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2017 Vol. 4, No. 1
Published: 2017-01-12
 
1 Nutrition education for cancer patients
1SHI Han-ping, 2YANG Jian, 1ZHANG Yan
Nutrition education is an essential component of nutrition intervention and a preferred method of nutrition therapy. Nutrition education for cancer patients follows the basic principles of nutrition education in the general population, but more targeted and more rich in its content, including 10 aspects: answer questions from patients/family/caretakers, outline the aim of nutrition diagnosis, evaluate dietary, nutrition and function status, review lab and instrument exam, deliver dietary and nutrition suggestion, clarify cancer pathophysiology, scheme nutrition intervention, inform nutrition intervention complication and solution, predict the result of nutrition intervention, plan and carry out nutrition follow-up. Studies have shown that nutrition education to cancer patients is an economic, practical and effective measure. Nutrition education is not only imparting knowledge of diet and nutrition, more important is learning how to improve the nutrition status, changing in eating behavior, forming good habits of diet and nutrition, in order to improve patients’ nutrition status and health. Therefore, nutrition education is a long-term process and a form of process. Due to higher malnutrition rate, more complex causes and more serious outcomes, cancer patients thus need more to accept a long-term nutrition education, to shorten the length of hospital stay, to reduce the complications and to improve clinical outcomes, and finally to improve the quality of life and prolong survival time.
2017 Vol. 4 (1): 1-6 [Abstract] ( 559 ) HTML PDF (2025 KB)  ( 337 )
7 The mechanism of radiation induced lean body mass loss and its clinical significance
FAN Ming, LI Tao, LANG Jin-yi
Radiotherapy often accompanies with malnutrition. The incidence, the time of occurrence, severity of malnutrition and so on were varied with different types of tumor, disease stages and treatment methods. Malnutrition is not only a decrease in body weight, but also a loss in lean body mass. Lean body mass is also called fat free weight, namely the mass of body after removal of fat, which is composed of cells, extracellular water and other solid components. Muscle and bones are main components of lean body mass. Many animal experiments showed that after irradiation, the muscles would appear acute atrophy, performed by decreasing of myosin and changes in proportions of myosin heavy chain, and this phenomenon was affected by radiation doses. In the clinical studies, the decrease of muscle content after radiotherapy was also observed, which was significantly related to prognosis. Bone loss caused by radiation is also one of the important factors that lead to loss of lean body mass. In the past, it was considered to be a late adverse reaction induced by radiation. However, it was found that bone loss occurred in the early stage of radiation therapy, and it was significantly affected by the radiation dose. In summary, radiation can lead to muscle atrophy, bone loss, resulting in loss of lean body mass, which increases the risk of death and affects the quality of life of patients. Because of the effects of radiotherapy varies in different muscles and bones, in clinical settings, radiotherapists should consider the adverse effects caused by muscle atrophy and bone loss when applying radiation to important bones and muscles, thus achieving optimistic treatment effect.
2017 Vol. 4 (1): 7- [Abstract] ( 293 ) HTML PDF (1507 KB)  ( 142 )
11 Therapeutic strategy to malignant biliary obstruction
1SUN Xiao-mei, 1TANG Xiu-fen, 2SUN Ling-yu
MBO was a class of diseases caused by a variety of malignant tumors in the liver and/or extrahepatic bile duct stenosis or occlusion, leading to obstructive jaundice and other systemic symptoms. The majority of patients with MBO were associated with poor immune function and malnutrition, removal of biliary obstruction, reasonable enteral nutrition, were to improve the patients' condition, as well as the basis for other treatment. However, most of the patients have lost the chance of radical operation, and could only be treated by palliative surgery and biliary drainage. A small number of patients with MBO could be surgically resected to establish a new approach to the biliary tract. For most patients who could not be operated, only biliary drainage could be used to relieve the obstruction. Bile drainage included internal and external drainage. Internal drainage achieved biliary drainage purposes through biliary stent implantation, however, external drainage achieved through percutaneous transhepatic biliary drainage which is the best choice after failure of biliary obstruction for internal drainage. Because the drainage would lead to loss of a large number of patients with serious influence on bile, digestive function and fluid balance, reinfusion of bile from external drainage by nasal catheter, jejunostomy, PEG/J pathway back into the intestine, and reconstruction of biliary enteric nutrition pathway have important clinical significance.The nutritional management of MBO was divided into enteral nutrition and parenteral nutrition. Patients with preoperative nutritional disorders should be based on central venous nutrition, as soon as possible to adjust the body to achieve the nutritional status of surgery, and enteral nutrition should be started as soon as possible after the recovery of intestinal function. For patients with external drainage for bile, nutritional management should be carried out as much as possible in the way of bile reinfusion combined with enteral nutrition.
2017 Vol. 4 (1): 11- [Abstract] ( 280 ) HTML PDF (2225 KB)  ( 352 )
17 Recognition of peripheral parenteral nutritio
FAN Yue-ping, SHI Han-ping
PPN is one of the methods belongs to total parenteral nutrition and partial parenteral nutrition, mainly through peripheral veins to provide nutritional support. Although PPN has long history in clinics, there still have various viewpoints to many researchers, such as indications of PPN, reasonable periods of PPN applying, appropriate osmotic pressure and applying in geriatric patients and children. PPN is suitable for situation such as enteral nutrition couldn’t be established or insufficient enteral nutrition, central vein route couldn’t be established, parenteral nutrition with short time , low calorie and low nitrogen. PPN has the advantages of establishing infusion route of nutrition rapidly, costless than deep vein route, avoiding catheter related blood stream infection. Many researchers validated that PPN was safe and efficient during the period of perioperation. It has been accepted that osmotic pressure of parenteral nutrition was low and could be used in PPN. Fat emulsion had low osmotic pressure and could also lower the osmotic pressure of amino acid and dextrose, so it was benefit for PPN adding fat emulsion to parenteral nutrition. The incidence of complication was less for PPN than that of central vein route and had minimal damage to the body. The major complication relating to PPN are thrombotic phlebitis and leakage of fluid. It should be noticed that osmotic pressure should not be high at the time of PPN, the fat emulsion should be added in parenteral nutrition, according to the patients’ nutritional status and illness, applying duration of PPN should be shorten. Detection should be in progress regularly on the site of puncture during PPN to find the signs and symptoms of thrombophlebitis and processed in time.
2017 Vol. 4 (1): 17- [Abstract] ( 267 ) HTML PDF (986 KB)  ( 295 )
26 Laparoscopic gastrostomy
CAI Kai-lin, SHEN Li-ming
Gastrostomy is a main enteral nutrition access for patients who needed long term tube feeding, or who cannot swallowing. Open surgical procedure of gastrostomy had been used for more than 100 years and had been proved safe and effective, but resulting in large trauma. With the wide application of endoscopic and laparoscopic technique, many minimally invasive gastrostomy technique had been used in clinical. Percutaneous endoscopic gastrostomy operation had almost replaced the surgical procedure, because of its simple steps, small trauma, fast recovery, rare complications, and also avoidable of general anesthesia. But for those patients with throat or oesophageal obstruction or patients are unable to tolerate gastrointestinal endoscopy, surgical operation is necessary. Laparoscopic gastrostomy has advantages of minimally invasive surgery than traditional open surgery. Here we evaluated the common used minimally invasive gastrostomy operations and introduced our experience on the laparoscopic gastrostomy. We prefered the janeway procedure when making a gastrostomy. The fistula tube was made by the anterior wall along the large curvature of gastric body. With a bridge of the fistula tube between the anterior gastric wall and the abdominal wall, the gastric body dose not need to be stretched up with tension which could be symptomatic. With normal mucosal lining in the fistula tube, the feeding catheter could be changed easily, or be easily put away in occasion of taking in oral pills or capsules through the fistula tube. A foley’s urine catheter was competent for feeding and also for securing the fistula tube when the balloon was inflated.
2017 Vol. 4 (1): 26- [Abstract] ( 420 ) HTML PDF (2431 KB)  ( 293 )
30 Nasogastric and nasointestinal tube feeding in nutritional therapy
Chinese Anti-Cancer Association, Chinese Society for Oncological Nutrition and Supportive Care, The Committee of Rehabilitation and Palliative Care, Chinese Clinical Nutritionist Center, Chinese Nutri
Enteral nutrition is a nutritional therapy to supply nutrients by the gastrointestinal tract. The approaches of enteral nutrition therapy mainly include oral feeding, tube feeding (nasogastric tube and nasointestinal tube) and gastrostomy. It is vitally important for nutritional therapy to choose reasonable enteral nutrition treatment and to prevent complications. Nasogastric tube and nasointestinal tube are the most commonly used techniques to meet the therapeutic demands of patients. Nasogastric tube and nasointestinal tube are non-invasive, simple, economical and safe. They have been applied in many large and medium-sized hospitals in China. In this paper, the background of nasogastric and nasointestinal tube application in enteral nutrition, their advantages, disadvantages and complications of patients with different diseases are analyzed. The application indications, contraindications and complications of nasogastric tube feeding and nasointestinal tube feeding are compared and recommendation for the nasogastric and nasointestinal tube selection are summarized.
2017 Vol. 4 (1): 30-32 [Abstract] ( 356 ) HTML PDF (1007 KB)  ( 101 )
33 Omega-3 PUFAs reduces postoperative infection in digestive system malignant tumor patients: a Meta-analysis
HAN Fu-jun, LI Yan, LI Wei, TIAN Hui-min, CUI Jiu-wei
Objective To systematically review the effect of omega-3 PUFAs supplementation on postoperative patients with gastrointestinal cancer. Methods Databases of MEDLINE, EMBASE, cochrance central register of controlled trials, CNKI and CBM had been searched. The start time of retrieval is the default database, the deadline of retrieval is August 2016. The search terms were omega-3 PUFAs, omega-3 fatty acids, fish oil, gastrointestinal cancer, digestive system neoplasms, postoperative infection. According to include and exclude standard screening high quality randomized controlled trials, two groups independently reviewed articles, extracted data and assessed the methodological quality. RevMan 5.2 was used for statistical analysis. Results 928 articles were retrieved, 6 high-quality randomized controlled trials with 404 patients, from 4 different countries and nationalities were included. Meta-analysis results showed that the incidence of infection in the ω-3PUFAs group was lower than that in the control group, and the difference was statistically significant (OR=2.2, 95%CI=1.05~4.61, P=0.037). Subgroup analysis on country, time of omega-3 PUFAs supplements intake and ways of nutritional support, for the limitation of the number of the patients, subgroup analysis was unable to draw any definitive results. Conclusions Supplement with omega-3 PUFAs may reduce the incidence of infection complications on postoperative patients with gastrointestinal cancer. However, there was a high heterogeneity (I2=54.7%, P=0.051). Because of limitation of the number of patients included in the study, subgroup analysis was unable to draw any definitive conclusions, large prospective clinical trials are needed for this topic.
2017 Vol. 4 (1): 33- [Abstract] ( 299 ) HTML PDF (3154 KB)  ( 149 )
39 A multi-center survey on dietary knowledge and behavior among Chinese inpatients in oncology department
1CONG Ming-hua, 2WANG Jie-jun, 3FANG Yu, 4LIU Ying-hua, 5SUN Ming-xiao, 6WU Qiong, 2WANG Kan, 7HUANG Yan, 8LING Yiqun, 9LIU Yong, 10LI Quan-fu,11LIU Yi-bing, 12ZHU Jiang, 13ZHU Ling-jun, 14ZHENG Zhen
Objective To investigate the current associated factors of dietary knowledge, intake and nutritional status in malignancy inpatients, and the malnutrition causes involved in dietary nutrition knowledge level, behavior, providing recommendations to patients for nutrition education and intervention. Methods 535 participants, from 18 hospitals were investigated by a self-made questionnaire composed of dietary knowledge and behavior. Physicians asked and recorded the level of dietary intake and appetite scoring of the participants. Nutritional risk screened with NRS 2002 and dietary survey by 24h dietary recalls were completed by a dietitian. Besides, the target energy intake and the target protein intake was calculated by “rule of thumb” recommended by ESPEN guideline, comparing the difference between the actual intake and target intake. Results According to the questionnaire, 95.2% of participants thought it was important to have a good dietetic habit, and nearly half of them searched for guides on how to diet; 70% of the patients had no clear idea of what was a scientific dietary; 82% of patients had contradictary dietary knowledge contradiction; 64.2% of patients would listen to the opinion of the attending physician when contradiction happened. The three main ways to learn about diet are attending physician, network, and TV, respectively 26.0%, 18.5% and 16.1%. Importantly, 99.6% of the patient mistakes on dietary knowledge, for example, crab, chicken, lamb, fish and prawns should not be eaten by cancer patients. In addition, more than 90% of participants taking ganoderma lucidum spore powder, sea cucumber, ginseng, cordyceps sinensis and so on. 93% of the patients never received a qualified nutrition education. Besides, 15.6% of the participants had nutritional risk (NRS 2002≥3 scores). The actual daily energy intake was 1169.20±465.97kcal, which was significantly less than target energy intake (P<0.01), amounting to 65.3% of the target requirements. Actual daily protein intake was 46.55±21.40g, which was significantly less than target energy intake (P<0.01), amounting to 74.4% of target requirements. On the other hand, 69% of the participants were “Not too bad, Ok, Good or Very good” according to the records of physicians, while 34% of them did not reach 60% of the target requirements through dietary recall. So the results of physicians’ inquiries did not reflect the actual dietary intake for cancer patients. Conclusions The survey indicated that cancer patients had poor understanding of the scientific dietary nutrition and were in low level of normative nutritional education among Chinese malignancy inpatients. Dietary intake of most cancer patients decreased, and the actual intake cannot be responded by NRS 2002 scoring or the physicians’ inquiring. It is necessary to enhance the cooperation between dietitians and physicians, and hold targeted nutrition education, in order to improve the level of dietary knowledge.
2017 Vol. 4 (1): 39- [Abstract] ( 368 ) HTML PDF (1842 KB)  ( 248 )
45 Nutritional status assessment for patients with common cancer in a hospital of Chongqing
1, 2HE Ying, 1LIN Xin, 2LIU Li, 1WANG Jia-jia, 3SONG Chun-hua, 4SHI Han-ping, 1XU Hong-xia, Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) Group
Objective To investigate the nutritional status of hospitalized patients with common malignant tumor in Chongqing General Hospital. Methods From May 4th 2015 to Dec 31st 2015, we enrolled 311 patients with cancer hospitalized for treatment in Chongqing General Hospital. These patients were diagnosed with one of the following 16 different types of malignant tumors: lung cancer, gastric cancer, liver cancer, colorectal cancer, breast cancer, esophageal cancer, cervical cancer, endometrial cancer, nasopharyngeal carcinoma, malignant lymphoma, leukemia, pancreatic cancer, ovarian cancer, prostate cancer, bladder cancer and brain tumor. Nutritional risk screening 2002 (NRS 2002), patient-generated subjective global assessment (PG-SGA), anthropometric measurements, and laboratory examination were used to evaluate the nutritional risk or nutritional status. We also investigated the nutritional therapy of these cancer patients. Results According to the NRS 2002 score, 138 patients (44.37%) had the nutritional risk (score≥3); With PG-SGA score as standard, 52.73% (164/311)of the cancer patients were malnutrition (PG-SGA≥4), and 31.19% (97/311) were severe malnutrition (PG-SGA≥9). The rate of malnutrition for gastrointestinal cancer patients is higher than Nongastrointestinal cancer patients (65.41% vs. 43.26%, χ2=13.417, P<0.001). Multiple linear regression analysis, PG-SGA scores and body mass index (P<0.001), serum albumin (P<0.001), prealbumin (P<0.001), the percentage of weight loss in the recent 1 month(P<0.001), calf circumference (left side, P=0.001)，non-profit grip strength (P=0.001) were correlated, in which left calf circumference, last 1 month weight loss percentage correlation with PG-SGA scoring the best (regression coefficient b-0.872, 0.861, P<0.001, respectively), hemoglobin, arm muscle circumference and PG-SGA scores correlated without statistical significance (P, 0.268, 0.218, respectively); 43.90% (72/164) of all the moderately and severely malnourished patients received nutritional therapy, 91.7% (66/72) were receive only parenteral nutrition, 6.94% (5/72) were received enteral and parenteral nutrition, just one case (1.38%, 1/72) were received only enteral nutrition. Conclusions 52.73% of the common malignant tumor patients enrolled in the present study were malnutrition. PG-SGA is an effective tool to assess malnutrition in cancer patients, it is recommended to conduct routine assessment of cancer patients at the beginning of admission. Nutritional therapy of malignant tumor patients with malnutrition is very low, especially enteral nutritional support. Suggestions for patients with malignant tumor after admission nutritional risk screening, and comprehensive nutritional evaluation, including PG-SGA score, and to give the right nutritional therapy.
2017 Vol. 4 (1): 45- [Abstract] ( 353 ) HTML PDF (1097 KB)  ( 139 )
51 Detecting KRAS gene mutations in peripheral blood of colorectal carcinoma with COLD-PCR-HRM
LI Yan-li, ZHAO Dong-mei, XU Yu-hong, ZHANG Yan
Objective To evaluate the value of COLD-PCR-HRM in detecting KRAS gene mutations in peripheral blood of patients with colorectal carcinoma. Methods DNA from known mutation type was serially diluted into wild-type DNA to the following percentages: 50%, 25%, 10%, 5%, 3%, 2% and 1%. Tasting KRAS gene mutations in different proportions of DNA by conventional PCR-HRM and COLD-PCR-HRM to validate the sensitivity of two testing methods. At the same time, 62 cases of peripheral blood and tumor tissue matching samples were tested by COLD-PCR-HRM for consistency verification. Results The method of PCR-HRM minimum detectable concentration was 3%, and COLD-PCR-HRM was 1%, both methods were significantly higher than that of direct sequencing (P<0.05). KRAS mutations detection in two kinds of sample by COLD-PCR-HRM: 13 cases mutations in serum samples (mutation rate 21.0%, 13/62), 12 cases mutations in tumor tissue (mutation rate 19.4%, 12/62), 9 cases mutations in both two kinds of samples. Mutations in tumor tissue shall prevail, two mutations uniformity was 75.0% (9/12). There were consistency in KRAS mutations in tissue and peripheral blood (κ=0.649; P<0.001). Conclusions COLD-PCR-HRM significantly improved detection sensitivity of KRAS mutations, which provided favorable conditions for its application in low abundance mutation samples.
2017 Vol. 4 (1): 51- [Abstract] ( 308 ) HTML PDF (1068 KB)  ( 129 )
55 Surgical intervention, chemotherapy and nutritional support in the maintenance treatment of advanced gastric cancer
1LIU Na-xin, 2JIANG Yi-yan, 3LI Wen-feng, 1WANG Peng-fei, 1DU Zhou, 1JIANG Pei-pei, 1HAN Shao-liang, 1ZHU Guan-bao
Objective Discuss surgical intervention (timing and option) and the effects of maintenance therapy with low dose chemotherapy and nutritional support in patients with advanced gastric cancer by observing 3 cases from the first affiliated hospital of wenzhou medical university. Methods 3 patients with advanced gastric cancer were treated by surgical intervention, low dose chemotherapy and nutritional therapy at different stages as maintenance therapy. Maintenance treatment of chemotherapeutic drugs lasted for 14 days, 7 days interval, 21 days for a cycle, with the 50%~75% dose of the average; the dose was adjusted in next cycle (the adjusted range ± 25%) according to the VAS score (visual analogue scale) of gastrointestinal reaction in the previous cycle and the degree of myelosuppression (blood routine test) and organ injuries; the nutrition program was adjusted (mainly enteral nutrition, supplementally parenteral nutrition) according to the VAS score of enteral nutrition tolerance in the previous day. Results 3 patients lived for 30 months, 15 months, and 22 months respectively; 3 patients had a good compliance to chemotherapy and nutritional treatment (VAS score of 7 points or more, total score of 10 points) and all performed surgery with different purposes. The first patient performed gastrointestinal short circuit operation on the early stage because of gastric intestinal obstruction, and survived total 30 months; the second patient, total survival of 15 months and the postoperative survival 12 months, performed the Palliative total gastrectomy, Roux-Y operation when imaging and anal examination showed primary lesions and pelvic metastases were regression after a period of chemotherapy; the third patient, total survival of 22 months and postoperative survival of 4 months, performed the operation of palliative total gastrectomy and esophageal jejunal Roux-Y anastomosis, total colectomy and ileostomy for malignant obstruction in the late stage for the purpose of reducing the tumor and disengage obstruction. Conclusions Low dose chemotherapy and nutritional support, with the plan adjusted according to the condition changes, can play a certain role in prolonging the survival time and improving the life quality of the advanced gastric cancer patients; the appropriate timing of operation and operative methods have certain effect to prolong the survival time of the patients, but the excessive surgery is not always able to achieve the desired objective, and maybe bring adverse effects due to surgical trauma.
2017 Vol. 4 (1): 55- [Abstract] ( 376 ) HTML PDF (1026 KB)  ( 124 )
60 The efficacy enhancing and toxicity reducing of ganoderma lucidum spore oil emulsion to mice undergoing chemotherapy
1LIU Guo-jian, 2LI Jing, 2CHEN Lu-lin, 2JIANG Zhao-jian, 3LIU Pei-qing, 3CHEN Jian-wen,1GUO Li-bing
Objective To investigate the anti-tumor effect of oral administration of ganoderma lucidum spores oil emulsion and its synergism and attenuation. Methods In this study, eighty mice were divided into 8 groups: control group, CP, CP+ ganoderma lucidum spore oil oral emulsion, low dose and high dose; ganoderma lucidum spore oil oral emulsion, low dose and high dose; Kanglaite soft capsule; CP+ Kanglaite soft capsule, with 10 rats in each group. To creating tumor bearing model, H22 cell line was inoculated into the back of the axilla of the mice. Giving administration in the treatment of ganoderma lucidum spores oil oral emulsion combined with chemotherapy drugs for 21 days, and observed whether tumor growth was inhibited. Results For oral administration of ganoderma lucidum spores oil emulsion combined with conventional chemotherapy drugs CP, there is a trend to enhance the effect of chemotherapy drugs to inhibit tumor growth. It can also improve the side effect of chemotherapy drugs on WBC, RBC, HGB. WBC (P<0.05) which was significantly increased in the high dose group of CP+ ganoderma lucidum spore oil emulsion. Ganoderma lucidum spores oil emulsion can reduce the damage of chemotherapy drugs on liver function. To improve the effect of chemotherapy drugs on the spleen index, thymus coefficient, the number of bone marrow cells, the number of cells in the reticulated red blood cells, and the reduction of the splenic nodules. Conclusions Ganoderma lucidum spores oil oral emulsion combined with chemotherapy drug CP, with certain tumor suppressor and attenuated synergistic effect and its mechanism may be related to enhance immunity, promote hematopoietic function of bone marrow.
2017 Vol. 4 (1): 60- [Abstract] ( 253 ) HTML PDF (1076 KB)  ( 130 )
67 Different reconstruction on the prognosis of Siewert II / III adenocarcinoma in esophagogastric junction
ZHOU Bin, WEI Wei, WEN Xu, LI Gang, GU Rong-min, MING Xue-zhi, CHEN Huan-qiu
Objective To compare the effects of enteral immunonutrition on recovery, nutritional status, immune function, quality of life in patients with Siewert II/III adenocarcinoma of esophagogastric junction received proximal gastrectomy plus jejunal interposition versus total gastrectomy. Methods 42 cases of Siewert II/III adenocarcinoma of esophagogastric junction patients were randomly divided into proximal gastrectomy plus jejunal interposition group (PG) and total gastrectomy group (TG). Postgastrectomy enteral immunonutrition therapy was early used in two groups. The changes of recovery, serum markers, nutritional status, immune function were evaluated on 1st day and 5th day postoperation. Quality of life were compared in 12 months postoperation. Results There were no significant difference neither in postoperative complications nor in levels of serum total protein, albumin, prealbumin and IgG, IgA, CD3+, CD4+, CD4+/CD8+ between 2 groups on the 5th day postoperation (P>0.05). The levels of weight loss and hemoglobin in PG+ jejunal interposition group was significantly increased (P<0.05) than TG group on 12 months after operation, no significant difference was seen in reflux symptoms between 2 groups. Conclusions Early usage of enteral immunonutrition in Siewert II/III adenocarcinoma of esophagogastric junction received PG+jejunal interposition can improve recovery, nutritional status and enhance immunity. PG+jejunal interposition was better than TG in postgastrectomy function reservation and life quality.
2017 Vol. 4 (1): 67- [Abstract] ( 340 ) HTML PDF (1004 KB)  ( 113 )
72 HMB intervention of muscle loss in community-dwelling elders with malnutrition
HUA Chao, CHEN Ge-liang, WEN Xiao-li, LIU Jing, ZHANG Jing
Objective To evaluate the nutritional status of Shanghai Xinjing community old people with MNA-SF, to analyze the relationship between nutritional status and sarcopenia, and to observe the effect of nutritional intervention. Methods 300 old people aged 65 or older were randomly selected from the community and to were divided into three groups based on the scores of MNA-SF: normal nutritional status group, risk of malnutrition group and malnutrition group. BIA was used to determine whether patients were with sarcopenia in all three groups. Malnutrition group was divided into interventional group and control group, interventional group implemented HMB for 90 days nutritional intervention. Results The prevalence rate of sarcopenia in male and female communitydwelling elders was 22.6% and 12.1% by using BIA respectively. The appendicular skeletal muscle to height squared ratio in normal nutritional status group (7.6±0.62 in males and 6.23±0.15 in females) was higher than those at risk of malnutrition group (7.15±0.83 in males and 5.84±0.26 in females) and the malnutrition group (6.42±0.54 in males and 5.46±0.68 in females). All differences were statistically significant (P<0.05). After intake of JiRou (HMB supplementation was 2.6g/d) intervention for 90 days in malnutrition people, appendicular skeletal muscle in intervention group was statistically increased than control group (P<0.05). Conclusions People with malnutrition were more likely to suffered from sarcopenia. HMB supplementation had shown its increase effect on appendicular skeletal muscle and could attenuated muscle wasting in elderly people.
2017 Vol. 4 (1): 72- [Abstract] ( 318 ) HTML PDF (1025 KB)  ( 193 )
78 Clinical trial of the JC724 combined capecitabine on advanced cancer
1,2RAO Ben-qiang, 3DING Yan, 2DENG Li
Objective Cell experiment showed that the combined use of JC724 extracted from natural plant compounds and 5-Fu had a synergistic antitumor effect. The clinical effects and side effects of JC724 combined with capecitabine in the treatment of pancreatic cancer, colorectal cancer and other advanced cancer were observed, and the dose and safety of JC724 in the treatment of advanced tumors were determined. Methods 35 patients with advanced colorectal cancer, pancreatic cancer and other tumors were treated using JC724 combined with capecitabine. Capecitabine was administered orally at a dose of 1,250 mg/m2 twice daily for 14 days followed by 7 days of rest (one cycle), and JC724 was administered 2 times a day in three different oral doses, 800mg, 1,000mg and 1,200mg. The evaluation indexes were tumor response and patient’s tolerance to the treatment. Results Totally 35 advanced cancer patients were 21 males, 14 females, with the average age of 62.3 years, 3 cases of pancreatic carcinoma, 18 cases of colorectal cancer, 3 cases of primary liver cancer, 1 cases of bile duct cancer, 7 cases of gastric cancer, 2 cases of breast cancer, 1 cases of metastatic liver cancer with unknown origin. The ECOG score of 0~1 in 30 cases, 2 points in 5 cases. All patients completed 132 cycles of capecitabine in the treatment (median 3.77 cycle, 1~6 cycle), and 134 cycles JC724 (median 3.83 cycles, 1~6 cycles ). Only one DLT was observed in 1,200mg group, which 1,000mg would be determined as the maximum dose of JC724. 3 patients had PR, 20 patients had SD for more than 8 weeks. Conclusions JC724 combined with capecitabine in the treatment of advanced cancer patients could obtain better curative effect, in which oral dose of JC724 1,000mg, 2 times a day for up to 1~14 days, was safe and effective, but further research was needed.
2017 Vol. 4 (1): 78- [Abstract] ( 265 ) HTML PDF (1029 KB)  ( 114 )
83 Self-expanding metallic stent or transanal drainage tube in malignant large-bowel obstruction: an observational cohort study
WEI Jing-jing,LIU Lu-peng,ZHUANG Ze-hao, ZHUANG Ze-hao, ZHENG Jian-tao, ZHENG Jian-tao,CHEN Qun,DING Jian,PAN Yu-feng
Objective To compare the outcomes after SEMS or TDT placement in patients with malignant large-bowel obstruction (MLBO). Methods 48 patients with MLBO from the clinical unit accepted SEMS (n=26) or TDT (n=22) placement from 2012 to 2016 were collected. The outcomes evaluation, successful rates of placement, clinical outcomes after decompression, complications, the timing of resuming to EN, Karnofsky Performance Status (KPS) scoring and the following-up therapeutic options were included. Results Technical success were achieved in 100% patients in both groups. Clinical success rates were 96.2% (25/26) for SEMS and 95.5% (21/22) for TDT. There was no perforation found in any group, while 7.7% (2/26) in SEMS and 18.2% (4/22) in TDT group experiencing a complication of displacement (P=0.26). 2 IQR(0~2) days and 3 IQR(2~5) days should be taken to resume to EN in each group, respectively (P=0.001). KPS scores were significantly higher in patients with SEMS (75 IQR50~80) than in those with TDT (35 IQR30~50) (P=0.001). There were 30.8% (8/26) patients undergoing stenting as bridge to surgery, 7.7% (2/26) patients for chemotherapy only and 61.5% (16/26) for palliation and nutritional therapy in SEMS group, while 31.8% (7/22), 0 and 59.1% (13/22) in TDT group, respectively (P=0.36). The patients requiring stoma creation were 57.1% (4/7) in TDT group and 25.0% (2/8) in SEMS group, respectively, while postoperative anastomotic leakage was found only in TDT group (1/7). Conclusions Both SEMS and TDT placement could achieve a clinical relief for MLBO effectively. However, SEMS placement is associated with earlier EN and is more obvious postoperative quality-of-life benefits in MLBO.
2017 Vol. 4 (1): 83- [Abstract] ( 256 ) HTML PDF (1077 KB)  ( 109 )
88 Perioperative enteral nutrition on the prognosis of patients with esophageal cancer#br#
ZHOU Cheng-wei, XU Fen, SU Wen-min, ZHAO Xiao-dong
Objective In most cases, preoperative and postoperative fasting can aggravate the nutritional status and body immunity, and increase the incidence of infection and mortality rate of patients with alimentary tract malignant tumor. The objective of this study is to investigate the effects of perioperative enteral nutrition on the prognosis of patients with esophageal cancer after operation. Methods A prospective randomized controlled clinical study was designed. The patients with esophageal cancer who underwent operation in our hospital were randomly divided into enteral nutrition group and total parenteral nutrition group. 40 cases were carried out in EN group, and 39 cases in PN group. In EN group, enteral nutrition solution 600ml/d were added from 5 days before operation, based on normal diet, and they were given enteral nutrition within 24h after operation. In PN group, parenteral nutrition (750kcal/d) were added from 5 days before operation, based on normal diet, and were given intravenous nutrition after operation. The changes of peripheral blood lymphocyte count, serum albumin, anal exhaust recovery time and defecation recovery time, infection, anastomotic leakage and cardiovascular events were observed in the two groups. Results The average time for anal exhaust recovery and defecation recovery in EN group was shorter than PN group with statistical difference (P<0.05). Before and after operation, the lymphocyte count, serum albumin count in EN group was lower than PN group with statistical difference (P<0.05). Postoperative infection and anastomotic fistula in EN group was less than in PN group, but more cases of abdominal distension. Conclusions EN is superior to PN, and it has a positive impact on the prognosis of patients with esophageal cancer in postoperative period. It is worth promoting as an important part of fast track surgery.
2017 Vol. 4 (1): 88- [Abstract] ( 233 ) HTML PDF (1085 KB)  ( 116 )
92 Thyroid stimulating hormone promotes the proliferation of papillary thyroid carcinoma by regulating the expression of Cpt1c
1WANG Rui, 2SU Dong-wei, 1PANG Zhi-jun, 1ZHOU Xin-yu, 1CHENG Ling-tao, 1GONG Bo-shen, 1HE Xiao-bo, 1MIAO Ming-yong, 1YAO Zhen-zhen
Objective Though TSH is closely related to the incidence and prognosis of thyroid carcinoma, the underlying mechanisms have not been elucidated. This study was to investigate whether thyroid stimulating hormone in papillary thyroid carcinoma can regulate the expression of Cpt1c and to investigate the effect of Cpt1c on TSH promoting the proliferation of papillary thyroid carcinoma cells. Methods Firstly, the expression of Cpt1c was detected by qRT-PCR in 35 papillary thyroid carcinoma specimens and their adjacent normal tissues from papillary thyroid carcinoma patients. Secondly, the effects of TSH on the expression the Cpt1c from B-CPAP was detected at time and concentration gradient respectively. Finally, Cpt1c siRNA was constructed and transfected into B-CPAP. Western blot and qRT-PCR were used to identify the siRNA transfection efficiency of tumor cells. After identification, CCK-8 and FACS were used to detect cell proliferation and cell cycle with stimulation of TSH. Results Cpt1c is highly expressed in human papillary thyroid cancer compared with paired normal tissues. TSH could promote the expression of Cpt1cin a dose-dependent manner. Cpt1c could affect the proliferation of thyroid cancer cells by S phase stagnation and the expression of Cpt1c in papillary thyroid carcinoma is higher than that in adjacent tissues. At the same time, TSH could promote Cpt1c expression caused by cells into the G2 phase to increase proliferation. Conclusions TSH could promote the proliferation of papillary thyroid carcinoma cells by regulating the expression of Cpt1c. Cpt1c gene may be a new target for the treatment of papillary thyroid cancer in the future.
2017 Vol. 4 (1): 92- [Abstract] ( 337 ) HTML PDF (1298 KB)  ( 111 )
97 Normalized home enteral nutrition in cancer patients
1FANG Yu, 1XIN Xiao-wei, 1WANG Yan-li, 1LIU Ni, 1GONG Li-qing, 2ZHANG Xiao-tian, 3LI Zi-yu, 4SUN Yan, 5LUAN Chun-na, 6YANG Yue-xin, 7SHI Han-ping
With the development of medical technology and length of hospital stay reduced home nutrition is widely acceptd by patients. As malnutritional patients are often accompanied with complex clinical condition, some problemes needed to be soved urgently, i.e., how to implement normalized HEN, which can improve the effect and efficiency of home nutrition, and can reduce the complications of nutritional therapy. By searching literatures related about nutrition therapy through Pubmed, Embase and CNKI, combined with our HN work experiences, results showed that HEN not only reduced weight loss of patients and complications of HEN, but also improved the satisfaction of patients, by establishing NST (including physicians, dieticians, nurses, pharmacists, etc.) , making regulations and procedures of nutrition therapy and follow-up. HEN interview through outpatient service, telephone or APP is the key process of cancer patients' nutrition management, which is beneficial to find and solve the problems timely during the process of HEN, improve patients' compliance and curative effect. Planed, repeated and progressive nutrition education and nutrition management by NST, combined with professional and individualized nutrition counseling, could make patients understand the purpose and significance of nutritional therapy, improve significantly the patient's health behavior and compliance to nutrition therapy. Home nutrition under the guidance of NST is the extension of hospital nutrition therapy, and it’s beneficial to improve the effectiveness and security of nutritional therapy. HEN has been shown good cost effectiveness in developed countries, while in developing countries, more researches need to be done.
2017 Vol. 4 (1): 97- [Abstract] ( 366 ) HTML PDF (1277 KB)  ( 132 )
104 Incredible relationship: intestinal flora and colon cancer
OU Jun-wen, GUI Xiao-shi, LI Xue-mei, WANG Zheng-yu
Colon cancer, which is a common malignant disease of digestive system, seriously threatens the health of human being. With the improvement of living standard, people's dietary structure, way of life had significant differences from the past. In China, there was a trend that the incidence and mortality of colon cancer had been increased year by year. The major reasons for that included excessive intake of energy and fat, decreasing intake of dietary fiber, and gradually increasing incidence of obesity. Therefore, it was necessary for the medical researchers to research into the cause of colon cancer and found out a reasonable intervention. Although the cause and the pathogenesis of colon cancer was not clear, more and more studies had found that intestinal microbiota played an important role in the development of colon cancer recently. The balance of intestinal microbiota under normal condition played an important role in the improvement of digestion and absorption of nutrients, also in the maintenance of a normal physiological function of the intestinal tract as well as in the modulation of the immune system. The steady state of intestinal flora will be destroyed when there was a change of internal or external causes. Intestinal flora imbalance could cause many kinds of disease, including colon cancer. Previous studies indicated that incidence of colon cancer decreased by adjusting the intestinal flora imbalance. In addition, a variety of probiotics had the effect of inhibiting tumor, we could adjust the intestinal flora through change the dietary structure and inhibit the colon disease. This paper reviewed the latest research on the pathogenesis of intestinal microbiota in the development of colon cancer, and the preventive effect of probiotics on colon cancer.
2017 Vol. 4 (1): 104- [Abstract] ( 333 ) HTML PDF (1057 KB)  ( 221 )
109 Ribosomal protein family in tumorigenesis and development
1, 2YUAN Fei, 2, 3, 4WANG Shu-bin, 2, 3, 4WANG Yue-li
Ribosomal protein (RP) is a major component of the ribosome which are the sites of protein synthesis. However, RP is not stale, easy to be degradated by nuclear protease. When the synthesis of cellular ribosomal subunits is increased, the abnormal regulation of cell function and metabolic disorder leads to abnormal cell proliferation and dysfunction, and even malignant transformation. Tumor onset and progression, often accompanied by genomic instability, will lead to the change of encoding ribosomal protein gene, tumor regional hypoxia and nutritional deficiencies. Chemical drugs used in treatment and radiation may affect the ribosome synthesis, ribosomal protein imbalance or dysfunction. All of these factors lead to ribosomal stress, which stimulates the formation of ribosomal proteins in the form of free ribosomes. The rapid growth and proliferation of tumor cells requires more ribosome synthesis mechanism than somatic cells, which promotes the synthesis of ribosomes. A large number of studies have confirmed the abnormal expression of ribosomal proteins in tumors, suggesting that ribosomal proteins play an important role in the development and progression of human diseases and tumors. Ribosomal protein family, the key members of the body for protein synthesis, play an irreplaceable role in the process of genetic information transfer and also play other functions besides protein translation. The research results showed the ribosomal protein family could regulate tumor cell cycle and apoptosis, and promote tumor proliferation, infiltration, metastasisangiogenesis, or ohter malignant biological behaviors through regulating oncogenes and tumor suppressor gene expression or collaborating with chromosome genes. The ribosomal protein family which play an important role in the occurrence and development of the tumor, is one of the important factors in promoting tumor occurrence and development.
2017 Vol. 4 (1): 109- [Abstract] ( 399 ) HTML PDF (1006 KB)  ( 135 )
114 The recent development of SREBP-1 and SREBP-1 inhibitors in regulation of cancer metabolism
1,2ZHANG Wei-rui, 1,2LIU Xiao-yu, 1,2YU Hao-bing, 1,2LU Xiao-ling, 1,2JIAO Bing-hua
Lipids, one of the three major nutrients, plays an important role in supplying and storing energy, constructing cells and taking part in cell life activities as an active molecule. One of the most important characteristics of cancer metabolism is the abnormal lipid metabolism, showing the denovo fatty acid synthesis and the active oxidative metabolism, which are closely related to the enhancement of tumor signal transduction pathway and the change of metabolic enzymes. Recently, the related enzymes and transcription factors in the lipid metabolism pathway are potential drug targets for cancer therapy. SREBP-1 is a key transcription factor which regulates the expression of key enzymes in cholesterol or fatty acids synthesis and controls lipogenesis. The expression and activity of SREBP-1 and its regulated fatty acid synthesis pathway are low in normal tissues and cells, while SREBP-1 is activated, accompanying the increase of the downstream gene expression in the tumor cells, which accelerate the synthesis of intracellular fatty acids and cholesterol and regulate lipid metabolism, glucose metabolism and amino acid metabolism via intracellular signaling pathways to provide additional energy and substrates to maintain proliferation and metastasis of tumor cells. The expression and activation of SREBP-1 in tumor cell can be inhibited by genetic and pharmacological means, which significantly suppress the proliferation and migration of tumor cells in vivo and in vitro. Therefore, SREBP-1 has emerged as a promising tumor therapeutic target. In this paper, the effects of abnormal expression of SREBP-1 on tumor signal pathway and metabolism and the development of SREBP-1 inhibitors as anti-cancer agents in cancer were reviewed.
2017 Vol. 4 (1): 114- [Abstract] ( 495 ) HTML PDF (1942 KB)  ( 146 )
120 Cancer patients appetite status evaluation and drug intervention
DU Hong-zhen, WEI Yu-jia, ZHANG Ling-ling, LI Zeng-ning
Anorexia , a common symptom of cancer patients, is not conducive to the implementation of the anti-tumor treatment measures, it can lead to inadequate intake of nutrients, pancytopenia, weight loss, decrease of adipose tissue and skeletal muscle and decline their quality of life. Accurate assessment of the anorexia process is essential to both research and clinical management, scientific evaluation methods and techniques of appetite are not only a tool to objectively evaluate the appetite, but also the basic of further understanding and predicting the malnutrition. By reviewing domestic and foreign researches on the evaluation of appetite and cancerous anorexia, we summarized the evaluation methods and drugs commonly used. The appetite evaluation methods for cancer patients included inquiry method, VAS, FAACT-A/CS-12 and so on, each method had its own focus. However, there was no consensus on the appetite evaluation tool for cancer patients. Although the clinical treatment of anorexia could bring patients putting on weight, it was still necessary to take the side-effects of drugs into account, in order to effectively improved the anorexia situation of cancer patients and made the most of it.
2017 Vol. 4 (1): 120- [Abstract] ( 338 ) HTML PDF (1081 KB)  ( 193 )
125 The development of phenomics and its clinical application: a reveiew
1, 2HUANG Gui-xiang, 2, 3JIANG Hua, 2WANG Kai, 2, 3CHEN Wei, 2YANG Hao, 2ZENG Jun
A phenome is the whole phenotypes expressed by an organism. Phenomics is a systematic study about the whole phenomes of organisms or cells in different environments, especially concern the laws of changing of physical and chemical character. In 1996, Steven A. Garan, director of the aging research centre (ARC), proposed the concept of phenomics at a guest lecture at the University of Waterloo. In 2005, Christophe published a significant article, in which he elaborated the technical facility by crop design company in Belgium, so called Trait Mill, can be used to analyze large-scale plant phenotypes in the whole growth period automatically on a large scale. In 2014, Zoltan Takats, a professor in British imperial college, reported the iKnife in the study of the tumor phenome and metabolomics, which is a new technology for surgeons identify tumor. Nuclear magnetic resonace and mass spectrometry is the most common method in clinical phenomics. In addition, the ultraviolet absorption, high performance liquid chromatography high performance liquid chromatography, gas chromatography technical means such as fluorescent scattering also gradually be introduced in this field of research. After decades of development, phenomics have got many significant breakthroughs, which seem to be promising for wide clinical application. This paper is to summarize the concept, development and clinical application of phenomics.
2017 Vol. 4 (1): 125- [Abstract] ( 356 ) HTML PDF (1133 KB)  ( 117 )
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