ObjectiveTo understand the mechanisms of malnutrition in patients with gastric cancer (GC) and which affecting on therapy outcomes, and explore effective nutritional intervention strategies so as to improve general therapy outcomes for patients with GC. MethodThe literature on studies relevant malnutrition in the patients with GC both domestically and internationally was reviewed and analyzed. ResultsThe mechanisms of malnutrition in the patients with GC are complex and diverse, including abnormal tumor metabolism, side effects of treatment, psychological and economic factors, etc. The malnutrition made the mortality and recurrence rates increase, hospital stay prolong, and medical costs elevate, meanwhile led to the multiple complications. The use of various screening tools could effectively assess the malnutrition status at the different therapy stages, then the individualized nutritional therapy plans could be developed based on the assessment results. These plans included oral nutrition, enteral nutrition, parenteral nutrition, and immunonutrition. ConclusionsMalnutrition severely affects the treatment outcomes and quality of life of patients with GC. It is necessary to timely screen and assess. The reasonable nutritional support plan should be chosen based on the patient’s individualized situation. Future research should be needed to explore the long-term efficacy and safety of nutritional support, optimize the application of immunonutrition and parenteral nutrition, and enhance the general treatment outcomes for patients with GC.
Objective To investigate the factors influencing the need for surgical intervention after percutaneous catheter drainage (PCD) in patients with infected necrotizing pancreatitis (INP), and to construct and validate a nomogram-based predictive model. MethodsA total of 197 INP patients who underwent PCD at the Second Hospital of Lanzhou University between January 2021 and December 2023 were retrospectively enrolled. Patients were randomly divided into a training cohort (n=137) and a validation cohort (n=60) in a 7∶3 ratio. Univariate and multivariate logistic regression analyses were performed in the training cohort, and a nomogram was developed based on the multivariate results. Model discrimination was evaluated using receiver operating characteristic (ROC) curves, calibration was assessed using calibration plots, and clinical utility was examined using decision curve analysis (DCA) in both cohorts. ResultsMultivariate logistic regression revealed that C-reactive protein (CRP) [OR=1.028, 95%CI (1.005, 1.051), P=0.015], neutrophil-to-lymphocyte ratio (NLR) [OR=1.876, 95%CI (1.240, 2.839), P=0.003], computed tomography severity index (CTSI) [OR=6.701, 95%CI (2.827, 15.884), P<0.001], and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [OR=1.353, 95%CI (1.075, 1.703), P=0.010]were independent predictors of surgical intervention after unsuccessful PCD. A nomogram was constructed accordingly. The areas under the ROC curve (AUCs) of the predictive model were 0.95 [95%CI (0.92, 0.98)]in the training cohort and 0.94 [95%CI (0.88, 0.99)]in the validation cohort. Calibration curves and Hosmer-Lemeshow goodness-of-fit tests demonstrated good agreement between predicted and observed outcomes (training cohort P=0.633, validation cohort P=0.236). DCA showed that the nomogram provided the greatest net clinical benefit within threshold probabilities of 5%–97% in the training cohort and 10%–95% in the validation cohort. ConclusionsThe predictive model which including CRP, NLR, CTSI score and APACHE II score has significant predictive value of surgical intervention following PCD failure in INP patients. The proposed nomogram offers a reliable tool for early identification and clinical decision-making in this population.