Explain this table (shown in picture) from a study with the help of the information below and additional information from the article (shown in picture):
Explain this table (shown in picture) from a study with the help of the information below and additional information from the article (shown in picture):
Explain this table (shown in picture) from a study with the help of the information below and additional information from the article (shown in picture):
Explain this table (shown in picture) from a study with the help of the information below and additional information from the article (shown in picture):
Primary liver cancer is one of the most prevalent life- threating diseases in China, and liver resection is the major therapy for this malignancy. Recently, various methods have been advocated perioperatively to maintain liver function and promote liver regener- ation after liver resections. These include systemic interventions such as antibiotics in perioperative period and methods to improve general health and the immunity of the individual such as prebiotics and probiotics. Among them, nutritional support is also a vital approach to protect liver function. It has been demonstrated that a good preoperative nutri- tional status could reduce the postoperative morbidity or mortality and consequently the costs of care after surgery. Moreover, malnutrition is frequent in patients suffering from malignant liver disease. Optimization of nutritional status may improve hepatic function, and preoperative nutritional status is one of the key points for success of liver resection. Enteral nutrition was suggested by the ESPEN as the first choice for liver cancer patients and should be initiated within 12–24 h postoperatively to reduce infection rate. Whole protein formulae and concentrated high-energy formulae are generally recommended as enteral nutrition for patients following liver resection. As a renewed EN, TP-MCT contains 20% and 30% of total energy from protein and fat, respectively. Total protein effectively improve the level of albumin in patients. The fat contains 60% MCT in the enriched nutrition in order to supply energy quickly, promote fat digestion and absorption, and also reduce fat diarrhea. The postoperative patients were in a status of high catabolism and negative nitrogen balance. Intervention with enteral nutrition of different composition improves calorie supply as well as protein intake for patients after major operations. Meanwhile, MCT hydrolyzes faster in the gut. Although median duration of hospital stay and length of postoperative hospital stay were shorter in the treatment group, the difference were not signifi- cant (P 1⁄4 0.484 and P 1⁄4 0.514) (Table 2). In contrast to hospital stay, we found a significant reduction in the time to first flatus in the treatment group, when compared with control group (1.0 (1.0–2.0) d vs. 2.0 (2.0–2.0) d; P 1⁄4 0.001). Consistent with this, the time to first defecation was significantly shorter in the treatment group. The median time to first defecation was 3.0 (2.0–4.0) d in the control group and 2.0 (2.0–3.0) d in the treatment group (P < 0.001) (Table 2).
The intraoperative characteristics, including type of hepatectomy, blood loss and blood transfusion, did not show any significant difference between the control group and the treatment group (Table 1). It showed a significantly reduced surgery time in the treatment group compared with that in the control group (P 1⁄4 0.029). The value of Pringle maneuver time was significantly lower in the treat- ment group than that in the control group (P1⁄40.016).
The decrease of carnitine production in patients with liver dysfunction directly affects the oxi- dation and energy supply of LCFA. MCT oxidation process is short and can provide energy for human body quickly. This is also the reason why the state of negative nitrogen balance can be quickly corrected, and protein decomposition can be reduced in the treatment group in this study.
There are several limitations in this study which need further discussion and exploration. First, limited number of patients were included in outcome analysis although this is a multicenter, prospective, randomized controlled trial. In addition, our results might have been confounded by the absence of standardiza- tion and supervision among the participating centers. Study protocols were compared before the start of the study, and most protocol components were applied similarly in all hospitals. However, adherence to the protocol was not monitored continuously during the trial, leading to possible bias. Finally, our trial did not have a group to assess the impact of a placebo, but as appreciated it is impossible for our study to compose a placebo group.
In conclusion, this study provided evidence that protein-enriched enteral nutrition (TP-MCT) improves postoperative recovery for patients with pri- mary liver cancer following hepatectomy.
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