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2021 Vol. 8, No. 6
Published: 2021-12-09
 
569 Value‑based nutrition therapy: clinical nutrition from the value‑based care perspective
1, 2 Shi Hanping，3, 4Wang Kunhua，5Xu Xiping
Value⁃based care (VBC) emphasizes the quality and cost⁃effectiveness of medical care, creating value and providing comprehensive services throughout the course. Person⁃centered care, patient⁃centered care, personalized medicine, and precision medicine lay the foundation of VBC. The ultimate goal of VBC is to maximize the patient’s benefit. In this paper, we discussed the application of VBC on clinical nutrition, namely value⁃based nutrition therapy, and its importance in realizing VBC from the following aspects: boost the discipline of clinical nutrition; set up hungry free hospitals; change the perception of nutrition therapy and recognize it as first⁃line therapy; organize multi⁃disciplinary teams for nutrition therapy; deliver nutritional diagnosis at admission; provide early, standardized, precise nutrition therapy; develop more nutritional formula; value health economic benefits; enhance efficacy evaluation of nutrition therapy and follow⁃ups. In practice, we should concrete the concept of“nutrition is a first⁃line therapy”, as nutrition therapy has a dual role in improving health outcomes and saving medical costs. Nutrition therapy is a good vehicle for and reflection of VBC.
2021 Vol. 8 (6): 569-575 [Abstract] ( 240 ) HTML PDF (866 KB)  ( 534 )
576 Metabolism of vitamins and trace elements in refractory cachexia in cancer patients and its treatment
Zhou Lan
In order to provide reference for the clinical diagnosis and treatment of vitamins and trace elements in patients with tumor⁃refractory cachexia, this article reviewed the metabolism and treatment of several vitamins and trace elements in patients with refractory cachexia through literature search. Studies have found that patients with tumor⁃refractory cachexia often have changes in the metabolism of vitamins or trace elements, such as Wernicke encephalopathy caused by vitamin B1 deficiency, vitamin B12 deficiency or functional vitamin B12 deficiency, vitamin C deficiency, clinical or subclinical vitamin K deficiency, low serum vitamin D level, iron deficiency anemia, and prolonged bleeding time caused by zinc deficiency, etc., these are caused by insufficient intake and/or reduced reserves, and abnormal metabolism caused by tumors. Vitamin B1 supplementation can effectively alleviate delirium caused by Wernicke encephalopathy, vitamin B12 supplementation can improve neurological dysfunction caused by vitamin B12 deficiency or functional deficiency, vitamin C supplementation can help improve the patient's overall condition and quality of life, and vitamin K supplementation can reduce the risk of bleeding caused by vitamin K deficiency or functional deficiency. When the patient's serum vitamin D level is low and accompanied by pain, vitamin D3 supplementation can be tried to reduce the dose of opioids. When the patient's ferritin is elevated but other parameters indicate the presence of iron deficiency anemia, iron replacement therapy can be tried, but it is necessary to closely monitor the adverse effects of iron on promoting tumor growth. When the coagulation function of patients with advanced tumors is only manifested as prolonged bleeding time, zinc supplementation can be tried. In short, patients with tumor refractory cachexia are high⁃risk groups of vitamin and trace element deficiencies. Patients with symptoms or suspected vitamin/trace element deficiencies should be diagnosed and treated.
2021 Vol. 8 (6): 576-581 [Abstract] ( 131 ) HTML PDF (803 KB)  ( 302 )
582 Research progress on the effect of glucose and lipid metabolism disorders on malignant cancer
Pan Zhendong, Kong Weimin
Cancer is the leading cause of deaths worldwide and its incidence is increasing. Glucose/lipid metabolism disorders increase the incidence and mortality of many malignant tumors, such as breast cancer, liver cancer, pancreatic cancer, colorectal cancer, etc. Multiple mechanisms linking glucose/lipid metabolism and cancer progression have been described. The possible mechanisms include affecting the cell metabolism, body inflammation and immune disorders, inhibiting tumor cell apoptosis, and promoting tumor cell proliferation and metastasis. However, it remains unclear which factors are the main drivers of cancer development. The interaction between glucose/lipid metabolism disorders and cancers restricts the choice of drugs, affects the efficacy of surgery and patient prognosis, making the formulation of treatment plans more challenging. Metformin and statins may reduce the risk of a variety of cancers, but the results of relevant clinical prospective trials are still unclear. Therefore, it is necessary to analyze the research progress related to glucose/lipid metabolism disorders and cancers. This review aims to explore the association between glucose/lipid metabolism disorders and the occurrence of cancers. Discuss the evidence supporting glucose/lipid metabolism disorders in cancers and how this phenotype may contribute to cancers growth and progression. Finally, the potential role of blood glucose or lipid lowering strategies for the treatment of cancers will be discussed.
2021 Vol. 8 (6): 582-587 [Abstract] ( 175 ) HTML PDF (973 KB)  ( 219 )
588 Advances in how fatty acid metabolism affects tumor immune microenvironment and immunotherapies
Wang Hanbing, Liu Baorui,Wei Jia
The tumor immune microenvironment is the micro⁃structure surrounding tumor cells, which plays an indispensable role in tumorigenesis and tumor progression. It is also the core area targeted by a variety of immunotherapies and is impacted by complicated factors. Many studies have revealed multiple regulatory mechanisms that promote immune tolerance and immune escape in the tumor immune microenvironment, including the upregulation of immune checkpoint molecules, the loss of antigen presentation and the metabolic reprogramming of immune cells. Fatty acid metabolism is an essential metabolic process in the immune microenvironment and can reprogram under the condition of tumor signaling and nutrient competition. It has been emerging as a hotspot in recent years. In this review, we focus on the regulatory mechanism of fatty acid metabolism on the survival and functions of immune cells such as effector T cells, memory T cells, regulatory T cells, and tumor⁃associated macrophages in the tumor immune microenvironment. We then discuss how fatty acid metabolic reprogramming of immune cells affects the treatment efficacy of immunotherapies, such as immune checkpoint blockade therapy, adoptive cell therapy, and tumor therapeutic vaccines. We also summarize the latest developments of fatty acid⁃related targets and drugs. We point out the unique characteristics and difficulties for research of fatty acid metabolism in tumor⁃related immune cells. Via this review, we hope to provide new insights for tumor immunotherapies.
2021 Vol. 8 (6): 588-594 [Abstract] ( 335 ) HTML PDF (1021 KB)  ( 743 )
595 Advances and future development directions of nutritional oncology in 2020
Professional Committee of Cancer Nutrition, Chinese Anti?Cancer Association
Nutrition therapy plays a crucial role in the treatment of malignant tumors, which is beneficial to improve the immunity of cancer patients, improve the quality of life, reduce complications, and reduce treatment costs. In the past few decades, cancer nutrition therapy has developed rapidly and has attracted more and more attention in the international academic field. In 2020, a number of studies at home and abroad have conducted in⁃depth discussion on the nutritional therapy of cancer patients, evidence⁃based medicine continues to emerge and update, and important breakthroughs and advances have been made in the clinical diagnosis, evaluation, and treatment of cancer nutrition. Based on this, the Professional Committee of Cancer Nutrition, Chinese Anti⁃Cancer Association summarized the latest research progress and future development directions of cancer nutrition discipline in 2020 based on the current cancer nutrition research data and evidence.
2021 Vol. 8 (6): 595-599 [Abstract] ( 185 ) HTML PDF (980 KB)  ( 222 )
600 Expert opinion on nutritional treatment for patients with nasopharyngeal carcinoma
Chinese Society of Nutritional Oncology，Chinese Society for Parenteral and Enteral Nutrition
The incidence of nasopharyngeal carcinoma is relatively low in Western countries such as Europe and the United States, but is high in southern China. Compared with other tumors, patients with nasopharyngeal carcinoma are more likely to suffer from malnutrition, especially after patients undergoing radiotherapy and chemotherapy, their appetite, eating and digesting abilities are decreased, which in turn causes insufficient intake and/or malabsorption, and ultimately leads to malnutrition. In addition, malnutrition will reduce the treatment effect and quality of life of patients, and even lead to death. Therefore, the early prevention and treatment of malnutrition is of great help to the treatment effect and quality of life of patients. The principle of selection of nutritional treatment approaches for nasopharyngeal carcinoma is basically the same as that for other malignant tumors, but it also has its characteristics: ① Because patients with side effects of treatment can easily give up oral feeding, nasogastric feeding tube is the most common way of short⁃term enteral nutrition therapy. ②If enteral nutrition treatment is longer than 4 weeks, consider using percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy, the patients who use this method will lead less traumatic, have a long indwelling tube and not easy to block, so that the patients can have a high quality of life. ③ Parenteral nutrition should be used when enteral nutrition is insufficient or intolerant, once the patient's condition improves, enteral nutrition should be changed as soon as possible. ④ Nutritional treatment for patients with nasopharyngeal carcinoma should appropriately increase the fat energy supply ratio, and the recommended protein supply is 1.0～ 1.5 g/(kg·d).
2021 Vol. 8 (6): 600-604 [Abstract] ( 192 ) HTML PDF (782 KB)  ( 246 )
605 Effects of enteral nutrition on inflammatory factors, cancer-related fatigue and quality of life in patients with lung cancer
Dai Zhong, Yao Keqing, Tao Fengjuan, Tian Lixia, Cong Minghua, Ji Xue
Objective To investigate the effects of enteral nutrition on inflammatory factors, cancer⁃induced fatigue and quality of life in patients with advanced lung cancer complicated with pneumonia. Methods A total of 124 patients with advanced lung cancer complicated with pneumonia admitted to our hospital from May 2019 to March 2020 were selected as the research object, and the patients were divided into observation group and control group on average according to the lottery method.The control group was fed ordinary food, and the observation group was supplemented with enteral nutritional support. Inflammatory factors, cancer⁃induced fatigue and quality of life were observed in 2 groups. Results There were no significant differences in procalcitonin, C⁃reactive protein, interleukin⁃6, tumor necrosis factor ⁃α and α⁃1 acidic glycoprotein between 2 groups before treatment (t=0.161, 0.134, 0.692, ⁃0.412, 0.226, P=0.436, 0.446, 0.245, 0.340, 0.410). After 2 weeks of treatment, the levels of interleukin⁃6, tumor necrosis factor ⁃α and α⁃1 acid glycoprotein in the observation group were significantly higher than those in the control group (t =3.566, 9.833, 3.951, P < 0.01).After treatment, the fatigue score in the observation group was (22.07±3.45) points, significantly lower than that in the control group (31.12±3.13) points; after treatment, the scores of physical fatigue (9.93±4.31), emotional fatigue (6.11±2.36), cognitive fatigue (6.03±3.22) and the scores of physical fatigue (12.25±3.77), emotional fatigue (9.84±2.79) and cognitive fatigue (9.03±1.98) in the observation group were compared with those in the control group points were statistically significant (P < 0.01).Before treatment, there was no significant difference in quality of life score between the observation group and the control group (P > 0.05). The total score of quality of life in observation group was (191.22±5.39) points, which was significantly higher than that in control group (150.88±6.27) points. The scores of the observation group were (48.17± 10.62), mental function (58.24±2.39), social function (46.55±2.16), material life (38.36±4.88) and the control group were (40.95±12.31). The scores of psychological function, social function and material life were (41.45±1.77) points, (37.24±3.79) points and (31.24±5.13) points respectively (P < 0.05). Conclusion In the treatment of patients with advanced lung cancer complicated with pneumonia, enteral nutrition agents can effectively improve the therapeutic effect of lung infection, significantly reduce fatigue caused by cancer and improve the quality of life, which has important clinical significance.
2021 Vol. 8 (6): 605-608 [Abstract] ( 167 ) HTML PDF (827 KB)  ( 154 )
609 The evaluation value of preoperative albumin/globulin ratio and prognosis nutrition index in the prognosis of patients after endometrial cancer resection
Zhao Fang, Xie Hong, Huang Haiwei
Objective To analyze the evaluation value of preoperative albumin/globulin ratio (A/G) and prognosis nutrition index (PNI) for the prognosis in patients with endometrial carcinoma (EC) after operation. Methods 101 patients with EC admitted into our hospital from March 2016 to March 2018 were reviewed. The patients were treated with radical resection and radiochemotherapy after operation. The follow⁃up time was 38⁃60 months and the median time was 50.5 months. According to receiver operating curve (ROC curve), the area under curve (AUC) and optimal cut⁃off value of preoperative serum A/G and PNI for predicting and overall survival rate were obtained. They were divided into low A/G group (<1.5, n=58) and high A/G group (≥1.5,n=43), low PNI group (< 45.0,n=62)and high PNI group (≥45.0,n=39). The relationship between A/G, PNI and EC clinical data (including age, body mass index, tumor diameter, FIGO stage, pathological classification and differentiation grade, treatment mode, myometric infiltration depth and lymphatic vascular space infiltration) were analyzed, and independent predictors of progression free survival rate and overall survival rate were screen. Results ROC showed that the AUC values of A/G and PNI for overall survival rate were 0.802 and 0.856, respectively (P<0.05),Youden index were 0.742 and 0.739. The age, FIGO stage, myometric infiltration depth and lymph vessel space infiltration in low A/G group were higher than high A/G group,FIGO stage, myometric infiltration depth, lymph vessel space infiltration, low differentiation and radiochemotherapy in low PNI group were higher than high PNI group(P<0.05). The univariate Cox regression analysis showed that age, FIGO stage, myometric invasion depth, lymph vessel space infiltration, differentiation grade, treatment mode,serum A/G and PNI were risk factors of progression free survival rate and overall survival rate(P<0.05). The multivariate Cox regression analysis showed that age≥65 years, FIGO stage Ⅲ~Ⅳ, myometric infiltration depth ≥ 1/2, lymph vessel space infiltration, A/G < 1.5 and PNI < 45.0 were independent risk factors of progression free survival rate and overall survival rate (P<0.05). The Kalpan⁃Meier curve showed that progression free survival rate and overall survival rate in low A/G group were significantly lower than high A/G group,low PNI group were significantly lower than high PNI group(P<0.05). Conclusion Lower serum A/G and PNI are of great value for predicting the adverse outcome of progression free survival rate and overall survival rate in EC patients. A/G < 1.5 and PNI < 45.0 can be used as important references for early evaluation of worse prognosis in EC patients.
2021 Vol. 8 (6): 609-614 [Abstract] ( 169 ) HTML PDF (1064 KB)  ( 149 )
615 Effect of down‑regulation of XRCC6 on colorectal cancer cells based on ATM/CHK2/p53 signaling pathway
1 Liu Jiantong, 2 Fang Yu, 3 Gao Hongbo, 1 Song Mengmeng, 1 Lin Chao
Objective To explore the effect of down⁃regulation of XRCC6 on apoptosis and invasion of colorectal cancer cells and the changes of ATM/CHK2/p53 signaling pathway. Methods Human colorectal cancer SW620 cells were divided into three groups: control group, si⁃NC group and si⁃XRCC6 group. MTT assay was used to detect cell viability. Flow cytometry was used to detect cell apoptosis. Cell scratch test was used to detect cell migration. Transwell was used to detect cell invasion. qPCR was used to detect ATM, CHK2 and p53 mRNA expression. Western blot was used to detect ATM, CHK2, p53 protein expression and the phosphorylation level of p⁃ATM, p⁃CHK2 and p⁃p53. Results MTT results showed that the cell viability of si⁃XRCC6 group was significantly lower than that of control group and si⁃NC group (P<0.05). Flow cytometry results showed that the survival rate of si⁃XRCC6 group was lower than that of control group and si⁃NC group (P<0.01), the early apoptosis rate was increased (P<0.01), the proportion of late apoptotic cells increased significantly (P<0.01), and there was no significant difference between si⁃NC group and si⁃XRCC6 group (P>0.05).Compared with the control group and si⁃NC group, the migration ability and invasion ability of si⁃XRCC6 group decreased (P<0.01). qPCR and Western blot results showed that the mRNA and protein expression levels of ATM, CHK2 and p53 in si⁃XRCC6 cells increased, and the phosphorylation level of p⁃ATM, p⁃CHK2 and p⁃p53 also increased. Conclusion Down regulation of XRCC6 can inhibit the activity of human colorectal cancer cells and induce early apoptosis, which may be related to the regulation of ATM, CHK2 and p53 signaling pathways and their phosphorylation levels.
2021 Vol. 8 (6): 615-619 [Abstract] ( 136 ) HTML PDF (1306 KB)  ( 142 )
620 Predictive value of controlling nutritional status score and prognostic nutrition index for prognosis of patients with severe traumatic brain injury
Sun Mingyue, Ao Dan
Objective To evaluate the predictive value of controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) for 6⁃month prognosis of patients with severe traumatic brain injury (STBI). Methods A total of 100 patients with STBI into our hospital from January 2018 to June 2020 were retrospectively summarized. The modified Rankin Scale (mRS) was used to evaluate the 6⁃month clinical prognosis. The best cut⁃off value of CONUT score and PNI for poor prognosis was obtained by receiver operating curve (ROC curve). The relationship between CONUT score,PNI and clinical datas was analyzed, and univariate and multivariate Logistic regression analysis to screen the risk factors of prognosis. Results There were 53 patients (53.0%) of poor prognosis (mRS≥3). The best cut⁃off value of CONUT score was 4, and PNI was 44. The patients with CONUT score ≥4 or PNI <44 were older than CONUT score < 4, or PNI ≥44, Glasgow Coma Scale (GCS) score was less, cerebral hernia and pneumonia were more, serum albumin and total cholesterol were lower,too(P<0.05). Univariate regression analysis showed that age ≥50 years, GCS score < 6, cerebral hernia, pneumonia, albumin < 3.8 g/dl, total cholesterol<130 mg/dl, CONUT score ≥4 and PNI < 44 were associated with poor prognosis (P<0.05). Multivariate regression analysis showed that GCS score<6, pneumonia, CONUT score ≥4 and PNI <44 were independent risk factors for poor prognosis (P <0.05). Conclusion CONUT score and PNI before treatment have good predictive values for 6⁃month prognosis of STBI patients. CONUT score ≥ 4 and PNI < 44 are independent risk factors for poor prognosis
2021 Vol. 8 (6): 620-624 [Abstract] ( 186 ) HTML PDF (855 KB)  ( 226 )
625 The effect of first‑line chemotherapy on the intestinal flora of patients with lung cancer
1,2 Xu Yehong, 3 Li Suyi
Objective To investigate the effect of chemotherapy on the intestinal flora and signaling pathways in patients with primary lung cancer. Methods 26 patients with primary lung cancer who received chemotherapy for the first time from February 2019 to July 2019 were enrolled, and fresh stool samples were collected within 48 to 72 hours before chemotherapy (CBG group) and after the second cycle of chemotherapy (CAG group). The Illumina MiSeq high⁃throughput sequencing platform was used to sequence the 16S rRNA genes of gut microbes in fecal specimens. QIIME 2.0 was used to process the sequencing data and to predict the functional characteristics of the gut microbiota through PICRUST. Results Compared with the CAG group, the CBG group had higher intestinal bacteria richness, but the difference in the diversity of the two groups of bacteria was not statistically significant (P>0.05), in terms of the composition of intestinal flora, the CBG and CAG groups had four common phylum of superior bacteria includes Firmicutes, Bacteroidetes, Proteobacteria and Actinobacteria(P<0.05). The genus composition of CBG group Faecalibacterium, Oscillospira and Alipipes were significantly reduced, while Veillonella, Streptococcus and f_Christensenellaceae_uncl. were significantly increased. In terms of functional metabolism, it was found that the metabolic type of the intestinal microbiota in the CAG group was up⁃regulated in fatty acid metabolism, tryptophan metabolism, glycolysis and other functions. Conclusion After the first two cycles of chemotherapy for patients with primary lung cancer, the pathogenic bacteria in the intestinal condition increased while the butyrate⁃producing bacteria decreased. The tumor⁃promoting, drug⁃resistant metabolic pathways and inflammation⁃related metabolic pathways were up⁃regulated. It is suggested that the damage of the intestinal mucosa is not easy to recover, and the function of intestinal barrier is decreased.
2021 Vol. 8 (6): 625-630 [Abstract] ( 153 ) HTML PDF (975 KB)  ( 258 )
631 Prognostic value of fibrinogen/albumin ratio combined with prognostic nutrition index in patients with resectable gastric cancer
1 Yang Huan, 2 Zhang Yiqi,2 Chen Zhaoyong
Objective To analyze the application value of serum fibrinogen/albumin ratio (FAR) combined with prognostic nutrition index (PNI) in predicting prognosis of patients with resectable gastric cancer after radical operation, and screen simple biochemical indicator with higher sensitivity and accuracy. Methods A retrospective summary of a total of 155 patients with resectable gastric cancer who were admitted to the Ganyu District People’s Hospital in Lianyungang City from October 2017 to October 2020. The follow⁃up was 3.0⁃38.0 months after radical operation, and the median time was 27.5 months. The AUC and optimal cut⁃off values of the baseline serum FAR and PNI were obtained by receiver operator characteristic curve（ROC curve）as the basis of grouping, then the clinical data, biochemical indicators and cumulative total survival rate of the patients were compared, the risk factors were screened by univariate and multivariate Cox regression analysis. Results There were up to 64 patients of death during the follow⁃up, with a mortality rate of 41.3% (64/155).ROC curve analysis showed that the AUC values for predicting the total death by FAR and PNI were 0.798 and 0.812, the cut⁃off were 0.112 and 41.52 respectively, and the AUC value of FAR combining with PNI was 0.865, higher than FAR or PNI (P<0.05). 155 patients were divided into three groups, 60 patients in group A (FAR≥0.112 and PNI≥41.52), 45 patients in group B (FAR≥0.112 and PNI<41.52, or FAR<0.112 and PNI≥41.52), 50 patients in group C (FAR<0.112 and PNI<41.52),there were significant differences of patients’age, tumor diameter, TNM stage, T stage and N stage among the three groups (P<0.05).Kaplan⁃Meier curve showed that one⁃year and three⁃year cumulative survival rates of group C were lower than group A and group B (P<0.05). The univariate and multivariate Cox regression analysis showed that age (≥60 years), TNM stage (stage Ⅲ),FAR (<0.112)and PNI (<41.52) were independent risk factors to death (P<0.05). Conclusion The decreases of FAR and PNI values before operation may indicate poor prognosis in patients with resectable gastric cancer, combined with FAR and PNI can be used as important biochemical indicator to evaluating the prognosis of patients, which has a good predictive effect.
2021 Vol. 8 (6): 631-635 [Abstract] ( 174 ) HTML PDF (921 KB)  ( 189 )
636 L‑carnitine inhibits skeletal muscle fibrosis in aged mice with cancer cachexia via Runx2/COL1A1 pathway
1 Zhang Yaowen, 1 Lu Zongliang, 1 Li Long, 1 Yin Liangyu, 2 Li Yanwu, 1 Xu Hongxia
Objective To investigate the inhibitory effect of L⁃carnitine on skeletal muscle fibrosis in aged mice with cancer cachexia via Runx2/COL1A1 pathway. Methods A cancer cachexia model was constructed by subcutaneously implanting colon cancer MC38 cells in the right inguinal groin of C57 aged mice. The mice were divided into non⁃tumor⁃bearing group (NTB group), tumor⁃bearing group (TB group) and L⁃carnitine group (LC group), with respect to corresponding interventions. After the cessation of the intervention, one side of the gastrocnemius muscle (GM) was weighed. Hematoxylin and eosin (HE) staining and Masson staining were then performed, and the cross⁃sectional area of the GM and the percent of collagen fiber area were measured respectively. The total protein from the opposite side of the GM was extracted, and the levels of Runx2 and COL1A1 protein were detected by Western blotting. NIH/3T3 cells were induced using transforming growth factor⁃β1 (TGF⁃β1) to establish fibrosis model in vitro. Total protein and mRNA were extracted after L⁃carnitine intervention, respectively. Runx2 and COL1A1 protein levels were detected by Western blotting, and COL1A1 mRNA levels were detected by qRT⁃PCR. cDNA⁃Runx2 was transfected to verify that COL1A1 was regulated by the L⁃carnitine through Runx2. Results By comparing the three groups, the weight of the GM in the TB group was significantly lower than that of the NTB group [(98.12±17.04)mg vs (122.18±6.91)mg] (P<0.05); the cross⁃sectional area of the GM in the TB group (207.46±54.55)µm2 was significantly lower than the NTB group (488.61±46.72) µm2 and the LC group (434.54±113.84)µm2 (P<0.05); the area of collagen fibers in the TB group (9.69±1.55)% was significantly higher than that of the LC group (5.48±1.19)% and the NTB group (3.88±0.86)% (P<0.05). The results of Western blotting showed that compared with the LC group and the NTB group, Runx2 and COL1A1 were highly expressed in the TB group(P<0.05). In vitro studies showed that L⁃carnitine reversed the TGF⁃β1 induced high expression of Runx2 protein and COL1A1 mRNA. Overexpression of Runx2 confirmed that L⁃carnitine down⁃regulated COL1A1 mRNA by inhibiting Runx2 protein expression. Conclusion L⁃carnitine ameliorates skeletal muscle fibrosis in aged mice with cancer cachexia partly due to its down⁃regulating effects of Runx2 / COL1A1.
2021 Vol. 8 (6): 636-641 [Abstract] ( 236 ) HTML PDF (1036 KB)  ( 150 )
642 Prognostic value of prognostic nutritional index combined with peripheral blood CTLA‑4 expression for esophageal squa‑ mous cell carcinoma patients
1 Zhu Jianjun, 1 Wu Jian, 1 Li Lingling, 1 Xu Leirong, 1 Yu Jing, 2 Yu Zhenghong
Objective To investigate the predictive value of prognostic nutritional index (PNI) and cytotoxic T lymphocyte associated antigen 4 (CTLA⁃4) expression level in peripheral blood for postoperative recurrence of esophageal squamous cell carcinoma (ESCC) patients. Methods A total of 133 ESCC patients who underwent curative resection in People's Hospital of Tinghu District, Yancheng City and General Hospital of Eastern Theater Command from April 2014 to June 2018 were included, and the clinic pathological and follow⁃up data of all patients were retrospectively collected. Receiver operating characteristics (ROC) curve was used to determine the optimal cut⁃off point and predictive value of preoperative PNI and CTLA⁃4 expression level in peripheral blood for postoperative recurrence in ESCC patients. Kaplan⁃Meier curve was plotted to evaluate the impact of PNI and CTLA⁃4 expression level in peripheral blood on the recurrence⁃free survival (RFS) of ESCC patients. In addition, Cox multivariate regression analysis was performed to determine the independent predictors of postoperative recurrence and metastasis in ESCC patients. Results ROC curve indicated that the cut⁃off values of PNI and CTLA⁃4 expression in peripheral blood for predicting recurrence of ESCC patients were 48.2 and 0.410 ng/ml, respectively. The AUC values for PNI and CTLA⁃4 expression in peripheral blood were 0.666 (95%CI= 0.572-0.759) and 0.606 (95%CI=0.507-0.704), respectively. Based on the optimal cut⁃off point, high CTLA⁃4 expression in peripheral blood was significantly associated with histological grade (χ２ = 10.231, P=0.001) and T stage (χ２ = 5.198, P=0.023). Kaplan⁃Meier curve showed that ESCC patients with high CTLA⁃4 expression had a poorer RFS than those with low CTLA⁃4 expression (5⁃year RFS rate, 41.7% vs 61.2%), with a statistically significant difference (χ２= 3.919, P=0.047). On the other hand, the 5⁃year RFS of ESCC patients with preoperative PNI <48.2 was significantly worse than that of those with PNI ≥48.2 (39.6% vs 61.3%, χ２ = 6.362, P=0.016). Multivariate Cox regression analysis further confirmed the independent prognostic significance of PNI (HR=3.043, 95%CI=1.290-7.179, P=0.011) and CTLA⁃4 expression in peripheral blood (HR=2.250, 95%CI=1.286-3.938, P=0.004) in ESCC patients. In addition, ROC curve showed that the AUC value of PNI combined with CTLA⁃4 expression in peripheral blood for predicting recurrence in ESCC patients was 0.694 (95%CI= 0.604-0.7849), which was better than that of either PNI or CTLA⁃4 expression alone. Conclusion Combination of PNI and the expression level of CTLA⁃4 in peripheral blood further improved predictive performance of recurrence in ESCC patients, and it might be a sensitive indicator for prognostic assessment of ESCC patients.
2021 Vol. 8 (6): 642-647 [Abstract] ( 187 ) HTML PDF (1416 KB)  ( 137 )
648 Prognostic value of controlling nutritional status and serum CYFRA21‑1 expression for non‑small cell lung cancer patients
Dai Ninghuang, Zheng Zhongfeng, Ji Zhonghua, Lu Bo, You Jinzhi
Objective To evaluate the relationships between controlling nutritional status (CONUT), serum expression level of CYFRA21⁃1 and the prognosis of non⁃small cell lung cancer (NSCLC) patients, and to explore the prognostic value of their combination for these patients. Methods The clinicopathological features and follow⁃up data of 168 NSCLC patients who received surgical resection in our hospital from February 2015 to March 2019 were retrospectively analyzed from Suqian People's Hospital. The optimal cut⁃off point of serum CYFRA21⁃1 expression for the prediction of overall survival (OS) rate was determined by the receiver operation characteristics curve (ROC curve). Kaplan⁃Meier curve and Cox multivariate regression analysis were used to evaluate the prognostic value of CONUT score and serum CYFRA21⁃1 expression for NSCLC patients. Results All patients were divided into high expression (≥4.05 ng/ml, n=99) and low expression group (<4.05 ng/ml, n=69) based on the cut⁃off value of serum expression level of CYFRA21⁃1. The area under curve (AUC) value of serum CYFRA21⁃1 expression for predicting the OS of NSCLC patients was 0.661 (95%CI=0.553-0.770), the sensitivity and specificity was 78.1% and 58.9%, respectively. Kaplan⁃Meier curves showed that the 3⁃year OS of patients with high and low CYFRA21⁃1 expression was 78.7% and 90.5%, with a significantly statistical difference ( χ２=5.966, P=0.015). High expression of CYFRA21⁃1 was an indicator of poor survival in NSCLC patients. Moreover, high CONUT was associated with poor prognosis of NSCLC patients. The 3⁃year OS of patients with CONUT<2 and CONUT≥2 points were 88.4% and 76.6%, respectively(χ２= 7.526, P=0.006). Compared with other patients, those with CONUT≥2 points and high CYFRA21⁃1 expression had the poorest prognosis. The results of the univariate and multivariate Cox analysis demonstrated that T stage (HR=2.382, 95%CI= 1.141-4.969, P=0.021), lymph node metastasis(HR=2.451, 95%CI =1.206-4.982, P=0.013), CONUT (HR=2.636, 95%CI=1.301-5.344, P=0.007) and serum CYFRA21⁃1 expression (HR=2.481, 95%CI= 1.071-5.748, P=0.034) were independent prognostic factors for NSCLC patients. Based on the above these factors, a nomogram model for prognostic prediction of NSCLC patients was constructed, and the C⁃index of the model was 0.768 (95%CI=0.678-0.859). Conclusion Preoperative CONUT and serum expression level of CYFRA21⁃1 were independent predictors of poor OS in NSCLC patients, and their combination analysis might provide useful information for prognostic assessment and individualized treatment of NSCLC patients.
2021 Vol. 8 (6): 648-653 [Abstract] ( 138 ) HTML PDF (938 KB)  ( 162 )
654 Relationship between body mass index and prognosis in patients with primary gastric cancer
1 Wang Shengzhi, 1 Luo Chaohui, 1 Li Hu, 1 Shi Haiyan, 2 Zhao Anrong
Objective To investigate the relationship between postoperative body mass index(BMI) and prognosis in patients with primary gastric cancer(PGC). Methods 362 cases of PGC in Bazhong Central Hospital from January 2011 to December 2016 were selected as the research objects. According to the Chinese standard of BMI, they were divided into low weight (BMI<18.5 kg/m2) , normal weight(BMI:18.5-23.9 kg/m2 ), over weight(BMI:24.0-27.9 kg/m2) and obesity(BMI≥28.0 kg/m2 ). Kaplan⁃Meier method was used to calculate OS and DFS in 4 groups , Log rank test was used to compare the differences among the 4 groups. Cox proportional hazard model was used to evaluate the prognosis factor analysis. Results The 3⁃year DFS of PGC with low weight, normal weight, overweight and obesity were 90.0%, 77.4%, 78.9% and 79.8%, respectively. By Log⁃rank test, there was significant difference between the groups (χ2= 1.110, P=0.832); the 5⁃year OS of low weight, normal weight, overweight and obese PGC were 32.3%, 86.9%, 71.5% and 69.0%, respectively, and the difference was statistically significant (χ2=7.616, P=0.027), and further pairwise comparison found that the OS level of low weight and obesity patients was the lowest. Multivariate analysis showed that obesity (BMI≥28.0 kg/m2) patients (RR=1.559, 95%CI= 1.262-2.420, P=0.022) and underweight (BMI≤18.5 kg/m2) patients (RR=3.385, 95%CI=1.698-6.767, P=0.002) were independent risk factors for postoperative survival of patients with PGC. Conclusion Postoperative underweight and obesity can be considered as independent factors affecting the survival rate of primary gastric cancer.
2021 Vol. 8 (6): 654-657 [Abstract] ( 123 ) HTML PDF (915 KB)  ( 129 )
658 The clinical application progress of oral nutritional supplementation in cancer patients
1 Chen Liru,1 Liu Chengyu, 1 Ding Lili, 2 Cui Hongyuan, 1,2 Zhu Mingwei
Tumor seriously endangers human life and health. The nutritional status of tumor patients is closely related to various clinical outcomes of tumor diseases. Due to multiple factors such as emotion, tumor itself and anti⁃tumor treatment, it is easy to lead to insufficient intake of tumor patients, nutritional risk, and then malnutrition. Therefore, scientific nutritional treatment is needed for tumor patients. Oral nutritional supplements(ONS), as a method of enteral nutrition, it is the most feasible and convenient medical nutrition treatment for tumor patients, and has high⁃level evidence support. It has been recommended as the preferred application way of enteral nutrition for tumor patients by many guidelines. ONS is one of the important ways of nutritional intervention for cancer patients. Whether the patient is in the perioperative period, during radiotherapy and chemotherapy, and any tumor disease stage such as cachexia or end⁃stage tumor, ONS is suitable for patients with substandard nutritional intake. Choosing scientific and reasonable preparations, appropriate taking methods and perseverance will certainly play a role in improving the nutritional status of patients, helping patients better complete anti⁃tumor treatment, reducing complications, improving the quality of life of tumor patients and optimizing health economic indicators. This paper will review the progress of clinical application of ONS in tumor patients.
2021 Vol. 8 (6): 658-661 [Abstract] ( 143 ) HTML PDF (818 KB)  ( 463 )
662 Clinical research progress on anti‑tumor effect of ketogenic diet
1 Jia Sheng，1 Wang Xinyue，2 Gao Jian
In recent years, the increasing prevalence of cancers constitutes a global public health crisis. Tumor incidence is closely related to individual living environment and diet is the most important part of it, especially for colorectal, gastric, pancreatic and breast cancer. Compared with normal cells, the energy metabolism of tumor cells is significantly changed since glucose uptake is increased, and anaerobic glycolysis has become the main energy resource for tumor cells. The ketogenic diet is a dietary mode that contains fat as the main food source. In this mode, ketone bodies become the main energy source for the body's cells. Therefore, in view of the unique metabolism of cancer cells, the ketogenic diet is considered to have a potential auxiliary anti⁃tumor effect which has been verified in many animal models, but its clinical application is still in exploration and there is still a lack of reliable evidence⁃based medicine guidelines. This article have specifically summarized clinical studies of the ketogenic diet in the field of malignant tumors, including clinical case reports, observational studies and clinical randomized controlled trials, and then discussed the current problems and challenges of applying the ketogenic diet in the clinical treatment of malignant tumors.
2021 Vol. 8 (6): 662-667 [Abstract] ( 167 ) HTML PDF (803 KB)  ( 220 )
668 Biological characteristics of exosomes and its application as targeted drug carriers in malignant tumors
Wang Ying, Yang Tingrong, Chen Ya, Zhao Xingmin, Tan Denghang
The current methods of treating cancer have serious side effects. Therefore, how to specifically target the drug to cancer cells has become an urgent problem in cancer treatment. Exosomes are disc⁃shaped vesicles secreted by cells at a nanometer level and with double lipid layers. Both normal cells and tumor cells can secrete exosomes. The exosomes secreted by donor cells carry proteins, lipids and ribonucleic acid (including microRNA and lncRNA), which can be directly absorbed by recipient cells in the same tissue. At the same time, exosomes exist in almost all body fluids such as saliva, blood, urine, and cerebrospinal fluid, and are absorbed by receptor cells in different tissues through body fluid transportation, and provide necessary nutrients for the growth of recipient cells. Tumor cells can often release exosomes that are higher than normal tissues. Exosomes play an important role in tumor growth, metastasis and angiogenesis during the development of cancer. At the same time, there are exosomes secreted by cancer cells. It can be used to distinguish characteristic molecules that are different from other cellular exosomes, can be used as a molecular marker for tumor clinical diagnosis, and can also be used as an important basis for tumor grading, precise treatment and prognostic evaluation. In view of this, this article collects relevant research data abroad, summarizes the biological characteristics of exosomes, and summarizes its role and application potential in clinical tumor diagnosis and treatment, and prospects for the further development of exosomes, in order to provide theoretical support for the application of exosomes in clinical tumor precision treatment.
2021 Vol. 8 (6): 668-673 [Abstract] ( 140 ) HTML PDF (823 KB)  ( 237 )
674 Clinical value and progress of musculoskeletal ultrasound in the diagnosis of hyperuricemi
Lan Jiafu, Zhong Qiuhong, Li Qing, Wang Xin
Hyperuricemia (HUA) is a disorder of purine metabolism, with an increasing incidence. Long⁃term HUA can easily induce gout, and it can easily affect the kidneys and cardiovascular system. Musculoskeletal ultrasound (MSKUS) refers to the use of conventional ultrasound diagnostic equipment and special high⁃frequency ultrasound probes to confirm the diagnosis of human muscles, soft tissues and skeletal diseases. MSKUS in the diagnosis and observation of gouty arthritis HUA MSKUS can more effectively detect the intra⁃articular double⁃track sign, aggregates, tophi and bone erosion that are easy to ignore, compared with other inspection methods, and has a certain degree in the diagnosis of gouty arthritis. Therefore, the use of MSKUS can comprehensively evaluate the condition of HUA patients with gout. Besides, the characteristic changes of ultrasound in asymptomatic HUA patients all occur at MPT1. Therefore, MSKUS can screen the key parts of MPT1 in asymptomatic HUA patients, which can detect and treat more promptly and better prevent the occurrence and development of gout. MSKUS can be used to relieve the disappearance of the dual⁃track sign in the joint during the follow⁃up treatment of gout patients, which can better evaluate its efficacy. MSKUS has many advantages such as high sensitivity, repeatable operation, simple use, etc. Therefore, it has high application value in the diagnosis and treatment of HUA and gout patients.
2021 Vol. 8 (6): 674-677 [Abstract] ( 186 ) HTML PDF (921 KB)  ( 180 )
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