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Current Issue
2021 Vol. 8, No. 3
Published: 2021-06-09
225
Implementation and thinking of the first⁃line nutrition treatment in cancer patients
Li Tao,Lyu Jiahua
Malnutrition in cancer patients restricts the treatment and prognosis. In the past 10 years, with the great attention of our country, a large number of scholars in China began to pay attention to the nutrition therapy of cancer patients, and cancer nutrition developed rapidly and made remarkable progress. However, cancer nutrition in China is also facing great challenges. Although the concept of nutrition first⁃line treatment has been accepted by more and more oncologists, there are still many difficulties in its implementation. According to the current situation of nutrition treatment in cancer patients, combined with the clinical practice experience of the first⁃line nutrition treatment, starting from the systematic construction of the classification system of cancer nutrition treatment, this paper proposes to formulate refined treatment paths and guidelines, improve the clinical nutrition work system, improve nutrition laws and regulations, and clarify the responsibilities of nutrition treatment subjects, so as to establish a nutrition diagnosis and treatment standard system with the characteristics of cancer patients in China. It also advocates promoting the standardization, refinement and diversification of China′s "Hospital ⁃ Community ⁃ Home" nutrition management mode, food for special medical purpose and therapeutic diets for special medical purposes, and then calls for increasing investment in basic and clinical research of cancer nutrition, so as to enhance the research ability of cancer nutrition.
2021 Vol. 8 (3): 225-231 [
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Advances in understanding the relationship between the dietary inflammatory index and metabolic diseases
Zhu Sirui, Chong Feifei, Xu Hongxia
Chronic systemic inflammation plays an important role in the development of metabolic diseases such as cardiovascular metabolic diseases, diabetes, non⁃alcoholic fatty liver disease, and cancer. Diet is an important factor that regulates body′s inflammatory status. In recent years, a literature⁃derived, population⁃based dietary inflammatory index (DII) was developed to provide a tool that could be used to assess the inflammatory potential of an individual′s diet. A large body of research has thus recently emerged about the associations between the DII and the risk of metabolic diseases. The DII was based on the literature on dietary composition and inflammation published between 1950 and 2014. Articles were scored according to their effects on six inflammatory biomarkers: IL⁃1β, IL⁃4, IL⁃6, IL⁃10, TNF⁃α and C⁃reactive protein. According to a composite global database of foods and nutrients consumption from 11 representative countries on four continents, individuals′ intakes to be expressed relative to the range of intakes of the forty⁃five food parameters, then the final DII score were calculated. In this review, we summarize the development and scoring of the DII, as well as recent advances in understanding the relationship between the DII and metabolic diseases such as cardiovascular metabolic diseases, diabetes, and cancer.
2021 Vol. 8 (3): 232-239 [
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An overview of the effect of quinoa on regulating blood glucose and its mechanism
Chen Meicui, Du Hongzhen, Li Zengning
Quinoa is a kind of nutritious fake grain, which has the characteristics of low sugar, low starch, low fat and so on. Because the essential amino acid composition of quinoa is close to that of the human body, it is a source of high quality protein, and quinoa is rich in antioxidants such as vitamin C, E, saponins, polyphenols and flavonoids to reduce postprandial blood sugar in patients with diabetes. it plays an important role in improving overweight/obesity, reducing blood lipids, reducing the risk of cardiovascular disease, anti⁃inflammation, anti⁃tumor and so on. Among them, quinoa plays a particularly prominent role in regulating blood sugar. In recent years, human and animal experiments have shown that quinoa diet can alleviate the increase of postprandial blood glucose and improve glucose tolerance. Quinoa regulates blood glucose mainly by slowly releasing glucose, reducing the burden of insulin secretion, promoting islet cell activity, improving insulin resistance, improving glucose metabolism, improving intestinal microflora and so on. In addition, quinoa also reduces diabetes risk factors by reducing blood lipids, improving overweight or obesity, reducing inflammation and other potential health benefits. This paper mainly describes the nutritional value of quinoa, the effect and mechanism of quinoa on blood glucose regulation, as well as other potential health benefits, so as to provide a basis for further research and development.
2021 Vol. 8 (3): 240-244 [
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456
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The effects of lactate and its transporters on tumors and immunity and advances in the corresponding treatment
Bai Rilan, Bai Ling, Li Wei, Cui Jiuwei
Tumor metabolic reprogramming confers competitive advantages to its survival and progression, one of the important features being increased lactate production caused by the aerobic glycolytic, "Warburg" effect. Lactate and its transport receptors, monocarboxylate transporters (MCTs), especially MCT1 and MCT4 subtypes, play an essential role in the biological activity of tumors and immune cells. On one hand, the tumor microenvironment acidified by lactate contributes to the migration and invasion of tumor cell, angiogenesis and escape to immune surveillance; and MCT1/4, as the indispensable porter of lactate, play an essential role in metabolic adaptations, metabolic symbiosis, and maintenance of the metabolic phenotype of cancer cells, as well as tumor malignant activities. on the other hand, lactate itself and the process of lactate transport mediated by MCTs also affect the activity and differentiation of immune cells. In recent years, inhibitors targeting MCTs in lactate metabolism seem to be promising means of cancer treatment, and although immune cells may be affected to varying degrees, some breakthroughs have been made in the gradual exploration as a whole. This article provides an overview of the relationship between lactate and its transporters with the tumor and immune microenvironment. It also explores the possibility of therapeutic strategies targeting MCTs in lactate metabolism.
2021 Vol. 8 (3): 245-250 [
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Expert consensus on ketogenic diet intervention for patients with malignant glioma
1Li Zhenshui, 1Hao Chunman, 1Xu Yingxia, 2Ren Xiaohui, 3Wang Qun, 4Yu Kang, 4Chen Wei,5Guo Ruifang, 6Hu Huaidong, 7Li Zengn?
Gliomas are primary brain tumors and comprise anaplastic gliomas (WHO grade Ⅲ) and glioblastomas (grade Ⅳ). In the past 30 years, the incidence rate is increasing year by year, especially among the elderly. The standard treatment for glioblastomas, the most common and lethal subtype,is maximal surgical resection, followed by radiotherapy with concomitant and adjuvant temozolomide chemotherapy. Despite this aggressive policy, practically all patients develop disease progression or recurrence with limited second⁃line treatment options, resulting in a poor 5⁃year overall survival of 5%~10%. Diets with high fat, low carbohydrate, moderate amount of protein and other nutrients, such as ketogenic diet are hypothesized to reduce tumor growth and improve survival. However, most clinicians have insufficient experience in ketogenic diet therapy. The aim of this expert consensus is to summarize all clinical and early clinical data on ketogenic diet for the treatment of malignant gliomas, soas to better guide the ketogenic diet in malignant.
2021 Vol. 8 (3): 251-256 [
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Expert opinion on nutritional treatment for patients with biliary tract tumors
Although biliary tract Chinese Society of Nutritional Oncology malignancy is not common in the world, its incidence is increasing year by year and its malignancy is high. The incidence of biliary tract malignancy in China is also increasing year by year. The prognosis of patients with cholangiocarcinoma is poor. Therefore, the palliative and supportive treatments of malignant tumors of the biliary tract system are particularly important, with the main purpose of improving the quality of life and extending the survival time as much as possible. The malignant tumor palliative biliary system and nutrition treatment is particularly important. Its main purpose is to improve the quality of life as much as possible, to prolong survival time. Early postoperative feeding in patients with hilar cholangiocarcinoma can effectively reduce the incidence of complications such as abdominal distention and urinary retention, and accelerate postoperative rehabilitation of patients. The principle of selection of nutritional treatment approaches for biliary tract malignant tumors is basically the same as that for other malignant tumors, but it also has its characteristics:1. biliary tract surgery is mostly limited to the upper digestive tract, and the intestinal canal below the jejunum is less affected. 2. For patients with preoperative malnutrition, especially those with moderate or above obstructive jaundice, enteral nutrition through oral or nasojejunal catheterization or through T⁃tube jejunal catheterization is recommended. For patients with poor liver function reserve and extensive hepatectomy or severe obstructive jaundice, biliary stent drainage or percutaneous hepatocentesis biliary drainage should be actively performed for biliary decompression, so as to improve liver function as soon as possible and promote the metabolism and absorption of nutrients. 4.PTCD is a method widely used in clinical treatment of malignant biliary obstruction
2021 Vol. 8 (3): 257-260 [
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Study on the expression of CK2α in thyroid tumors and its mechanism of action in cancer metastasis
1 Dou Juan, 1 Li Hengyu, 1 Chen Jing, 2 Liu Zhou
Objective To investigate the expression level of CK2α in thyroid carcinoma, and to evaluate the biological function and its mechanism of CK2α in thyroid carcinoma. Methods Twenty pairs of clinical thyroid carcinoma tissues and corresponding paracancerous normal tissues were obtained, and the expression of CK2α in thyroid carcinoma tissues and different human thyroid cancer cell lines were detected by qRT⁃PCR analysis. The effect of CK2α on cell proliferation of thyroid cancer cells was detected by CKK⁃8 method. The effects of CK2α on the migration and invasion of thyroid cancer cells were detected by wound healling test and Transwell test. The qRT⁃PCR was used to analyze the relationship between CK2α and YBX1 expression. Results CK2α was significantly up⁃regulated in thyroid carcinoma tissues and cell lines. In addition, decreased CK2α expression significantly inhibited the proliferation, migration and invasion of thyroid cancer cells, whereas overexpression of CK2α promoted the proliferation, migration and invasion of thyroid cancer cells. Mechanistically, we found that down⁃regulation of CK2α expression inhibited YBX1 expression, thereby inhibiting the biological function of thyroid cancer cells. Conclusion CK2α promotes the development of thyroid cancer by promoting the expression of Y-box binding protein 1.
2021 Vol. 8 (3): 261-266 [
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Expression of proline⁃rich protein 11 in hepatocellular carcinoma and its effect on the biological behavior of cancer cells
Liu Linsen, Zhang Yue, Luo Biwei
Objective To investigate the expression of proline protein 11 (PRR11) in hepatocellular carcinoma (HCC) tissues and its effect on the biological behavior of HCC cells. Methods Gene expression profile data dynamic GEPIA was used to analyze the expression of PRR11 in HCC tissues and paracancerous tissues and its influence on the prognosis of patients. PRR11 silencing cell lines were constructed to verify the biological behavior of PRR11 on HCC cells through experiments. Results GEPIA analysis showed that The level of PRR11 was higher in HCC tissues (P<0.05). The survival time of HCC patients with low expression of PRR11 was significantly higher (P<0.05). The OD values of SH⁃PRR11 group at 48 h, 72 h and 96 h were (0.32±0.05), (0.43±0.06) and (1.25±0.05), respectively, and those of NC group were (0.52±0.05), (0.73±0.06) and (1.81±0.08), respectively. Repeatability analysis of variance showed that the difference between the two groups at different time points was statistically significant (P<0.05). The number of invaded cells and cell migration rate in SH⁃PRR11 group were (36.15±2.06) % and (42.36±2.12) %, respectively, which were significantly lower than (83.25±6.35) % and (80.42±3.64) % in NC group. The tumor volume of SH⁃PRR11 group was (43.85±3.52) mm3, which was significantly higher than that of NC group (22.68± 2.86) mm3 (P<0.05). The relative expression level of E⁃cadherin in SH⁃PRR11 group was (1.63±0.52), which was significantly higher than that in NC group (1.03±0.61), and the relative expression level of N⁃cadherin in SH⁃PRR11 group was (0.72±0.43), which was significantly higher than that in NC group (1.01±0.54). The differences in the above indexes were statistically significant (P<0.05).Conclusion PRR11 is highly expressed in HCC, and silencing PRR11 can inhibit the malignant behavior of HCC cells. The mechanism may be related to the regulatory role of PRR11 in the process of epithelial mesenchymal transformation.
2021 Vol. 8 (3): 267-273 [
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The prognostic value of nutritional index in patients with esophageal cancer surgery and its correlation with systemic inflam⁃ matory response markers
Miao Yan, Yin Hong, Li Shanshan, Wang Fang, Gao Jiajing, Zhou Hong, Leng Xuefeng,Han Yongtao
Objective To investigate the prognostic significance of prognostic nutritional index in patients with esophageal squamous cell carcinoma (ESCC) surgery and its correlation with systemic inflammatory response markers. Methods A retrospective analysis of the clinical data of patients with esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at Sichuan Cancer Hospital from December 2017 to October 2018. And calculate the patient′s prognostic nutritional index (PNI), neutrophil⁃to⁃lymphocyte ratio (NLR), lymphocyte⁃to⁃monocyte ratio (LMR), platelet⁃to⁃lymphocyte ratio (PLR) and other indicators. Spearman was used to analyze the correlation between PNI and systemic inflammatory response markers, and Kaplan⁃Meier survival curve and Cox proportional hazard regression model were used to analyze the impact of different PNI levels on the prognosis of patients with esophageal squamous cell carcinoma surgery. Results PNI was positively correlated with LMR (R=0.514, P<0.001), and negatively correlated with NLR (R=-0.401, P<0.001) and PLR (R=-0.591, P< 0.001). Univariate analysis showed that age (P=0.13), LMR (P=0.004), NLR (P=0.018), PNI (P=0.017) were significantly related to the patient′s OS. Further multivariate analysis showed that age (OR=1.676, 95%CI=1.056-2.661, P=0.028) and PNI (OR= 0.589, 95%CI=0.370-0.939, P=0.026) are independent prognostic factors of OS. PNI≥45.26 and age<65 years old indicate a better prognosis for patients undergoing radical esophageal cancer surgery. Conclusion PNI is an important predictor of survival outcome for patients with esophageal squamous cell carcinoma undergoing radical resection of esophageal cancer. It has certain clinical value.
2021 Vol. 8 (3): 274-278 [
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Effect of preoperative oral carbohydrate on rapid rehabilitation of elderly patients with lung cancer
1Liu Pengfei, 2Zhang Xugang, 1Zhang Jing, 2 Li Weiqing, 2Jiang Fusheng, 3Shi Hanping, 1 Qiao Hui, 1 Li Tianzuo
2021 Vol. 8 (3): 279-284 [
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Effect of nutritional therapy on radiotherapy and chemotherapy for patients with unresectable locally advanced esophageal squamous cell carcinoma
Shen Xiaoping, Liu Guixiang, Shi Haiyan, Jiang Wenjuan
Objective To explore the effect of nutritional therapy on the clinical efficacy and immune response of patients with unresectable locally advanced esophageal squamous cell carcinoma undergoing radiotherapy and chemotherapy. Methods A total of 100 patients with locally advanced esophageal squamous cell carcinoma from May 2018 to may 2019 in Rugao Hospital Affiliated to Nantong University were enrolled. They were treated with 5-fluorouracil and cisplatin based chemotherapy and concurrent radiotherapy. They were divided into conventional treatment group (53 cases) and nutritional treatment group (47 cases), Objective to analyze the correlation between nutritional therapy and treatment response and immune status of patients. Results Nutritional therapy group in the incidence of neutropenia, objective response rate, the change of serum albumin and length of hospital stay were significantly better than routine nursing group. In addition, IgG and IL ⁃2 levels from the nutrition therapy group were obviously higher than those of routine nursing group, natural killer, higher percentage of CD3+and CD4+T cells, CD4+/CD8+ T cell ratio were higher (P<0.05). Nutrition therapy group patients significantly lowered level of IL⁃6. Conclusion Nutrition care plan can improve treatment compliance, reduce the radiation and chemotherapy in patients with LAOSCC toxicity and length of hospital stay, enhance the immune response.
2021 Vol. 8 (3): 285-289 [
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Study on the diet and lifestyle affecting the occurrence and development of gastrointestinal cancer
Ju Ying,Shen Zhaoying, Zhai Chunmei
2021 Vol. 8 (3): 290-294 [
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Meta⁃analysis of pro⁃inflammatory diet and risk of digestive system cancer
Li Xiaoling,Yao Zhicui,Zhang Tianfeng,Chen Meicui,Li Zengning
2021 Vol. 8 (3): 295-303 [
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Clinical observation of olanzapine combined with opioids in the treatment of cancer pain
Wang Zhan, Ye Chenyang, Jiao Xiaodong, Qin Wengxing, Zang Yuansheng
Objective To assess the efficacy and safety of a combination of Olanzapine and strong opioid drugs in treating cancer pain. Methods Clinical data of patients with cancer pain treated with strong opioids from January 2018 to August 2020 in Department of Oncology, Changzheng Hospital, Naval Military Medical University were retrospectively analyzed. Patients were divided into 4 groups according to the dose of olanzapine they received: group 10 mg/d, group 5 mg/d, group 2.5 mg/d and the control group. The change in NRS score of cancer pain after 1⁃week treatment was assessed. Adverse events (AEs) monitoring occurred throughout.Results Among the 6 patients who received Olanzapine 10 mg/d, 4 patients experienced 3⁃grade drowsiness, 2 patients experienced 3⁃grade fatigue, 1 patient experienced 3⁃grade constipation. This group was discontinued owing to the AEs. After 1⁃week treatment, the NRS score of the 3 groups were 3.9±1.5、3.5±1.4、4.8±1.0 for group 5 mg/d olanzapine 2.5 mg/d olanzapine and control group respectively. In the study, treatment with 5 mg/d olanzapine, compared with Control group, resulted in statistically significant improvement(P=0.032). Treatment with 2.5 mg/d olanzapine, compared with Control group, also resulted in statistically significant improvement(P=0.002). Treatment with 5 mg/d olanzapine, compared with Treatment with 2.5 mg/d olanzapine, didn′t result in any statistically significant improvement(P=0.364). Conclusion Treatment with a combination of 10 mg/d and 5 mg/d olanzapine with strong opioid drugs can significantly reduce the NRS score, improve the efficacy of cancer pain.
2021 Vol. 8 (3): 304-308 [
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Analysis of the effects of enteral nutrition on nutritional status of patients with esophageal cancer and prognosis factors
Li Jiaoyang, Ma Hu
2021 Vol. 8 (3): 309-314 [
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Correlation between nutritional status and quality of life during chemotherapy after radical gastrectomy
Zhou Huali,Ma Hongli,Zhao Fazhi,Gu Qiong,Tang Xiaoqiong
2021 Vol. 8 (3): 315-320 [
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Comparison of the efficacy and safety of two⁃step and three⁃step strategy in the treatment of moderate cancer pain
1Liu Ke, 1Jiao Xiaodong, 2Zhou Xincheng, 1Qin Baodong, 1Wu Ying, 1Ling Yan, 1He Xi, 1Zang Yuansheng
Patients with cancer often experience pain that affects their daily activities and quality of life. The inadequate pain treatments for patients who suffered from the moderate pain are still existed though the analgesic ladder recommended by the World Health Organization contributed outstanding. Current international guidelines recognize that low doses of a step Ⅲ opioid may be used instead of the step Ⅱ for patients with mild⁃moderate pain, although such recommendations are weak. These previous studies showed that to abolish the second step and start directly with a step three opioid will effectively control the pain better with less adverse effects. The effect of clinical analgesia treatment is affected by many factors. In addition to the different efficacy between the step Ⅱ and Ⅲ, the actual conditions such as cancer therapy (antitumor therapy or palliative care), pain types and living distance to the hospital affect the outcome of the patients. Therefore, clinicians need to formulate the analgesic strategy with multi⁃dimensional evaluations in order to improve the curative effect of moderate cancer pain. In our paper, we made efforts to evaluate the efficacy, tolerability and the factors related to adherence to long⁃term opioid therapy of low doses of morphine in comparison with standard doses of weak opioids in the treatment of moderate cancer pain in opioid⁃naive patients in order to provide more references for clinical job.
2021 Vol. 8 (3): 321-325 [
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Advances of the expression of PD⁃1/PD⁃L1 in peripheral blood in breast cancer
1Yuan Keyu,2Song Qingkun,1Lyu Shuzhen,1Li Yanping
Atezolizumab was approved to be applied to treating patients with inoperable triple⁃negative breast malignant tumor which was assured to be PD⁃L1 positive by tissue biopsy. Generally, the expression of PD⁃1/PD⁃L1 in the tissue microenvironment is used as an indication of whether to use this inhibitor in clinical practice. A number of clinical studies have shown that the expression of PD⁃1/PD⁃L1 can imply the tumor staging, prognosis, and reflect the immune status of the individual, as well as the sensitivity and efficacy of the immune checkpoint inhibitors. However, tissue biopsy can′t monitor the dynamic change of the expression of immune checkpoint molecules to Adjust clinical medication relevantly. As a result the use of other forms of PD⁃1/PD⁃L1 detection in peripheral blood as an alternative to histopathological examination has become a research focus. This article will briefly review the current detection methods of PD⁃1 and PD⁃L1 in the peripheral blood in patients with breast tumors, including plasma soluble PD⁃1/PD⁃L1 (sPD⁃1/sPD⁃L1); exosomal PD⁃1/PD⁃L1; circulating tumor cells PD⁃1/PD⁃L1 and circulating lymphocytes PD⁃1/PD⁃L1, point out the prospect and challenge in breast cancer in this field and provide new directions for new clinical PD⁃1/PD⁃L1 detection methods.
2021 Vol. 8 (3): 326-331 [
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Human gut microbiome and application of antibiotics
Ji Wei, Liu Xiangliang, Liu Pengfei, Zhao Yixin, Cui Jiuwei, Li Wei
Gut microbiome is the largest known microorganism in human body, which is closely related to the metabolic health of the host. The maturity and popularization of gene function annotation and metabolomics have enriched the exploration dimension between host and microbiome. Antibiotics affect the composition of gut microbiome and the load of antibiotic resistance gene (ARG). After the use of antibiotics, gut microbiome forms a new homeostasis, which interferes with the process of disease and treatment. There is no clear evidence that fecal microbiome transplantation (FMT) and probiotic supplement can be used to restore gut microbiome after antibiotic disturbance. This paper reviews the research progress of human gut microbiome and the application of antibiotics.
2021 Vol. 8 (3): 332-337 [
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Analgesics combined with bisphosphonates in the treatment of bone metastases in malignant tumors
Wu Ying,Jiao Xiaodong,Liu Ke,Qin Baodong,Ling Yan,Zang Yuansheng
Bone metastasis is one of the most common complications of advanced malignant tumors. The most common malignant tumors with bone metastasis mainly include: lung cancer, breast cancer, prostate cancer, kidney cancer, gastrointestinal tumors, etc. Once bone metastasis occurs in advanced tumors, it will cause local bone destruction, which further results in a series of skeletal⁃related events (SREs) such as pain, pathological fractures, nerve compression and hypercalcemia. They will seriously affect the patient′s quality of life, and even lead to spinal cord compression and paraplegia. Most patients with bone metastases in advanced malignant tumors have missed the best timing for surgery. For the treatment of related complications caused by bone metastases, in addition to the active etiological treatments of the primary tumor, the treatment of cancer pain requires a comprehensive strategy that involves with the combination of systemic drug therapy and local therapy, including interventional therapy and palliative radiotherapy. Systemic drug therapy includes non⁃steroidal drugs, weak opioids, opioids, bisphosphonates/desulumab, antidepressants, anticonvulsants or antiepileptics, Chinese traditional medicines and other combined applications. After comprehensive treatments, the patient′s pain symptoms can be significantly relived, bone⁃related adverse events can be also prevented to occur, the curative effect is obvious with less adverse reactions, the quality of life has been significantly improved, and the most of all, patients can have a better prognosis. This paper reviews the progress of analgesics combined with bisphosphonates in the treatment of advanced tumor bone metastasis.
2021 Vol. 8 (3): 338-341 [
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