Objective: To determine the impact of antiepileptic drugs and nutrition therapy on the plasma carnitine concentration in patients with severe motor and intellectual disabilities.

Subjects & Methods: Plasma carnitine concentration was measured in 129 outpatients and inpatients with severe motor and intellectual disabilities to examine its association with feeding method and administration of sodium valproate (VPA) and phenobarbital (PB).

Results: Among patients on oral feeding, the concentration of free carnitine was significantly lower in the VPA(+) PB(+) group (29.5 μmol/L) compared with the VPA(-) PB(-) group (48.0 μmol/L). Among patients on tube feeding, the concentration of free carnitine was significantly reduced to 30.5 μmol/L even in the VPA(-) PB(-) group, and the reduction was more prominent with the administration of VPA and PB.

Conclusion: We demonstrated that the administration of VPA and PB reduced the plasma carnitine concentration in patients with severe motor and intellectual disabilities, and the use of a carnitine-free enteral formula enhanced this reduction synergistically. Our findings suggest that these antiepileptic drugs and nutrition therapy using carnitine-free enteral formula may increase the risk of carnitine deficiency.

Objective: Chemotherapy is used to improve otherwise poor prognosis of advanced gallbladder cancer (GBC), especially that with distant metastasis. The prognostic nutritional index (PNI) has been reported as a prognostic factor for different types of malignancies, but the association of the PNI with the prognosis of GBC with distant metastasis after chemotherapy has not yet been investigated. In this study, we assessed significance of nutritional assessment in relation to duration of chemotherapy in GBC patients with distant metastasis.

Methods: From 76 consecutive patients with GBC, 11 with distant metastasis who underwent chemotherapy using gemcitabine or S1 plus gemcitabine and had complete PNI data were selected, and the association of PNI with duration of chemotherapy and prognosis was analyzed.

Results: Median survival time was significantly worse in 8 patients with low PNI (< 39) than in 3 with high PNI (≥ 39) (median survival time: 5.3 vs 7.8 months, p = 0.027). Median duration of chemotherapy was significantly longer in the 3 patients with high PNI than in the 8 with low PNI (13.0 vs 3.6 months, p = 0.036).

Conclusion: The findings of this study suggested that high initial PNI indicates the possibility of long-term chemotherapy and thus better prognosis in GBC patients with distant metastasis.

Purpose: The purpose of this study was to evaluate the effects of differences in perioperative pain management methods on the physical recovery indicators of exercise capacity and nutritional status.

Methods: This study involved 48 patients who underwent laparoscopic colorectal surgery for colorectal cancer in our hospital between March and October 2017. Patient-controlled epidural analgesia or intravenous patient-controlled analgesia was used; in addition, analgesics were administered as needed in 25 patients (standard group) or according to a predetermined schedule in 23 patients (scheduled group). We compared 6-min walking distance, grip strength, and controlling nutritional status score between the two groups at admission, discharge, and the first outpatient visit.

Results: Compared with the standard group, the scheduled group showed significantly improved measured values and change rate in the 6-min walking distance at discharge and the first outpatient visit, significantly improved change rate in grip strength at the first outpatient visit (all p<0.05), and a tendency toward shorter the postoperative hospital stay.

Conclusions: The findings of this single-center study suggest that scheduled administration of analgesics reduces postoperative pain and enhances the effect of rehabilitation.

Objective: We conducted this study to evaluate whether early short-term (4-day) nutritional support using enteral feeding immediately after gastrectomy can improve nutritional status compared with conventional early oral feeding in patients with stomach cancer.

Methods: The medical records of 503 patients with stomach cancer who underwent gastrectomy between January 2007 and July 2018 at Asahikawa Medical University Hospital were retrospectively analyzed. Patients were divided into the enteral nutrition (EN) group (n = 336) and oral nutrition (ON) group (n = 167). Both groups started water intake on postoperative day 2 and conventional oral feeding on postoperative day 3. In addition, the EN group received elemental formula (Elental^®) immediately after surgery for 4 days via a nasojejunal feeding tube (5 Fr) that had been inserted intraoperatively. Propensity score matching was performed to adjust for any differences in baseline characteristics.

Results: On preoperative day 7, the weight loss rate was significantly lower (p < 0.001), and the transthyretin level was significantly higher (p < 0.001) in the EN group than in the ON group.

Conclusions: The addition of short-term EN immediately after gastrectomy could improve the nutritional status of patients with gastric cancer, resulting in maintenance of both body weight and the level of transthyretin in the early postoperative period.

Objective: We retrospectively examined factors affecting controlling nutritional status (CONUT) score 1 year after surgery in gastric cancer patients.

Methods: Subjects were 50 patients with gastric cancer who underwent gastrectomy with curative intent between May 2015 and May 2018, received Nutrition Support Team intervention postoperatively, had no recurrence 1 year after surgery, and had CONUT scores assessed before and 1 year after surgery. Changes in the CONUT score 1 year after surgery and factors associated with the CONUT score were retrospectively analyzed.

Results: It was suggested that oral energy intake at discharge was an independent factor affecting the CONUT score 1 year after surgery.

Discussion: Perioperative nutritional management may affect medium- to long-term nutritional status in patients with gastric cancer.

Objective: There are few reports on early oral nutrition in the perioperative management of maintenance hemodialysis patients with chronic kidney disease following colorectal cancer surgery. Since 2006, we have been using an early oral nutrition protocol after elective colorectal cancer surgery for hemodialysis patients. This study examined its validity and safety.

Methods: From January 2007 to December 2019, 23 maintenance hemodialysis patients with chronic kidney disease and 676 non-dialysis patients underwent elective colon cancer surgery including anastomosis at our hospital. Short-term outcomes were retrospectively compared between these patient groups.

Results: In the hemodialysis group, median time to start of oral nutrition after surgery was 1 day and median time to the earliest possible date of discharge after surgery was 8 days. Complications of Clavien-Dindo classification grade 3 or higher were shunt occlusion in 2 cases (9%). There were no cases of anastomotic leakage in the hemodialysis group.

Conclusion: Early oral nutrition after elective colorectal cancer surgery was considered safe for maintenance hemodialysis patients with chronic kidney disease.