutamineandprobioticsupplementation.Finally,currentapplicableguidelinesandtheeffectsoftheseguidelinesonclinicalpracticearediscussed.Thelatestmeta-analysessuggestthatenteralnutritionsignificantlyreducesthemortalityrateofsevereacutepancreatitiscomparedtoparenteralfeeding.Tomaintaingutbarrierfunctionandpreventearlybacterialtranslocation,enteralfeedingshouldbecommencedwithinthefirst24hofhospitaladmission.Also,thesafetyofnasogastricfeeding,whicheasestheadministrationofenteralnutrientsintheclinicalsetting,islikelyequaltonasojejunalfeeding.Furthermore,anearlylow-fatoraldietispotentiallybeneficialinpatientswithmildpancreatitis.Despitetheinitialencouragingresults,thecurrentevidencedoesnotsupporttheuseofimmunoenhancednutrientsorprobioticsinpatientswithacutepancreatitis.

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简介：Wepresentthreecasesofself-expandablemetallicstent（SEMS）placementusingaballoonenteroscope（BE）anditsovertube（OT）formalignantobstructionofsurgicallyreconstructedintestine.ABEiseffectivefortheinsertionofanendoscopeintothedeepbowel.However,SEMSplacementisimpossiblethroughtheworkingchannel,becausetheworkingchannelofBEistoosmallandtoolongforthestentdevice.Therefore,weusedatechniqueinwhichtheBEisinsertedasfarasthestenoticarea;thereafter,theBEisremoved,leavingonlytheOT,andthenthestentisplacedbyinsertingthestentdevicethroughtheOT.Inthepresentthreecases,amodificationofthistechniqueresultedinthesuccessfulplacementoftheSEMSforobstructionofsurgicallyreconstructedintestine,andtheprocedureswereperformedwithoutseriouscomplications.Weconsiderthatthepresentprocedureisextremelyeffectiveasapalliativetreatmentfordistalbowelstenosis,suchasinthesurgicallyreconstructedintestine.

简介：AbstractPurpose:To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU).Methods:Clinical data of trauma patients in the ICU of Daping Hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (<48 h) and delayed enteral nutrition group (control group, >48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q1, Q3) (non-normal distribution) and analyzed by Chi-square test, Student's t-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition.Results:Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%, p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%, p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8), p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result in early enteral nutrition group than in control group regarding morality (0 vs. 11.9%, p = 0.03), length of hospital stay (days) (76.8 ± 41.4 vs. 81.4 ± 44.7, p = 0.01) and wound infection (10.3% vs. 26.2%, p = 0.03). Logistic regression analysis showed that the incidence of wound infection was related to the duration required to achieve the enteral nutrition standard (OR = 1.095, p = 0.002). Seventy-six patients (69.1%) achieved the nutritional goal within a week and 105 patients (95.5%) in the end. Trauma patients unable to reach the enteral nutrition target within one week were often combined with abdominal infection, peritonitis, bowel resection, intestinal necrosis, intestinal fistula, or septic shock.Conclusion:Early enteral nutrition for trauma patients in the ICU is correlated with less wound infection, lower mortality, and shorter hospital stay.

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简介：AbstractBackground:Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients.Methods:We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis.Results:The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064–3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115–10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233–3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108–18.228, P = 0.001) in the ICU patients.Conclusions:FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.

简介：Objective:Toexploretheeffectofearlyenteralnutrition(EN)onpostoperativenutritionalstatus,intestinalpermeability,andimmunefunctioninelderlypatientswithesophagealcancerorcardiaccancer.Methods:Atotalof96patientswithesophagealcancerorcardiaccancerwhounderwentsurgicaltreatmentinourhospitalfromJune2007toDecember2010wereenrolledinthisstudy.TheyweredividedintoENgroup(n=50)andparenteralnutrition(PN)group(n=46)basedonthenutritionsupportmodes.Thebodyweight,timetofirstflatus/defecation,averagehospitalstay,complicationsandmortalityafterthesurgeryaswellastheliverfunctionindicatorswererecordedandanalyzed.Peripheralbloodsampleswerecollectedonthedays1,4and7aftersurgery.Theplasmadiamineoxidase(DAO)activityandD-lactatelevelweredeterminedtoassesstheintestinalpermeability.TheplasmaendotoxinlevelsweredeterminedusingdynamicturbidimetricassaytoassesstheprotectiveeffectofENonintestinalmucosalbarrier.Thepostoperativebloodlevelsofinflammatorycytokinesandimmunoglobulinsweredeterminedusingenzyme-linkedimmunosorbentassay(ELISA).Results:Afterthesurgery,thetimetofirstflatus/defecation,averagehospitalstay,andcomplicationsweresignificantlylessintheENgroupthanthoseinthePNgroup(P<0.05),whereastheENgrouphadsignificantlyhigheralbuminlevelsthanthePNgroup(P<0.05).Onthe7thpostoperativeday,theDAOactivity,D-lactatelevelandendotoxincontentsweresignificantlylowerintheENgroupthanthoseinthePNgroup(allP<0.05).Inaddition,theENgrouphadsignificantlyhigherIgA,IgG,IgM,andCD4levelsthanthePNgroup(P<0.05)butsignificantlylowerIL-2,IL-6,andTNF-αlevels(P<0.05).Conclusions:Inelderlypatientswithesophagealcancerorcardiaccancer,earlyENaftersurgerycaneffectivelyimprovethenutritionalstatus,protectintestinalmucosalbarrier(byreducingplasmaendoxins),andenhancetheimmunefunction