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2020 Vol. 7, No. 4
Published: 2020-12-09
 
381 Construction of malnutrition management system in hospital： an introduction to hunger-free hospital programme
Wang Li，Yang Liuqing，Li Suyun，Shi Hanping
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.001
 In “Healthy China 2030” planning outline and national nutrition plan (2017—2030), the important role of nutrition has been established in the construction of healthy China from the national policy level. In October 2018, to strengthen malnutrition management of patients, we took the lead in starting up the hunger-free hospital programme in China. We explored actively in constructing the hospital malnutrition management system, establishing the technical route of malnutrition management system, improving the multi-department linkage mechanism, standardizing diagnosis and treatment, implementing nutrition management standard strictly, improving the concept of nutrition management and establishing closed-loop nutrition management mechanism, and etc. After implementation of one year, we analyzed indexes such as ratio of dual diagnostic for cancer patients, ratio of nutritional risk screening, ratio of nutritional assessment for patients with positive nutrition risk screening, and ratio of nutritional consultation and nutritional treatment. We also focused on the medical documents records about nutritional screening, nutritional assessment and therapy. The proportion increased significantly. The indexes also suggest that simple enteral nutrition therapy and enteral nutrition therapy combined with nutrition consultation can reduce hospitalization costs and the incidence of postoperative complications. It can be concluded that the positive effect of  management  has emerged obviously through the innovation of nutrition treatment concepts, management models and mechanisms. Malnutrition management system has   achieved initial results. Malnutrition patients can benefit from the mode of hunger-free hospital programme. Hunger-free hospital programme is of great significance.
2020 Vol. 7 (4): 381-386 [Abstract] ( 404 ) HTML PDF (659 KB)  ( 367 )
387 Research progress on traditional Chinese medicine constitution of malnourished patients with malignant tumors
Jiao Jing, Zheng Jin, Zhao Canjun
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.002
Malnutrition is one of the most common complications of malignant tumors, which seriously harms the life and quality of life of patients. Malnutrition can directly lead to prolonged hospitalization of cancer patients, reduced sensitivity to anti-tumor therapy, increased complications, increased treatment costs, and reduced quality of life and survival rate. Malnutrition leads to serious physiological and biochemical changes in tumor patients, leads to treatment failure, decreases the quality of life and it is the root cause of deterioration. Therefore, it is of great significance to carry out standardized nutrition therapy for patients with malignant tumors. Tumor malnutrition belongs to the category of “invalid labor” in traditional Chinese medicine (TCM). It is treated according to the theories of “strengthening and consolidating body resistance” and “treating deficiency syndrome with tonifying methods”, and TCM has its unique advantages in the prevention and treatment of tumor malnutrition. TCM physiology is the basis for achieving individualized nutritional support for tumors. Combined traditional Chinese and western medicine nutritional therapy combined with traditional Chinese medicine physical fitness and nutritional support has a good clinical effect on patients with malignant tumor malnutrition, which can significantly improve the patients nutritional status, thereby improving the patients tolerance and sensitivity to treatment. At the same time, combined with the differences in the genetic constitution and metabolic types of different physical types, an individualized nutrition plan was formulated to provide new ideas for individualized comprehensive treatment of tumors.
2020 Vol. 7 (4): 387-390 [Abstract] ( 320 ) HTML PDF (535 KB)  ( 218 )
391 The potential role of sulforaphane in breast cancer, ovarian cancer and cervical cancer
Zhang Wei, Li Suyi
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.003
As our understanding of the genetic and environmental factors that glucosinolates accumulate in plants and the effects of these compounds and their derivatives has increased, so has our understanding of the role glucosinolates and their products may play in reducing the risk of cancer and heart disease when consumed as part of a diet. After absorption and distribution in the body, they will affect the general defensive mechanisms of the body, including the prevention and treatment of tumors.It has been found that the combination of these bioactive substances with traditional anti-tumor therapies can improve the effectiveness of anti-tumor therapy.Sulforaphane is a homologous isothiocyanate mainly found in brassica vegetables.Evidence shows that the intake of sulforaphane is significantly negatively correlated with cancers such as breast cancer and ovarian cancer. It may be that sulforaphane can regulate cell growth in addition to improving the detoxification and antioxidant capacity of cells, which is particularly important for cancer prevention.The mechanism of cell inhibition and cytotoxicity of sulforaphane includes induction of cell apoptosis, inhibition of cell cycle progression and inhibition of angiogenesis, targeting multiple sites of key cell signaling pathways of tumor cells, and playing an anti-tumor effect similar to that of targeted drugs.This review introduces the possible mechanism of sulforaphane in clinical adjuvant chemotherapy and radiotherapy for breast cancer, ovarian and cervical cancer, and provides theoretical clues for its clinical application in breast cancer and ovarian and cervical cancer.
2020 Vol. 7 (4): 391-395 [Abstract] ( 273 ) HTML PDF (443 KB)  ( 297 )
396 Research progress on lactatedehydrogenase and immunometabolism in cancer
Zhou Wenli, Miao Mingyong
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.004
The metabolic characteristics are different in different immune cell subsets. The immune cells in antitumor adaptive immunity mainly rely on aerobic glycolysis and glutamine catabolism to obtain energy and metabolites. Immunosuppressive cells in promoting cancer occurrence and progression can use the metabolites from cancer cells to get energy and intermediate products through fatty acid metabolism or other manners. As the critical product of glycolysis, lactic acid directly or indirectly affects the biological behavior of cancer and immunometabolism in tumor microenvironment. Lactate dehydrogenase （LDH） is a key enzyme connecting the metabolism of immune cells by lactic acid metabolism, generally with high expression in cancers, which regulates immune response and participates in carcinogenesis and development by activating some signal transduction pathway. It is identified as an important driver of immunosuppressive microenvironment. The increase of LDH level is mainly caused by the increase of glycolysis activity and hypoxia necrosis in cancer. To some extent, the levels of LDH can reflect and be used for the assessment of glycolysis activity and immune metabolism. However, the roles of LDH in immunometabolic regulation varies in different immune cells such as T lymphocytes, macrophages and dendritic cells. This paper reviews the researches on LDH and metabolism of these immune cells to explore the possible application in evaluating prognosis, predicting and monitoring efficacy of anti-tumor treatment, especially in cancer immunotherapy.
2020 Vol. 7 (4): 396-401 [Abstract] ( 614 ) HTML PDF (1239 KB)  ( 344 )
402 Research progress of drug therapy for cancer cachexia
Wang Lin
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.005
Cancer cachexia  mainly contains the gradual decrease of muscle mass, anorexia, fatigue, and impaired functional status, which seriously affects the quality of life and survival time of patients. Among them, gastrointestinal and pulmonary malignancies are the most common. Drug therapy plays an important role in the comprehensive treatment, but currently the more commonly used drugs, such as appetite stimulants and some drugs to control symptoms, have unsatisfactory efficacy. In recent years, many metabolic regulators, targeted drugs and traditional Chinese medicine have shown good efficacy and tolerance in the treatment of cancer cachexia, such as ghrelin analogues, which promote growth and anabolic metabolism, and monoclonal antibodies which inhibit catabolic metabolism. The treatment of cachexy requires comprehensive intervention of clinical multidisciplinary collaboration, which can be controlled and even reversed. We made a comprehensive review on the progression of current drug therapy for cancer cachexia.
2020 Vol. 7 (4): 402-406 [Abstract] ( 315 ) HTML PDF (455 KB)  ( 315 )
407 Research status of the mechanism of intestinal barrier function injury and its clinical detection methods
Yu Haobin,Zhang Xiaodan, Li Suyi
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.006
As the digestive organ of the body, the intestinal tract not only has the functions of digestion, absorption and peristalsis, but also has the functions of endocrine, immune regulation and mucosal barrier. The intestinal barrier function under physiological conditions can digest and absorb nutrients, effectively prevent the internal environment from being harmed by harmful substances, ensure the stability of internal environment, it consists of mechanical barrier, immune barrier, chemical barrier and biological barrier. The mechanism of intestinal barrier function damage is complex, and a variety of clinical factors can directly or indirectly damage intestinal barrier function, including severe infection, trauma, burn, intestinal obstruction, acute pancreatitis, severe malnutrition, severe blood loss, fluid loss, long-term application of broad-spectrum antibiotics or immunosuppressive agents, ionizing radiation,  radiotherapy, chemotherapy, etc. These factors can lead to impaired intestinal barrier function in one or more ways, causing vertical translocation of intestinal pathogenic microorganisms and their metabolites into the blood through the portal vein and lymphatic system, causing bacteremia and toxaemia, and in severe cases, leading to systemic inflammatory response syndrome and multi-system organ failure. At present, the level of D-lactic acid, diamine oxidase and endotoxin in blood are mostly used to evaluate the intestinal barrier function. Attention should be paid to the treatment of intestinal barrier dysfunction in clinical work. In this paper, the mechanism, diagnosis and treatment of intestinal barrier and its injury are reviewed.
2020 Vol. 7 (4): 407-414 [Abstract] ( 292 ) HTML PDF (1111 KB)  ( 270 )
415 Expert consensus on nutritional therapy for patients with endometrial cancer
Chinses Society of Nutritional Oncology
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.007
Endometrial cancer accounts for 20%-30% of malignant tumors of the female reproductive system. Since 2008, endometrial cancer has become the most common malignant tumor in the female genital tract, and in 2012, it ranked the 5th among female malignant tumors. Different from gastrointestinal cancer, endometrial cancer has a low incidence of cachexia. On the contrary, About 68% of patients with early-stage endometrial cancer were obese, with higher rates of obesity or overweight. Obese endometrial cancer patients were more likely to be associated with metabolic diseases, which increased the risk of death. Obese patients with endometrial cancer had a higher incidence of surgery-related complications. Abnormal chemotherapeutic drug metabolism affects the efficacy of obese endometrial cancer patients. Therefore, individualized nutritional assessment and nutritional intervention in patients with endometrial cancer should be paid more attention.
2020 Vol. 7 (4): 415-417 [Abstract] ( 373 ) HTML PDF (375 KB)  ( 543 )
418 Expert consensus on nutritional therapy for patients with ovarian cancer
Chinses Society of Nutritional Oncology
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.008
Ovarian cancer is one of the most common malignant tumors in women, ranking the 5th among the causes of tumor-related death in women. About 70% of newly diagnosed patients and 85% of recurrent patients may be associated with peritoneal metastasis. Ovarian cancer leave the body in a state of high decomposition, which increases the risk of malnutrition, and 23 percent of patients are diagnosed with cachexy. Nutritional status of ovarian cancer patients may be associated with prognosis. Regular assessment helps to assess the nutritional status of patients with ovarian cancer in a comprehensive and accurate manner. Obese women have a higher mortality rate from ovarian cancer, overweight or obese ovarian cancer patients should control their weight, exercise and nutrition treatment can help improve patient survival.
2020 Vol. 7 (4): 418-420 [Abstract] ( 444 ) HTML PDF (406 KB)  ( 473 )
421 Compilation and reliability and validity test of nutrition belief-appetite-function scale for cancer patients
Zhao Wenzhi, Ji Linlin, Yu Kaiying, Zhang Xiaowei, Zhang Bingdong, Wang Xin, Zhang Zhanzhi, Shi Hanping
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.009
ObjectiveTo develop a nutritional risk screening scale of cancer patients containing assessments of nutrition belief, appetite, and physical function, and to test its reliability and validity. MethodsThe evaluation dimensions were determined on the basis of literature review, patients interview, and research group discussion, and then the items pool was formed. The initial scale was developed by Delphi expert advisory. A total of 104 cancer patients in Beijing Shijitan Hospital were selected as subjects. The reliability and validity of the scale were tested. ResultsThe final nutrition belief-appetite-function (BAF) scale included the following 3 dimensions: nutritional belief, appetite, and physical functions, and 13 items. In the item analysis, the correlation coefficients with the total points of the scale and the Critical ratio (CR) of every item met the preset standards, without deleting any items. The split-half reliability of the BAF scale was 0.750, from 0.590 to 0.847 of each dimension. The Cronbachs α coefficient of the BAF scale was 0.806, from 0.631 to 0.866 of each dimension. The retest reliability coefficient was 0.784, from 0.588 to 0.721 of each dimension. The correlation coefficients of each dimension with the total points of the scale were from 0.539 to 0.890, and all were significant. Exploratory factor analysis (EFA) extracted 2 factors, whose cumulative contribution of variance accounted for 56.36%, and 2 items were deleted. The total points of the scale and the points of each dimension were all positively correlated with Nutritional risk screening 2002 (NRS 2002). ConclusionThe BAF scale has good reliability and validity. The scale can be used as a screening tool for evaluating the nutritional risk of cancer patients.
2020 Vol. 7 (4): 421-427 [Abstract] ( 558 ) HTML PDF (536 KB)  ( 396 )
428 Randomized controlled trial of application of antibiotic lock technique in preventing implantable venous access port-related infection in infants
Yu Haijiao, Zhu Yubing, Li Wenxia, Zhao Aimin, Ding Lei, Gao Hong, Ma Ling
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.010
Objective This research was designed to explore the effect of antibiotic lock technique (ALT) in preventing implantable venous access port (IVAP)-related infection in infants with malignant tumors. MethodsSixty infants with neurological malignant tumors were underwent implantation of IVAP by the same surgical team in our hospital. They were randomly divided into two groups. Prophylactic cefuroxime mixed with heparin saline was used as the seal liquid in 30 infants after the implantation, and the same volume of heparin saline was applied in the other 30 infants. All the patients were followed to observe whether there was IVAP-related infection within one month. The differences between two groups were compared and the risk factors for IVAP were investigated. ResultsThe general characteristics had no significant difference between two groups. Only one infant got infection in the ALT group (3.33%), while four infants developed infection in the control group (13.33%). Although the difference between two groups was not statistically significant (P=0.353). No significant independent risk factor for IVAP was revealed by the present study. ConclusionThe application of ALT in the IVAP implantation might be an effective method to decrease the infection rate in infants with malignant tumors to a large extent, but it still needs a large sample of research to confirm the clinical effect.
2020 Vol. 7 (4): 428-432 [Abstract] ( 307 ) HTML PDF (476 KB)  ( 227 )
433 The effect of oligopeptide-enhanced maltodextrin fructose solution on accelerated rehabilitation surgery in gastric cancer patients
Liu Gang, Shen Yang
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.011
ObjectiveTo investigate the effect of oligopeptide strengthening maltodextrin fructose solution on the clinical effect of accelerated rehabilitation surgery in gastric cancer patients. MethodsUsing the random number table method, 110 patients with gastric cancer who underwent radical gastric cancer surgery at  the Affiliated Huaian NO.1 Peoples Hospital of Nanjing Medical University from October 2017 to December 2019 were randomly divided into a control group and a combined group, with 55 cases in each group. The patients in the control group were given routine diet instruction and comprehensive intervention, the patients in the combined group were given 12.5% maltodextrin fructose drinks and egg membrane active peptide during the perioperative period based on the control group. The postoperative rehabilitation effect between the two groups were compared. ResultsCompared with the control group, the total amount of intraoperative fluid infusion in the combined group was significantly reduced, and the first ventilation time, defecation time, intravenous infusion time, hospitalization time and total hospitalization cost were significantly reduced (P<0.05). The levels of albumin, total protein, prealbumin and hemoglobin in the combined group were significantly higher than those in the control group (P<0.05). The incidence of postoperative infection in the combined group was lower than that in the control group, but the difference was not statistically significant (P>0.05). There were significant differences in the quality of life core 30 questionnaire (QLQ-C30) score of European Organization for research and treatment of cancer (EORTC) scores between the combined group and the control group after operation, except in the field of cognitive function (P<0.05). Conclusion ERAS combined with oligopeptide-enhanced intervention can increase the energy and nitrogen reserve of patients under the condition of fasting, it can further promote their subjective feelings during the perioperative period and nutritional status in the near future, which is conducive to the overall rapid recovery and improvement of quality of life.
2020 Vol. 7 (4): 433-437 [Abstract] ( 337 ) HTML PDF (516 KB)  ( 199 )
438 The clinical value of modified Glasgow prognosis score in predicting the prognosis of advanced pancreatic cancer
Liu Yiqian,Wang Jian,Liu Lingxiang, Shu Yongqian
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.012
ObjectiveTo investigate the effect of modified Glasgow prognosis score (mGPS) on the survival of patients with advanced pancreatic cancer, and to evaluate its potential clinical value in the prognosis of advanced pancreatic cancer. MethodsThe clinical data of 56 patients with advanced pancreatic cancer treated in the Department of oncology and gastroenterology, the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2018 were retrospectively analyzed. The relationship between mGPS, clinical features and prognosis was analyzed. Kaplan Meier method was used to draw survival curve, log-rank was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis to analyze the prognostic factors affecting poor prognosis of patients with advanced pancreatic cancer. Results Among the 56 patients, 32 were male and 24 were female. There were 29, 21 and 6 patients with mGPS score of 0, 1 and 2 respectively. Univariate analysis showed that age ≥ 65 years (P=0.035), high mGPS score (P<0.001) and no chemotherapy (P<0.001) were risk factors for OS in patients with advanced pancreatic cancer. Further multivariate Cox regression analysis showed that age ≥ 65 years (P=0.021), mGPS score of 2 (P<0.001) and non chemotherapy (P<0.001) were independent poor prognostic factors of advanced pancreatic cancer. Conclusion mGPS has important clinical significance in evaluating the prognosis of patients with advanced pancreatic cancer. High mGPS score indicates poor prognosis.
2020 Vol. 7 (4): 438-442 [Abstract] ( 317 ) HTML PDF (536 KB)  ( 197 )
443 Evaluation of a simple diet self-assessment tool(SDSAT) in esophageal cancer patients after operation
Yu Yuan, Li Min, Cong Minghua
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.013
Objective  This study aimed to evaluate the reliability and validity of the simple diet self-assessment tool (SDSAT) among esophageal cancer patients after operation. Methods  Three studies were conducted to measure the interrater reliability, test-retest reliability and predictive validity separately. Sixty patients were involved in study A prior to operation to be measured by 2 researchers with SDSAT separately in order to get the interrater reliability of SDSAT. Thirty patients were involved in study B 1month after operation to be measured with SDSAT. Two weeks later, they were be measured again to get the test-retest reliability. The predictive validity was established by exploring the impact of the score of SDSAT on prealbumin among 171 esophageal cancer patients in study C which was a longitudinal observational study measured 3 points including before operation, 1month after operation and 3months after operation. Results  The interrater reliability of SDSAT was 0.854(P<0.01). Test-retest reliability was 0.782(P<0.01). Generalized estimating equation(GEE) showed that the score of SDSAT had a significant impact on prealbumin(P<0.01), which demonstrated good predictive validity. Conclusion   The SDSAT demonstrated favorable reliability and validity. It is appropriate for estimation of dietary intake among esophageal cancer patients.
2020 Vol. 7 (4): 443-447 [Abstract] ( 296 ) HTML PDF (424 KB)  ( 277 )
448 Meta-analysis of the use of oral nutritional supplements containing omega-3 fatty acids for patients with cancer cachexia
Li Ting, Zeng Jun, Deng Hongfei, Wang Yu, Jiang Hua
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.014
Objective  To systematically evaluate the clinical efficacy of oral nutritional supplements of omega-3 fatty acids in patients with cancer cachexia. Methods  PubMed, EMbase, SinoMed, Web of Science, CNKI and Wanfang Data databases were comprehensively searched to collect randomized controlled trial on oral nutritional supplements containing omega 3 Fatty Acids for cancer cachexia from January 1, 2000 until July 4, 2020. Two reviewers independently screened literature based on inclusion and exclusion criteria, and then evaluated the risk of bias and literature quality of the included studies in accordance with the Cochrane Handbook of Systematic Reviews of Interventions and the modified Jadad scoring scale. Finally, meta-analysis was performed using Revman 5.3 software. Results  A total of 316 potential related articles were searched and 54 articles were obtained after preliminary screening. Finally, we determined a total of 7 randomized controlled trials (RCTs) involving 901 patients. The result of meta-analysis showed that: compared with placebo group, oral nutritional supplements containing omega 3 Fatty Acids significantly put on weight (MD=2.4kg, 95%CI=2.26-2.53, P<0.001) and improve the quality of life(MD=4.71, 95%CI=3.99-5.42, P<0.001). However, lean body mass showed no statistically significant difference between the two groups(MD=﹣0.79, 95%CI=-2.09-0.51), P=0.23)；Qualitative analysis of survival time showed that ONS containing omega-3 fatty acids could not delay the course of cachexia and prolong the survival time of patients. Conclusion   Oral nutritional supplements containing omega-3 fatty acids have the potential to improve the quality of life in patients with cancer cachexia.
2020 Vol. 7 (4): 448-454 [Abstract] ( 304 ) HTML PDF (2467 KB)  ( 262 )
455 Study on energy expenditure of inpatients with digestive tract cancer
Chen Lijun, Liao Xin, Yu Jinlong, Zhou Qi, Shi Xia, Tu Ling, Zeng Yuan, Yuan Qiaoying
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.015
Objective  To evaluate the energy consumption of patients with digestive tract cancer, and to explore the optimal calculation formula and the influencing factors of energy consumption. Methods  The patients in the oncology department of our hospital from March 2016 to December 2016 were consecutively enrolled in this study. The resting energy expenditure(REE) was measured by the metabolic cart. The 30kcal/(kg·d) coefficient and Harris-Benedict equation were used to predict the total daily energy expenditure (TEE) of patients. The related indices such as age, height, weight, course of disease, location of primary tumor and so on were collected. Results  There was a total of 26 patients, including esophageal cancer(n=11), gastric cancer(n=8), and colorectal cancer(n= 7). 73% of the patients were in a state of high metabolism, about 69% of patients are in tumor stage Ⅳ. The course of disease, treatment times and tumor stage were positively correlated with REE and were statistically significant. The estimation of TEE by 30kcal/(kg·d) formula multiplied by body weight may not be suitable for the patients who was wasted. Conclusion   Most of the digestive tract cancer patients were malnourished and in a state of high metabolism. When providing energy to the patients, we should properly consider whether or not to bear the tumor, the course of the disease, the frequency of treatment, tumor stage and tumor location. Using metabolic carts to estimate the TEE of digestive tract cancer patients is recommended. If a metabolic cart is not available, and the patients are not bedridden, if the BMI was≥18.5kg/m2, the TEE can be estimated by the equation that 30kcal/(kg·d) multiplied the actual body weight, when the BMI was<18.5kg/m2, the equation that 30kcal/(kg·d) multiplied the standard body weight is recommended.
2020 Vol. 7 (4): 455-459 [Abstract] ( 293 ) HTML PDF (412 KB)  ( 207 )
460 Risk factors and targeted precaution of gastric retention in patients after esophageal cancer surgery receiving enteral nutritional
Xin Miao, Tang Xinyan
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.016
To observe the risk factors and targeted precaution of gastric retention in patients after esophageal cancer surgery receiving enteral nutritional. Methods  Retrospective analysis of the incidence and time of enteral nutrition in 165 cases after esophageal cancer surgery were performed. The data were compared using single factor and multivariate analysis methods to investigate and analyze the factors that may affect gastric retention. Results  The incidence of gastric retention in patients after esophageal cancer operation receiving enteral nutrition was 21.21%. Chi-square test or t-test was used to screen the relevant factors of gastric retention. The results found that the main related factors were hypotension, hypokalemia, constipation, hyperglycemia, infection, electrolyte disturbances （P<0.05）. Furthermore, multivariate analysis using logistic regression analysis found that hyperglycemia, hypokalemia, constipation, and electrolyte disturbance were risk factors of postoperative gastric retention in patients with esophageal cancer after enteral nutrition （P<0.05）. Conclusion  The incidence is high of gastric retention after esophageal cancer surgery receiving enteral nutritional. Hyperglycemia, hypokalemia, constipation, and electrolyte disturbances were the risk factors of postoperative gastric retention. It is necessary to take the precaution to reduce the risk.
2020 Vol. 7 (4): 460-464 [Abstract] ( 289 ) HTML PDF (463 KB)  ( 208 )
465 Effects of different nutritional approaches on the nutritional status of patients with esophageal cancer during perioperative period
Yu Jingjing, Gu Runhuan, Li Xiaojie, Liu Hong
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.017
Objective  To explore the effects of enteral nutrition and parenteral nutrition on the nutritional status and complications of patients with esophageal cancer during perioperative periodMethods  73 patients with esophageal cancer during perioperative period treated in the Second People's Hospital of Huai'an from January 2017 to June 2018 were retrospectively analyzed. They were divided into 23 cases in total parenteral nutrition (TPN) group and 50 cases in total enteral nutrition (TEN) group according to different ways of nutrition intervention. The TPN group was given intravenous nutritional, and the TEN group was given enteral nutritional via a nasal feeding tube (through the nose to the beginning of the jejunum). The nutritional and immune indexes, postoperative intestinal function and safety indexes in the two groups were compared.Results  There was no significant difference in the weight loss, serum albumin and lymphocyte group between the two groups of patients on admission (P>0.05). The comparison of serum albumin and lymphocyte counts in the TPN group, and the comparison of lymphocytes in the TEN group at different time points showed statistically significant differences (P<0.05). The weight loss of TEN group was lower than that of TPN group, and the difference was statistically significant；Serum albumin at 72h and 120h after the surgery in the TEN group was lower than that in the TPN group, the lymphocytes at 120h after the surgery in the TEN group were higher than that in the TPN group, and the differences were statistically significant (P<0.05)；The recovery time of anal exhaustion and bowel sounds in the TEN group were shorter than those in the TPN group, and the differences were statistically significant (P<0.05). There was no significant difference in safety between the two groups (P>0.05).Conclusion   For perioperative patients with esophageal cancer, total enteral nutrition is generally better than total parenteral nutrition, but total parenteral nutrition can quickly increase serum albumin levels.
2020 Vol. 7 (4): 465-468 [Abstract] ( 289 ) HTML PDF (404 KB)  ( 220 )
469 Effects of levocarnitine on nutritional status and adverse reactions in colorectal cancer patients during adjuvant chemotherapy
Hu Gang, Yang Jianwu, Huang Zhen, Zhou Yinghao, Gao Ran, Yang Heming
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.018

 Objective  To investigate the protective effect of levocarnitine on nutritional status and adverse reactions in patients with colorectal cancer during adjuvant chemotherapy. Methods   Patients with colorectal cancer who received mFOLFOX6 chemotherapy in our department after surgery were randomly divided into the observation group (use levocarnitine) and  the control group. Detection (T0), 4 cycles of chemotherapy before the chemotherapy (T1) and 8 cycles (T2) patients after nutrition index, index of blood, the evaluation of degree of bone marrow suppression and gastrointestinal toxicity and peripheral nerve toxicity, and analyzed. Results   There was no significant difference in body mass index (BMI), peripheral blood hemoglobin (Hb), peripheral blood lymphocyte (PBL) and serum albumin (ALB) between the two groups at T0. The content of Hb and PBL in peripheral blood of T1 observation group was higher than that of control group, and the difference was statistically significant (P<0.05). The difference between BMI and ALB were not statistically significant (P>0.05). The difference between White blood cell (WBC) and platelet (PLT) was not statistically significant, and the gastrointestinal toxicity and peripheral neurotoxicity were not statistically significant. At T2, the contents of Hb, PBL and ALB in peripheral blood of patients in the observation group were higher than those in the control group, and the differences were statistically significant (P<0.05), while the differences in WBC in peripheral blood were statistically significant (P<0.05). The differences in gastrointestinal toxicity were statistically significant (P<0.05), while the differences in BMI, peripheral blood PLT content and neurotoxicity were not statistically significant (P>0.05). Conclusion   Levocarnitine can better maintain the nutritional status of patients, alleviate the reduction of neutrophils, and reduce the gastrointestinal toxicity of patients during adjuvant chemotherapy after colorectal cancer surgery, which is helpful for the maintenance of treatment.
2020 Vol. 7 (4): 469-473 [Abstract] ( 260 ) HTML PDF (430 KB)  ( 178 )
474 The efficacy and prognosis of early enteral immunonutrition in postoperative patients with gastrointestinal cancer
Liu Xiaofei, Luo Hongyu, Li Guoquan, Guo Chaohui, Zhang Jingyi
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.019
Objective  To investigate the effect of early enteral immunonutritional nutrition (EIN) support therapy on postoperative clinical efficacy and prognosis of patients with gastrointestinal cancer. Methods  Eighty postoperative patients with gastrointestinal cancer admitted to our hospital from January 2015 to December 2018 were randomly divided into the experimental group and the control group according to the random number method, with 40 patients in each group receiving early enteral nutrition support treatment in the experimental group and total parenteral nutrition support treatment in the control group, to observe the clinical efficacy of the two groups of patients, including serum total protein (TP), serum prealbumin (PA), albumin (ALB), transferrin (TF) and other nutritional status, humoral immune indicators (IgM, IgA, IgG and IgG) cellular immune indicators (CD3+, CD4+, CD8+) and other immune functions, gastrointestinal function, the prognosis of postoperative gastrointestinal complications in the two groups was compared after 1 year of follow-up. Results  After early postoperative enteral immunonutritional nutrition treatment, TP, PA, ALB, TF levels, IgM, IgA, IgG levels, CD3+, CD4+ levels in the Experimental group were significantly higher than those before treatment and the control group, and CD8+ levels were significantly lower than those before treatment and the control group, with statistically significant differences (P<0.05). Compared with the control group, the experimental group’s first exhaust time, first defecation time, first feeding time, bowel sound recovery time and hospitalization time were significantly shortened (P<0.05)；the incidence of postoperative gastrointestinal complications in the experimental group was significantly lower than that in the control group, with statistically significant difference (P<0.05). Conclusion  The clinical effect of early enteral immunonutritional nutrition support treatment after gastrointestinal cancer is significant, which can improve the nutritional status and immune function, promote the recovery of gastrointestinal function, reduce the occurrence of gastrointestinal complications, and effectively improve the prognosis of patients.
2020 Vol. 7 (4): 474-478 [Abstract] ( 232 ) HTML PDF (428 KB)  ( 211 )
479 Effect of neoadjuvant chemotherapy combined with nutritional support in patients with primary lung cancer
Zhang Li, Xue Jing
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.020
Objective  To explore the effect of neoadjuvant chemotherapy (NAC) combined with nutritional support in patients with primary lung cancer, and to provide a reference for its clinical research. Methods  Eighty-eight patients diagnosed with primary lung cancer were selected as the research subjects. All patients were treated with NAC. They were divided equally into observation group and control group by random number method. The control group was given conventional diet and the observation group was given nutrition support treatment. The differences in nutritional status (including total protein, albumin, and prealbumin), lung function, and T cell subsets were compared before NAC and after 4 courses of treatment. Results  After NAC, the nutrition index level of the control group was lower than that before NAC, and the difference was statistically significant (P<0.05)；the nutrition index of the observation group after NAC was higher than that of the control group (P<0.05). After NAC, FEV1, MVV, V/Q, and RV/TCL in the control group were lower than before NAC (P<0.05)；V/Q and RV/TCL in the observation group after NAC were lower than before NAC (P<0.05)；The FEV1, MVV and V/Q of the group were higher than those of the control group (P<0.05)；the RV/TCL of the observation group after NAC was lower than that of the control group (P<0.05). CD4+/CD8+in the observation group after NAC was lower than before NAC (P<0.05)；CD4+, CD4+/CD8+in the control group after NAC were lower than before NAC (P<0.05)；CD4+, CD4+/CD8+in the observation group after NAC were higher than the control Group (P<0.05). Conclusion  Nutritional support can significantly improve the nutritional decline caused by NAC treatment in patients with primary lung cancer, reduce lung function damage caused by chemotherapeutic drugs, and ensure that patients have better immune function, which is worthy of clinical application.
2020 Vol. 7 (4): 479-483 [Abstract] ( 210 ) HTML PDF (455 KB)  ( 192 )
484 Progress of perioperative immunonutrition therapy for gastric cancer
Wang Miaozhou, Liu Yi, Zhao Junhui, Chai Haipin, Lu Na, Zhang Tao
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.021
Immunity is a physiological function to ensure human health. At present, human beings have experienced four stages in their understanding and development (empirical immunology, scientific immunology, modern immunology, applied immunology). Among them, in the application of immunology stage, derived a lot of branches, such as: immunotherapy, immune prevention and immune nutrition. With the emergence of immunotherapy in malignant tumors, it not only proves its feasibility and importance in the treatment of malignant tumors, but also makes people extend this idea to solve the problem of malnutrition in tumor patients. This method of regulating immunotherapy for malnutrition is called “immunonutrition therapy” and has been developed rapidly in clinical practice in recent years. Among them, gastric cancer has the highest incidence of malnutrition, and the development of immunonutrition therapy in gastric cancer has attracted much attention. It is hoped that this treatment can reduce perioperative adverse clinical outcomes, prolong patients overall survival, and improve patients quality of life. In this paper, the mechanism of malnutrition in patients with gastric cancer, the role of immune nutrition in maintaining intestinal barrier, and the application, mechanism and efficacy of common immunonutrients in patients with gastric cancer during perioperative period were reviewed, so as to provide clinical reference for the treatment of immune nutrition in patients with gastric cancer during perioperative period.
2020 Vol. 7 (4): 484-489 [Abstract] ( 273 ) HTML PDF (599 KB)  ( 228 )
490 Research progress of antitumor effects and mechanisms of selenite
Li Yushan, Zhou Lan
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.022
Selenium is an important trace element required by the human body and is closely related to human health and diseases.In recent years, selenium and its compounds have attracted widespread attention for their highly selective cytotoxicity against tumor cells. Selenite, as the most common and studied inorganic selenide in nature, is generally regarded as a pro-oxidant to kill tumor cells. Selenite can react with intracellular thiols to mediate the production of reactive oxygen species, oxidize sulfhydryl groups in related proteins involved in metabolism, transcription, signal transduction, and change its biological activity to inhibit tumor cell proliferation, but its effects of anti-cancer are far more than that. Studies have reported that selenite can regulate these mechanisms to play a role in tumor suppression： inhibiting related enzyme activities and regulating metabolic genes to interfere with tumor nutrient metabolism, activating endogenous and exogenous apoptosis pathways, regulating the epigenetic modification of tumor suppressor genes or oncogenes, being converted into endogenous selenium nanoparticles to mediate cytotoxicity, stimulating immune cells division and activation and assisting in identifying tumor antigens, etc. Further strengthening the research and understanding of the anti-tumor effect of selenite can not only provide certain evidence for the development of new clinical drugs, but also provide new treatment ideas for clinical oncologists, which is of great significance for improving the effect of tumor treatment. This review aims to summarize the research progress of the antitumor effects and mechanisms of selenite.
2020 Vol. 7 (4): 490-496 [Abstract] ( 285 ) HTML PDF (3001 KB)  ( 316 )
497 Research progress of QCT in quantitative diagnosis of cancer cachexia syndrome and evaluation of curative effect
Chen Dong, Wang Chuanbin, Shi Bin, Gao Fei, Dong Jiangning
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.023
The changes in body composition of cancer patients during treatment are affected by many factors and are closely related to the poor prognosis of patients. Patients with advanced malignant tumors are often accompanied by cachexia, which seriously affects the patients quality of life and prognosis. The pathogenesis of cancer cachexia has not been elucidated. Changes in the body composition of patients with early cancer cachexia often have certain hints and early warning significance for the clinicians. In the past, the BMI was used to assess cachexia, ignoring changes in muscle fat content and abnormal fat infiltration, and it was impossible to accurately quantify body components. Quantitative computed tomography (QCT) can comprehensively, accurately and efficiently quantify the patients muscle density, bone mineral density (BMD) and body fat content, etc. which can be used as relevant indicators for evaluating the patients nutritional status, and those relevant information has great advantages in evaluating cancer cachexia. The author summarizes quantitative diagnosis of cachexia and the application progress of QCT in evaluating the efficacy of cancer treatment based on changes in body composition are reviewed, aiming to improve the application value of QCT in the diagnosis and efficacy evaluation of cancer cachexia.
2020 Vol. 7 (4): 497-501 [Abstract] ( 322 ) HTML PDF (432 KB)  ( 240 )
502 Nutrition and physical activity in the prevention and treatment of sarcopenia: a systematic review
Yang Jing, Zhu Cuifeng
DOI: 10.16689/j.cnki.cn11-9349/r.2020.04.024
Sarcopenia is a progressive, systemic skeletal muscle disorder associated with aging, with reduced skeletal muscle mass and loss of muscle strength or muscle function as its primary manifestations, and is associated with an increased risk of weakness, falls, functional decline, and death. It is largely attributed to aging, but also includes other high-risk factors such as cancer, osteoarthritis, neurological disorders, decreased activity, inadequate or malabsorbed nutritional intake, drug-related anorexia, overnutrition, or obesity. The diagnostic process for sarcopenia is FACS: Find—Assessment — Confirmation — Severity. Scientific nutritional and exercise interventions have a significant positive effect on the prevention and treatment of sarcopenia, which can improve skeletal muscle mass, function and balance to varying degrees. Adequate energy intake, supplementation with leucine-rich protein, vitamin D, omega-3 polyunsaturated fatty acids, prebiotics, probiotics and combination with resistance exercise and aerobic exercise can slow, improve and even reverse sarcopenia. This article reviews the definition, diagnosis, pathogenesis, nutrition and physical activity in the prevention and treatment of sarcopenia, with a view to strengthening clinicians understanding of sarcopenia, and providing a basis for the prevention and treatment prescription of Sarcopenia in China.
2020 Vol. 7 (4): 502-505 [Abstract] ( 349 ) HTML PDF (432 KB)  ( 440 )
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