鱼油脂肪乳剂对胃肠肿瘤患者术后单核细胞功能的影响

目的探讨鱼油脂肪乳对胃肠肿瘤患者术后单核细胞功能的影响。方法64例胃肠道肿瘤患者采用信封法随机分为对照组（32例）和研究组（32例）,两组患者均给予含中长链脂肪乳剂肠外营养支持,研究组加用鱼油脂肪乳。于患者术后第1、3、6天分别检测人类主要组织相容性抗原-DR、单核细胞培养液白细胞介素（IL）-1β、IL-6、IL-10、肿瘤坏死因子（TNF）-α的变化。结果术后连续5d肠外营养支持后,研究组IL-1β[（1818±213）pg／L]、IL-6[（415±71）pg/L]、TNF-α[（2194±350）pg／L]含量较对照组[IL-1β：（2292±289）pg／L;IL-6：（791±163）pg／L;TNF—α：（2509±507）pg/L]显著降低（P=0．027,P=0．001,P=0．036）,但两组IL-10的差异无统计学意义。研究组外周血单核细胞人类主要组织相容性抗原-DR表达水平（76．6±15．2）％较对照组（62．3±16．8）％显著升高（P=0．029）。结论使用添加鱼油脂肪乳的肠外营养有利于改善胃肠肿瘤患者术后的单核细胞功能。     

Human leukocyte death after a preoperative infusion of medium/long-chain triglyceride and fish oil parenteral emulsions: a randomized study in gastrointestinal cancer patients

Background: Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. Material and Methods: Twenty-five patients from a randomized, double-blind clinical trial (ID: NCT01218841) were randomly included to evaluate leukocyte death after 3 days of preoperative infusion (0.2 g fat/kg/d) of an LE composed equally of medium/long-chain triglycerides and soybean oil (MCTs/LCTs) or pure fish oil (FO). Blood samples were collected before (t0) and after LE infusion (t1) and on the third postoperative day (t2). Results: After LE infusion (t1 vs t0), MCTs/LCTs did not influence cell death; FO slightly increased the proportion of necrotic lymphocytes (5%). At the postoperative period (t2 vs t0), MCTs/LCTs tripled the proportion of apoptotic lymphocytes; FO maintained the slightly increased proportion of necrotic lymphocytes (7%) and reduced the percentage of apoptotic lymphocytes by 74%. In the postoperative period, MCT/LCT emulsion increased the proportion of apoptotic neutrophils, and FO emulsion did not change any parameter of apoptosis in the neutrophil population. There were no differences in lymphocyte or neutrophil death when MCT/LCT and FO treatments were compared during either preoperative or postoperative periods. MCT/LCTs altered the expression of 12 of 108 genes related to cell death, with both pro- and antiapoptotic effects; FO modulated the expression of 7 genes, demonstrating an antiapoptotic effect. Conclusion: In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis.     

Elemental diet as an adjuvant for patients with locally advanced gastrointestinal cancer receiving radiation therapy: a prospectively randomized study.

Thirty patients with locally advanced, nonresectable, nonmetastatic cancer in the peripancreatic region, stomach and colorectum-anus, to be treated with radiation therapy with or without adjuvant chemotherapy, were randomized to receive standard diet and either usual between-meal feedings or 300 calories tid of a high nitrogen elemental diet. Although weight loss associated with radiation therapy was not significantly reduced in those receiving the nutritional supplement, delayed hypersensitivity skin test responses tended to improve in patients receiving the elemental dietary supplement and to deteriorate in controls. Planned radiation therapy was completed in all nutritionally supported patients. One control patient expired shortly after treatment was halted abruptly, and three other control patients required rescue by total parenteral nutrition.     

Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia

Weight loss in advanced cancer patients is refractory to conventional nutritional support. This may be due to metabolic changes mediated by proinflammatory cytokines, hormones, and tumor-derived products. We previously showed that a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia. The present study examines the effect of this supplement on a number of mediators thought to play a role in cancer cachexia. Twenty weight-losing patients with pancreatic cancer were asked to consume a nutritional supplement providing 600 kcal and 2 g of eicosapentaenoic acid per day. At baseline and after 3 wk, patients were weighed and samples were collected to measure serum concentrations of interleukin (IL)-6 and its soluble receptor tumor necrosis factor receptors I and II, cortisol, insulin, and leptin, peripheral blood mononuclear cell production of IL-1 beta, IL-6, and tumor necrosis factor, and urinary excretion of proteolysis inducing factor. After 3 wk of consumption of the fish oil-enriched nutritional supplement, there was a significant fall in production of IL-6 (from median 16.5 to 13.7 ng/ml, P = 0.015), a rise in serum insulin concentration (from 3.3 to 5.0 mU/l, P = 0.0064), a fall in the cortisol-to-insulin ratio (P = 0.0084), and a fall in the proportion of patients excreting proteolysis inducing factor (from 88% to 40%, P = 0.008). These changes occurred in association with weight gain (median 1 kg, P = 0.024). Various mediators of catabolism in cachexia are modulated by administration of a fish oil-enriched nutritional supplement in pancreatic cancer patients. This may account for the reversal of weight loss in patients consuming this supplement.     

Prognostic factors in advanced gastrointestinal cancer patients with weight loss

There are few reports on factors that determine survival in advanced gastrointestinal cancer with weight loss. In these patients (n = 91, median weight loss 16.6%), we prospectively examined the importance of metastatic spread, anthropometry, blood parameters, Karnofsky performance status, appetite, and the acute-phase response as predictors of survival. Survival was calculated from date of assessment to the most recent clinic attendance (> or = 30 mo) or until death. On multivariate analysis, metastatic spread (p < 0.05), Karnofsky performance status (p < 0.01), and C-reactive protein concentration (p < 0.001) had independent prognostic value. In locally advanced disease (n = 64), Karnofsky performance status and C-reactive protein concentration remained significant. There was a significantly lower survival in patients with an acute-phase response (median 136 days) than in patients with no response (median 466 days; p < 0.01). Performance status and the acute-phase response are associated, independent of weight loss, with survival duration in advanced gastrointestinal cancer patients.     

Glutamine supplementation in infants with gastrointestinal disease: a randomized, placebo-controlled pilot trial

OBJECTIVE: Glutamine (Gln) is a non-essential amino acid that plays an important role in energy metabolism for gastrointestinal epithelia and other cells with rapid turnover. We evaluated the effects of enteral supplementation with Gln in infants undergoing surgery for congenital or acquired gastrointestinal disease. METHODS: This was a randomized, double-masked, controlled clinical trial. RESULTS: Twenty infants were randomly assigned to receive Gln (n = 9) or placebo amino acid (n = 11), with a goal of supplemental amino acid intake of 0.4 g.kg(-1).d(-1). Infants were weaned from parenteral nutrition, and enteral feeds were started according to a standardized feeding protocol. Median (interquartile range) durations of parenteral nutrition were 39 d (12 to 99) in the Gln group and 21 d (6 to 59) in the control group (P = 0.201). Median (interquartile range) durations needed to reach 80% of the US recommended dietary allowance for energy with enteral nutrition were 24 d (8 to 55) in the Gln group and 12.5 d (5 to 32) in the control group (P = 0.313). There were no differences in the occurrence of infections between groups. Among all infants enrolled, significant correlations were found between duration of parenteral nutrition and residual small bowel length, peak concentrations of direct bilirubin, and alanine aminotransferase. Peak direct bilirubin was associated with longer duration of parenteral nutrition, shorter gestation, older age before feeds were started, shorter bowel length, and larger amounts of parenteral energy and protein intake. CONCLUSIONS: In this pilot trial, enteral Gln supplementation was well tolerated among infants with surgical gastrointestinal disease. There was no effect observed on the duration of parenteral nutrition, tolerance of enteral feeds, or intestinal absorptive or barrier function. Larger, multicenter trials in infants with surgical gastrointestinal disease are needed due to the variability in important outcome measurements.     

Symptom assessment of patients with advanced cancer and AIDS and their family caregivers: the results of a quality-of-life pilot study

This longitudinal pilot study examined differences in demographic characteristics of 101 patients with advanced illness (cancer, AIDS) and 81 Family caregivers, evaluated the reliability of the Memorial Symptom Assessment Scale for these patients and their family caregivers; obtained preliminary data regarding similarities or differences in the symptom experience oF these patients and their family caregivers and changes in symptoms over time; and identified demographic variables that may be potential covariates related to the symptom experience. All demographic variables were significantly different for patients with advanced cancer and AIDS, and their symptom experience is similar only with regard to psychologic symptoms; however, based on the Memorial Symptom Assessment Scale, cancer and AIDS patients and their family caregivers have similar symptom experiences, indicating the need for palliative care for both patients and family. Further research is needed to establish the reliability of the Memorial Symptom Assessment Scale for use with family caregivers.     

Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study.

Psychostimulants such as methylphenidate are used for fatigue in cancer patients. We report a prospective, open-label, pilot study of the successful use of methylphenidate to treat fatigue in nine of 11 consecutive patients with advanced cancer. Seven had received radiation or chemotherapy, a median of three weeks (range from one to 30 weeks) prior to methylphenidate. A rapid onset of benefit was noted, even in the presence of mild anemia. Sedation and pain also improved in some. Only one patient had side effects severe enough to stop the medication.     

Examining the effect of peer helping in a coping skills intervention: a randomized controlled trial for advanced gastrointestinal cancer patients and their family caregivers

Purpose

At the end of life, spiritual well-being is a central aspect of quality of life for many patients and their family caregivers. A prevalent spiritual value in advanced cancer patients is the need to actively give. To address this need, the current randomized trial examined whether adding a peer helping component to a coping skills intervention leads to improved meaning in life and peace for advanced gastrointestinal cancer patients and their caregivers. Feasibility and acceptability outcomes were also assessed.

Methods

Advanced gastrointestinal cancer patients and caregivers (n = 50 dyads) were randomly assigned to a 5-session, telephone-based coping skills intervention or a peer helping + coping skills intervention. One or both dyad members had moderate–severe distress. Peer helping involved contributing to handouts on coping skills for other families coping with cancer. Patients and caregivers completed measures of meaning in life/peace, fatigue, psychological symptoms, coping self-efficacy, and emotional support. Patient pain and caregiver burden were also assessed.

Results

Small effects in favor of the coping skills group were found regarding meaning in life/peace at 1 and 5 weeks post-intervention. Other outcomes did not vary as a function of group assignment, with both groups showing small decreases in patient and caregiver fatigue and caregiver distress and burden. High recruitment and retention rates supported feasibility, and high participant satisfaction ratings supported acceptability.

Conclusions

Although a telephone-based intervention is feasible and acceptable for this population, peer helping in the context of a coping skills intervention does not enhance spiritual well-being relative to coping skills alone.

     

Changing weight-loss expectations: a randomized pilot study

Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives. The failure to achieve such benefits may contribute to poor maintenance of lost weight. This randomized pilot study investigated a new cognitive-behavioral intervention designed to modify unrealistic expectations regarding weight loss and its likely impact on appearance, attractiveness, and self-esteem. Twenty-eight overweight and obese young women who completed 10 sessions of standard behavioral weight-loss treatment were randomly assigned to 10 additional sessions of either standard behavioral (SB) treatment or a reformulated cognitive-behavioral (RCB) treatment. At posttreatment, the RCB intervention produced more realistic weight-loss expectations, decreased participants' motivation to lose weight as a means of improving self-confidence, and increased their overall self-esteem, compared with the SB condition (all p's<.05). The mean posttreatment weight changes achieved in the SB (-6.2+/-4.5 kg) and RCB (-5.5+/-3.6 kg) conditions were equivalent, as were the amounts of weight regained during a 6-month follow-up (SB=2.3+/-2.7 kg; RCB=1.5+/-1.7 kg). Collectively, these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations, but it did not produce significantly better maintenance of lost weight than did the SB intervention.     

Impact of lipid emulsion containing fish oil on outcomes of surgical patients: Systematic review of randomized controlled trials from Europe and Asia

ObjectiveThis study aimed to systematically review the clinical efficacy of lipid emulsion containing fish oil in surgical patients.MethodsMedline, SCI, Embase, Cochrane Library, and Chinese Biomedicine Database were searched for studies published before January 1, 2009 that were randomized controlled trials for postoperative patients. Parenteral nutrition with or without fish oil emulsion was the only difference between the intervention and control groups. Methodologic quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and Jadad's score scale. RevMan 5.0 statistical software was used for meta-analysis.ResultsSix trials met all inclusion criteria and were enrolled for final meta-analysis. The aggregated results of the trails showed that fish oil was associated with no mortality advantage. There was a significant reduction in infectious complications in patients receiving fish oil (relative risk 0.49, 95% confidence interval 0.26–0.93, P = 0.03). The result on length of hospital stay showed a trend of shortening by 3.06 d associated with receiving fish oil. However, the difference was not significant. When excluding one obviously heterogeneous study and aggregating the other three remaining studies, results showed significantly shortening of length of hospital stay associated with receiving fish oil. Fish oil also significantly shortened length of stay in the intensive care unit by 2.07 d.ConclusionThe administration of lipid emulsion containing fish oil to patients undergoing elective major operations improves outcomes. The infectious complications are significantly fewer and length of hospitalization significantly shortened for patients treated with lipid emulsion containing fish oil. Further well-designed randomized controlled trials are needed to demonstrate the cost effectiveness of lipid emulsion containing fish oil to postoperative patients.     

Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial

Background

Tumor patients exhibit an increased peripheral demand of fatty acids and protein. Contrarily, tumors utilize glucose as their main source of energy supply. Thus, a diet supplying the cancer patient with sufficient fat and protein for his demands while restricting the carbohydrates (CHO) tumors thrive on, could be a helpful strategy in improving the patients' situation. A ketogenic diet (KD) fulfills these requirements. Therefore, we performed a pilot study to investigate the feasibility of a KD and its influence on the quality of life of patients with advanced metastatic tumors.

Methods

Sixteen patients with advanced metastatic tumors and no conventional therapeutic options participated in the study. The patients were instructed to follow a KD (less than 70 g CHO per day) with normal groceries and were provided with a supply of food additives to mix a protein/fat shake to simplify the 3-month intervention period. Quality of life [assessed by EORTC QLQ-C30 (version 2)], serum and general health parameters were determined at baseline, after every two weeks of follow-up, or after drop out. The effect of dietary change on metabolism was monitored daily by measuring urinary ketone bodies.

Results

One patient did not tolerate the diet and dropped out within 3 days. Among those who tolerated the diet, two patients died early, one stopped after 2 weeks due to personal reasons, one felt unable to stick to the diet after 4 weeks, one stopped after 6 and two stopped after 7 and 8 weeks due to progress of the disease, one had to discontinue after 6 weeks to resume chemotherapy and five completed the 3 month intervention period. These five and the one who resumed chemotherapy after 6 weeks report an improved emotional functioning and less insomnia, while several other parameters of quality of life remained stable or worsened, reflecting their very advanced disease. Except for temporary constipation and fatigue, we found no severe adverse side effects, especially no changes in cholesterol or blood lipids.

Conclusions

These pilot data suggest that a KD is suitable for even advanced cancer patients. It has no severe side effects and might improve aspects of quality of life and blood parameters in some patients with advanced metastatic tumors.     

Systemic inflammation, cachexia and prognosis in patients with cancer

PURPOSE OF REVIEW: Cachexia remains an important cause of morbidity and mortality among cancer patients. The mechanisms underlying this syndrome remain unclear and are almost certainly multifactorial. Evidence from animal models suggests a compelling link between cachexia and inflammation, and a variety of pro-inflammatory cytokines play an integral role. This review summarizes current thinking relating to inflammation, cachexia and prognosis in cancer patients, with particular emphasis on studies relating to recent therapeutic advances. RECENT FINDINGS: Pro-inflammatory cytokines induce the acute phase protein response, a key marker of systemic inflammation. Recent evidence has also implicated other tumour-derived mediators, such as proteolysis-inducing factor and parathyroid hormone-related peptide. In addition, systemic inflammation has been found in association with many malignancies, and has been correlated with weight loss, hypermetabolism, anorexia, and adverse prognosis. Treatments such as fish oil, monoclonal antibodies, and non-steroidal anti-inflammatory drugs, have all been utilized to attenuate systemic inflammation and influence weight loss. Recent clinical studies have suggested that eicosapentaenoic acid and cyclo-oxygenase 2 inhibitors promote weight gain and downregulate the acute phase protein response. SUMMARY: Pro-inflammatory processes are clearly implicated in the hypermetabolism and weight loss associated with cancer-associated cachexia. In addition, the presence of systemic inflammation is now clearly linked with adverse prognosis in patients with cancer, which cannot be fully explained by the association with weight loss. Systemic inflammation remains an important area for novel therapeutic targets in combating cachexia, and eicosapentaenoic acid and cyclo-oxygenase 2 inhibitors appear to be efficacious in the armory against cachexia.     

A pilot study of taste changes among hospice inpatients with advanced cancer

Identification of taste abnormalities can help understand difficulties in nutrition. We evaluated 15 hospice inpatients with advanced cancer for subjective taste changes. The majority had both subjective and objective taste changes. Most thought all food was tasteless followed by loss of sweet sensation and meat aversion. About half of the participants exhibited anorexia and weight loss with decreased energy intake. Both detection and recognition thresholds for these basic tastes were abnormal for the majority of participants. Reduced sensitivity for sweet and salt taste and altered perception for sour predominated in formal taste testing.