Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China / 中华胃肠外科杂志

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.

Role of nutrition support in the enhanced recovery after surgery for gastrointestinal surgery patients / 中华胃肠外科杂志

Nutrition support therapy can improve the general condition of the patient and is one of the main factors to ensure the success of the operation. Enhanced recovery after surgery (ERAS) improves the recovery following gastrointestinal surgery by reducing postoperative stress response. The application of nutrition support in ERAS includes nutrition risk assessment before surgery and preoperative nutrition treatment for malnutrition. The time to fasting and clear liquid was shortened to 6 h and 2 h before anesthesia induction. Early postoperative recovery of oral feeding can improve the patient's clinical outcome. The application of ERAS enables the development and improvement of clinical nutrition concepts, and deepens the role of nutrition support therapy, which is conducive to the recovery of patients.

Complications analysis of subcutaneous venous access port for chemotherapy in patients with gastrointestinal malignancy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To describe and analyze the complications of subcutaneous venous access port for patients with gastrointestinal malignancy.</p><p><b>METHODS</b>Data of 1 912 patients with gastrointestinal malignancy who accepted chemotherapy in our department via subcutaneous venous access ports, including 127 cases in upper arm, 865 cases in subclavicular vein and 920 cases in internal jugular vein, from June 2007 to April 2016 were analyzed retrospectively. Associated complications and risk factors were emphatically investigated.</p><p><b>RESULTS</b>Postoperative complications were confirmed in 233 patients(12.2%), and complication morbidity was 37.0%(47/127), 15.5%(134/865), 6.7%(62/920) in upper arm group, subclavicular vein group, internal jugular vein group respectively, whose difference was statistically significant (χ=71.060, P=0.000). Sixty-one(3.2%) patients developed early complications (in the day of insertion, including catheter dislocation, pneumothorax, arterial damage). Early complication morbidity of upper arm group (14.2%, 18/127) was higher as compared to subclavicular vein group (3.4%, 29/865) and internal jugular vein group(1.5%, 14/920) with significant difference (χ=57.867, P=0.000). Postoperative long-term complications (catheter dislocation, thrombosis, pinch-off syndrome, infusion base exposure, catheter detachment) were found in 182(9.5%) patients. Morbidity of long-term complication was 5.2%(48/920) in internal jugular vein group, which was significantly lower than 22.8% (29/127) in upper arm group and 12.1% (105/865) in subclavicular vein group with statistically significant difference (χ=50.828, P=0.000). Multivariate analysis indicated that subclavicular vein intubation (OR=0.536, 95%CI: 0.341 to 0.843; P=0.007 OR=0.156, 95%CI: 0.096 to 0.253, P=0.000), internal jugular vein intubation (OR=0.156, 95%CI: 0.096 to 0.253, P=0.000), operation time <40 minutes (OR=0.458, 95%CI: 0.342 to 0.613, P=0.000) and standardized training (OR=0.233,95%CI: 0.171 to 0.318, P=0.000) were protective factors of postoperative complication; besides, subclavicular vein intubation (OR=0.458, 95%CI: 0.342 to 0.613, P=0.000), internal jugular vein intubation (OR=0.233, 95%CI: 0.171 to 0.318, P=0.000) and standardized training (OR=0.313, 95%CI: 0.173 to 0.568, P=0.000) were protective factors of thrombosis.</p><p><b>CONCLUSIONS</b>Subcutaneous venous access port implantation is a preferable access to central vein. Appropriate intubation approach and standardized training may reduce postoperative complications effectively. Internal jugular vein approach is safer and more reliable than upper arm vein and subclavian vein approach.</p>

Prevention and treatment of complications related to the digestive tract reconstruction in laparoscopic gastric cancer surgery / 中华胃肠外科杂志

With the development of laparoscopic techniques and equipments, laparoscopic-assisted, even total laparoscopic radical surgery for gastric cancer can be performed successfully. However, the incidence of postoperative complications is higher in the laparoscopy group as compared to the open-surgery group, which is still the barrier for the total laparoscopic radical gastrectomy. Similar to open surgery, the major complications of digestive tract reconstruction after laparoscopic radical gastrectomy are anastomotic leakage, anastomotic bleeding, anastomotic stricture and stenosis of input or output loop. Moreover, due to the lack of tactile feedback and a narrow field of vision, the laparoscopic operation may be associated with complications due to technical reasons. In clinic, we tried to reduce the incidence of these complications by improving surgical skills and strengthening the perioperative treatment of patients. According to our experience, the complications mainly occur in the early stage, and with the cumulative experience, the complications can be effectively reduced.

Association of colorectal adenoma and metabolic syndrome and relevant parameters / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the association of colorectal adenoma with metabolic syndrome (MS) and relevant parameters.</p><p><b>METHODS</b>Clinical data of 289 subjects who underwent screening colonoscopy in the University of Hong Kong-Shenzhen Hospital from January 2014 to June 2015 were retrospectively analyzed, including 130 normal subjects (normal group) and 159 cases with colorectal adenoma confirmed by pathology(adenoma group). Levels of MS-associated parameters were compared between the two groups, and the association of metabolic diseases with colorectal adenoma was examined.</p><p><b>RESULTS</b>The gender, smoking and drinking habit, regular physical activity, family history of colorectal cancer, and consumption history of long-term non-steroidal anti-inflammatory drugs were not significantly different between two groups (all P>0.05). As compared to normal group, adenoma group had higher body mass index (BMI) [(23.5±3.2) kg/m(2) vs. (22.7±2.8) kg/m(2), t=1.97, P=0.050], larger abdominal circumference [(83.4±10.3) cm vs. (79.6±13.8) cm, t=2.46, P=0.015], higher serum high-density lipoprotein level [(1.3±0.3) mmol/L vs. (1.2±0.3) mmol/L, t=2.03, P=0.044], and higher serum cholesterol [(5.4±1.0) mmol/L vs. (5.0±1.1) mmol/L, t=2.39, P=0.018]. No significant difference was demonstrated in comparing hip circumference and waist-hip ratio, as well as serum fasting glucose and triglyceride(all P>0.05). Higher incidence of colorectal adenoma was found in subjects with MS [69.8%(37/53) vs. 1.7%(122/236), P=0.017], overweight or obesity [65.1% (56/86) vs. 50.7%(103/203), P=0.025], hypertension [67.3%(37/55) vs. 52.1%(122/234), P=0.046] and hypercholesterolemia [66.7%(64/96) vs. 49.2%(95/193), P=0.005].</p><p><b>CONCLUSIONS</b>Metabolic syndrome increased the risk of developing colorectal adenoma. The mechanism may be related to higher serum cholesterol and high density lipoprotein, which may lead to the elevated catabolism of serum cholesterol. Screening colonoscopy should be performed for patients diagnosed as metabolic syndrome, especially for those with central obesity and hypercholesterolemia, thus early diagnosis and treatment of colorectal adenoma may be available.</p>

Evaluation of reconstruction technique after esophagectomy for esophageal cancer / 中华胃肠外科杂志

Surgery remains the cornerstone of treatment for esophageal cancer, although improvements have been made in surgical maneuvers and perioperative care, serious complications still occur after operation. The reconstruction of alimentary tract is a key procedure to ensure success of operation, it is related to perioperative complication and prognosis. Selection of procedure should be individualized based on the stage and location of the disease, medical condition and the surgeon's experience.

Nutrition support therapy of inflammatory bowel disease / 中华胃肠外科杂志

Malnutrition is common in patients with inflammatory bowel disease(IBD). The therapeutic role of nutrition has attracted more and more attention in the development of IBD. In recent years, researches have demonstrated that nutrition support has its unique advantages in improving patients nutritional status and reducing adverse events, and it has been recommended as the first line therapy in children with active Crohn disease. Since there are no standardized guidelines of nutritional support therapy worldwide, this article is to review the relationship between nutrition and IBD, the choice of nutritional therapy mode, the duration of the nutritional treatment and evaluation of therapeutic effects based on Expert Consensus on Nutrition Support Therapy of Inflammatory Bowel Disease (2013·Shenzhen).

Association of arachidonic acid level in gastric cancer tissue with gender and tumor differentiation / 中华临床营养杂志

Objective To explore the association of arachidonic acid (AA) level in gastric cancer (GC) tissue with tumor differentiation and patients' gender.Methods The contents of AA in GC tissue and adjacent matched normal mucosa were measured using gas chromatography/mass spectrometry.The relationships of AA with GC differentiation and patients' gender were analyzed.Results The level of AA significantly decreased in GC tissue (0.190％ ± 0.255 ％) compared with normal tissue (0.274％ ± 0.254％,n =30,P =0.011 ),while the level of AA had no significant difference in the tissues of matched normal mucosa and different TNM stages or among different TNM stages ( all P ＞ 0.05).The AA levels in well and moderately differentiated adenocarcinoma (0.173％ ±0.244％ ) and in poorly differentiated adenocarcinoma (0.195％ ±0.264％) were significantly decreased when compared with those in the paired normal mucosa (0.334％ ± 0.170％,P =0.018; 0.256％ ± 0.275％,P =0.043,respectively),while no significant difference was observed between the different differentiated grades (P =0.895).The level of AA significantly decreased in male patients (0.137％ ± 0.209％ ) as compared with paired normal mucosa (0.275％:± 0.238％,P =0.010),while no positive correlation was observed in female patients as compared with normal group (P=0.477) or in the comparison between male and female groups (P =0.139).Conclusions The AA level remarkably decreases in GC tissue,which may be associated with differentiated grades and patients'gender.In addition,more AA is utilized in male GC patients than female patients.

Castleman's disease:a report of 45 cases and literature review / 中华全科医师杂志

Clinical features and related information on diagnosis and treatment of 45 cases of Castleman's disease (CD) were retrospectively analyzed.Based on the clinical classification, localized CD (LCD) was found in 26 cases, multicentric CD (MCD) was found in 19 cases.Most cases of LCD presented the symptoms of compression, while MCD had complicated and non-specific clinical manifestations, making the early diagnosis more difficult.All 26 cases with LCD underwent surgery, among which only 2 cases relapsed.Sixteen out of 19 patients with MCD were treated with glucocorticoids or combined chemotherapy, and 14 cases achieved complete or partial remission.The results show that patients with CD have variant manifestation and the diagnosis depend on CT scan or histopathology examination.Most LCD can be cured by complete surgical resection, and MCD can achieve remission by the treatment with glucocorticoids or combined chemotherapy.

Clinical features and treatment of localized Castleman's diaease / 中华普通外科杂志

Objective To improve our understanding of localized Castleman's disease ( Localized Castleman's disease, LCD) ,and to improve its diagnosis and treatment. Methods Clinical characteristics and treatment of 26 LCD cases were retrospectively analyzed, and its clinical features and treatment strategies were reviewed. Results Among the 26 cases, there were 10 cases with clinical symptoms, which mainly showed local pain induced by the compression of the tumors, and 3 in the 10 cases associated with paraneoplastic pemphigus. The swollen lymph node was at a localized area, which was mostly at retroperitoneal (10 cases) and mediastinum (7 cases). The CT scan of LCD had its special characters including local calcification and necrosis. 22 cases were of hyaline vascular type, and the other 4 cases were of plasma type based on histopathologic examination. Twenty-five patients received complete tumor resection and 2 cases of them recurred after a follow-up of 5 to 206 months averaging at 48 ± 13 months. In one case the tumor adjoining vital organs deep in the mediastinum couldn't be completely resected. This patient and another with complete tumor resection recurred and received combined chemotherapy with complete tumor disappearance and were all alive without recurrence as found by follow up to May, 2010. The other patient with recurrent tumor after tumor resection didn't receive chemotherapy and died 11 years later. Conclusions LCD patients mainly have isolated lymphadenectasis, and some patients may have systemic symptom and show abnormal laboratory results. CT scan is helpful in establishing a diagnosis of LCD.Complete surgical resection offers a favorite result for this disease.

Effects of ecoimmunonutrition on intestinal barrier and pancreas in rats with severe acute pancreatitis / 中华临床营养杂志

@#Objective To explore the effects of ecoimmunonutrition support on the intestinal barrier function and pancreas in rats with severe acute pancreatitis (SAP). Methods Totally 64 SPF rats were randomly divided into sham operation group (control group) , SAP without enteral nutrition support group (SAP group), SAP with early enteral nutrition support group (EEN group), and SAP with early ecoimmunonutrition support group (EIN group). Bacteria translocation (BT), plasma endotoxin (ET) , gut permeability, pancreas pathology score,and distant ileum pathology were determined on the 4th and 7th post-modeling day. Results The BT rate was significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜ 0.05), was significantly lower in EEN group and EIN group than in SAP group (P ＜ 0.05), and was significantly lower in EIN group than in EEN group (P ＜ 0.05). ET and FD-40 levels in blood were both significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜0.01)and were significantly lower in EIN group and EEN group than in SAP group (P ＜0.01); ET was significantly lower in EIN group than in control group (P ＜0.05). Pathological scores were significantly higher in SAP group, EEN group, and EIN group than in control group (P ＜0.01)and were significantly lower in EEN group and EIN group than in SAP group (P ＜ 0.01). The individual pathological scores of EIN group were not significantly different from EEN group (P ＞ 0.05), while the total score was significantly lower in EIN group than in EEN group (P ＞ 0.05). Distant iliac mucosa was significantly thicker in EIN group than in other groups. Conclusions Early enteral nutrition support protects the intestinal barrier and pancreas in rats with SAP. Ecoimmunonutrition has better nutritional effectiveness than the normal enteral nutrition.

A new rat model for enteral feeding / 肠外与肠内营养

Objective: To develop a new rat model for studies of enteral nutrition support.Methods: After acute pancreatitis models induced by laparotomy,32 SPF rats were put a catheter always used for epidural anesthesia, through pylorus to 5 cm of jejunum below Treitz ligament, and sutured and fixed apart at the entrance, stomach, peritoneum, neck, and the tail, which then connected to an one-time infusion tube. By regulating the infusion tube on the pulley, the enteral nutrition input was kept uniform.Results: The routes All rats were successfully built in all rats for TEN, with an average input time of 7days in which rats well tolerated without diarrhea. All rats got positive nitrogen balance after TEN for 3-4 days. No extrusion, bending, or leakage of the infusion tubes happened.Conclusion: This rat model of enteral feeding had advantages of simplicity, firmness, reliability and cheapness, which could be used in large-scale and fulfill the need of experimental EN study in small animals like rats.

The new progresses in the clinical application of probiotics / 肠外与肠内营养

Probiotcs are viable organisms or bacterial meal replenishers that do good to our body.They have multiple functions like improving internal gut environment,reinforcing immunity,antitumors,and are more and more widely used in clinical studies to cure some diseases,such as IBD,pouchitis,infective diarrhea and so on.This review is about the new progress in the acting mechanism and clinical application of probiotics.

The effect of FasL expression on pancreatic islet allografts / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the immune privilege induced by the Fas ligand (FasL) expressed by cotransplanted testicular Sertoli cells in islet allografts, and the effect of FasL gene transfection on islet cells in pancreatic islet allografts.</p><p><b>METHODS</b>Allogeneic islets and testicular cells were cotransplanted into diabetic recipients. Pancreatic islets were infected with the recombinant adenovirus, AdV-FasL, and transplanted into diabetic recipients. Allograft survival, islet function, apoptosis of infiltrative lymphocytes in allografts and gene transfected islet allografts were analyzed.</p><p><b>RESULTS</b>All animals receiving islet allograft alone returned to a diabetic state in a few days (mean survival time 6.3 +/- 0.6 days). When the quantity of testicular cells cotransplanted with islets increased to 1 x 10(7), all animals remained normoglycemic throughout the follow-up period (60 days). FasL expression by cotransplanted Sertoli cells induced apoptosis of activated lymphocytes. Rejection of allografts in the FasL gene transfer group was accelerated and allograft survival was shortened to 3.4 +/- 0.2 days (P < 0.05). Pancreatic islets infected with AdV-FasL demonstrated positive staining for FasL at 24h after transplantation, with increased intensity at 48h. Apoptosis assays of pancreatic islet allografts at 24h and 48h revealed apoptosis of transfected islets.</p><p><b>CONCLUSIONS</b>FasL-expressing testicular Sertoli cells can induce apoptosis of activated lymphocytes. Cotransplantation of testicular cells allows long-term survival of allogeneic islets because of immune privilege, but the direct expression of FasL on islet allografts infected with AdV-FasL accelerates islet rejection via islet apoptosis and granulocyte infiltration.</p>

Comparison of colonic J-pouch and straight coloanal anastomosis after low anterior resection for rectal carcinoma: a meta-analysis of 8 randomized trails / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of colonic J-pouch coloanal anastomosis after low anterior resection for mid or low rectal cancer on improving defecation and anorectal physiology.</p><p><b>METHODS</b>To make a meta-analysis, prospective randomized controlled trial of with or without colonic J-pouch after low anterior resection for mid or low rectal cancer was conducted. The key words included rectal cancer, J-pouch (or J-pouch) and those randomized from selected reports. The data on bowel function and physiological function of the anal canal and (neo) rectum were meta-analyzed using fixed effect model and random effect model.</p><p><b>RESULTS</b>Eight randomized trails including 378 patients entered this study. After one year follow-up, the functional results showed that there were significant differences in stool frequency per day, urgency and use of medication between colonic J-pouch group and straight coloanal anastomosis group. On physiological function of the anal canal and (neo) rectum, there was significant difference only in rectal compliance between the two groups. But there was no significant difference in other 4 items.</p><p><b>CONCLUSIONS</b>The functional improvement gained from colonic J-pouch coloanal anastomosis continues to benefit the patient with mid or low rectal cancer for at least 12 months. It is necessary to further study about the effect of colonic J-pouch coloanal anastomosis on physiological function of the anal canal and (neo) rectum.</p>

Lymph node metastasis versus peritoneal dissemination in patients with gastric cancer: analysis of the correlated factors and prognosis / 中国普通外科杂志

Objective To investigate the correlated factors of peritoneal dissemination and lympah node metastasis from gastric cancer, the prognosis of patients with peritoneal dissemination and N_2 lymph node metastasis, and the impact of palliative surgery on the prognosis. Methods Based on our database built from 1994, the clinicopathologic data and the outcomes of the follow-up were analyzed respectively. Results The clinicopathologic factors correlated with peritoneal dissemination included T_4, hepatic metastasis, the primary tumor involving the whole stomach, undifferentiated carcinoma, female sex and lymph node metastasis, while those correlated with lymph node metastasis included the primary tumor involving the whole stomach, Borrmann III, T_2, T_3 and T_4, hepatic metastasis and peritoneal dissemination (P

Clinicopathologic characteristics and prognosis in patients with gastric cancer complicated by peritoneal dissemination / 中国普通外科杂志

Objective To investigate the correlation between clinicopathologic factors and peritoneal dissemination from gastric cancer, and the impact of palliative resection on the prognosis of patients with gastric cancer complicated by peritoneal dissemination. Methods Based on our database built in 1994, the clinicopathologic data and the result of follow-up of all gastric cancer patients were analyzed retrospectively using the software of SPSS. Results One hundred and five out of 792 (13. 3% ) patients with primary gastric cancer were found complicated with peritoneal dissemination. The clinicopathologic factors in patients with peritoneal dissemination were significantly correlated with primary tumor penetrating through serosa, lymph node metastasis, primary tumor involving whole stomach, undifferentiated carcinoma, Borrmann IV and female gender (P

Prognosis of colorectal cancer with synchronous liver metastasis / 中国普通外科杂志

ObjectiveTo explore risk factors of colorectal cancer with synchronous liver metastases and its prognosis. Methods From Aug 1994 to Feb 2004, 106 colorectal cancer patients with synchronous hepatic metastases were enrolled. Fifteen clinicopathological parameters were collected for mono-variable and multi-variable analysis. Treatment result was analyzed by Kaplan-Meier method and COX regression. Results Bowel obstruction, ascites, pelvic nodules, peritoneal invasion, serosal infiltration, organs involvement, tumor size, circumference of bowel invasion, depth of invasion were all individually relevant with synchronous hepatic metastasis. Logistic regression demonstrates depth of invasion, serosal infiltration, pelvic nodules and ascites were most important factors resulting in synchronous hepatic metastases. Radical resection(57 cases), palliative resection(39 cases) and laparotomy only(10 cases) resulted respectively in mean survival time and median survival time of 41.0 and 34.0 months,23.6 and 18.0 months,16.5 and 12.0 months,respectively (all P=0.0095).Surgery, location of tumor and pelvic nodules were independent prognostic factors. Conclusions Synchronous liver metastasis may present when primary tumor infiltrates serosa, or pelvic nodules and ascites are present. Radical excision significantly improves survival rate.

Induction of tumor cell apoptosis in colorectal cancer xenografts of nude mice with low dosage of ~(131) I-labelled anti-carcinoembryonic antigen antibody C50 combined with chemotherapy / 中华消化杂志

Objective To investigate the outcome of induction of tumor cell apoptosis with low dosage of 131 I labelled anti carcinoembryonic antigen(CEA) monoclonal antibody C50( 131 I C50) and the therapeutic efficacy of combining radioimmunotherapy(RAIT) with chemotherapy in colorectal cancer xenografts. Methods Human colorectal cancer xenografts with positive CEA expression were established in nude mice with LoVo cell line. 5 fluorouracil(5 FU), 75 ?Ci 131 I C50, and 5 FU, combined with 131 I C50 were given to nude mice through tail vein to treat xenografts on 9th day after implantation of tumor cells. Fifteen days after implantation, each mouse was sacrificed and tumor tissues were stained with HE and terminal deoxynucleotidyl transferase mediated X DUTP nick end labeling technique(TUNEL technique). Apoptosis index(AI) of xenograft cells in each mouse was calculated. Results Under light microscope, no obvious cytolysis or necrosis of tumor cells was seen in all four groups. Apoptosis indexes in blank control group, chemotherapy group, radioimmunothera py(RAIT) group, and RAIT+chemotherapy group were (0.29?0.08)%, (18.68? 2.69 )%,(40.88 ?4.54 )% and (62.33?8.00)%, respectively. There were significant difference of apoptosis indexes between any groups( P

The roles and mechanism of tumor-derived factors in the development of cancer cachexia / 肠外与肠内营养

Syndrome of cachexia,which is a common feature of many types of cancer,characterized by loss of adipose tissue and skeletal muscle,is responsible not only for a poor quality of life and poor response to chemotherapy,but also a decreased survival time.It can not be fully explained by the accompanying anorexia,because increasing nutrient support is unable to reverse the wasting syndrome.Although patients with cachexia frequently show an elevated resting energy expenditure,cachexia can occur with a normal energy expenditure.Lipid mobilizing factor and proteolysis inducing factor,two tumor-derived factors,can directly mobilize fatty acids and amino acids from adipose tissue and skeletal muscle respectively.It is important of the knowledge about the roles and mechanism of LMF and PIF in the development of cancer cachexia,which should lead to the development of new therapeutic methods.