[in Japanese]

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[in Japanese]

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[in Japanese]

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The choices of drug therapy were increased in the field of hepatobiliary cancers. Many studies reported that nutritional status could predict the prognosis in various drug therapies including immune checkpoint inhibitor. The nutritional status sometimes became worse depend on the adverse event of drug therapy. In accordance with nutritional evaluation, nutritional intervension should be considered from an early phase of drug therapy. Even though there is no golden standard for nutritional intervention for patients with hepatobiliary carcinoma, evidence‐based clinical practice guidelines for liver cirrhosis 2020 can be helpful. The reduction of skeletal muscle mass during drug therapy is also known as one of predictor of prognosis. Branched‐chain‐amino acids should be administered if patients with hepatobiliary carcinoma present the reduction of skeletal muscle mass during drug therapy．

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Although pancreatic cancer has an extremely low 5‐year survival rate, making it the most prognostically poor malignant tumor, there has been gradual improvement in outcomes. Preoperative and postoperative adjuvant chemotherapy are already being practiced as standard treatments. For resectable pancreatic cancer, it is crucial to implement these therapies according to the planned protocol in order to enhance survival rates. However, in pancreatic cancer, the tolerability of chemotherapy is often insufficient for various reasons. To improve the tolerability of chemotherapy, support from various angles is necessary. Among them, essential support comes from nutrition management. It is necessary to understand and practice specialized nutritional care tailored to pancreatic cancer and pancreatic diseases．

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[in Japanese]

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Objective: To clarify the characteristics of inflammation and nutritional metabolism in COVID‐19 pneumonia to inform therapeutic intervention measures.
Materials and Methods: Inflammation and nutritional metabolism data obtained from blood tests and indirect calorimetry were analyzed in 28 patients admitted to our emergency ICU with a diagnosis of COVID‐19 pneumonia.
Results: We identified 18 patients with moderate disease and 10 patients with severe disease. All patients with severe disease required intubation and four patients required vv‐ECMO management. Inflammation was significantly higher and lymphocyte counts were significantly lower in patients with severe disease（p = 0.005）. Furthermore, nutritional metabolism data showed significantly higher CONUT scores and PGC‐1α levels in the patients with severe disease（p = 0.03, 0.003, respectively）. In the five cases in which indirect calorimetry was performed, fatty acid oxidation tended to be lower and respiratory quotient higher than in normal pneumonia.
Conclusion: COVID‐19 pneumonia is associated with high inflammatory and immunoparalysis states and high nutritional risk, depending on the severity of the disease. Our findings suggest that there are specific changes in nutritional metabolism that should be considered in nutritional therapy.

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