BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of c...BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of colorectal cancer(CRC).AIM To explore the relationship between nutritional and inflammatory indicators and microsatellite stability(MSS)status in CRC.METHODS The clinical data of 56 patients who underwent surgical treatment for CRC were collected.Furthermore,the expressions of nutritional(levels of serum albumin,triglycerides,serum cholesterol,and body mass index)and inflammatory response indicators(absolute neutrophil count,absolute lymphocyte count,absolute monocyte count,neutrophil-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)as well as their correlation with microsatellite instability(MSI)status were investigated in patients with CRC.RESULTS Compared to the patients with MSS tumors,those with MSI tumors demonstrated significantly lower levels of two nutritional indicators,namely serum albumin and body mass index(P<0.05).Moreover,patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group(P<0.05),indicating pronounced differences in inflammatory responses and immune states between the two groups.CONCLUSION Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC,highlighting their potential role in the clinical treatment and health management of this specific population.展开更多
BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplan...BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.展开更多
Objective:To evaluate the nursing effects of targeted care for children with nutritional iron-deficiency anemia(IDA).Methods:A total of 88 children with IDA admitted to the hospital from November 2021 to November 2023...Objective:To evaluate the nursing effects of targeted care for children with nutritional iron-deficiency anemia(IDA).Methods:A total of 88 children with IDA admitted to the hospital from November 2021 to November 2023 were selected(each child included one accompanying family member).Using a random number table,the participants were divided into two groups:the observation group,which received targeted nursing care,and the reference group,which received standard nursing care.The anemia correction rate,nutritional indicators,and family knowledge level were compared.Results:The anemia correction rate in the observation group was higher than in the reference group,with post-nursing nutritional indicators superior to those in the reference group.Additionally,family members in the observation group had a higher level of knowledge(P<0.05).Conclusion:Targeted nursing can effectively correct anemia symptoms in children with IDA,improve nutritional indicators,and increase family members’knowledge,demonstrating high nursing effectiveness.展开更多
Objective:To study the application effects of the entire-course nutrition management model led by specialized nutrition nurses in patients with distant cholangiocarcinoma.Methods:Using convenience sampling,one hundred...Objective:To study the application effects of the entire-course nutrition management model led by specialized nutrition nurses in patients with distant cholangiocarcinoma.Methods:Using convenience sampling,one hundred and twenty patients with distant cholangiocarcinoma admitted from April 2023 to October 2024 were selected as the experimental subjects of this study.They were grouped using a random number table method.The intervention group consisted of 60 patients with distant cholangiocarcinoma who received the entire-course nutrition management led by specialized nutrition nurses,while the observation group consisted of 60 patients who received conventional management.The intestinal function,nutritional indicators,quality of life,and satisfaction were compared between the intervention and observation groups.Results:After intervention,the intestinal function,nutritional indicators,quality of life,and satisfaction of patients with distant cholangiocarcinoma in the intervention group were significantly better than those in the observation group,with statistically significant differences(P<0.05).Conclusion:The application of the entire-course nutrition management model led by specialized nutrition nurses in patients with distant cholangiocarcinoma has more prominent effects and can further improve prognosis,making it worthy of widespread clinical application.展开更多
Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospita...Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospital from January 2022 to January 2024 were selected and divided into groups according to the random number table method.The control group(n=30)received routine nursing after surgery,while the observation group(n=30)received early enteral nutrition nursing after surgery.The perioperative indexes,nutritional indexes before and after nursing,humoral and cellular immune indexes before and after nursing,gastrointestinal hormone levels before and after nursing,and the incidence of postoperative complications were compared between the two groups.Results:The perioperative indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the nutritional indexes between the two groups(P>0.05).After nursing,the nutritional indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the humoral and cellular immune indexes between the two groups(P>0.05).After nursing,the humoral and cellular immune indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the gastrointestinal hormone levels between the two groups(P>0.05).After nursing,the gastrointestinal hormone levels of the observation group were better than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:For elderly patients with gastric cancer,early enteral nutrition nursing after surgery can improve their nutritional indexes and gastrointestinal hormone levels,enhance their immune ability,and prevent the incidence of postoperative complications,with good effects.展开更多
[Objective] The study aimed at reducing the economic cost in feeding Tenebrio molitor and improving the utilization ratio of corn stalks.[Method] The effects of different proportions of corn stalks on the weigh of Ten...[Objective] The study aimed at reducing the economic cost in feeding Tenebrio molitor and improving the utilization ratio of corn stalks.[Method] The effects of different proportions of corn stalks on the weigh of Tenebrio molitor and the contents of crude protein,crude fat,Ca,P,dry matter and crude ash in the half-dry matter of Tenebrio molitor had been studied in the laboratory.[Result] Compared with the recipes of all wheat bran and pure fine fodder,feeding Tenebrio molitor by applying 30%-60% of corn stalks could significantly improve the content of crude protein in the half-dry materials of Tenebrio molitor,but it was detrimental to the improvement in weight of Tenebrio molitor and the accumulation of crude fat.To be specific,the recipe V（50% of corn stalks ＋ 50% of fine fodder） was beneficial to the accumulation of dry matter and crude ash.The recipe VII（70% of corn stalks ＋ 30% of fine fodder） and the recipe VIII（70% of corn stalks treated with Guangda feed leaven ＋ 30% of fine fodder） were beneficial to the accumulation of crude protein,Ca and P.There were differences among the influences of corn stalks in different treatments on the crude protein and other nutrition indicators of Tenebrio molitor.[Conclusion] Appropriately applying corn stalks can improve the accumulation of the crude protein,crude ash,dry matter,Ca and P of Tenebrio molitor but was detrimental to the growth and development of Tenebrio molitor and the accumulation of crude fat.展开更多
BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the opti...BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.展开更多
Objective: to discuss the specific implementation process and application effect of enteral nutrition support nursing mode for gastric cancer. Methods: Anze County People's Hospital of, Linfen city, Shanxi provinc...Objective: to discuss the specific implementation process and application effect of enteral nutrition support nursing mode for gastric cancer. Methods: Anze County People's Hospital of, Linfen city, Shanxi province suffered from gastric cancer from June 2017 to June 2018, in 80 patients treated with a total gastrectomy protocol, randomization, that is, 40 cases were included in the two groups each. In the observation group, patients were implemented in the usual care mode, combined enteral nutrition support care implementation intervention. In the control group, the postoperative routine care mode was applied alone. The nutritional indicators (including HB, STB, ALB), postoperative gastrointestinal function recovery, complication rate, nutritional status, and quality of life scores of the two groups were compared. Results: all 80 patients showed lower ratio (P > 0.05) and 40 subsequent intervention (P <0.05). After total gastric resection for gastric cancer in both groups, the anal exhaust, the defecation, bowel sounds and diet were faster than those of the control group (P < 0.05). The number of complications in the observed group was a lower level (P < 0.05). The incidence of malnutrition after the nursing intervention was lower than that in the control group (P < 0.05). Before the nursing operation, the scores of QoL between groups were lower and there was no significant difference between the two groups (P > 0.05). After the nursing operation, the scores were improved and the level of observation group was higher (P < 0.05). Conclusion: for patients treated with gastric cancer, the intervention program can effectively improve their gastrointestinal function, improve their malnutrition status, and actively prevent complications.展开更多
Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease.Data regarding its clinical significance and consequences in the course of liver disease have been growing;many of the...Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease.Data regarding its clinical significance and consequences in the course of liver disease have been growing;many of the data support the idea that it impacts decompensation event frequency,prolonged hospitalization,and mortality,as well as providing the possibility to better prioritize patients on lists awaiting liver transplantation.When assessing the whole clinical scope of the field,which includes malnutrition and frailty,as well as the complete spectrum of muscle mass,strength,and function,it becomes clear that a well-founded approach in everyday clinical practice is essential.In this respect,this article attempts to unveil the most recently published data regarding possible methods and modalities that could be used to diagnose sarcopenia as early as possible,along with the required accuracy and reliability.From the most important field discoveries to data that need further clarification,the merits and weaknesses of the very diverse existing evaluation methods are presented.Finally,a critical overview is given,in an attempt to discern study lines of importance from those that could pose further ambiguity for the theme.The author also poses relevant questions that remain unanswered but are of clinical importance in the field.展开更多
基金Supported by Grants of the Suzhou Medical Key Discipline,No.SZXK202109Suzhou Clinical Key Disease Project,No.LCZX202111Suzhou Promoting Health through Science and Education Research Project,No.KJXW2021028.
文摘BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of colorectal cancer(CRC).AIM To explore the relationship between nutritional and inflammatory indicators and microsatellite stability(MSS)status in CRC.METHODS The clinical data of 56 patients who underwent surgical treatment for CRC were collected.Furthermore,the expressions of nutritional(levels of serum albumin,triglycerides,serum cholesterol,and body mass index)and inflammatory response indicators(absolute neutrophil count,absolute lymphocyte count,absolute monocyte count,neutrophil-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)as well as their correlation with microsatellite instability(MSI)status were investigated in patients with CRC.RESULTS Compared to the patients with MSS tumors,those with MSI tumors demonstrated significantly lower levels of two nutritional indicators,namely serum albumin and body mass index(P<0.05).Moreover,patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group(P<0.05),indicating pronounced differences in inflammatory responses and immune states between the two groups.CONCLUSION Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC,highlighting their potential role in the clinical treatment and health management of this specific population.
基金Supported by The Self-Funded Research Project of the Health Commission of Guangxi Zhuang Autonomous Region,No.Z-A20230045.
文摘BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.
文摘Objective:To evaluate the nursing effects of targeted care for children with nutritional iron-deficiency anemia(IDA).Methods:A total of 88 children with IDA admitted to the hospital from November 2021 to November 2023 were selected(each child included one accompanying family member).Using a random number table,the participants were divided into two groups:the observation group,which received targeted nursing care,and the reference group,which received standard nursing care.The anemia correction rate,nutritional indicators,and family knowledge level were compared.Results:The anemia correction rate in the observation group was higher than in the reference group,with post-nursing nutritional indicators superior to those in the reference group.Additionally,family members in the observation group had a higher level of knowledge(P<0.05).Conclusion:Targeted nursing can effectively correct anemia symptoms in children with IDA,improve nutritional indicators,and increase family members’knowledge,demonstrating high nursing effectiveness.
文摘Objective:To study the application effects of the entire-course nutrition management model led by specialized nutrition nurses in patients with distant cholangiocarcinoma.Methods:Using convenience sampling,one hundred and twenty patients with distant cholangiocarcinoma admitted from April 2023 to October 2024 were selected as the experimental subjects of this study.They were grouped using a random number table method.The intervention group consisted of 60 patients with distant cholangiocarcinoma who received the entire-course nutrition management led by specialized nutrition nurses,while the observation group consisted of 60 patients who received conventional management.The intestinal function,nutritional indicators,quality of life,and satisfaction were compared between the intervention and observation groups.Results:After intervention,the intestinal function,nutritional indicators,quality of life,and satisfaction of patients with distant cholangiocarcinoma in the intervention group were significantly better than those in the observation group,with statistically significant differences(P<0.05).Conclusion:The application of the entire-course nutrition management model led by specialized nutrition nurses in patients with distant cholangiocarcinoma has more prominent effects and can further improve prognosis,making it worthy of widespread clinical application.
文摘Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospital from January 2022 to January 2024 were selected and divided into groups according to the random number table method.The control group(n=30)received routine nursing after surgery,while the observation group(n=30)received early enteral nutrition nursing after surgery.The perioperative indexes,nutritional indexes before and after nursing,humoral and cellular immune indexes before and after nursing,gastrointestinal hormone levels before and after nursing,and the incidence of postoperative complications were compared between the two groups.Results:The perioperative indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the nutritional indexes between the two groups(P>0.05).After nursing,the nutritional indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the humoral and cellular immune indexes between the two groups(P>0.05).After nursing,the humoral and cellular immune indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the gastrointestinal hormone levels between the two groups(P>0.05).After nursing,the gastrointestinal hormone levels of the observation group were better than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:For elderly patients with gastric cancer,early enteral nutrition nursing after surgery can improve their nutritional indexes and gastrointestinal hormone levels,enhance their immune ability,and prevent the incidence of postoperative complications,with good effects.
基金Supported by National Special Fund for Scientific Research in Public Welfare Trade(Agriculture)(200803033-B0602-01)Project of Hebei Province Scientific and Technological Department(10221019)+1 种基金Project of Qinghuangdao City Science and Technology Burea of Hebei Province(201001A152)Foundation of Education Committee of Hebei Province(2003308)~~
文摘[Objective] The study aimed at reducing the economic cost in feeding Tenebrio molitor and improving the utilization ratio of corn stalks.[Method] The effects of different proportions of corn stalks on the weigh of Tenebrio molitor and the contents of crude protein,crude fat,Ca,P,dry matter and crude ash in the half-dry matter of Tenebrio molitor had been studied in the laboratory.[Result] Compared with the recipes of all wheat bran and pure fine fodder,feeding Tenebrio molitor by applying 30%-60% of corn stalks could significantly improve the content of crude protein in the half-dry materials of Tenebrio molitor,but it was detrimental to the improvement in weight of Tenebrio molitor and the accumulation of crude fat.To be specific,the recipe V（50% of corn stalks ＋ 50% of fine fodder） was beneficial to the accumulation of dry matter and crude ash.The recipe VII（70% of corn stalks ＋ 30% of fine fodder） and the recipe VIII（70% of corn stalks treated with Guangda feed leaven ＋ 30% of fine fodder） were beneficial to the accumulation of crude protein,Ca and P.There were differences among the influences of corn stalks in different treatments on the crude protein and other nutrition indicators of Tenebrio molitor.[Conclusion] Appropriately applying corn stalks can improve the accumulation of the crude protein,crude ash,dry matter,Ca and P of Tenebrio molitor but was detrimental to the growth and development of Tenebrio molitor and the accumulation of crude fat.
基金Supported by Ningxia Natural Science Foundation Project,No.2022AAC03488the National Key Research and Development Program of China,No.2016YFD0400605.
文摘BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.
文摘Objective: to discuss the specific implementation process and application effect of enteral nutrition support nursing mode for gastric cancer. Methods: Anze County People's Hospital of, Linfen city, Shanxi province suffered from gastric cancer from June 2017 to June 2018, in 80 patients treated with a total gastrectomy protocol, randomization, that is, 40 cases were included in the two groups each. In the observation group, patients were implemented in the usual care mode, combined enteral nutrition support care implementation intervention. In the control group, the postoperative routine care mode was applied alone. The nutritional indicators (including HB, STB, ALB), postoperative gastrointestinal function recovery, complication rate, nutritional status, and quality of life scores of the two groups were compared. Results: all 80 patients showed lower ratio (P > 0.05) and 40 subsequent intervention (P <0.05). After total gastric resection for gastric cancer in both groups, the anal exhaust, the defecation, bowel sounds and diet were faster than those of the control group (P < 0.05). The number of complications in the observed group was a lower level (P < 0.05). The incidence of malnutrition after the nursing intervention was lower than that in the control group (P < 0.05). Before the nursing operation, the scores of QoL between groups were lower and there was no significant difference between the two groups (P > 0.05). After the nursing operation, the scores were improved and the level of observation group was higher (P < 0.05). Conclusion: for patients treated with gastric cancer, the intervention program can effectively improve their gastrointestinal function, improve their malnutrition status, and actively prevent complications.
文摘Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease.Data regarding its clinical significance and consequences in the course of liver disease have been growing;many of the data support the idea that it impacts decompensation event frequency,prolonged hospitalization,and mortality,as well as providing the possibility to better prioritize patients on lists awaiting liver transplantation.When assessing the whole clinical scope of the field,which includes malnutrition and frailty,as well as the complete spectrum of muscle mass,strength,and function,it becomes clear that a well-founded approach in everyday clinical practice is essential.In this respect,this article attempts to unveil the most recently published data regarding possible methods and modalities that could be used to diagnose sarcopenia as early as possible,along with the required accuracy and reliability.From the most important field discoveries to data that need further clarification,the merits and weaknesses of the very diverse existing evaluation methods are presented.Finally,a critical overview is given,in an attempt to discern study lines of importance from those that could pose further ambiguity for the theme.The author also poses relevant questions that remain unanswered but are of clinical importance in the field.
