ObjectiveTo investigate the influence of enteral nutrition (EN) and total parenteral nutrition (TPN) on liver, kidney and gastrointestinal function in patients after esophagectomy. MethodsA total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years (range 31 to 85 years). All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1, 3 and 7 days postoperatively, plasma alanine transaminase (ALT), aspartate transaminase (AST), indirect bilirubin (I_BIL), direct bilirubin (DB), total bilirubin (TB), total protein (TP) and albumin (ALB) were examined to evaluate liver function, blood urea nitrogen (BUN) and serum creatinine (Scr) were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. ResultsThere was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups (P > 0.05), but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day (P < 0.05). There was no statistical difference in TP or ALB between the 2 groups (P > 0.05). There was no statistical difference in BUN or Scr preoperatively, on the 1st or 3rd postoperative day between the 2 groups (P > 0.05). BUN (4.94±1.07 mmol/L vs. 6.67± 2.88 mmol/L, P < 0.05) and Scr (52.50±12.46 μmol/L vs. 68.23±7.61 μmol/L, P < 0.05) of the experimental group were significantly lower than those of the control group on the 7th postoperative day. Postoperative time to first audible bowel sounds (42.00±1.68 hours vs. 50.00±1.54 hours), time to first flatus (64.15±10.35 hours vs. 70.64±14.73 hours) and time to first stool (4.20±1.50 days vs. 5.20 ±1.40 days) of the experimental group were significantly shorter than those of the control group (P < 0.05). ConclusionPostoperative EN can promote the recovery of gastrointestinal function, and has less influence on liver and kidney function, which is beneficial to postoperative recovery and morbidity reduction after esophagectomy.
ObjectiveTo investigate the association between kidney function indicators in routine health examinations and the incidence of urinary stone disease using longitudinal repeated-measurement data. MethodsThis study was based on the large-scale longitudinal data in the WHALE study. Cox proportional hazards models were first applied to examine the associations between baseline kidney function indicators and incident urolithiasis. Subsequently, Poisson regression and mixed-effects models were used to analyze repeated-measurement data to further explore the relationships between kidney function indicators and urolithiasis. Latent class trajectory modeling was then employed to characterize longitudinal patterns of kidney function indicators. Based on the optimal trajectory models, logistic regression analyses and Cox regression analyses were performed to assess the associations between trajectory classes and the risk of urolithiasis. ResultsAmong 313 280 health examination participants included in the study, 8 864 incident cases of urolithiasis were identified during follow-up. In the baseline Cox analyses, cystatin C showed the strongest association with urolithiasis (HR=1.230, 95%CI 1.083 to 1.396, FDR=0.001). In analyses incorporating repeated measurements, serum uric acid demonstrated a strong association in both Poisson regression and mixed-effects models (RR=1.123, 95%CI 1.094 to 1.152, FDR<0.001; RR=1.106, 95%CI 1.075 to 1.137, FDR<0.001). In trajectory analyses, U-shaped trajectories of blood urea (HR=0.548, 95%CI 0.438 to 0.685, FDR<0.001) and uric acid (HR=0.910, 95%CI 0.857 to 0.685, FDR=0.005) were associated with a lower risk of urolithiasis. ConclusionBoth baseline levels and longitudinal changes in kidney function indicators measured during routine health examinations are significantly associated with the incidence of urolithiasis. Regular assessment and longitudinal monitoring of kidney function may contribute to the prevention and early identification of urolithiasis development and progression.