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2018 Vol. 5, No. 2
Published: 2018-06-09
 
111 Cancer is a metabolic disease
SHI Han-ping
DOI: 10.16689/j.cnki.cn1
What is the biological nature of cancer? Is cancer a genetic disease or a metabolic disease? Controversy exists in history about this question which is a fundamental issue that determines the cancer treatment strategy. Genetic analysis has revealed that there are nearly 1,000 known cancer-associated genes in humans, including ~250 oncogenes and ~700 tumor suppressors. Many of these cancer genes play a key role in cell metabolism, mainly affecting five major metabolic pathways: 1) aerobic glycolysis, 2) glutaminolysis, 3) one-carbon metabolism, 4) pentosephosphate pathway and 5) de novo synthesize fatty acids. Studies via metabolomics and oncometabolites indicate that the above pathways allow cancer cells to shift from simply producing ATP to generating large quantities of amino acids, nucleotides, fatty acids and other intermediates needed for rapid cell growth and division, which in turn serve for the five pathways, that ultimately lead to an increased cancer growth and a decreased cell apoptosis. Based on the existing findings, this paper views cancer as a metabolic disease and urges for a better adjustment of cancer therapies. Cancer nutrition and metabolic modulation therapy should be and must be the main efforts for anticancer treatment. Due to the highly metabolic adaptive ability, cancer cell can rewire or shift to another metabolic pathway in face of harmful stress. Metabolic modulation therapy should therefore target different metabolic pathways.
2018 Vol. 5 (2): 111-116 [Abstract] ( 544 ) HTML PDF (31165 KB)  ( 263 )
117 The mechanism, diagnosis and treatment of cancer-related anorexia
MA Huai-xing, LI Su-yi

 Cancer-related anorexia is defined as decreased desire to eat, resulting in reduced food intake and/or weight loss. Anorexia is prone to occur in patients with cancer, leading to reduced quality of life, decreased treatment tolerance, reduced the effect of treatment and increased risk of mortality. Therefore, correct understanding, evaluation and intervention of CA are indispensable in the treatment of cancer. In this review, the pathogenesis of anorexia tumor, diagnosis, evaluation, treatment and follow-up were discussed. Cancer anorexia is closely related to factors of tumor disease, gastrointestinal dysfunction, delayed gastric emptying, and poor absorption caused by tumor or various adverse reactions of anti-tumor treatment. Tumor tissue releases the active substances that cause anorexia into the circulatory system or the tumor itself induces metabolic abnormalities that cause the host tissue to release appetite suppressor factors. Accurate assessment of CA is based on related symptoms such as change in taste, nausea, early enough, combined with the appetite symptoms scale (commonly used with “symptom-based assessment” questionnaire and the visual analogue scale for diagnosis, and comprehensive evaluations of nutrition status, oncology and psychology. The PG-SGA method is recommended for nutritional assessment, following the triple diagnosis model of malnutrition. Psychological evaluation contains observation, interview, and psychological tests. The symptom checklist (SCL-90) is recommended. The purpose of the treatment is to improve the eating status and clinical manifestations of malnutrition, ensure the uptake of energy and nutrients in cancer patients, and improve patients’ immunity and the tolerance of anti-tumor treatments. Treatment needs more than one mode, including antitumor/ symptomatic treatment and the elimination of anorexia, stimulates the appetite and drug treatment for inflammatory factor, nutritional metabolic therapy and bowel function adjustment, exercise and psychological emotion regulation of a variety of treatments. Patients with CA need regular follow-up and evaluation, including laboratory parameters, nutritional status, oncology and other indicators. Guidance and treatment will be adjusted according to the follow-up situation.
2018 Vol. 5 (2): 117-121 [Abstract] ( 241 ) HTML PDF  (0 KB)  ( 57 )
122 Cancer and cholesterol: friend or foe
BAI Ri-lan, BAI Ling, CUI Jiu-wei
Cholesterol plays an important role in the body. The regulatory pathways mediated by LXR and SREBP2 can regulate intracellular cholesterol homeostasis by affecting cholesterol synthesis and metabolism. The tumor cells can enhance their ability of malignant proliferation, invasion, metastasis and adapt to the unfavorable living environment through metabolic reprogramming, in which the reprogramming of cholesterol metabolism plays a role, mainly manifested in the up-regulation of cholesterol synthesis in cancer cells and abnormal accumulation of their metabolites. Recent studies have shown that in the microenvironment of tumors, there is a reprogramming of cholesterol metabolism in the opposite trend of change, and its normal function is affected. Therapeutic strategies targeting cholesterol synthesis pathways also interfere with the normal metabolic homeostasis of immune cells. Therefore, looking for new antitumor drugs targeting different metabolic pathways is imminent. This review explores the roles and mechanisms of intracellular cholesterol homeostasis, cholesterol and its metabolites in the development of cancer, finding that modulators targeting cholesterol esters, 27-hydroxycholesterol, and Dendrogenin A may be potential targets of antitumor metabolic treatments. The cholesterol esterification inhibitor, Avasimibe has been shown to enhance immune system function and gets attention in antitumor metabolic therapy strategies. The proposed concept of anti-tumor metabolic therapy, which mainly regulates cholesterol metabolism of immune cells in the tumor microenvironment, delays cancer progression and metastasis, may bring new hope for the treatment of cancer patients.
2018 Vol. 5 (2): 122-127 [Abstract] ( 401 ) HTML PDF (1023 KB)  ( 157 )
128 Weight loss
LIN Ning
 Fat and fat-free mass (FFM) comprise the weight. Lean body mass, which describes the skeletal muscle and differs from the FFM, relates colsely to the metabolism. Weight is commonly used to present the dynamic balance of enegy intake and waste. Weight loss is very common in patients with various diseases, which can be classified as active loss and passive loss. Active loss of weight is often seen in fasting or food control in obese or overweight patients. Stress, infection, trauma, cancer are reasons for passive weight loss, including loss of both fat and fat-free mass. The time-speed and amount of weight loss are usually used to evaluate the nutrtional risk and malnutrition status. However, malnutrition is a more comprehensive index to predict the prognosis of patient. Weight loss, especially the lean body mass loss is related with nutritional metabolism, quality of life and clinical outcomes. It is urgent for medical staffs to diagnose and treat weight loss as soon as they find out.The Five-step approach for treating malnutrition may have effect on treating weight loss. Nutrition education, enteral and parenteral can promote weight gain on patiens. Whey protein, N-3 Polyunsaturated, leucine, and L- carnitine can reduce the loss of lean body tissue.
2018 Vol. 5 (2): 128-133 [Abstract] ( 235 ) HTML PDF (1193 KB)  ( 213 )
134 Molecular mechanisms of cachexia and tumor metastasis
SHEN Shuang-ting, ZHENG Zhe-wen, LIAO Zheng-kai
 Cachexia is a complex metabolic syndrome characterized by loss of skeletal muscle (with or without loss of fat mass), which affects the majority of late stage cancer patients. Cancer cachexia often seriously affects the treatment efficacy and increases the toxicity by chemotherapy and radiotherapy, further increasing mortality and leading to poor prognosis for cancer patients. The mechanism of cancer cachexia on metastasis have not been understood completely, which may be associated with inflammation, hypoxia, decreased expression of leptin and the release of proangiogenic factors in cancer patients with cachexia. The pathological and physiological characteristics of cachexia are complicated, and cancer cachexia is associated with poor response of therapy without standard treatment. There remains an urgency to study the pathophysiology of cachexia and the impact on metastasis to guide early nutrition screening and assessment, to identify the diagnosis of cachexia and to evaluate the stage and grade of cachexia. Also,   it is useful to predict and treat cachexia positively and effectively, to decrease the metastatic rate of tumor and improving quality of life. This review will summarize the effect of cancer cachexia on metastasis by exploring the pathophysiology of cachexia and the pathogeneses of cachexia on metastasis, to provide important basis on the treatment of cancer cachexia and metastasis.
2018 Vol. 5 (2): 134-138 [Abstract] ( 216 ) HTML PDF (1060 KB)  ( 101 )
139 Interpretation of Chinese experts consensus on nutritional therapy access of cancer patients: non-surgical jejunostomy
YANG Zhi-yong, WEI Jing-jing, ZHUANG Ze-hao
 Non-surgical jejunostomy, including endoscopic and iconographic guided jejunostomy is an important method for enteral nutrition access establishment, which is especially beneficial to the patients with gastrectomy, high risk of aspiration or gastric dysmotility. “Chinese experts consensus on nutritional access of cancer patients (2018)”, which was released by the the Nutritional Access Group of Chinese Society for Oncological Nutrition and Supportive Care, suggested several recommendations on nonsurgical jejunostomy. Here we provide further related information for the recommendations , including the technical characteristics of percutaneous endoscopic gastrojejunostomy and direct percutaneous endoscopic jejunostomy, the advanced modification on localization techniques of tube placement and puncturing site selection, the updated evidences on clinical application of sonographic/ radiologic jejunostomy and combined techniques. We also previewed related literatures and interpret  the optional strategy of percutaneous endoscopic gastrojejunostomy or direct percutaneous endoscopic jejunostomy in patients who are unsuitable for percutaneous gastrostomy, the technological difficulties and  resolutions in direct percutaneous endoscopic jejunostomy, the technical progress and clinical significance of radiologic application in non-surgical jejunostomy, and the positive role of single-balloon enteroscopy or double-balloon enteroscopy in improving the success rate of direct percutaneous endoscopic jejunostomy.
2018 Vol. 5 (2): 139-143 [Abstract] ( 313 ) HTML PDF (1302 KB)  ( 260 )
144 Glioblastoma progression is inhibited by methotrexate via RAS/MEK/ERK/MYC/CD47 signaling pathways
1BAI Yue, 2ZHONG Xiao-song, 3LI Wen-bin
 Objective  To investigate the effect of methotrexate (MTX) on the localization of RAS protein and the downstream signal pathway and to explore the mechanism of MTX to inhibit the growth of human glioblastoma cell line U87. Methods  After the treatment of U87 cells with different concentrations of MTX (75nmol/L, 375nmol/L, 750nmol/L, 7,500nmol/L, 15,000nmol/ L), the cell viability and apoptosis rate were detected by MTT and FCM respectively. The distribution of RAS protein and activation was observed by confocal microscopy and the expression level of the MAPK/ERK protein in the downstream was measured by immune blotting method after U87 cell transduced retrovirus carrying RAS-GFP fusion gene. Further, the effect of MTX on the level of phosphorylation of P-p42/p44 MARK protein and the level of its regulation of the transcription factor c-MYC expression using different MAKP/ERK signaling pathway specific inhibitors (U0126 and PD98059) was investigated. The expression level of CD47 on the surface of cells was further assayed by FCM on U87 cells treated with low dose of MTX at different time points. Results  The different concentrations of MTX (75nmol/L, 375nmol/L, 750nmol/L, 7,500nmol/L, 15,000nmol/L) could inhibit the proliferation of human glioblastoma cell line U87 in a dose-dependent manner but can not directly induce apoptosis. The cell cycle of most U87 treated with the different concentrations of MTX was arrested at G2/S compared to untreated U87 cells. After U87 cells transduced RAS-GFP fusion gene (100% GFP) were treated with U87compared with the control group, the RAS protein was mislocation from the cell membrane to the cytoplasm; the P-p42/p44 MARK level was inhibited (P<0.05); the expression level of the transcription factor c-MYC was down-regulated (P<0.05). More important we addressed that CD47 related to glioblastoma growth and metastasis on the cell surface of U87 treated with MTX was decreased at different times, which confirmed by flow cytometry. Conclusions  It is the first time that we have demonstrated that MTX can inhibit the growth of glioblastoma cell line the U87; cell cycle was arrested at G2/S; the localization of the RAS protein was changed; RAS/MAPR/ERK/C-MYC signaling pathway was inhibited; MTX may be an alternative therapeutic drug for patients with recurrent glioblastoma.
2018 Vol. 5 (2): 144-150 [Abstract] ( 235 ) HTML PDF (1985 KB)  ( 144 )
151 Screening and analysis of nutritional status in 51 patients with middle and late-stage cancer
1FENG Da-li, 2JIA Ping-ping,?3NIE Long, 4QU Jia-man, 5ZHOU Fu-xiang
 Objective  We investigated the nutritional status of newly admitted cancer patients in oncology department of the Second Hospital of Yichang/Second People’s Hospital, analysis the possible causes of these nutritional status, to explore the possible effect of nutritional therapy on the prognosis of patients with malignant tumor. Methods  We collected and registered basic data of patients with malignant tumor who hospitalized in the Second Hospital of Yichang/Second People’s Hospital during July 2015 to September 2015. Basic data on age, sex, diagnosis, height and weight were collected. NRS 2002 table was used to identify nutritional risk screening. Statistical analysis was used to analyze possible causes of nutritional status. Results  51 cases of malignant tumor were collected in two months. The stages were all in the middle and late stages, including 23 males and 28 females. The age range was 27~77 years old. At admission, the incidence of nutritional risk was 90.2%, and the incidence of undernutrition was 9.8%. Further analysis showed that the men's incidence of nutritional risk (95.7%) was higher than the  women’s (85.71%); Middle aged and elderly patients’ (>50years) incidence of nutritional risk was higher than the young (≤50 years), the differences were statistically significant (the P values were 0.042 and 0.036 respectively). Conclusions  Most of the patients with malignant tumor in our hospital were middle and advanced patients. The incidence of nutritional risk was high, and the incidence of nutritional risk varies greatly in different age and sex. We should pay attention to the nutritional status and nutritional risk and the causes of nutritional risk. For the nutritional status directly affected the prognosis of the patients, active nutritional therapy in clinical antitumor treatment will be beneficial for patients.
2018 Vol. 5 (2): 151-154 [Abstract] ( 294 ) HTML PDF (1108 KB)  ( 134 )
151 Nutritional assessment in oncology patients: a comparative analysis between NRS 2002 and PG-SGA
GONG Li-qing, LIU Ni, WANG Yan-li, XIN Xiao-wei, ZONG Xiang-long, SUN Yan, JIANG Lei-lei, ZHANG Xiao-tian, YUE Haizhen, FANG Yu
 Objective  To investigate the applicability of NRS 2002 and PG-SGA in screening nutritional risks in tumor inpatients. Methods  We carried on the cross-sectional investigation in the cancer inpatients with different therapy methods, from February 2015 to April 2015. NRS 2002 and PG-SGA were both used for nutritional screening and evaluation, comparing the correlation sensitivity, specific, positive and negative predictive value. Results  A total of 423 patients completed the study, including 124 from gastrointestinal surgery, 169 from radiotherapy and 130 from gastrointestinal oncology. There were 265(62.6%) cases of gastrointestinal tumor, 93(21.9%) cases of head and neck tumor, 65(15.4%) cases of other tumors. According to BMI, 9.5% of the participants were underweight. According to NRS 2002, 32.6% of the participants had nutritional risk; according to PGSGA, moderate and severe malnutriton accounted for 50.6%. Besides, NRS 2002 and PG-SGA had certain agreement by binary classification of cross (kappa=0.491, P<0.001). If we use NRS2002≥3 as nutritional risk assessment criterion, PG-SGA≥4 as positive control, the sensitivity and specificity of NRS 2002 were 57.0% and 92.3%, respectively. Conclusions  The study indicated that NRS 2002 using for screening the nutritional risk and PG-SGA had certain agreement for cancer patients. If the PG-SGA≥4 was used as the positive control, the specificity and positive predictive value of NRS 2002 were better, but the sensitivity and negative predictive value were poor.
2018 Vol. 5 (2): 151-154 [Abstract] ( 336 ) HTML PDF (1108 KB)  ( 97 )
159 Nutritional risk, undernutrition and nutritional support among elderly cancer inpatients
1XU Jing-yong, 2TANG Pu-xian, 3CHEN Wei, 4WANG Xin-ying, 5SUN Jian-qin, 6DONG Bi-rong, 7LOU Hui-ling, 1ZHU Ming-wei, 1WEI Jun-min
Objective  To investigate the prevalence of nutritional risk, undernutrition and nutritional therapy among elderly cancer inpatients in 6 tertiary hospitals in China. Methods  Data of elderly cancer patients were analyzed and collected between March 2012 and May 2012 from 6 tertiary hospitals in China. Nutritional risk screening was conducted within 24 hours after admission using the nutrition risk screening tool NRS 2002 to investigate the incidence of nutritional risk and malnutrition as well as the application status of nutritional therapy during hospitalization. Results  Totally 1,472 consecutive cases were recruited. The total nutritional risk prevalence is 62.8% and undernutrition is 25.3%. Two subgroups were separated according to whether receiving surgery. 906 cases were included in the non-surgical group and the prevalence of nutritional risk is 61.9%; 566 cases were included in the surgical group and the prevalence of nutritional risk is 64.1%. There is statistical significance between the two groups in the prevalence of undernutrition (27.7%vs18.9%, P=0.004). The prevalence of nutritional risk, nutritional risk score≥5 and undernutrition became higher with older age. The highest prevalence of nutritional risk is in the surgical group of alimentary tumour. Surgical group of gastric caner possessed the highest nutritional risk (77.7%). Morbidity of malnutrition of all patients was more than 25%, while non-surgical group of pancreatic cancer possessed the highest undernutrition mobidity (37.5%). 458 patients with nutritional risk were administrated nutrition support (52.4%) with PN 325 cases (71.0%), EN 9 cases (4.84%), PN plus EN 110 cases (24.0%); 186 patients without nutritional risk (36.1%) were administrated nutritional support with PN 131 cases (70.5%), EN+PN 46 cases (24.7%) and 139 cases were in surgical group (74.7%). Conclusions  The prevalence of nutritional risk and undernutrition of elderly cancer patients are high. The application of parenteral nutrition is high and the indications of nutritional therapy are not standardized.
2018 Vol. 5 (2): 159-164 [Abstract] ( 322 ) HTML PDF (1087 KB)  ( 128 )
165 HMB improves postoperative malnutrition status in patients with lower extremity fracture
YU Jing, CHAI Li-juan
 Objective  To study the effect of HMB on postoperative patients with lower extremity fracture and malnutrition. Methods  From February 2016 to August 2017, 84 patients with lower limb fracture and malnutrition in affiliated hospital of Hebei university of engineering were selected as the subjects. They were divided into a study group and a control group by random number table. The control group was given with 2013 version of Chinese annual dietary nutrient intake to provide dietary intervention. The study group was treated with HMB (1 packet/time, 2 times/d, 20 g/d) on the basis of the control group. The patients in both groups were treated for 3 months. TP, Hb and ALB levels and other nutritional indicators were compared between the two groups before and after intervention. Using Inbody 720 muscle diagnostic instrument detect and compare the muscle volume of two groups before and after intervention. The incidence of postoperative complications and satisfaction were compared. Results  There was no significant difference in nutritional index level between two groups before intervention (P>0.05). After the intervention, the study group of TP, Hb, ALB level was (65.12±4.90)g/L, (114.30±8.29)g/L and (31.59±3.17)g/L respectively, which were significantly higher than the control group of (50.39±6.24)g/L, (106.26±7.15)g/L and (26.15±3.47)g/L, differences between groups were statistically significant (P<0.05). There was no signifcant difference in  limbs muscle tissue level between two groups before intervention (P>0.05), After the intervention, the study group of limbs muscle tissue level was (24.39±2.76) kg, which was signifcantly higher than level before intervention of (20.87±2.50)kg, the limbs muscle tissue level of control group after  intervention was (24.39±2.76), which was not signifcantly higher than level before intervention of (20.76±2.51)kg (P>0.05), the limbs muscle tissue level of study group after  intervention was was signifcantly higher than level of control group (P<0.05). The study group of postoperative pulmonary infection and fracture healing, muscle weakness, muscle atrophy rate were 2.38% (1/42), 2.38% (1/42), 0.00% (0/42), 0.00% (0/42), which were significantly lower than the control group of 19.05% (8/42), 16.67% (7/42), 11.90% (5/42), 9.52% (4/42), differences between groups were statistically significant (P<0.05). The satisfaction of study group was 95.24% (40/42), which was significantly higher than 80.95% (34/42) of the control group, and the difference between groups was statistically significant (P<0.05). Conclusions  HMB used in lower limb fractures associated with poor nutrition in postoperative patients can improve the nutritional status, increase the limb muscle tissue level, at the same time effectively reduce the incidence of postoperative complications, improve patients’ satisfaction.
2018 Vol. 5 (2): 165-169 [Abstract] ( 206 ) HTML PDF (1088 KB)  ( 87 )
170 Clinical application of protein hydrolysate multi-nutrient powder in esophageal cancer postoperative patients
1LU Kai-jin, 2HOU Li-li
 Objective  To investigate the clinical application value of protein hydrolysate multi-nutrient powder in esophageal cancer postoperative patients. Methods  Sixty esophageal cancer postoperative patients were divided into the experimental group and the control group, 30 cases in each group. The experimental group received routine nutritional therapy, while protein hydrolysate multi-nutrient powder was administered orally or tube-fed, and the control group received routine nutritional therapy for a total of seven days. The time of initial exhaust, the relevant nutritional indicators and the incidence of abdominal diarrhea etc on the third day and the seventh day were observed and compared respectively, the differences between the two groups were significant differences (P<0.05). Results  After the nutritional therapy, the time of initial exhaust of the patients in the experimental group was significantly earlier [in the experimental group: (56.01±8.88)h, in the control group: (62.52±7.63)h; P=0.00)], the incidence of abdominal diarrhea was significantly lower than that of the control group, the differences were statistically significant. The incidence of nausea and vomiting was with no difference of the control group. The two groups of patients related to nutritional indicators had different degrees of improvement trend. The levels of prealbumin were significantly higher in the experimental group than that in the control group, the differences were statistically significant, but the serum total protein and albumin and transferrin between the two groups were with no statistical differences. Conclusions  protein hydrolysate multi-nutrient powder can effectively improve the negative nitrogen balance, promote gastrointestinal function recovery, with good gastrointestinal tolerance. It is of guiding significance to the clinical treatment of postoperative patients with esophageal cancer.
2018 Vol. 5 (2): 170-174 [Abstract] ( 531 ) HTML PDF (1061 KB)  ( 210 )
175 Salted fat intake and esophageal cancer risk in a case-control study
1WU Jiang-ping, 1ZHAO Yan-jie, 1SONG Qing-kun, 2LI Jun, 2HE Yong-ming, 3QU Chen-xu
Objective  This study aimed to investigate the association between salted fat consumption and the risk of esophageal cancer in Yanting, one of the high risk areas. Methods  The frequency-matched case-control study was conducted by comparisons among people with esophageal carcinoma, normal population and people with endoscopic esophageal mucosal coloration. The odds ratio and 95% confidence interval of intake frequency and duration of salted fat were estimated in unconditional logistic regression model. Results  55.6% cases with esophageal cancer consumed salted fat frequently, compared with less than 25% individuals with normal or abnormal esophagus mucosa. Compared with individuals with normal esophagus mucosa, frequent consumption of salted fat increased esophageal cancer risk by more than seven times (OR=7.37, 95%CI=2.53~21.48) and a cumulative intake of salted fat more than 6-month over a year increased the risk of esophageal cancer by up to 85 times (OR=85.45). Compared with individuals with abnormal esophagus mucosa, frequent consumption of salted fat increased esophageal cancer risk by more than five times (OR=5.05, 95%CI=1.79~14.27) and a cumulative intake of salted fat more than 6-month over a year increased the risk to 74-fold high (OR=74.90). Conclusions  Salted fat intake was a risk factor for esophageal cancer and the action of reducing salted fat intake was necessary among Yanting people to decrease the risk of esophageal cancer.
2018 Vol. 5 (2): 175-178 [Abstract] ( 308 ) HTML PDF (1405 KB)  ( 70 )
179 Investigation and consideration of cancer patients’ understanding of clinical research
WEI Yan, PENG Jin, LIU Qi, ZHOU Fu-xiang
 Objective  To investigate the level of awareness of cancer patients on clinical research and related ethical knowledge, so as to lay the foundation for improving patients’ understanding of clinical research. Methods  A random questionnaire survey was conducted among cancer patients in the department of oncology and radiotherapy in Zhongnan Hospital of Wuhan University, and make a statistical analysis of the results. Results  A total of 90 questionnaires were issued, of which 81 were valid questionnaires, with a recovery rate of 95.6%. 96.30% (78/81) of the patients indicated that they wanted to know their condition, and 75.31% of them believed that they had the hope of cure when they were aware of the disease. At present, 70.37% (57/81) of patients were still sceptical about whether the clinical research is beneficial or not. Among all the cancer patients surveyed, the willingness to participate in clinical research was only 40.7%. 82.72% (67/81) of the patients believed that signing the informed consent was unnecessary or indifferent. Multifactor analysis showed that the degree of education was an important factor affecting the patients’ understanding of clinical trials (P<0.05, OR=2.559, 95%CI=1.037~6.314), and the difference was statistically significant. Age factor affected patients’ demand for the right of informed consent (P<0.05, OR=3.450, 95%CI=1.684~7.067). Conclusions  At present, hospitalized cancer patients have strong demands o know their conditions, but they lack the knowledge of clinical research and related ethical knowledge. The publicity and explanation of clinical research and its ethical content in the treatment group of cancer patients should be expanded. The significance of the ethical review of clinical research and the protection of the subjects should be emphasized to improve the willingness of the cancer patients to participate in the clinical study.
2018 Vol. 5 (2): 179-183 [Abstract] ( 284 ) HTML PDF (1432 KB)  ( 165 )
184 Patient blood management for sacral neurilemmoma resection
1ZHANG Hai-jing, 1ZHOU Zhuo, 1LI Tian-zuo, 2YAO Qi
Objective  To investigate the patient blood management for sacral neurilemmoma resection. Methods  Retrospectively analyzed the blood administration and surgical procedures during 12 sacral neurilemmoma resection from Beijing Shijitan Hospital Affiliated to Capital Medical University from September 2012 to December 2016, to discuss the preoperative preparation, anesthetic induction and maintainance, intraoperative monitoring and use of vasoactive drugs related experience. Results  12 patients with sacral neurilemmoma were resected with marginal margin. Sacral 1 nerve was not preserved only in 1 patient, foot droop nerve dysfunction occurs. The remaining 11 patients successfully dissociated the nerve from the tumor and preserved the nerve. One patient suffered from cerebrospinal fluid leakage after surgery, and was cured after drug exchange and symptomatic treatment. The average follow-up time was 13 months, and there was no recurrence of schwannoma. Intraoperative blood loss was (15,004±670) ml, mean allogeneic blood transfusion use (1,567±247) ml. Through the implementation of the medical strategy of blood management, the intraoperative circulation remained stable, and all patients stopped taking blood tube active drugs within 1 hour after surgery, and the tracheal tube was removed and sent back to the ward. Conclutions  Blood management programs including erythrocyte enhancement drugs and stored autologous transfusion are effective ways to reduce the bleeding of sacral schwannoma.
2018 Vol. 5 (2): 184-188 [Abstract] ( 242 ) HTML PDF (1251 KB)  ( 119 )
189

The effect preoperative nutritional risk screening on postoperative quality of life in colorectal cancer patients

The effect preoperative nutritional risk screening on postoperative quality of life in colorectal cancer patients[J]. Electronic Journal of Metabolism and Nutrition of, 2018,5(2): 189-193')" href="#"> YAN Rong-yi, LI Mei, ZHU Ling-yan, DING Biao
Objective  To investigate the influence of preoperative nutritional rik on the quality of life colorectal cancer of patients , and to provide the strategy of clinical nutritional support therapy. Methods  150 patients with colorectal cancer were selected from June 2014 to June 2016 in the department of general surgery of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and no nutritional support treatment was performed within 24 hours after admission. The nutritional status of patients with colorectal cancer was assessed by the European nutritional risk screening scale (NRS-2002). The patients were divided into two groups according to the score, namely, control group (less than 3 points) and study group (greater than or equal to 3 points) to compare the incidence of postoperative complications in two groups. The difference of life quality was compared  according to core scale QLQ-C30 of European Research and Treatment and the Organization. Results  According to the NRS-2002 score, 64 patients were  aasigned to study group (43%) and 86 patients were in control group (57%). The incidence of postoperative infection and anastomotic leak were higher in study group  than in control group (P<0.05). The significant differences were found in general health status, physical function, conggnitive function, fatigue and insomnia in patients with different nutritional status (P<0.05). But there was no significant differences in social function, emotion function, nausea/vomiting, pain, dyspnea, appetite loss, constipation, diarrhea and financial difficulties (P>0.05). Multiple linear stepwise regression analysis indicated that nutritional status of patients with colorectal cancer was the independent influence factor of life quality. Conclusion  Colorectal cancer patients with nutrition risk was closely associated with higher postoperative complications and quality of life declines. Therefore, it is necessary to strengthen preoperative nutrition support therapy in colorectal cancer patients with nutrition risk.
2018 Vol. 5 (2): 189-193 [Abstract] ( 382 ) HTML PDF (1061 KB)  ( 129 )
194 Evaluation and analysis of psychological health status and psychological needs in young breast cancer patients
WANG Qian, SONG Ying, LI Er-ni, LIANG Yuan, LI Jing, ZHOU Chun-wu, ZHAO Xin-ming
 Objective  To explore psychological health status and psychological needs of young patients with breast cancer, and to provide reference for the development of clinical strategy of nutrition support therapy plan. Methods  74 breast cancer patients were selected under 35 year old. To access respectively the rating scale for of young patients with breast cancer (n=50) 50 cancer patients were in study group and 24 patients with benign lesion were in control group. The psychological status,  psychological needs  and Social support degree were evaluated. All patients were interviewed and called-back after the completion of. Results  The rating scales of EPQ-RSC with N type, SAS, SDS in study group was higher than those in control group, there was significant difference (t1=5.439, t2=1.454, t3=3.758, P<0.05), compared with control group. Psychological needs mainly focused on treatment cost, defect remedy of breast, marriage quality and fertility, among which 88% patients had fertility plan, however, the correct answering rate of fertility knowledge was only 8.6%~42.9%. All of patients with social support utilization scores were low, and there was no statistically significant difference between two groups (t=0.798, P>0.05). Conclusion  Young breast cancer patients are of obvious tension, anxiety, irritability and nervousness tendency. They should be given professional psychological guide and psychological needs should be attached great importance. Meanwhile, utilization of social support in young patients with breast cancer is obviously insufficient, which should be improved by increasing the channels, innovation and optimizing social support network.
2018 Vol. 5 (2): 194-197 [Abstract] ( 383 ) HTML PDF (996 KB)  ( 113 )
198 Enteral nutrition support on nutritional status in gastrointestinal cancer patients
Objective  To investigate the effect of enteral nutrition and parenteral nutrition on the nutritional status of patients with gastrointestinal cancer after operation. Methods  Selected patients with gastrointestinal cancer in Affliated Hospital of Hebei University of Engineering and Handan Central Hospital from October 2016 to February 2018 evaluated the nutritional status by were using nutritional risk screening tool (NRS-2002) and scored patient-generate subjective global assessment (PG-SGA). The results showed that  there were 200 patients with high nutritional risk. According to random number table method, the patients  were divided into observation group and control group with 100 cases in each group. The control group were administrated  parenteral nutrition treatment and the observation group were received enteral nutrition therapy. Results  The incidence of complications in patients with no nutritional risk was 12.5% (27/216), and in patients with risk was 23% (46/200). The difference was statistically significant (P<0.05). Gender, mean age, mean body mass index (BMI), hemoglobin (HGB), total protein (TP), albumin (ALB), prealbumin (PA) and the types of cancer between two groups were l no statistical significance (all P>0.05). Two weeks after the nutritional therapy, hemoglobin (HGB), albumin (ALB) level of observation group were both significantly higher than those of the control group, and the difference was statistically significant (P<0.05). However, there was no statistical difference between the two groups of prealbumin (PA) and total protein (TP) (P>0.05). The incidence of complications in the study group was 8% and lower than that of the control group which was 19% (P<0.05). Conclusions  The incidence of nutritional risk is high in patients with gastrointestinal cancer, which can lead to higher incidence of complications. Enteral nutrition therapy of patients with gastrointestinal cancer can  effectively improve the nutritional status compared to parenteral nutrition treatment.
2018 Vol. 5 (2): 198-201 [Abstract] ( 355 ) HTML PDF (1024 KB)  ( 137 )
202 Removing blood stasis with the obverse and reverse Warburg effects in cancer
1DENG Li, 2JIN Shuai, 1RAO Ben-qiang
 Blood-stasis syndrome (BSS) was the main pathogenesis of cancer which runs through the whole process of carcinogenesis. Blood-activating and stasis-resolving (BASR) for cancer had a history of more than 2000 years; however, the molecular mechanism of BASR for cancer was still not clear, especially whether BASR can cause cancer metastasis was  controversial. For a long time, it was deeply rooted in the idea that BASR was mainly to improve the high coagulation state, thus reducing the occurrence of metastasis. Actually, this view could not fully explain the intrinsic relationship between BSS and carcinogenesis, also could not clarify the controversies on BASR for cancer, such as BASR inhibiting or promoting blood vessels growth, BASR drugs causing or inhibiting cancer metastasis, and so on. This article reviewed literature on BSS and BASR in cancer patients, with beginning from the core of  cancer cells metabolism characteristics - obverse and reverse Warburg effect, and analyzed the causes and the main signaling pathways of BSS, explored the possible mechanism of BASR. At the meanwhile, we also put forward the appropriate treatment time of BASR, the main principles and feasible evaluation index for cancer. This article would help to improve the understanding of the treatment of BASR for cancer, and also help clarify whether BASR can cause cancer metastasis.
2018 Vol. 5 (2): 202-205 [Abstract] ( 368 ) HTML PDF (1653 KB)  ( 130 )
208 The clinical characteristics of delayed gastric perforation after endoscopic submucosal dissection
WANG Jun-jie, CHEN Hao-long, HAN Zhen-guo, LI Hong-zhuo, FAN Ti-wu
Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer with a negligible risk of lymph node metastasis. Delayed gastric perforation after ESD is a rare complication. However, once this complication occurs, the symptoms are usually severe and most patients should be treated emergently. Until now, related researches have two main problems. For one thing, the sample size and source are limited; for another, the results of these researches varied widely. In order to prompt more scientists to pay attention to this complication, to do further researches on it and to acquire more reliable results, which can promote the better management, prevention and recovery of this complication, thus minimize the pain for the patients, we summarized some related researches and introduced the clinical characteristics such as reasons, clinical manifestations, management, prognosis and prevention of this complication.
2018 Vol. 5 (2): 208-211 [Abstract] ( 288 ) HTML PDF (985 KB)  ( 133 )
212 HMB supplementation on sarcopenia in ICU patients
WANG Shu-ying, YAN Wei-qing
 In 2010, sarcopenia was defined and its diagnostic methods were provided by European Working Group on Sarcopenia in Older People. In 2016, sarcopenia was included in the new ICD-10-CM code, representing a major step forword in recognizing sarcopenia as a disease, and its attention gradually increased. Nutritional therapy is an important part of critical care medicine. Muscle loss is prevalent in ICU patients, especially in the elderly, and providing nutritional therapy can shorten the hospital stays and reduce the mortality rate. β-hydroxy-β-methylbutyrate possesses a unique mechanism of action - increases protein synthesis and reduces protein breakdown, making it a clinical nutritional supplementation already in the population in need of increasing muscle for many years, and there is a large number of research literature support. The group of people who need to increase muscle mass include older people, AIDS patients, cancer patients, or other patients with chronic diseases. For residents of the ICU, sarcopenia means not only weakness and malnutrition, but also increased the risk of death. Therefore, preventing and reducing muscle loss in hospitalized patients is one of the therapeutic factors that ICU doctors should consider. However, in the field of critical care medicine, little research has been done on HMB. By analyzing existing studies synthetically, it suggests that HMB is considered to be a nutritional supplementation and is worthy of use in ICU patients with muscle loss.
2018 Vol. 5 (2): 212-215 [Abstract] ( 326 ) HTML PDF (1185 KB)  ( 196 )
216 Traditional Chinese Medicine nutrition in the treatment of tumor
CAO Yan-hui, ZHAO Li-ting, LIU lian-yun
 TCM nutrition is discipline which is concidered with health improvement, prevention of disease, and promotion of physical rehabilitation by food under the guidance of the theory of Traditional Chinese Medicine (TCM). It is an important part of clinical nutritional therapy. It involves many aspects such as herbal food, diet regimen, diet therapy, diet control and taboo of food. The article discusses the role of TCM nutrition in the prevention, treatment and prognosis of tumor. TCM nutrition takes advantage of diet guidance, diet adjustment and diet counseling based on the positive effects of food on health improvement and disease treatment. At the same time, it utilizes the treatment based on disease and dialectical feeding and can preserve the body's positive gas, regulate spleen and stomach, treat disease based on syndrome differentiation, enhance the ability of disease resistance, and thereby,  treat desease as a whole. It further summarizes the deficiency of TCM nutrition in the clinical research of tumor. In the future, the dialectical treatment theory of TCM will be used to combine diet therapy with enteral nutrition and set up a nutritional therapy team to form a perfect system of nutritional screening, nutritional assessment, and Chinese and Western medicine nutritional therapy. To carry out an in-depth study on the big data of TCM nutritional therapy and summarize the relevant guidelines and consensus of TCM nutritional therapy. To establish the outpatient clinic of TCM nutrition so as to improve the family nutritional monitor and followup, furthermore, to publicize professional knowledge of TCM nutrition. As a result, to have TCM nutrition play a crutial role in the treatment of tumor, and build a characteristic combination of traditional Chinese and Western medicine nutritional therapy system.
2018 Vol. 5 (2): 216-219 [Abstract] ( 309 ) HTML PDF (978 KB)  ( 221 )
220 Malnutrition status in chemotherapy cancer patients
1QIN Nan, 2JIANG Gui-chun
 The study of  cancer chemotherapy patients syndromes  increased year by year in China. Clinical trials revealed that most of cancer chemotherapy patients sufferred form side effects such as nausea, vomiting and decreased appetite. These symptoms leaded to thequality of life declines in cancer chemotherapy patients and can easily cause weight loss and malnutrition. Nutritional status not only influenced directly the quality of life in cancer patients with chemotherapy, but also was related closely to the treatment effect, complications and clinical outcomes. Therefore, the nutritional status of cancer chemotherapy patients has important clinical research value and significance. This article reviewed the etiology and pathogenesis of malnutrition of cancer chemotherapy patients, nutritional status of cancer chemotherapy patients in China, the impact of malnutrition on cancer chemotherapy patients, and clinical application of nutrition screening and assessment tools to attach clinical attention to the nutritional status of patients with cancer chemotherapy, and then strengthen the nutritional support therapy of such patients; To provide reference by choosing and using nutritional status screening and assessment tools in clinical practice, and to prevent the occurrence of malnutrition in patients with chemotherapy, and then to improve their nutritional status,  the quality of life of cancer chemotherapy patients, and ultimately improve the clinical outcomes of cancer chemotherapy patients.
2018 Vol. 5 (2): 220-224 [Abstract] ( 398 ) HTML PDF (973 KB)  ( 215 )
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