相位角与原发性肝癌患者营养状况及临床结局的关系

目的 观察用生物电阻抗法测得的相位角（PA）与原发性肝癌患者营养状况的关系,探讨其对患者临床结局的影响。方法 收集原发性肝癌住院患者120例,进行营养风险筛查、综合营养状况评估、人体测量、血生化检查、人体成分分析,根据相位角将患者分为低PA组和正常PA组,分析PA与营养相关指标的关系;随访1年,比较两组生存情况。结果 原发性肝癌患者中56.7%（68/120）PA低于正常。低PA组血清总蛋白（TP）、白蛋白（ALB）和胆碱酯酶（CHE）、血红蛋白（HB）、上臂肌围（AMC）、握力（GS）、身体细胞量（ B C M ）、去脂体重（FFM）、骨骼肌质量指数（ASMI）均低于正常PA组（均P<0.05）,浮肿指数（ECW/TBW）高于后者（P<0.05）。相关性分析显示,PA与ECW/TBW呈负相关（P<0.05）;而与TP、ALB、CHE、HB、AMC、GS、BCM、FFM、ASMI呈正相关（均P<0.05）。低PA与肝功能恶化、肝癌临床分期、营养风险、营养不良程度明显相关（均P<0.05）。随访期间低PA组死亡率高于正常PA组（P<0.05）,其死亡风险升高2.738倍（OR=3.738, 95%CI: 1.465, 9.535）。结论 PA是反映原发性肝癌患者营养状况经济、有效指标,与患者死亡风险密切相关。相位角的检测有助于原发性肝癌患者的营养状况评估及临床结局预测。     

相位角对食管癌手术患者营养状况的评估意义

目的：探讨相位角（phase angle， PA）对食管癌患者围手术期营养状况的评估意义。方法：根据纳入排除标准，选择 2019 年 4 月至 9 月本院初治并拟行食管癌根治术的患者 60 例。比较术前、术后 1 周、术后 1 月人体成 分分析指标变化，包括 PA、身体质量指数（body mass index， BMI）、水分比率（extracellular water/total body water， ECW/TBW）、体细胞量（body cell mass，BCM）、去脂体重（fat free mass，FFM）、体脂率（body fat rate， BFT）。比较研究对象手术前后不同时间血液生化指标变化，包括血清白蛋白（albumin， ALB）、前白蛋白（prealbumin， PALB）、血红蛋白（hemoglobin， HGB）、超敏 C 反应蛋白（hypersensitive C-reactive protein，hs-CRP）、白细胞（white blood cell， WBC）、中性粒细胞（neutrophil， NEU），同时计算预后营养指数（prognostic nutritional index，PNI）。将 60 名患者根据术前 PA 大小分为低 PA 组和正常 PA 组，分别比较两组研究对象血液生化指标、PNI、住院时间、住院费用的不同。结果：与术前相比，60 名研究对象术后各时间段 PA 及 ALB、PALB、HGB、PNI 均有明显降低，ECW/TBW、WBC、hs-CRP、NEU 均较术前明显升高。正常 PA 组患者术前及术后 3 日 ALB 水平明显高于低 PA 组（P < 0.001，P = 0.024），正常 PA 组术前 PALB明显高于低 PA 组（P ＜ 0.001）。 正常 PA 组术前和术后 1 周的 hs-CRP 值明显低于低 PA 组（P = 0.001，P = 0.028）。低PA 组患者住院时间和费用明显高于正常 PA 组患者（P = 0.026，P = 0.005），术前 PNI 明显低于正常 PA 组（P = 0.048）。结论：食管癌患者术后营养状况明显降低，术前 PA 在预测食管癌手术患者营养变化方面具有一定作用。     

肺癌手术患者营养风险调查及对临床结局的影响

目的 了解肺癌手术患者营养状况，对营养风险相关因素进行分析并评估营养风险对临床结局的影响。方法 收集同济大学附属上海市肺科医院2014年1月至2017年12月收治的肺癌手术患者，采用营养风险筛查2002（NRS 2002）评估肺癌手术患者营养风险和营养不良发生率，并记录患者一般资料和营养相关指标实验室检查结果。结果 本研究共收集到符合纳入、排除标准肺癌手术患者640例。营养风险发生率为41.6%，其中女性发生率高于男性（χ2=6.80，P<0.05）；年龄65岁以上的患者发生率高于65岁以下患者（χ2=35.96，P<0.001）；不同手术方式肺癌患者营养风险发生率不同，且存在统计学差异（χ2=17.96，P<0.001）；营养风险发生率在不同等级手术患者之间存在着显著的差异（χ2=6.61，P<0.05），且发生率随手术等级的增大而升高；肺癌手术患者营养风险发生率在体质指数（BMI）低于正常值范围组（<18.5kg/m2）、正常值范围组（18.5~23.9kg/m2）和高于正常值范围组（≥24kg/m2）之间存在显著的差异（χ2=168.80，P<0.001），且随BMI值升高其营养风险发生率下降。而营养风险发生率在不同病理类型肺癌患者间差异无统计学意义（χ2=0.19，P>0.05）。有营养风险的患者术后引流量（t=2.42，P<0.05）、住院时间（t=2.48，P<0.05）及住院费用（t=2.45，P<0.05）明显高于营养状况正常的患者，差异均有统计学意义。结论 肺癌手术患者营养风险发生率较高，且与性别、年龄、手术方式和等级、BMI有关。且营养风险发生可导致患者术后引流量增加，住院时间延长，住院费用增加。因此，对肺癌手术患者进行营养风险筛查并及时进行干预，改善患者临床结局。     

营养风险与腹膜后肿瘤患者住院时间的相关性研究

目的 探讨营养风险与腹膜后肿瘤患者住院时间的相关性。方法 采用回顾性研究，选取2012年1月至2018年12月四川大学华西医院血管外科新入院腹膜后肿瘤患者60例，采用营养风险筛查表评估患者营养风险，收集患者体质指数、围术期血红蛋白和白蛋白水平、住院天数、术后恶心呕吐发生情况、术后排气、排便时间和首次进食时间。采用单因素分析比较不同患者住院时间，采用多重线性逐步回归分析患者住院时间的影响因素。结果 纳入的60例腹膜后肿瘤患者中，40例患者（66.7%）术前存在营养风险，52例患者（86.7%）术后存在营养风险；单因素分析显示，患者术前、术后营养风险 （术前P<0.001，术后P=0.043）、术前白蛋白 （P=0.019）、术后血红蛋白 （P=0.019）、术后白蛋白（P=0.025） 水平以及术后恶心呕吐 （P=0.001） 均会影响患者的住院时间；患者住院时间与围术期营养风险筛查工具评分、术后首次进食时间、术后排气时间和排便时间具有相关性，且相关性强（r=0.759~0.770； P<0.01）；多因素分析显示术前营养风险是腹膜后肿瘤患者住院时间的重要预测因素（β=0.399）。结论 术前营养风险是腹膜后肿瘤患者住院时间的预测因子。     

非霍奇金淋巴瘤患者营养不良状况调查研究

目的 调查吉林大学第三医院非霍奇金淋巴瘤患者营养风险、营养不良及营养治疗情况。方法 采用定点连续抽样方法，以2017年10月至2019年10月吉林大学第三医院非霍奇金淋巴瘤患者作为研究对象，在患者入院后48h内采用营养风险筛查2002（NRS 2002）进行营养风险筛查，调查营养不良发生率，记录患者住院期间营养治疗情况。结果 在入选的134例患者中，营养风险发生率为52.24%（n=70）；营养不良有两个来源：NRS 2002中营养状况评分≥3分评估营养不良发生率为13.43%（n=18），体质指数（BMI）<18.5kg/m2，结合一般状况较差者比例10.45%（n=14）；男、女患者在营养风险、营养不足营养不良发生率方面差异无统计学意义（P>0.05）；≥60周岁患者营养风险及营养不良发生率高于<60周岁患者（P<0.05）；营养风险患者营养治疗的比例为54.29%。结论 非霍奇金淋巴瘤患者营养风险、营养不良发生率较高，营养治疗比例有待提升；NRS 2002可以将这部分患者筛查出来，为临床合理营养治疗提供依据。     

肝癌患者行肝动脉化疗栓塞术前营养风险筛查的应用研究

目的 探讨肝癌患者行肝动脉化疗栓塞术前营养风险筛查的应用及对手术疗效、生活质量和生存预后的影响。方法 选取2013年1月至2018年12月首都医科大学附属北京世纪坛医院介入治疗科收治的行肝动脉化疗栓塞术治疗的中晚期肝癌患者180例，根据营养风险筛查2002（NRS 2002）将研究人群分为有营养风险组（NRS 2002≥3分）和无营养风险组（NRS 2002<3分），比较两组患者的临床基线特征、反映营养状况的物理和生化指标以及行肝动脉化疗栓塞术（TACE）手术疗效及并发症和生活质量评分，采用Kaplan-Meier方法对两组患者进行生存分析，比较上消化道出血、肝性脑病等临床终点事件的发生率。结果 纳入标准的180例患者中，无营养风险患者有85例，有营养风险患者有95例，营养风险发生率52.8%。两组患者的肱三头肌皮褶厚度、上臂肌围、体质指数、白蛋白之间存在统计学差异（P<0.05）；两组患者的总蛋白和前蛋白之间没有显著的统计学差异（P>0.05）。两组患者的TACE治疗肿瘤的临床有效率和术后并发症没有显著的差异（P>0.05）。无营养风险患者生活质量评分比有营养风险患者评分高（P<0.05）。有营养风险患者3年生存率为54.74%；无营养风险患者3年生存率为68.24%，存在统计学意义（HR=0.61，P=0.05， 95%CI=0.38~0.98）。肝性脑病、低蛋白血症和贫血的发生率两组之间有统计学差异（P<0.05）。上消化道出血和门脉癌栓堵塞的发生率之间没有统计学差异（P>0.05）。结论 营养风险筛查对于行TACE手术患者具有重要意义，营养风险与临床结局密切相关。     

预后营养指数和NRS 2002评分对肺癌患者预后的临床 研究

目的 运用预后营养指数（PNI）和营养风险筛查2002（NRS 2002）评估筛查肺癌患者术前的营养状况,比较其对预后的 影响。方法 收集中国科学技术大学附属第一医院（安徽省立医院）胸外科2017年1月至10月确诊肺癌患者172例,采用PNI和 NRS 2002评估肺癌患者术前的营养状况。以PNI 48为截点分为高PNI组与低PNI组;NRS 2002评分≥3分者存在营养风险,<3分 者为无营养风险。结果 低PNI组淋巴结转移例数、TNM分期较晚比例及术后并发症发生率高于高PNI组,且术后住院时间和拔 胸引管时间长于高PNI者（P<0.05）;营养风险发生率为16.86%, 有营养风险组的TNM分期较晚、术后辅助治疗比例及术后并发 症发生率高于无营养风险者,且拔胸引管时间长于无营养风险组（P<0.05）。在预测肺癌术后并发症方面,PNI的特异度高于NRS 2002评分（85.5%比67.5%,P>0.05）。结论 术前营养状况在一定程度上影响肺癌患者预后;两种评价方法在预测肺癌患者的术 后并发症方面无明显差异,但PNI 的特异性更高。鉴于两个评价方法获得简单方便,具有一定的临床应用价值。     

胃癌患者术前营养筛查对其围手术期营养状况及术后恢复的作用

摘 要：［目的］探讨术前营养风险筛查对胃癌患者围手术期营养状况及术后恢复的作用。［方法］ 回顾性分析200例行根治性切除的胃癌患者临床资料,根据营养风险筛查2002（NRS2002）结果及是否行营养支持将其分为A组（存在营养风险,行营养支持）89例,B组（存在营养风险,不行营养支持）14例,C组（不存在营养风险,行营养支持）24例,D组（不存在营养风险,不行营养支持）73例,分别于手术前及手术后检测各组患者血红蛋白（Hb）、白蛋白（Alb）、前白蛋白（PA）水平等营养指标,观察记录患者术后并发症发生率和术后住院时间。［结果］ A、B两组患者术前Hb、Alb、PA水平差异均无统计学意义(P＞0.05);术后B组患者Hb、Alb、PA水平均明显低于A组(P均＜0.05),而并发症发生率及住院时间明显高于/长于A组,差异均有统计学意义(P均＜0.05)。手术前后C、D两组患者Hb、Alb、PA水平及并发症发生率、住院时间差异均无统计学意义(P均＞0.05)。［结论］ 对胃癌患者进行营养风险筛查能为营养支持治疗提供依据,营养支持治疗对存在营养风险的人群具有一定意义。     

初诊食管癌患者生物电阻抗相位角与营养状况的关系研究

目的： 探讨初诊食管癌患者生物电阻抗相位角与营养状况的关系。 方法： 采用方便抽样法，选取四川省肿瘤医院的初诊食管癌患者287例，采用生物电阻抗测量人体成分，并分别通过体格测量、主观整体营养评估量表（patient-generated subjective global assessment，PG-SGA）和预后营养指数（prognostic nutritional index，PNI）等进行综合营养评估。根据生物电阻抗相位角 (phase angle，PA)将患者分为正常PA组和低PA组（男性PA＜5°、女性PA＜4.6°），比较两组患者各营养相关指标，分析PA与营养状况的关系。结果： 食管癌低PA组患者PG-SGA高于正常PA组（P＜0.05）；低PA组患者PNI、四肢骨骼肌指数、身体质量指数低于正常PA组（P＜0.05），两组患者体脂百分比、内脏脂肪面积比较差异无统计学意义（P＞0.05）；相关分析中PA与PNI、四肢骨骼肌指数、身体质量指数、身体细胞含量成正相关（P＜0.05）；PA与PG-SGA、浮肿指数、体脂百分比、内脏脂肪面积呈负相关（P＜0.05）。PG-SGA（OR=0.920，P=0.001）和PA（OR=5.948，P＜0.001）与患者发生营养不良显著相关。结论： 初诊食管癌中PA与多项营养指标密切相关，低PA患者营养不良发生率高，并可能预测患者的不良临床结局。     

营养风险筛查对胃癌手术并发症发生率的预测价值*

目的:探讨营养风险筛查对胃癌手术后并发症发生率的预测价值。方法:对2013 年1 月至2014 年10 月新疆医科大学附属肿瘤医院胃肠外科择期行胃癌根治术的353 例胃癌患者,采用欧洲营养风险筛查2002 （NRS 2002 ）评分进行术前营养评估,比较存在营养风险的患者和无营养风险的患者术后并发症发生率。结果:按照 NRS 2002 评分,术前存在营养风险和无营养风险者术后并发症发生率分别为47 .0%（77 /164）和31 .2%（59 /189）,差异有统计学意义（P=0.002）。NRS 2002 评分≥3 分的患者,术前有营养支持比无营养支持并发症发生率低,差异有统计学意义（P=0.013）。经Logistic多因素风险回归分析证实,NRS 2002 评分是胃癌手术后并发症的独立危险因素（P=0.039,0R=1.634,95 % CI :1.025～2.606）。结论:NRS 2002 评分作为一种术前营养风险筛查方法,可有效预测胃癌手术后并发症的发生率。      

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60–3.53) and 1.64 (95% CI 1.02–2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63–1.13) for CM and 1.03 (95% CI 0.95–1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.