Do some patients receive unnecessary parenteral nutrition after pancreatoduodenectomy? Results from an international multicentre study
-
- Annals of Hepato-Biliary-Pancreatic Surgery
- /
- v.28 no.1
- /
- pp.70-79
- /
- 2024
Backgrounds/Aims: After pancreatoduodenectomy (PD), an early oral diet is recommended; however, the postoperative nutritional management of PD patients is known to be highly variable, with some centers still routinely providing parenteral nutrition (PN). Some patients who receive PN experience clinically significant complications, underscoring its judicious use. Using a large cohort, this study aimed to determine the proportion of PD patients who received postoperative nutritional support (NS), describe the nature of this support, and investigate whether receiving PN correlated with adverse perioperative outcomes. Methods: Data were extracted from the Recurrence After Whipple's study, a retrospective multicenter study of PD outcomes. Results: In total, 1,323 patients (89%) had data on their postoperative NS status available. Of these, 45% received postoperative NS, which was "enteral only," "parenteral only," and "enteral and parenteral" in 44%, 35%, and 21% of cases, respectively. Body mass index < 18.5 kg/m2 (p = 0.03), absence of preoperative biliary stenting (p = 0.009), and serum albumin < 36 g/L (p = 0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication, i.e., those who had a relatively uneventful recovery, 20% received PN. Conclusions: A considerable number of patients who had an uneventful recovery received PN. PN is not without risk, and should be reserved for those who are unable to take an oral diet. PD patients should undergo pre- and postoperative assessment by nutrition professionals to ensure they are managed appropriately, and to optimize perioperative outcomes.
This study was conducted to investigate the effect of salinity stress on the antioxidant and anti-inflammatory activities of Crepidiastrum sonchifolium. The plant was treated with NaCl at concentrations of 0, 50, 100, and 200mM for 6 weeks. After treatment, the whole plant was collected, and 70% ethanol extracts were prepared. The DPPH radical scavenging activity was highest in the order of NaCl treatment concentrations of 0, 100, and 50mM, while the 200mM treatment group showed the lowest radical scavenging. The total phenol and total flavonoid contents showed very similar results to the antioxidant activity depending on the NaCl concentration, confirming that the phenolic compounds of the plant can contribute to the antioxidant capacity against salinity stress. In addition, the investigation of the effect of NaCl-treated C. sonchifolium extract on the inhibition of NO production in the LPS-stimulated mouse macrophage cell line (Raw 264.7) revealed that NO production significantly decreased in the 1,000㎍/mL treatment group across all NaCl concentration groups. But, the high concentration (1,000㎍/mL) treatment of the 100mM and 200mM NaCl treatment groups was found to have a negative effect on cell survival. These results suggest that radical scavenging activity is highest in healthy plants and that they produce antioxidants to respond to NaCl salinity stress up to 100mM. However, a high NaCl concentration of 200mM has a negative effect on the physiological activity of the plants. Compared with the results of the previously reported growth index, it is thought that the growth and physiological activity of plants can be positively affected in an NaCl treatment environment of 50mM or less.
The purpose of this thesis is to disclose some characteristics of water consumption in relation to the quantities of dry matters through the growing period for two statured varieties of paddy rice which are a tall statured variety and a short one, including the water consumption during seedling period, and to find out the various coefficients of evapotranspiration that are applicable for the water use of an expected yield of the two varieties. PAL-TAL, a tall statured variety, and TONG-lL, a short statured variety were chosen for this investigation. Experiments were performed in two consecutive periods, a seedling period and a paddy field period, In the investigation of seedling period, rectangular galvanized iron evapotranspirometers (91cm
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
In order to assess the quality of dietary intake among the elderly, a survey was conducted during Jucy-August, 1999, of 230 subjects who were 65 years or older and who were living in Jeonju City. Results of the analysis of the data are as follows : Regarding Dietery Variety Score (DVS), the average number of food items consumed per person was significantly higher for males (19.6) than for females (17.7). The intake of plant food was higher than animal food for both sexes the proportion of plant versus animal foods consumed by fresh weight was 85 : 15 for males and 89 : 11 for females. Diet Diversity Score (DDS) is determined by how many from five food groups (cereal, meat, dairy, vegetable and fruit) consumed per day while Korean Diet Diversity Score (KDDS) is determined by how many from five different food groups (cereal, meat, vegetable, dairy and oil) consumed per day. The subjects'average DDS and KDDS were 4.0 and 3.5 for males, and 3.7 and 3.2 for females, respectively. Overall, the distribution of DDS was lower than that of KDDS. The average Meal Balance Score (MBS : Apply the KDDS at breakfast, lunch and dinner) was 9.1 for malts and 8.1 for females. Average daily caloric intake for males and females was 1,740 kcal and 1,433 kcal, which was 84.0% and 80.9% of the RDA, respectively. Average daily protein intake for males and females, at 67 g and 49 g (100.7% and 88.3% of the RDA), respectively, was satisfactory. However, intakes of calcium and vitamin A were below 75% of the RDA (calcium : 62.7% for males and 55.3% for females ; vitamin A : 60.7% for males and 53.9% far females). The average proportional contribution of protein/fat/carbohydrate (PFC) to total calorie intake was 15.8 : 15.7 : 68.5 for males and 13.8 : 13.2 : 73.0 for females. Distribution of energy for each meal (breakfast : lunch : afternoon snack : dinner : night snack) was 29.2 : 32.4 : 5.0 : 31.2 : 2.2 among males and 30.5 : 33.5 : 4.5 : 28.6 : 2.91 among females. The Index of Nutritional Quality (INQ) was above 1 for protein, phosphorus, iron, vitamin B
Corporate credit rating assessment consists of complicated processes in which various factors describing a company are taken into consideration. Such assessment is known to be very expensive since domain experts should be employed to assess the ratings. As a result, the data-driven corporate credit rating prediction using statistical and artificial intelligence (AI) techniques has received considerable attention from researchers and practitioners. In particular, statistical methods such as multiple discriminant analysis (MDA) and multinomial logistic regression analysis (MLOGIT), and AI methods including case-based reasoning (CBR), artificial neural network (ANN), and multiclass support vector machine (MSVM) have been applied to corporate credit rating.2) Among them, MSVM has recently become popular because of its robustness and high prediction accuracy. In this study, we propose a novel optimized MSVM model, and appy it to corporate credit rating prediction in order to enhance the accuracy. Our model, named 'GAMSVM (Genetic Algorithm-optimized Multiclass Support Vector Machine),' is designed to simultaneously optimize the kernel parameters and the feature subset selection. Prior studies like Lorena and de Carvalho (2008), and Chatterjee (2013) show that proper kernel parameters may improve the performance of MSVMs. Also, the results from the studies such as Shieh and Yang (2008) and Chatterjee (2013) imply that appropriate feature selection may lead to higher prediction accuracy. Based on these prior studies, we propose to apply GAMSVM to corporate credit rating prediction. As a tool for optimizing the kernel parameters and the feature subset selection, we suggest genetic algorithm (GA). GA is known as an efficient and effective search method that attempts to simulate the biological evolution phenomenon. By applying genetic operations such as selection, crossover, and mutation, it is designed to gradually improve the search results. Especially, mutation operator prevents GA from falling into the local optima, thus we can find the globally optimal or near-optimal solution using it. GA has popularly been applied to search optimal parameters or feature subset selections of AI techniques including MSVM. With these reasons, we also adopt GA as an optimization tool. To empirically validate the usefulness of GAMSVM, we applied it to a real-world case of credit rating in Korea. Our application is in bond rating, which is the most frequently studied area of credit rating for specific debt issues or other financial obligations. The experimental dataset was collected from a large credit rating company in South Korea. It contained 39 financial ratios of 1,295 companies in the manufacturing industry, and their credit ratings. Using various statistical methods including the one-way ANOVA and the stepwise MDA, we selected 14 financial ratios as the candidate independent variables. The dependent variable, i.e. credit rating, was labeled as four classes: 1(A1); 2(A2); 3(A3); 4(B and C). 80 percent of total data for each class was used for training, and remaining 20 percent was used for validation. And, to overcome small sample size, we applied five-fold cross validation to our dataset. In order to examine the competitiveness of the proposed model, we also experimented several comparative models including MDA, MLOGIT, CBR, ANN and MSVM. In case of MSVM, we adopted One-Against-One (OAO) and DAGSVM (Directed Acyclic Graph SVM) approaches because they are known to be the most accurate approaches among various MSVM approaches. GAMSVM was implemented using LIBSVM-an open-source software, and Evolver 5.5-a commercial software enables GA. Other comparative models were experimented using various statistical and AI packages such as SPSS for Windows, Neuroshell, and Microsoft Excel VBA (Visual Basic for Applications). Experimental results showed that the proposed model-GAMSVM-outperformed all the competitive models. In addition, the model was found to use less independent variables, but to show higher accuracy. In our experiments, five variables such as X7 (total debt), X9 (sales per employee), X13 (years after founded), X15 (accumulated earning to total asset), and X39 (the index related to the cash flows from operating activity) were found to be the most important factors in predicting the corporate credit ratings. However, the values of the finally selected kernel parameters were found to be almost same among the data subsets. To examine whether the predictive performance of GAMSVM was significantly greater than those of other models, we used the McNemar test. As a result, we found that GAMSVM was better than MDA, MLOGIT, CBR, and ANN at the 1% significance level, and better than OAO and DAGSVM at the 5% significance level.
Purpose: The purpose of this study was to evaluate dietary habits, food intakes, nutrient intakes, and diet quality of non-alcoholic fatty liver disease in a health screening and promotion center. Methods: The total number of study subjects was 10,111 adults, where 3087 subjects (30.5%) were diagnosed as NAFLD. The dietary intakes were obtained using a food frequency questionnaire. They were then compared with the dietary reference intakes could be used in the future for development of diet and nutrition guidelines s (KDRIs). Results: Mean age of subjects in the normal group was
This study investigated the daily physical activity level, energy expenditure, energy balance, and body composition and their relationship with university students. The participants were 130 male students (
This study was conducted to identify the correlation of bacterial phytase (