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2018 Vol. 5, No. 4
Published: 2018-12-09
 
333 Scope, model and development of supportive care for cancer
SHI Han-ping, YU Shi-ying,BA Yi,TANG Li-li，LI Wei
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.001
Abstract: Supportive care is a typical multidisciplinary model for basic cancer treatment that shares the same level importance as surgery, radiotherapy and chemotherapy. Ideally, a supportive care team consists of physicians, psychologists, pharmacists, rehabilitation therapists, religious workers, nutritionists, and nurses (acronym: PRN). Supportive care is representative for integrated medical services with care from aspects of spiritual, pharmacologic treatment, exercise, nutritional support, communication, emotion, and rehabilitation, with a acronym of SPENCER. There are three distinct models for supportive care in China, namely solo practice model, congress practice model and integrated care model. Solo practice model is the major model utilized in large-scale cancer specialized hospitals while congress practice model is often employed in general hospitals. Although integrated care may be a better direction for supportive care development, a three-in-one model may even better meet clinical need. The efficacy of supportive care is evident in various researches, and the underestimation of supportive care may be one of the reasons for the low survival rate and low quality of life among Chinese patients. Therefore, supportive care for cancer patients should be emphasized as one of the basic treatment for cancer.
2018 Vol. 5 (4): 333-336 [Abstract] ( 625 ) HTML PDF (1366 KB)  ( 418 )
337 Application of nutritional intervention in perioperative gynecologic oncology patients
1LI Hui, 1NING Yan-hui, 1XU Chang-juan, 2SHANG Wei-hu, 3YANG Fan
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.002
Abstract: Cervical cancer, endometrial cancer and ovarian cancer are three types of gynecological cancer with high incidence, which seriously threaten human health. Nutritional problems happened normally in gynecological cancer patients because of intake less, which induced by tumor metabolic abnormalities and digestive tract oppression. Furthermore, nutritional status of the perioperative patients with gynecological cancer affect the clinical outcome, it has been reported that malnutrition may be responsible for 20% of gynecological cancer deaths. In this article, we reviewed the current methods and progress of nutrition screening, assessment, and intervention in perioperative patients with gynecological cancer through by searching in Pubmed, Embase and CNKI
database. Common nutrition screening tools include nutritional risk screening 2002 (NRS 2002), mini nutritional assessment (MNA), malnutrition universal screening tool (MUST), malnutrition screening tool (MST) and nutritional risk index (NRI). Common nutrition assessment tools include subjective global assessment (SGA) and patient-generated subjective global assessment (PG-SGA). Previous studies suggested that nutrition intervention by immune-enhanced enteral nutrition or oral supplement helps to shorten the hospital stay, reduce the postoperative complications, accelerate intestinal function recovery, improve immune function and nutritional status for perioperative patients with gynecological cancer. However, the effect of nutrition intervention on quality of life and long-term survival still need to be further studied.
2018 Vol. 5 (4): 337-341 [Abstract] ( 567 ) HTML PDF (997 KB)  ( 493 )
342 Research progress in cancer cachexia-induced regulation of skeletal muscle oxidative metabolism
GUAN Chun-yan, NIU Hui-yan
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.003
Abstract:Improving the survival rate and quality of life is the main goal for the successful treatment of cancer patients. Treatment of cachexia is also an important part of cancer treatment. Cancer cachexia is a group of symptoms and signs commonly seen in advanced metastatic tumors. Cachexia may occur in 50% of cancer patients and is one of the leading causes of cancer death.Although the progression of cachexia is directly related to the morbidity and mortality of cancer patients, the pathogenesis and treatment of cachexia are still unclear. There is evidence that cancer-induced weight loss is associated with global endocrine and metabolic abnormalities, and the disrupted function of many tissues and organs. Skeletal muscle consumption caused by cancer has become an important research direction. In recent years, more attention has been paid to the regulation of skeletal muscle oxidative metabolism in cancer cachexia. Oxidative metabolism has become one of the biological therapeutic targets for cancer muscle atrophy.The response of skeletal muscle to external stimuli such as inflammation, hormones, and contraction requires integrated cellular signaling pathways involving several organelles and structures. Although the response of skeletal muscle to external stimuli such as inflammation, hormones, and contraction requires integrated cellular signaling pathways involving several organelles and structures, the involvement of muscle mitochondria in the regulation of both wasting and metabolic quality has become firmly established. Mitochondrial content and function are altered by a host of stimuli, including increased and decreased use, systemic inflammation, and systemic hormonal signaling. With the development of cachexia, the increase of inflammatory cytokines and the decrease of steroids can destroy the ability of muscle oxidative metabolism. The decrease of activity in cachexia patients is closely related to the atrophy of skeletal muscle consumption. In this review, we will explore the role and progression of skeletal muscle oxidative metabolism regulation related to cancer cachexia.
2018 Vol. 5 (4): 342-347 [Abstract] ( 456 ) HTML PDF (1159 KB)  ( 351 )
348 Cancer related nausea and vomiting
LIANG Ting-ting, CHEN Xiao, LI Wei
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.004
Abstract: As a common clinical symptom of cancer patients, nausea and vomiting have obvious negative effects on the physiology and psychology of the patients, cause the metabolic disorder of the body, increase the patient's fear of treatment, reduce the compliance of the patients, and influence the quality of life and the overall survival of the patients. There are many causes of nausea and vomiting. Tumor related nausea and vomiting are the main contents of this article. The specific causes include nausea and vomiting caused by the tumor itself, treatment related nausea and vomiting, mental factors associated nausea andvomiting, and systemic factors associated nausea and vomiting. It is helpful to effectively alleviate the adverse effects of nausea and vomiting. The research on the mechanism of nausea and vomiting mainly focuses on the study of the mechanism of vomiting. At present, this part has been explained clearly, but the mechanism of nausea is not clear, which needs further research and exploration. The incidence of nausea and vomiting is different, to have different effects on the body`s nutrition metabolism. In order to treat more individually, it is necessary to prevent and treat the nausea and vomiting according to the cause, mechanism and degree of nausea and vomiting, so as to improve the patient's symptoms and quality of life. This paper expounds the causes of nausea and vomiting, pathophysiological mechanism, the influence of metabolism and treatment, which is helpful to the active prevention and treatment of nausea and vomiting, and thus to improve the quality of life and the overall survival.
2018 Vol. 5 (4): 348-353 [Abstract] ( 472 ) HTML PDF (1808 KB)  ( 547 )
354 The research progress of sarcopenia in elderly patients with chronic obstructive pulmonary disease
1,2LIN Xu, 3DONG Bi-rong
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.005
Abstract: As a chronic respiratory disease, chronic obstructive pulmonary disease occupies a high incidence in the elderly, while sarcopenia is one of the complications in COPD. For the past few years, many researches have reported cases that many elderly people attacked COPD have sarcopenia. We find that there is a high prevalence of sarcopenia among the elderly people when we set “sarcopenia” and “COPD&r; as keywords to search in CNKI, VIPI, Wang fang and pubmed. The risk factors in elderly patients of COPD with sarcopenia include: advanced-age, low-BMI, long-course, smoking. The pathophysiological mechanism of elderly COPD with sarcopenia is complicated, including the anabolism of muscle decreases and the catabolism of muscle increases, and the inflammatory factor, growth factor and hormone are the mainly reasons. Clinical features include: limited physical activity, slow gait, poor endurance at the same time the entire body is in a weak state. Clinical features include: limited physical activity, slow gait, poor endurance and the entire body in a weak state. Drug intervention strategies are still in the research stage, and other intervention strategies include: smoking cessation, reasonable exercise, strengthen nutrition. Eldery COPD patients with sarcopenia have reduced quality of life, increased hospitalization and mortality risk, and have a poor prognosis. Therefore, to prevent elderly's disability in early stage, it is significant to pay attention to eldery COPD with sarcopenia. This article reviews the epidemiology, risk factors, pathophysiological mechanisms, clinical features, diagnosis, intervention and prognosis of elderly COPD with sarcopenia.
2018 Vol. 5 (4): 354-357 [Abstract] ( 433 ) HTML PDF (1056 KB)  ( 477 )
358 Expert consensus on nutrition therapy in cancer patients receiving radiotherapy
1LI Tao, 1LV Jia-hua,1LANG Jin-yi, 2SHI Han-ping, 3XU Hong-xia, 4LI Bao-sheng, 5ZHANG Zhen, 6 ZHU Shu-chai, 7CHEN Ming, 8KANG Jing-bo,
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.006
Abstract: The incidence of malnutrition was high in cancer patients receiving radiotherapy. Malnutrition may reduce the antitumor effect and increase the radiotherapy adverse reactions. NRS 2002 is recommended for nutritional risk screening, and PG-SGA is recommended for nutritional assessment. The cancer patients receiving radiotherapy should carry out whole-process nutrition management during the peri-radiation period. We should correctly assess the nutritional status of patients using PG-SGA before, during and after radiotherapy and acute radiation injury during and after radiotherapy according to RTOG criteria. Then, we can select the standardized and individualized nutrition treatment method according to the assessment result. Nutritional therapy should follow the "five-stage model". Enteral nutrition access should follow the "four-stage model". Only when the patient is unable to obtain adequate nutritional needs through enteral nutrition or the presence of severe radioactive mucositis, radiation enteritis or intestinal failure, it is recommended to combine partal or whole enteral nutrition in time. The recommended amount of energy intake for radiotherapy patients with malignant tumor is 25~30kcal/(kg·d). It should be adjusted dynamically according to tumor burden, stress state and acute radiation injury during radiotherapy. Cancer patients receiving radiotherapy are recommend higher protein intake, and 1.5~ 2.0g/(kg·d) is recommended for patients with severe malnutrition. For patients with cachexia, it can be increased to 2.0g/(kg·d).
2018 Vol. 5 (4): 358-36 [Abstract] ( 1138 ) HTML PDF (1194 KB)  ( 1107 )
366 Effect of appetite condition reflex stimulation on tolerance of early enteral nutrition after colorectal-carcinoma surgery
1LI Dong-yong, 2SUN Yan-bo, 1QI Ying-hua, 1LI Jian-guang, 1WANG Bin, 1LI Zhi-jun, 2CEN Yun-yun, 2XU Peng-yuan
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.007
Objective This study aims to discuss effects of appetite condition reflex stimulation on early enteral nutrition tolerance, complications and postoperative hospital stay of patients after colorectal-carcinoma surgery. Methods A total of 70 patients (42 cases of colon cancer and 28 cases of rectal cancer) scheduled for laparoscopic colorectal cancer surgery in department of gastrointestinal surgery, the 2th Affiliated Hospital of Kun Ming Medical University from February to December, 2017 were divided into stimulate appetite group (experimental group, n=35) and conventional treatment group (control group, n=35) randomly. Both of the two groups were treated with EEN, and the tolerance of EEN, the rate of surgery complications and the time of postoperative hospital stay were compared respectively. Results There were 66 cases, including 34 cases in experimental group and 32 cases in control group, were finished the relevant experiment. Patients in experimental group had better tolerance of EEN than patients in control group (rates of nausea, vomiting, bloating, use of prokinetic drugs, and gastric tube replacement were lowers than control group, P<0.05), and shorter time to tolerate regular eating (5.0±1.0 d vs. 6.4±1.9 d in control group, P<0.05) and shorter time of postoperative hospital stay (7.0±2.0 d vs. 8.0±1.8 d in control group, P<0.05). No significant difference of complication was detected (P>0.05). Conclusions Appetite condition reflex stimulation can improve tolerance of EEN, shorten time to ordinary diet recovery and shorten time of hospital stay, does not increase the incidence of surgical complications, so it is a group of simple, feasible, safety and economical measures to enhance patients recovery after surgery.
2018 Vol. 5 (4): 366-371 [Abstract] ( 397 ) HTML PDF (1012 KB)  ( 321 )
372 Observation on the effect of complex protein components on the nutritional status of patients with malignant tumors in digestive tract
ZHANG Xiao-wei, CHENG Xue-jiao, LI Yao, WANG Kai, DONG Guan-nan
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.007
Abstract:  ObjectiveTo observe the effect of oral nutritional supplementation with complex protein components on improving the nutritional status of patients with digestive tract malignant tumors, so as to provide a basis for improving the comprehensive treatment level of patients with malignant tumors. Methods106 patients with digestive tract malignant tumor in the diet on the basis of application of compound with protein components, self-reflection to observe, to collect oral nutritional supplements before and after the distribution of protein component of total protein, albumin, ferritin, lymphocytes, white blood cells, neutrophils level
for statistical analysis. ResultsUse of oral nutritional supplements after the distribution of protein components, the digestive tract malignant tumor patients with total protein [(56.59±8.74)g/L VS (63.55±7.03)g/L, t=-9.313, P<0.05], albumin[(31.86±4.74)g/LVS (36.16±4.94)g/L, t=-9.919, P<0.05)], ferritin[(0.15±0.05±4.74)g/L VS (0.21±0.11)g/L, t=-5.163, P<0.05)], lymphocyte [(1.41±1.08)×109/L VS (1.99±2.95)×109/L,  t=-2.433, P<0.05], leukocyte[(8.36±3.85)×109/L V(7.41±3.16)×109/L, t=3.007, P<0.05], neutrophil level [(6.52±3.91)×109/L VS (5.41±3.08)×109/L, t=3.476, P<0.05], all indicators improved, and the difference was statistically significant. ConclusionOral nutritional supplement complex protein components can improve the nutritional status and value of patients with digestivetract malignant tumors.
2018 Vol. 5 (4): 372-375 [Abstract] ( 464 ) HTML PDF (918 KB)  ( 355 )
376 Effect of marine collagen oligopeptide on plasma protein and complications in postoperative patients with esophageal cancer
1,2YANG Dong, 1,3HU Wen, 4 LI Xiao-cong,4 YANG Yan-gang, 4 LIU Zheng, 4 YANG Wei, 4 ZHANG Lin
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.009
Objective：To observe the effect of enteral nutrition with marine collagen oligopeptide on plasma protein and complications in postoperative patients with esophageal cancer. MethodsAccording to the inclusive and exclusive standard, 120 patients with esophageal cancer were randomized into study group and control group, with 60 cases in each group. Patients were given early enteral nutritional support within 24 hours after the operation. The study group patients were given with enteral nutrient solution with the marine collagen oligopeptide 6g, Tid, to replace part of the protein supply, and the control group patients were
given with enteral nutrient solution without the marine collagen oligopeptide. Both groups were prepared with the same energy and protein supply standards. The effect was evaluated with the plasma albumin and prealbumin on the 7th postoperative day, incidence of pulmonary infection and anastomotic fistula, body weight loss and length of hospital stay. ResultsIn both groups, on the 7th postoperative day, the plasma albumin and prealbumin levels were lower than the preoperative (both P<0.05); the plasma albumin and prealbumin of the study group were higher than the control group on the 7th postoperative day (both P<0.05), the study group had lower incidence of pulmonary infection than the control group (P<0.05), no significant differences about the incidence of anastomotic fistula were observed between two groups (P>0.05), the weight of the patients in both groups decreased compared with that before operation (both P<0.05), the body mass loss were no significant differences between two groups (P>0.05), the study group had shorter length of hospital stay than the control group (P<0.05). ConclusionsThe enteral nutrient solution with the marine collagen oligopeptide were effective in maintaining the plasma protein, reducing the incidence of pulmonary infection and shortening the time of hospitalization for the patients after esophagectomy.
2018 Vol. 5 (4): 376-379 [Abstract] ( 394 ) HTML PDF (1017 KB)  ( 323 )
380 The analysis and the investigation of malnutrition in 744 elderly inpatients with tumor
XIE Lin-ying, WANG Chang, WU Hai-tao, WANG Yi-zhuo, LIANG Ting-ting, HE Hua, YAO Cheng, LI Wei
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.010
Objective It was investigated the incidence of malnutrition in elderly patients with malignant tumor in our hospital, and further analyzed the correlation among malnutrition and different clinical factors. Methods PG-SGA was determined for the cancer inpatients in our hospital, then we analyzed the relativities among the age、stages、therapy、length of stay (LOS)、cost and other clinical factors. Results (1)The incidence of malnutrition was up to 67.9% in these 744 elderly inpatients; (2)Compared with non-gastrointestinal cancer patients, the incidence of malnutrition (81.9% vs 58.2%) and severe-malnutrition(40.5% vs 22.7%) increased significantly in patients with gastrointestinal cancer (P<0.001). (3)Correlation analysis of nutritional status and clinical factors in elderly patients with gastrointestinal malignant tumor: ①According to the Stratification by using age factors, malnutrition rates were no significant difference in patients (P=0.462); ②Different stages (TNM) didn’t show any difference on nutritional status (P=0.595), The malnutrition incidence of Stage Ⅰ+Ⅱ patients was 79.3% (88/111), and Stage Ⅲwas 88.8% (103/116), Stage Ⅳ was 87.5% (42/48); ③ Compared with chemotherapy (236 cases) , elderly cancer patients with surgery (37cases) had a lower rate of malnutrition (86.0% vs 64.9%, P=0.001); ④The median costs of hospitalization for patients with severe malnutrition (20672.70 yuan) were significantly higher than those without malnutrition(12420.15 yuan) or mild / moderate malnutrition (15384.20 yuan), P=0.004, and there was no significant difference in between the latter; ⑤The median length of stay for patients with severe malnutrition (14.00 days) were significantly higher than those without malnutrition (6.50 days) or mild / moderate malnutrition (7.50 days), P=0.002, and there was no significant difference in between the latter. Conclusion: ①Malnutrition is common in elderly patients with malignant tumors, especially in gastrointestinal cancers; ②The elderly cancer patients with severe malnutrition will significantly increase the cost of hospitalization and the length of stay; ③Different treatments have different effects on nutritional status, so we should judge and weigh the advantages and disadvantages and choose the right treatment; ④We should pay more attention to the nutritional status of elderly cancer patients, and it’s important early screening and timely intervention.
2018 Vol. 5 (4): 380-386 [Abstract] ( 486 ) HTML PDF (1332 KB)  ( 379 )
387 Clinical characteristics and treatment status of breast cancer in aged women
1WU Jiang-ping, 2SUN Xiao-tong 3WANG Jingn 1LI Yu-chen,4ZHAO Lin
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.011
Objective This study aimed to investigate the clinical characteristics and treatment status among aged breast cancer patients in order to provide evidence for further research. Methods Aged breast cancer patient (≥65) were received in a local hospital from January 2005 to March 2010, divided into two groups, <70 and ≥70 years old. Data including basic information, reproductive risk factors, pathological characters and treatment management were collected from medical records. The comparison was conducted between aged patients of <70 and ≥70 years old. Results The mean age of included patients was 70. The average BMI was 24.3. Most of patients received education below tertiary high school. The patients of ≥70 were more likely to have more living births (P<0.05) but lower lymph node metastasis (P<0.05). The pathological types were not statistically significant in the two groups (P>0.05). Currently chemotherapy, endocrine-therapy, surgery were still processed non-standardized. Endocrine-therapy, target therapy and breast conservative surgery was still applied inadequately. Conclusions The standardized treatment among aged breast cancer patients needed be strengthened. Chemotherapy, endocrinology, targeted therapy and surgical treatment still need to be further normalized. Breast conservation surgery, endocrine therapy and target therapy should be promoted for more application
2018 Vol. 5 (4): 387-390 [Abstract] ( 439 ) HTML PDF (947 KB)  ( 314 )
391 Application and analysis of MNA-SF in elderly inpatients
HE Yuan, LIU Xiao-qian, SHI Han-ping, LI Su-yun
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.012
Objective To evaluate the use of different nutrition evaluation methods to evaluate the nutritional status of elderly patients in hospital and analyze the related influencing factors, to provide a scitific basis by taking tnterventons improve the health of the elderly. Methods Selected 210 elderly patients in Beijing shijitan Hospital from April 2017 to April 2018 as the research objects. The nutritional status was evaluated by MNA-SF, BMI, CC, ALB levels, to analysis of the influence of related factors on the nutritional status of elderly patients. Results The rates of good nutrition were 40.48%, 42.86%, 78.57% and 79.52% respectively in MNA-SF, BMI, CC and ALB levels. In terms of MNA-SF score, CC, and ALB, there was a significant difference in the age group≥85、6574 years old and 75-84 years old in the elderly patients with statistical significance (P<0.05); Self-nutritional attention: The attention group compared MNA-SF score and ALB in elderly patients with general concern group with statistical significance (P<0.05); In terms of MNA-SF score, BMI, CC, and ALB, there is a statistical significance between the group of concern and the group of inpatient elderly patients (P<0.05). Daily life activity ability: In MNA-SF score, BMI, CC, and ALB, basic or complete self-care is statistically significant compared with the need for help, obvious or complete dependence (P<0.05). Conclusions Malnutrition accounts for a high proportion of elderly inpatients, and the nutritional evaluation results are influenced by age, educational level, self-nutritional attention and ability of daily activities. Health education and physical exercise to improve the patient's attention to their own nutrition and daily activities self-care ability, can help elderly inpatients improve nutritional status.
2018 Vol. 5 (4): 391-395 [Abstract] ( 379 ) HTML PDF (950 KB)  ( 370 )
395 Clinical value of dynamic detection of urinary Livin mRNA expression in early diagnosis of bladder cancer
1JIANG Long-lai, 1LI Cai-hong,2XIE Mei-mao2WANG Xiao-rong
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.013
Objective Dynamic detection of urinary Livin mRNA expression in patients with bladder cancer before and after operation and its clinical value in early diagnosis of bladder cancer. Methods Urine of 30 patients with initially diagnosed BTCC was collected before operation and one week, one month, three months, six months and 18 months after operation. Urine of 30 healthy volunteers and 30 Non-urological cancer patients was collected. Expression of survivin mRNA in urine exfoliated cells was detected by real-time PCR. Results Livin mRNA was highly expressed in the urine of 30 patients before operation, and the relative copy number was (96.33±35.79), and the expression level increased with the clinical stage and grade of the tumor from low to high; 2 of 30 patients in the control group showed high expression, the relative copy number was 43.17 and 47.52, the other was low expression, and the expression level was low. The copy number was (16.25±7.81); 30 cases in normal group were low expression, and the relative copy number was (13.74±1.57). The expression of Livin mRNA in urine of the case group was significantly higher than that of the control group and the normal group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the control group (P<0.05); the expression of Livin mRNA in urine of the case group was significantly lower than that of the normal group (P<0.05); there was no significant difference between the control group and the normal group (P>0.05). Follow-up to 18 months after surgery, 5 patients with recurrence before reoperation (98.27±26.55) and 6 months after the initial operation were significantly different (P<0.05). Conclusion Dynamic detection of urinary Livin mRNA expression with high specificity and sensitivity can be used as an important noninvasive marker for early diagnosis of bladder cancer.
2018 Vol. 5 (4): 395-398 [Abstract] ( 334 ) HTML PDF (1053 KB)  ( 274 )
399 Safety of high-dose vitamin C in cancer patients
1XYi-jie, 1WANG Zhi-chao, HOU Gao-fen1FAN Yue-ping, 1ZHOU Ai-mei, 2ZHAO Wen-zhi, 2YU Kai-ying,2AO Ben-qiang,2SHI Han-ping
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.014
Objective To observe the safety of high-dose vitamin C intravenous infusion in the treatment of advanced malignant tumors, and to provide reference for clinical rational use of vitamin C. Methods from April 2016 to June 2017, 21 patients with advanced malignant tumor were treated with high dose vitamin C in aviation general hospital, chinese medical sciences university. The symptoms of nausea, loss of appetite, abdominal distention, diarrhea, abdominal pain, dizziness, blood glucose, electrolytes (blood Na+, K+, Cl-) and liver and kidney function (alanine aminotransferase, aspartate aminotransferase, total bilirubin, urea, creatinine and Uric acid) were recorded in 21 patients with tumor before and after high dose vitamin C treatment. The paired test was then used to compare these patients' clinical symptoms and blood biochemical parameters after high-dose vitamin C treatment. Results there were no significant changes in blood glucose, electrolytes, liver and kidney function in patients with malignant tumor treated with high dose vitamin C intravenous drip. One patient complained of loss of appetite, one patient complained of nausea and abdominal distention, and one patient suffered from lower limb edema. However, no similar symptoms and manifestations were found when vitamin C was used again, and no diarrhea, abdominal pain, dizziness and other symptoms was observed. Conclusions High-dose vitamin C has not been found in the treatment of advanced malignant tumor patients with adverse reactions and the security is good.
2018 Vol. 5 (4): 399-402 [Abstract] ( 401 ) HTML PDF (2330 KB)  ( 413 )
403 Application of single incision laparoscopic surgery plus one assist port (SILS+1-AP) for distal gastric cancer for accelerated rehabilitation surgery
1WEI Cheng, 1XIAO Jun,1TENG Wen-hao,2LIAO Ling-hong,
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.015
Objective To investigate the feasibility and advantages of single incision laparoscopic surgery Plus One Assist Port (SILS+1-AP) technique in accelerating rehabilitation surgery in patients with distal gastric cancer. Methods A retrospective collection of 90 patients with pT1-4aNXM0 distal GC underwent laparoscopic surgery, random matched according to 1:2, including 30 cases of SILS+1-AP group, and 60 example of traditional 5-hole endoscopy group (CLS). The intraoperative observation indexes (operative time, intraoperative blood loss, and incision length) were compared between the two groups. Postoperative observations (first time after surgery, first exhaust time, extraction time of abdominal drainage tube, pain score, hospitalization days, maximum tumor diameter, number of lymph node dissections, and pain score). Results The total incision length of the SILS+1-AP group was shorter, the time of the first grounding and exhaust time were earlier, the postoperative pain was lighter, and the postoperative hospital stay was shorter (all P<0.05). The postoperative discharge time of the SILS+1-AP group was smaller than that of the CLS group (P<0.05). On the second day, for the SILS+1-AP group, the total protein and albumin were higher than those in the CLS group, but the CRP index was lower than that in the CLS group (all P<0.05). Conclusions The SILS+1-AP technique has good operability and popularity. Under the premise of the same radical degree, this technology not only reduces postoperative somatic pain, but also restores time faster and shortens hospital stay. At the same time, the surgical strike is smaller and the protection of the patient's nutritional status is better.
2018 Vol. 5 (4): 403-406 [Abstract] ( 351 ) HTML PDF (1283 KB)  ( 291 )
407 Application of enhanced recovery after sugery in perioperative period of colorectal cancer patients  JIANG Wen-juan, XIA Jing, MA Xia
JIANG Wen-juan, XIA Jing, MA Xia
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.016
Objective To investigate the significance of applying the principle of enhanced recovery after sugery to the patients undergoing colorectal surgery in the perioperative period. Methods From August 2015 to March 2017 in our hospital 64 cases of patients with colorectal cancer were divided into observation group and control group, and accelerated rehabilitation and routine treatment were given respectively. The observation group underwent psychological guidance before operation, and the patients with malnutrition were given enteral nutrition therapy. Solid diet were forbidden for 6 hours before surgery, 12.5% maltodextrin fructose drink was given orally under the guidance of a professional nurse 2 hours before surgery; insulation measures were given during operation; multi-mode analgesia, and early feeding was encouraged after surgery, etc. The control group received conventional treatment, and compared the rehabilitation effects of the two groups. Results The initial exhaust time of the observation group was (1.99±0.40) days, the frist feeding time was (5.16±0.41) hours, the defecation time was (2.86±0.37) days, and the postoperative hospital stay was (5.73±0.82) days, the overall complication rate was 3.13%; the initial exhaust time of the control group was (3.08±0.40) days, the frist feeding time (11.28±0.66) hours, the defecation time (3.92±0.55) days, and the postoperative hospital stay (8.50±1.25) days, the incidence of postoperative complications was 18.75%, and the difference was statistically significant (P<0.05). Conclusion It is clinically feasible to apply the principle of enhanced recovery after sugery to the nursing care of the colorectal surgery patients because it can significantly release pains, reduce complication rate, shorten hospital stay and accelerate the recovery after surgery.
2018 Vol. 5 (4): 407-410 [Abstract] ( 397 ) HTML PDF (976 KB)  ( 403 )
411 The impact of nutritional status and adverse effects in enteral nutrition support for chemotherapy patients with gastric esophageal cancer
1XU Hui-jun, 2YANG Yang, 1HE Yi-fu
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.017
Objective To explore the influence of enteral nutrition support treatment on nutritional status, immune function and adverse effects in patients with gastric and esophageal carcinoma after chemotherapy. Methods Patients with gastric and esophageal cancer receiving chemotherapy in our department from January 2017 to January 2018 were successively collected. The patients were randomly divided into the enteral nutrition group and routine dietary group. According to the degree of obstruction, nutritional structure and intake of the patients, all of the patients received nutrition advice. Besides, enteral nutrition preparation was given two days before the beginning of chemotherapy and one week after the end of chemotherapy for the patients in enteral nutrition group. The indicators of nutritional status, biochemical, immune function and adverse effects (blood system and gastrointestinal side effects) were observed between the two groups. Results 56 patients were enrolled, among which, the enteral nutrition group 29, the normal diet group 26, the male 36, the female 20. After chemotherapy, nutritional status in the enteral nutrition group improved obviously. The level of white blood cells, serum albumin, hemoglobin, and CD4+/CD8+ in enteral nutrition group were increased significantly (P<0.05). Besides, the 3~4 degrees blood system adverse effects decreased significantly (P<0.05). Conclusions Enteral nutrition support can improve the nutritional status and immune function of patients with gastric esophageal cancer during chemotherapy, reduce the adverse effects after chemotherapy, and help to improve the quality of life of patients. Due to the small number of cases, the further studies are needed.
2018 Vol. 5 (4): 411-414 [Abstract] ( 472 ) HTML PDF (1059 KB)  ( 493 )
415 Application of body composition analysis using by bioelectrical impedance analysis within cancer patients
1CONG Ming-hua, 1ZOU Bao-hua,1 SONG Chen-xin, 2DAI Zhong, 2YAO Ke-qing, 3*SHI Han-ping
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.018
Objective Bioelectrical impedance analysis has been widely used in clinical for detecting the human body composition. In this study, two kinds of human body composition analyzer were used to determine the body composition of cancer patients, providing a reference for the clinical application of human body composition analyzer. Methods Nutrition risk screening was used by NRS 2002, nutrition assessment was used by PG-SGA , and the body composition of cancer patients were detected by both IOI 353 body composition analyzer and BCA-2A body composition analyzer. The linear regression method was used to analyze the consistency between the indicators from two instruments, including body weight, body mass index, bone mass, visceral fat grade, muscle mass, basal metabolism, body fat rate, and body water rate. Results There were 110 cancer patients included, and 48 of them (44%) with NRS 2002≥3. Besides, 61 of them (56%) had a level of class B, and 31 of them (28%) had a level of class C of PG-SGA. The correlation coefficient of paired quantitative data between the two instruments was more than 0.975. There was a good correlation between the two instruments, and there was no significant difference in the analysis of paired quantitative data (P>0.05), showing difference is equivalent relationship between two instruments. Conclusions Cancer patients had a high incidence of nutrition risk and malnutrition. Nutritional risk screening and nutritional assessment should be carried out as early as possible, different instruments of human body composition analyzer showed good equivalence.
2018 Vol. 5 (4): 415-418 [Abstract] ( 410 ) HTML PDF (950 KB)  ( 391 )
419 The consumption, metabolism and biological effects of capsaicin
WANG Xin, SHI Han-ping
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.019
Chili is a widely used flavoring food. The major active compounds of chili are Capsaicin. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a naturally occurring alkaloid derived from plants of the genus Capsicum. It is a highly volatile, pungent, hydrophobic, colorless and odorless white crystalline powder. Topical capsaicin in humans is rapidly and well absorbed through the skin. 85%~95% of capsaicin can be absorbed by a nonactive process from the stomach and whole intestine. Cytochrome P450 enzymes participate in the metabolism of capsaicin in liver, and a small part of capsaicin is hydrolyzed in the small intestine. Capsaicin is eliminated mainly by the kidneys, with a small untransformed proportion excreted in the feces and urine. Systemic administration of capsaicin involves both intravenous and subcutaneous methods. Capsaicin in the liver, brain and spinal cord was very high compared with the blood. Clinical trials have shown that capsaicin may have various biological activities, such as weight loss, anti-cancer, pain relief, protection of cardiovascular and gastrointestinal tract, and rely on TRPV1 receptor to exert various pathophysiological functions. However, as the most active ingredient in capsicum extract, the exact function of capsaicin is still controversial. Capsaicin may have different effects depending on the dosage of intake, and its metabolism in the body is unique. Our article aims to systematically review the consumption, metabolism and biological effects of capsaicin, which provides new experimental ideas for medicinal prospects of capsaicin in the future, and a theoretical foundation for the potential clinical value of capsaicin.
2018 Vol. 5 (4): 419-423 [Abstract] ( 765 ) HTML PDF (1035 KB)  ( 499 )
424 The relationship between fatty acids supplement and gut microbiota in patients with cancer
1XU Hui-li,2CHEN Shi-liang,3RAO Ke,1TANG Qiu
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.020
The incidence and mortality rate of malignant tumors in China are increasing year by year. The occurrence and development of malignant tumors, especially gastrointestinal tumors, are closely related to disorder of intestinal microenvironment. Fatty acids, especially essential fatty acids, are important nutrients for human growth and life support. Fatty acids are actively involved in the intestinal microbiota during digestion and absorption in the gastrointestinal tract. Disorders of fat metabolism are closely related to the intestinal microbiota, and are associated with gastrointestinal inflammation, increased permeability of intestinal wall and the entry of toxins into the body, to resulted in an immune response. Intestinal microbiota, through cross-reactions between pathogenic microorganisms and tumor antigens, form a T-cell reserve and/or microbial product that stimulates pattern recognition receptors, affect the type and intensity of the immune response. Through the effects on immunity, microbiota help to control of or escape from the immune response to distant tumors. Microbial-derived metabolites can also promote the development of local tumors through direct cell-independent carcinogenesis. There is a relationship between the intestinal microbiota-gut-brain axis or the microbial-intestinal-liver axis with the external organs of the gastrointestinal tract. The important role of fatty acid nutrition and intestinal microenvironment should be taken into account in the prevention and treatment of malignant tumor. Fatty acids may also be given through the parenteral pathway, depending on the patient's needs. Patients with advanced malignant tumors are often accompanied by malnourishment or heterogeneity. Supplementation of ω -3 polyunsaturated fatty acids can improve the physique of patients and contribute to the treatment of tumors. By supplementing probiotics or transplanting intestinal microbiota, the disorders of intestinal micriobiota can be fixed and play an important role in the prevention and treatment of tumor.
2018 Vol. 5 (4): 424-429 [Abstract] ( 396 ) HTML PDF (1097 KB)  ( 420 )
430 The development of retinoic acid metabolism and common digestive tract tumors
WU Han-han, WANG Chen, HU An-la, HU Chuan-lai
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.019
Retinoic acid (RA) is the most important metabolite of vitamin A, which plays crucial roles in cell differentiation, growth as well as maintaining the functions of immune and epithelial cells. All of these roles were achieved by binding to its specific receptors, then regulating the transcription of target genes, finally activating the downstream signal pathways. The homeostasis of RA concentration is maintained by vivo microenvironment, including the availability of retinol, transport factors and enzymes of RA metabolism. In China, digestive tract tumor, such as oropharyngeal cancer, esophageal cancer, gastric cancer and colorectal cancer, is a disease with high morbidity and mortality, which threatens to human health and reduces the quality of life. Recently, it was reported that aberrant expressions of RA metabolism enzymes and related factors exist in digestive tract tumor tissues. Several risk factors of digestive tract tumor, such as betel nut, Helicobacter Pylori and high fat diet, affected the expression and function of RA metabolism enzymes and related factors, which further influenced the downstream signal pathway regulated by RA and finally affected the occurrence and progress of digestive tract tumor. This review showed the research progress about the metabolism of RA and the association between the metabolism of RA and some common digestive tract cancers. It provides theoretical basis for the molecular mechanism research and nutrition prevention of digestive tract cancer.
2018 Vol. 5 (4): 430-435 [Abstract] ( 694 ) HTML PDF (1242 KB)  ( 604 )
436 Malnutrition in patients with chronic kidney disease
FENG Ling,TAN Guijun
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.022
The metabolic milieu in chronic kidney disease (CKD) is significantly altered due to renal functional decline (such as metabolic acidosis, dyslipidemia, insulin resistance), and metabolic acidosis is associated with increased protein catabolism in patients with CKD. Renal functional decline could also cause hormonal imbalance and it is implicated in the suppression of appetite in patients with CKD. In the end it leads to inadequate nutrient intake. The intestinal microbial flora is significantly altered in patients with CKD and plays a pathogenic role in the chronic inflammatory state seen in CKD. Chronic inflammatory state increases resting energy expenditure and catabolism. Protein-energy wasting, which essentially refers to decreased body protein mass and energy reserves, is common in advanced chronic kidney disease patients and end-stage kidney disease patients undergoing chronic dialysis. Increased protein catabolism, inadequate nutrient intake and increased resting energy expenditure and catabolism could lead to protein-energy wasting (PEW) in patients with CKD. Malnutrition can increase the risk of morbidity and mortality in children and adults with chronic kidney disease. Decreased appetite, reduced dietary intake, loss of nutrients in dialysis patients, hormone imbalance, inflammation, increased catabolism and other factors interact easily to cause malnutrition in patients with chronic kidney disease. A better understanding of pathophysiologic mechanisms of protein-energy wasting in patients with CKD might lead to the development of novel and effective therapies for malnutrition
2018 Vol. 5 (4): 436-439 [Abstract] ( 400 ) HTML PDF (961 KB)  ( 339 )
440 Role of fatty acid synthase in tumor cells
1LUO Yi-cheng, 2WANG Ji-chen
DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.023
Fatty acid synthase (FASN) is an important biosynthetic enzyme,and it is a key enzyme in tumor lipid production. It plays an important role in catalyzing fatty acid synthesis. FASN is overexpressed in many tumor cells but not in the corresponding normal cells. Accumulating evidence suggests that FASN is a metabolic oncogene playing an important role in tumor growth and survival. The specific metabolic phenotype was originally known as the Warburg effect. Abnormal fatty acid metabolism is related to the survival and invasiveness of cancer cells indicating that abnormal fatty acid metabolism provides the crucial components and energy sources of cancer cells. Its overexpression is associated with the occurrence, evolution, invasion and prognosis of tumors. The expression and activity of FASN in the metabolic pathway of fatty acids were observed in various tumors, and it is closely related to poor prognosis. By down-regulating the expression of these metabolic enzymes or using specific inhibitors, inhibiting the activity of metabolic enzymes can inhibit tumor growth. It is found that FASN inhibitors inhibit tumor recurrence and metastasis. By inhibiting the enzyme activity of FASN, it leads to lipid starvation of tumor cells, thus effectively inhibiting the proliferation of cancer cells, so that it can break away from the vicious cycle and go to apoptosis. Understanding the regulatory mechanism of FASN expression may help developing novel FASN inhibitors and may provide new therapeutic moieties for neoplasms therapy. The role of FASN and FASN inhibitors in tumor cell, is reviewed in this paper.
2018 Vol. 5 (4): 440-445 [Abstract] ( 679 ) HTML PDF (1845 KB)  ( 398 )
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