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Objective:To understand the effects of proton and heavy ion radiotherapy on nutritional status in patients with malignant tumors and to analyze the influencing factors of adverse events.Methods:Patients with malignant tumors who received proton and heavy ion therapy between October 2016 and September 2021were retrospectively included. The demographic characteristics, clinical diagnosis, radiotherapy regimen, nutritional indicators and adverse events were collected. Paired t test was used to analyze the changes in nutritional status before and after treatment and logistic regression was used to analyze the influencing factors of adverse events. Results:A total of 2,390 patients were enrolled and were stratified into 4 groups according to different radiotherapy regimen, namely proton, heavy ion, proton + heavy ion and photon + heavy ion radiotherapies. The prevalence of nutritional risk were 17.5% and 27.8% at admission and discharge, respectively. The prevalence of nutritional risk at discharge were 73.9% ( χ2 = 237.149, P < 0.01) in patients who received photon + heavy ion radiotherapy and 30.8% ( χ2 = 36.925, P < 0.01) in those who received proton + heavy ion radiotherapy. The prevalence of critical weight loss at discharge was 14.1%, with the absolute weight loss of 4.84 kg ( t = 11.716, P < 0.01) and 1.52 kg ( t = 29.530, P < 0.01) in photon + heavy ion radiotherapy and proton + heavy ion radiotherapy groups, respectively. All groups showed significant changes in serum albumin (ALB) and total lymphocyte count (TLC). Specifically, photon + heavy ion and proton + heavy ion therapy had a greater effect on serum ALB and TLC, with a decrease of 2.88 g/L and 2.18 g/L for ALB as well as a decrease of (1.06×10 9) /L and (0.80×10 9) /L for TLC ( P < 0.01). Multivariate logistic regression analysis showed that nutritional risk at admission and concurrent chemotherapy were independent factors for adverse events of proton and heavy ion radiotherapy ( OR = 1.404, 95% CI: 1.039 to 1.898; OR = 2.370, 95% CI: 1.781 to 3.154). Compared with heavy ion radiotherapy, the other 3 groups had more adverse events (proton, OR = 3.982, 95% CI: 2.533 to 6.259; proton + heavy ion, OR = 4.995, 95% CI: 3.688 to 6.766; photon + heavy ion, OR = 7.716, 95% CI: 5.079 to 11.720). Conclusions:Patients receiving proton and heavy ion therapy showed poorer nutritional status. Photon + heavy ion therapy had the greatest impact on nutritional status. Nutritional risk at admission and concurrent chemotherapy were independent factors for adverse events in patients receiving proton and heavy ion therapy.
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Objective To explore the determinants of serum uric acid (UA) levels and the relationship between UA and cardiovascular disease in elderly patients.Methods A cross-sectional design was used.A total of 1 066 elderly patients were consecutively recruited in the study.Anthropometric measurement and lifestyle survey were performed,and serum UA,lipid profile,glucose,homocysteine (Hcy) and superoxide dismutase (SOD) were measured.The determinants of serum UA levels and correlation between UA and cardiovascular disease were analyzed by regression.Results The prevalence of hyperuricemia was 21.9％ (25.9％ in men and 18.7％ in women).Partial correlation analysis showed the level of serum UA was positively correlated with Hcy (r=0.163,P=0.000),body mass index (r=0.128,P=0.004) and triglyceride (r=0.133,P=0.003),and negatively correlated with HDL-C (r=-0.103,P=0.021).After adjustment for potential confounding factors,multivariate analysis showed eGFR (β =-2.044,t =-10.544,P =0.000),gender (β =42.065,t=4.700,P=0.000),Hcy (β=1.367,t=3.714,P=0.000),BMI (β=3.370,t=2.706,P=0.007),TG (β=14.120,t=2.589,P=0.010) and SOD (β=-0.636,t=-3.079,P=0.002) were independent determinants for UA levels in elderly patients.Logistic regression analysis indicated that mild elevation of UA levels was a risk factor of hypertension (OR=1.925,95％ CI=1.124-3.295) in women and OR=1.780 (95％ CI=1.010-3.136) in men].High UA levels increased the risk of coronary heart disease in women [OR=1.710 (95％ CI=1.157-2.526)],but decreased the risk of ischemic stroke in men [OR=0.524 (95％ CI=0.335-0.820)].Conclusions In elderly patients,serum UA levels were affected by renal function,gender,BMI and serum Hcy,TG and SOD.Mildly elevated UA levels increased the risk of hypertension.High UA levels increased the risk of coronary heart disease in women and decreased the risk of ischemic stroke in men.
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Objective To investigate the effects of risk factors on non thyroidal Illness syndrome (NTIS) in elderly inpatients.Methods A total of 819 elderly inpatients who met inclusion criteria were consecutively recruited in thiscross-sectional study.Physicalmeasurements and mini nutritional assessment using the mini nutritional assessment-short form (MNA-SF) score were conducted.A serum levels of thyroid stimulating hormone (TSH),free triiodothyronine (FT3),free thyroxine (FT4),brain natriuretic peptide (BNP) and C-reactive protein (CRP) were examined.Data were analyzed with multivariatelogistic regression.Results The significant differences were found between NTIS group (n=145) versus control group (n=674)inage (78.5±8.1) years vs.(75.1±8.6) years(t=5.422,P＜0.01),in body mass index (23.0 ±3.8) kg/m2 vs.(24.1±3.6) kg/m2,in MNA-SF score 11.2±2.3 vs.12.3± 1.8(t=-3.315,6.754,P＜0.01),in level of serum albumin (36.0±4.5) g/L vs.(38.4±3.6) g/L (t=-6.977,P＜0.01),in triglyceride level (1.3± 0.9) mmol/L vs.(1.5±1.0) mmol/L(t=-3.039,P＜0.01),inCRP (Z=-8.857,P＜0.01)),and in BNP (t=6.331,P＜0.01).Logistic regression analysis revealed that age＞ =80 years (OR=2.433,95％CI:1.357 4.361),malnutrition (OR=1.946,95％CI:1.261-3.001),renal insufficiency (eG FR＜60 ml/min,OR =2.131,95％ CI:1.367-3.322),and high level of CRP (10 mg/L and 50 mg/L:OR=3.446,95％CI:2.117-5.611;over 50 mg/L:OR =10.029,95％CI:4.693-21.432,all P＜0.01)) were risk factors for NTIS.Conclusions Non-thyroidal illness syndrome in elderly inpatients is correlated with advanced age,renal insufficiency,malnutrition and stress,which are the independent risk factors.
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Objective To observe the protective effects of quercetin on esophageal mucosa in chronic mixed reflux esophagitis (RE) rats and the effect of quercetin on nuclear factor (NF)-κB/interleukin (IL)-6 signaling pathway.Methods Mixed RE model was successfully induced by cardia ligation and esophagoduodenostomy.48 healthy male Sprague-Dawley rats were equally divided into the following 6 groups using random number table method:normal control group,sham-operation group,model control group,omeprazole group,low-dose quercetin group,and high-dose quercetin group.The 6 groups were treated with peritoneal injection of 2 ml normal saline (normal control,sham-operation,model control groups),20 mg/kg omeprazole,100 mg/kg quercetin (low-dose) and 200 mg/kg quercetin (high-dose) once daily,respectively.The rats were sacrificed after 6 weeks of intervention.The microscopic pathological changes of esophageal mucosa were scored.NF-κB p65 and IL-6 protein levels in esophageal mucosa and serum were assessed using immunohistochemistry and enzyme-linked immunosorbent assay,respectively.Results In normal control group,shamoperation group,model control group,omeprazole group,low-dose quercetin group and high-dose quercetin group,the pathological scores of esophageal mucosa were 0.250 ± 0.463,0.250 ± 0.463,2.625 ± 0.518,1.500 ±0.535,1.250 ±0.463,and 1.375 ±0.518; the NF-κB p65 protein scores in esophageal mucosa were 0.500±0.535,0.625 ±0.518,3.500 ±0.535,1.875 ±0.649,1.750 ±0.707,and 2.000 ±0.535; the IL-6 protein scores in esophageal mucosa were 1.125 ± 0.641,1.125 ± 0.835,5.375 ± 0.518,2.375 ± 0.518,2.000 ±0.535,and 2.250 ±0.463; the serum NF-κB p65 protein levels were (68.618 ± 18.500),(77.824 ± 22.228),(184.882 ± 49.165),(106.693 ± 45.312),(76.215 ± 16.588),and (108.207 ± 42.107) pg/ml; the serum IL-6 protein levels were (24.826 ±4.008),(23.599 ±4.351),(51.378 ± 9.697),(32.370 ± 11.657),(23.085 ± 4.660),and (26.243 ± 4.955) pg/ml.In terms of the 5 indicators,there were no statistically significant differences between the normal control group and the sham-operation group (P =1.000,P =0.642,P =1.000,P =0.518,P =0.673) ; the results in the normal control,shamoperation,omeprazole,low-dose quercetin,and high-dose quercetin groups were significantly different from those in the model control group (P < 0.001,P < 0.001,P < 0.001,P =0.002,P =0.001 ; P < 0.001,P < 0.001,P<0.001,P=0.004,P=0.002; P=0.001,P<0.001,P<0.001,P=0.025,P=0.023; all P <0.001 ; P <0.001,P <0.001,P <0.001,P =0.023,P <0.001) ; there were no statistically significant differences between low-dose quercetin group and omeprazole group,nor between high-dose quercetin group and omeprazole group (P=0.334,P=0.717,P=0.176,P=0.121,P =0.074; P =0.642,P=0.678,P=0.619,P =0.949,P =0.225); there were no statistically significant differences between low-dose quercetin group and high-dose quercetin group (P =0.619,P =0.438,P =0.334,P =0.086,P =0.243).The microscopic pathological score of esophageal mucosa was positively correlated with NF-κB p65 and IL-6 protein scores in esophageal mucosa (r =0.803,P < 0.001 ; r =0.758,P < 0.001),also positively correlated with serum NF-κB p65 and IL-6 protein levels (r=0.486,P=0.004; r=0.544,P=0.001).Conclusions The expression levels of NF-κB p65 and IL-6 protein in esophageal mucosa and serum increase with the severity of esophageal mucosal injury.Quercetin can reduce the severity of esophageal mucosal injury in RE,possibly through down-regulating NF-κB and IL-6 expression and mitigatng esophageal inflammatory status.
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Objective To determine the relationship between zinc and nutritional status or immunity in patients with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods Forty-five stable CAPD patients undergoing peritoneal dialysis were enrolled in this study. The dietary zinc intake and serum zinc levels were investigated, and the results were compared with the gender- and age-matched healthy populations (n = 45). The relationship between dietary zinc intake and serum zinc levels and subjective global assessment (SGA) score, blood cell counts, serum albumin (ALB), prealbumin (PA), C-reactive protein (CRP),and lymphocyte subsets were analyzed. Results The percentages of inadequate dietary zinc intake (P= 0. 007)and low blood zinc (P = 0. 036) were significantly higher in CAPD patients than in healthy group. CD8 levels were significantly lower (P = 0. 000) while CD4/CD8 ratio was significantly higher (P = 0. 033) in CAPD patients than in healthy group. In CAPD patients, correlation analysis showed that dietary zinc intake was significantly correlated with serum prealbumin levels (r = 0. 577, P = 0. 000), but was negatively correlated with SGA score (r = - 0.354,P = 0. 015) and CRP (r = - 0.354, P = 0. 015); however, it was not significantly correlated with lymphocyte subsets and CD4/CD8 ratio. Serum zinc level was significantly positively correlated with hemoglobin (r= 0. 411, P=0.005), hematocrit (r=0.345, P=0.023), WBC (r=0.318, P=0.035), SGA score (r=0.417, P=0. 005), and CRP (r=0.342, P = 0. 027), but was not significantly correlated with lymphocyte subsets and CD4/CD8 ratio. Conclusions Zinc deficiency is common among patients with CAPD. Adequate dietary zinc intake can facilitate protein synthesis and improve the overall nutritional status. High serum zinc concentrations are beneficial for the synthesis of hemoglobin and the improvement of anemia.