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Objective:To investigate the nutritional status of elderly inpatients in China, and to assess its relationship with clinical outcomes.Methods:A prospective, multicenter, parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged ≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF), in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized, and the correlation between nutritional status and clinical outcomes was analyzed.Results:A total of 10 184 elderly patients who met the inclusion criteria were enrolled in this study, aged 65-112(74.81±7.01)years, with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m 2.Grip strength of the dominant hand was(16.95±18.42)kg, upper arm circumference was(25.68±3.70)cm, and calf circumference was(32.07±3.89)cm.BMI, grip strength, upper arm circumference and calf circumference decreased significantly with age( F=13.74, 97.47, 28.31 and 88.68, all P<0.001). NRS2002 was conducted on 10 182 patients.Of them, 10.14%(895/10 182)suffered malnutrition(BMI≤18.5 kg/m 2), and 46.42%(4 726/10 182)were at nutritional risk(NRS2002 score≥3). Nutrition deficiency and nutritional risk showed upward trends with age( F=43.41 and 177.05, both P<0.001). A total of 9 755 patients(95.79%, 9 755/10 182)completed the MNA-SF.Of them, 14.67%(1 431/9 755)had malnutrition, 35.04%(3 418/9 755)were at risk of malnutrition, and 50.29%(4 906/9 755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age( F=172.79, 12.10 and 152.42, all P<0.05). Nutritional risk(NRS2002 score≥3)was related to age, BMI, mortality, infectious complications, length of hospital stay and total hospital cost(all P<0.05). Conclusions:The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.
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Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018
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Objective To investigate the application value of mini-nutritional assessment short-form(MNA-SF) in screening and evaluating nutritional status in elderly hospitalized patients with malignant tumor.Methods 1472 elderly hospitalized patients(≥65 years old)with malignant tumor were enrolled and prospectively studied for evaluating the nutritional status by nutritional risk screening 2002 (NRS 2002)assessment.Indicators of clinical outcomes were summarized.The consistencies of MNA-SF with body mass index(BMI),grip and results of NRS 2002 assessment,and the relationship between the different nutritional status and clinical outcomes were analyzed.Results The patients meeting the inclusion/exclusion criteria were aged(72.1±5.9)years,with BMI of(22.3 ±3.7)kg/m2 and grip of(21.7± 19.0)kg.Among 16.7％ of the malnourished patients with malignant tumors,pancreatic cancer (30.9 ％),bile duct cancer (24.1％) and esophageal cancer (21.2 ％) occupied the top three incidence of malnutrition,with the lowest (5.4％)incidence in breast cancer.Among 59.2％ of patients being malnourished (16.7％)or at risk(42.5％)of malnutrition,the highest incidence was in bile duct cancer(82.8％),and lowest one was in breast cancer(28.6 ％).MNA-SF-discriminated malnutrition(0～ 7 points)showed a great agreement with malnutrition evaluation by BMI(＜18.5),but had a poor agreement with grip in screening malnutrition.MNA-SF-discriminated nutrition problem(malnourishment plus at risk of malnutrition)showed a great agreement with NRS 2002-discovered nutrition problem (score≥3).Under-nourished patients had a higher infection complication(9.29％ vs.5.14％,P =0.006)and longer hospital stays(15.4 d vs.12.8 d,P＜0.01)as compared with patients with normal nutrition status.Conclusions The prevalence and risk factors for malnutrition are higher in elderly patients with malignant tumor.Poor nutritional status is correlated with poor clinical outcomes.MNA-SF can be used as a tool for evaluating the nutritional status of elderly patients with malignant tumor.
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[ ABSTRACT] AIM:To cultivate stem-like spheres from SW620 cell line in the specific serum-free medium and evaluate the features of the cancer stem cells, and to investigate the effects of docosahexaenoic acid ( DHA) and eicosapen-taenoic acid ( EPA) on the growth of SW620 stem cell-like cells.METHODS: Human colon cancer stem cell-like cells ( CSCLC) were obtained from SW620 spheres cultured in serum-free medium.These cells were tested for the expression of SSEA-1 and TRA-1-81 by immunofluorescence staining.The mRNA expression of Sox-2 and Oct-4 was detected by real-time PCR.The efficiency of colony formation on a soft agar gel and tumor formation in the nude mice was compared between SW620 adherent cells and CSCLC.The inhibitory effects of 5-fluorouracil (5-FU) and mitomycin C on both types of cells were measured by MTS assay.MTS assay, Annexin V/PI staining and trypan blue staining were used to determine the effects of DHA and EPA on both types of cells.MTS assay was also used to analyze the combined effect of DHA or EPA with chemotherapeutic drugs on SW620 CSCLC.RESULTS:SW620 cells formed spheres in serum-free culture.The cells from spheres highly expressed SSEA-1 and TRA-1-81, transiently expressed Sox-2 and Oct-4 genes and were more resistant to 5-FU and mitomycin C treatments.These cells exhibited a greater ability in clone formation and tumorigenicity, indica-ting that these cells carried stem cell-like features, hence were considered SW620-derived CSCLC.DHA and/or EPA sup-pressed SW620 CSCLC by inhibiting cell growth, inducing cell apoptosis and sensitizing them to chemotherapeutic drugs. CONCLUSION:The cells with stem cell-like features, such as high efficiency in clonogenicity, tumorigenicity and resist-ance to chemotherapeutic drugs, can be obtained from SW620 spheres cultured in serum-free condition.DHA and EPA in-duce apoptosis in SW620-derived CSCLC and sensitize them to chemotherapeutic drugs.
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This paper introduces a new treatment method for cancer, namely, cancer nutrition therapy (CNT). CNT is the plan-ning and delivery of nutrition intervention to treat cancers and their complications and improve therapeutic outcomes. The proposed treatment has three phases:(a) Assessing nutritional status;(b) Providing therapy, ranging from counseling, dietary modification, and oral supplementation to nutrient delivery by tube or parenteral feeding;and (c) Monitoring and follow-up, which are critical to assure that CNT could achieve its goals and appropriate for the dynamic nutritional status of the patient.
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Objective Radiofrequency ablation (RFA) and endoscopic breast conserving surgery (EBCS) has been developed as a potential means for treating breast tumors with minimal disruption to adjacent soft tissues.The purpose of this study was to evaluate the cosmetic outcomes of RFA assisted by EBCS on patients with early breast carcinoma (T1 -2 N0-1 M0).Methods Twenty-three patients with biopsy proven invasive breast carcinoma ( ≤3 cm in diameter),were treated with ultrasound (US)guided percutaneous-RFA for the local tumors followed by sentinel lymph node biopsy and endoscopic auxiliary node dissection and lumpectomy.The reactions to breast cosmetics were observed and compared to the conventional approaches using the breast asymmetry score for EBCS and a self -assessment questionnaire targeting objective and subjective data about treatment related breast change.Results Twenty-three patients were successfully treated with RFA.Complete coagulation necrosis of the tumor was visualized at US and mammography in 22 of 23 patients (95.6 ％).22 patients being per formed RFA and EBCS presented little scars and the breasts preserved more cosmetically acceptable than the reported results of traditional protocols.Self-assessment acceptable rate was 100 ％,aesthetic outcome as good or excellent rated in 95.5 ％(21/22).Within the follow-up of above 36 months,there were no local recurrence,metastasis,wound infection or necrosis,nerve damage,haematoma,as well as upper limb swelling or lymphoedema,no reduced upper limb mobility and tumor seeding.Conclusions RFA with endoscopic breast conservation therapy for the treatment of early breast carcinoma is more effective and cosmetically acceptable than the traditional approaches.
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e and feasible for postcolectomy patients.
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Objective To estimate the clinical characteristic and relevant problems of Roux-en-y surgical therapy for patients with gastric carcinoma in elderly patients. Method The clinical data of 86 elderly patients with gastric carcinoma over over years old were analyzed retrospectively. Result 86 cases received operations research,59 eases received distal end subtotal gastreetomy, 5 cases received total gastrectomy ,20 cases received proximal endsub-total gastrectomy, and 2 cases received short circuit,stoma or exploratory laparotomy. Conduslon Gastric carcinoma in elderly patients is not easy to find, and it is with more exist diseases, more postoperative complication. So it ineces-sary to enforce perioperative period management, and the options of operation methods should follow individual princi-ple.
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Lipids metabolism can change after traumas such as operation or injury.The process is com-prised of accelerated hydrolysis of triglyceride in adipose tissue,accelerated absorption of fatty acids by extra-he-patic tissue,improved lipid oxidation rate,and augmented re-esterification of fatty acids in liver and adipose tis-sue.Mechanisms of lipid mobilization include sympathetic stimulation,insulin resistance,and inflammation.How-ever,lipid absorption by liver and intestine is inhibited after trauma.Through post-trauma nutritional support,glu-cose administration improves re-esterification of fatty acids and inhibits lipid oxidation without affecting lipolysis.Fat emulsion infusion inhibits both absorption and secretion of triglyceride in liver.Therefore,clinicians should a-void over-alimentation of glucose and fat to prevent lipid overload,particularly in liver. Intervention of post-trau-matic lipid metabolism improves the outcomes:administration of long-chain triglycerides can prevent exhaustion of essential fatty acids,and administration of cholesterol can improve absorption and oxidation of fat emulsion.
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Malnutrition is a common problem in cancer and cancer cachexia is always present in advanced stage,which is responsible for poor prognosis.The mechanism of malnutrition and cancer cachexia has not been well understood.The major metabolism is change of glucose composing rate,glocongenesis and glycolysis to lactate increased,fat mobilization and oxidation accelerated and protein synthesis decreased.