Diabetes and cancer: Optimising glycaemic control

Diabetes and cancer are both common and increasingly prevalent conditions, but emerging epidemiological evidence confirms that the risk of developing a number of common cancers is increased in those with type 2 diabetes. The risk of cancer in type 1 diabetes is less clearly defined, and therefore this review focuses on type 2 diabetes. Emerging evidence also supports an influence of diabetes on outcomes of cancer treatment. However, this relationship is bi-directional, with cancer and its treatment impacting on glucose control, whereas there is also emerging evidence indicating that diabetes care can deteriorate after a cancer diagnosis. Despite these clear links, there is a lack of evidence to guide clinicians in how to manage patients with diabetes during their cancer treatment. Although recent UK guidelines have started to address this, with the development of guidance for the management of hyperglycaemia in cancer, there is a clear need for wider guidance on the management of multi-morbidity during cancer, including diabetes and obesity, to incorporate nutritional management. We have therefore undertaken a narrative review of the evidence of links between type 2 diabetes and cancer incidence and outcomes, and discuss the challenges to diabetes care during cancer treatment.     

结直肠癌手术后手术部位感染的病原菌特点及相关因素分析

目的 分析结直肠癌手术后手术部位感染的病原菌特点及相关因素,为临床防治提供指导.方法 回顾性分析2006年1月-2011年6月217例经手术治疗的结直肠癌患者,统计感染率和病原菌特征,采用x2检验进行单因素分析.结果 共有26例发生手术部位感染,感染率为11.98％;检出革兰阴性菌20株占76.92％,革兰阳性菌6株占23.08％,分布最多的两种病原菌为大肠埃希菌占34.61％,铜绿假单胞菌占19.23％;手术切口感染与患者的Dukes分期、体质量指数、合并糖尿病、手术持续时间和手术类别有关(P＜0.05),而与年龄、性别和肿瘤类别无关.结论 结直肠癌手术部位感染率较高,在临床上应引起重视,根据其相关感染因素,开展合理有效的防治工作.     

结肠癌病人新辅助化疗与营养支持的综合治疗

新辅助化疗与营养支持的综合治疗在结肠癌病人中的应用正受到广泛关注。在结肠癌病人的辅助化疗阶段,配合合理的肠外和肠内营养支持,可以提高结肠癌病人的免疫功能和手术耐受力,减少术后的并发症,改善预后。特别在结肠癌伴梗阻的病人中,这种综合性治疗可以缓解梗阻,降低肿瘤分期,为一期的吻合手术创造条件。     

420例结直肠癌患者手术部位感染状况及影响因素分析

目的探讨结直肠癌患者手术部位感染状况及其影响因素。方法采用回顾性调查方法,对某院2007年1月—2011年12月间420例结直肠癌手术患者病历资料进行分析。结果 420例结直肠癌患者手术部位感染率为20.24%(85/420);以表浅切口感染为主,占75.29%(64/85),深部切口感染占22.35%(19/85),器官腔隙感染占2.35%(2/85)。共分离病原菌98株,以大肠埃希菌为主(55株,56.13%)。超重或肥胖(BMI≥23)、合并糖尿病、手术持续时间>3.5 h、Dukes分期高的结直肠癌患者手术部位感染发生率显著升高(均P<0.05)。结论结直肠癌患者手术部位感染率较高。超重或肥胖、合并糖尿病、手术持续时间长和Dukes分期高是结直肠癌患者手术部位感染的重要影响因素。     

胱抑素C与肺癌、结肠直肠癌、子宫卵巢癌的关系

目的研究血清胱抑素C与肺癌、结肠直肠癌、子宫卵巢癌的关系。方法随机收集2008年10月至2009年11月间中山大学附属第三医院住院的肺癌、结肠直肠癌及子宫卵巢癌各84、56和53例,并根据临床资料排除有肾功能损害的患者作为研究对象,同时收集2009年8月份于我院健康体检者97例作为对照组。用胶乳增强免疫透射比浊法测定患者及对照组血清CysC水平,各患者组与对照者之间的比对采用方差分析。结果肺癌、结肠直肠癌和子宫卵巢癌患者中血清CysC水平均明显低于健康体检者,有统计学意义（P〈0.01）。结论在肺癌、结肠直肠癌和子宫卵巢癌患者中血清CysC水平均与恶性肿瘤有一定关系,这为以后临床诊断和治疗恶性肿瘤提供新思路。     

Small can be beautiful: 10 years managing colorectal cancer in a rural general hospital

There has been much recent debate on the relationship between surgical volume and outcomes. The aim of this study was to assess the ability of a rural general hospital to provide care for patients with colorectal cancer in a small-volume practice. A retrospective review of patients treated in a rural general hospital, between January 1993 and December 2002, was undertaken. Patient demographics, disease characteristics, treatments and complications were all recorded. Ninety-eight patients had a final diagnosis of colorectal cancer. There was an equal male: female ratio and an average age of 69 years (40-88 years). Eighty-five percent underwent treatment with curative intent. The postoperative complication rate was low (2% wound infections, 2.3% anastomotic leak rate) and Dukes-specific five-year survival was satisfactory (A > 80%, B and C > 60%). In conclusion, this study adds weight to the argument that even with low-volume workload, satisfactory results can still be obtained.     

结直肠癌手术切口感染因素分析

目的 分析结直肠癌患者手术切口感染病原菌分布特点及感染因素.方法 回顾性分析医院2009年2月-2011年5月收治的结直肠癌患者病历资料,对术后切口感染患者切口分泌物进行细菌培养鉴定,并对相关因素进行分析.结果 296例患者发生切口感染50例,感染率为16.9％;共检出64株病原菌,革兰阴性杆菌37株,占57.8％,革兰阳性球菌21株,占32.8％,真菌6菌株,占9.4％;肥胖患者术后切口感染率高,为24.1％,合并糖尿病患者术后感染率较无糖尿病患者高,差异有统计学意义(P＜0.05),不同Dukes分期的感染率差异有统计学意义(P＜0.05).结论 结直肠癌术后伤口感染与患者体质肥胖、糖尿病及Dukes分期有重要关系,应采取相应预防措施预防手术切口感染.     

Diabetes, gestational diabetes and the risk of cancer in women: epidemiologic evidence and possible biologic mechanisms

At present, more than 10% of adult American women are diagnosed with diabetes mellitus (DM). As the prevalence of the disease increases, there is greater interest in the relationship between DM and other major health issues, such as cancer - one of the leading causes of death in the western world. This paper reviews the literature on the relationship between Type 2 DM and different types of cancer among women. We discuss the possible biological mechanisms that may link diabetes and cancer, important confounders, shared risk factors and a short review of the epidemiologic literature on the association between Type 2 DM and cancer of specific organs (pancreas, liver, colorectal, bladder, endometrial, non-Hodgkin's lymphoma and breast). We also examine the association between gestational diabetes, a closely related risk factor for DM in women, and subsequent risk of cancer. Cancer survival of diabetic women is also briefly discussed. The paper concludes with an agenda for future research targeting the relationship between diabetes and cancer.     

The Role of Diet in Prognosis among Cancer Survivors: A Systematic Review and Meta-Analysis of Dietary Patterns and Diet Interventions

Cancer survival continues to improve in high-income countries, partly explained by advances in screening and treatment. Previous studies have mainly examined the relationship between individual dietary components and cancer prognosis in tumours with good therapeutic response (breast, colon and prostate cancers). The aim of this review is to assess qualitatively (and quantitatively where appropriate) the associations of dietary patterns and cancer prognosis from published prospective cohort studies, as well as the effect of diet interventions by means of randomised controlled trials (RCT). A systematic search was conducted in PubMed, and a total of 35 prospective cohort studies and 14 RCT published between 2011 and 2021 were selected. Better overall diet quality was associated with improved survival among breast and colorectal cancer survivors; adherence to the Mediterranean diet was associated to lower risk of mortality in colorectal and prostate cancer survivors. A meta-analysis using a random-effects model showed that higher versus lower diet quality was associated with a 23% reduction in overall mortality in breast cancer survivors. There was evidence that dietary interventions, generally combined with physical activity, improved overall quality of life, though most studies were in breast cancer survivors. Further cohort and intervention studies in other cancers are needed to make more specific recommendations.     

结直肠肿瘤术后并发感染的危险因素分析

目的 研究结直肠肿瘤术后并发感染的发生情况,并对其相关危险因素进行探讨.方法 选取2008年10月-2011年6月于医院进行治疗的82例结直肠肿瘤术后并发感染患者为研究对象,对术后并发感染的原因进行统计分析.结果 导致结直肠肿瘤术后并发感染的危险因素以免疫力低下最多见,占63.4％,其次为泌尿道插管占6.1％、手术时间延长占11.0％、糖尿病占7.3％、腹腔引流占7.3％以及消毒隔离不严占4.9％,免疫力低下明显高于其他原因,差异有统计学意义(P＜0.05).结论 提高患者免疫力,严格手术操作规程,积极控制糖尿病,合理使用抗菌药物,可以有效地降低结直肠肿瘤术后并发感染的概率.     

Diet, Lifestyle, and Colorectal Cancer: Is Hyperinsulinemia the Missing Link?

Several dietary and other lifestyle factors have been implicated in the development of colorectal cancer. However, the precise nature and actual magnitude of the relationship between individual nutrient intakes and other lifestyle factors and colorectal cancer risk are not clear. A unifying hypothesis has recently been proposed that explains why obesity, physical inactivity, alcohol, and consumption of a typical Western diet increase colorectal cancer risk. This hypothesis suggests that these dietary and other lifestyle factors are associated with insulin resistance and hyperinsulinemia and that hyperinsulinemia, in turn, may stimulate growth of colorectal tumors. Two recently published large prospective epidemiologic studies indicate a significant increase in colorectal cancer risk in subjects with diabetes mellitus, thereby supporting this hypothesis.     

预后营养指数在结直肠肿瘤术后手术部位感染的预测作用

目的 :分析预后营养指数(prognostic nutritional index,PNI)与结直肠肿瘤术后发生手术部位感染(SSI)的联系,探讨PNI作为结直肠肿瘤病人预后指标的作用价值。方法 :回顾性收集我院普外科2013年9月至2015年12月行手术治疗的332例经病理确诊结直肠肿瘤病人的临床资料,根据术后是否发生SSI将其分为感染组和对照组,通过单因素和多因素分析评价结直肠肿瘤术后的风险因素,通过ROC曲线评价PNI在SSI的预测价值。结果 :43例病人术后出现SSI,其中浅层或深层手术部位感染36例,器官/腔隙感染7例;ROC曲线分析显示,术前PNI48对预测术后SSI的发生具有显著价值(曲线下面积=0.782,灵敏度81.1%,特异度65.8%)。多因素分析结果显示,手术时间(OR=3.42,95%CI:1.22-8.78,P=0.04)和PNI48(OR=2.35,95%CI:1.20-4.53,P=0.03)是预测术后SSI的独立危险因素。结论 :PNI作为简单并有价值的临床指标,对于结直肠肿瘤术后预测SSI的发生具有重要的意义。     

Decision-making role preferences and information needs: a comparison of colorectal and breast cancer

Objective  An exploratory study has been carried out to examine decision-making role preferences and information needs for a sample of people with colorectal cancer ( n =48). The work replicated a larger study carried out for women with breast cancer ( n =150), and this paper compares and contrasts findings for both disease groups.
Design  A cross-sectional design was employed, involving structured interviews. The main variables investigated were decision-making preference (using a decisional role preference card sort), perceived decisional role and information need (using an information needs questionnaire).
Results  The majority (78%) of the colorectal cancer patients preferred to play a passive role in decision making, in contrast to 52% of women with breast cancer in previous work. Eighty per cent of the colorectal sample and 61% of the women with breast cancer perceived that the doctor had made treatment decisions. Priority information needs for both groups related to cure, spread of disease and treatment options.
Conclusions  The two most striking findings from the comparison between the two disease groups relate to the differences in decision-making role preferences and the similarities in information needs. The process of involving people with colorectal cancer in treatment decision making warrants further investigation. The similarity in information needs of the two disease groups has implications for health care professionals providing information to people with cancer.     

Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados Département,France

Screening for colorectal cancer is a high priority of public health in France, as in other Western countries. In spite of its effectiveness, shown by randomized studies, no national program of colorectal screening using fecal occult blood test has yet implemented, due mainly to the low sensitivity of the screening test and to the weak participation of the target population. Economic studies can make a useful contribution to helping the decision makers of public health. One of the advantages to the organization of a screening program is a financial saving generated by advance in diagnosis. To investigate this hypothesis this study assessed the cost of the management of colorectal cancer according to its stage of extension using medical data from a specialized cancer registry and economic data from the national Social Security System. No significant decrease in the first-year costs of treating colorectal cancer was found with advance of diagnosis. The average cost for the first year of management of colorectal cancer after diagnosis was of Euro 21,918. According to the stage of diagnosis, the highest average cost was for the subjects with a cancer with lymph node involvement, with a cost of Euro 31,110. Cancers with an invasion limited to the submucosa or visceral metastases had an equivalent cost, respectively, of Euro 17,579 and of Euro 17,384. With a limited power due to low strength, these results suggest that the organization of a colorectal cancer screening program does not significantly reduce in the first year the total cost of management of this cancer. However, the organization of such screening remains a public health priority, prevention aiming only to allow subjects to live in good health as long as possible,and not to save money.     

二甲双胍与卵巢癌发生及预后关系的研究

卵巢癌是世界上严重的妇科肿瘤之一,其死亡率位居妇科恶性肿瘤首位。二甲双胍不仅作为一线口服降糖药用于治疗2型糖尿病,而且对卵巢癌的发生发展还具有一定的抑制作用。近年来,国内外学者开展了关于二甲双胍与卵巢癌关系的实验和流行病学研究,共纳入了二甲双胍服用与卵巢癌发病及预后的7项队列和2项病例对照研究。结果提示使用二甲双胍可能改善卵巢癌的预后,但由于发病的流行病学研究较少,因此其与卵巢癌发病关系仍需进一步的探索。     

以肠梗阻为首发症状的老年人与中青年人大肠癌临床资料比较

目的比较老年与中青年大肠癌合并梗阻患者的临床、病理特点和外科治疗效果。方法回顾分析我院自2006年3月至2012年7月收治的大肠癌合并急性肠梗阻患者65例的临床资料。结果中青年组患者低分化腺癌比例(28.6%)明显高于老年患者(5.4%),差异有统计学意义(P﹤0.05),Dukes C、D期所占比例也高于老年患者(P﹤0.05)。两组患者术中一般情况与术后并发症及5年生存率无明显差异(P﹥0.05)。结论青年大肠癌患者应该争取早期诊断早期治疗,老年大肠癌患者应尽量争取一期切除才能提高患者的远期生存率,改善生存质量。     

The Dark Side of Iron: The Relationship between Iron,Inflammation and Gut Microbiota in Selected Diseases Associated with Iron Deficiency Anaemia—A Narrative Review

Iron is an indispensable nutrient for life. A lack of it leads to iron deficiency anaemia (IDA), which currently affects about 1.2 billion people worldwide. The primary means of IDA treatment is oral or parenteral iron supplementation. This can be burdened with numerous side effects such as oxidative stress, systemic and local-intestinal inflammation, dysbiosis, carcinogenic processes and gastrointestinal adverse events. Therefore, this review aimed to provide insight into the physiological mechanisms of iron management and investigate the state of knowledge of the relationship between iron supplementation, inflammatory status and changes in gut microbiota milieu in diseases typically complicated with IDA and considered as having an inflammatory background such as in inflammatory bowel disease, colorectal cancer or obesity. Understanding the precise mechanisms critical to iron metabolism and the awareness of serious adverse effects associated with iron supplementation may lead to the provision of better IDA treatment. Well-planned research, specific to each patient category and disease, is needed to find measures and methods to optimise iron treatment and reduce adverse effects.     

腹腔镜结直肠癌手术的研究现状及进展

以往的20多年中,腹腔镜技术已在结直肠癌疾病的手术治疗中得到应用.国内病例对照研究和国外大样本随机对照试验均证实,腹腔镜结直肠癌手术相比于传统开放手术,其短期疗效更理想,且疾病预后基本一致.但一直以来,针对腹腔镜结直肠癌手术治疗的状况仍然存在较大争议性.目前腹腔镜结直肠癌手术已有了明显进步,如结直肠癌合并肝转移腹腔镜治...     

KL-6粘蛋白和E-钙粘蛋白在大肠癌组织中的表达及其临床意义

目的研究KL-6粘蛋白和E-钙粘蛋白在结直肠癌中的表达和其对应的临床病理之间相互关系及KL-6粘蛋白作用机制。方法于手术中收集大肠癌组织与癌旁组织各60例（所有手术患者在术前均未进行全身化疗、放疗及其他治疗）,采用逆转录酶聚合酶链反应（RT-PCR）技术检测大肠癌组织及癌旁组织中KL-6粘蛋白与E-钙粘蛋白的RNA表达水平的变化。结果 1RT-PCR法检测结果显示,大肠癌组织中KL-6粘蛋白的表达明显高于癌旁正常组织,而E-钙粘蛋白表达明显低于癌旁正常组织,差异均有统计学意义（P〈0.05）。KL-6粘蛋白和E-钙粘蛋白RNA的表达与性别、年龄、临床TNM分期无关,差异无统计学意义（P〉0.05）;但与不同肿瘤的分化程度以及有无淋巴结转移有关,且差异有统计学意义（P〈0.05）。2相关性分析显示,KL-6粘蛋白和E-钙粘蛋白在大肠癌中的表达呈显著负相关（P〈0.05）。结论 1KL-6粘蛋白和E-钙粘蛋白的表达异常在大肠癌的发生、发展中起重要作用,KL-6粘蛋白和E-钙粘蛋白的表达与大肠癌的分化程度及淋巴结转移情况有相关性;联合检测两者在大肠癌中的表达可能有助于恶性程度的评估与预后判断。2KL-6粘蛋白其发挥作用的作用机制可能与其抗粘附作用以及Wnt/β-catenin信号通路的激活密切相关。     

抗菌药物使用与结直肠癌术后切口感染的相关性研究

目的探讨结直肠癌患者术后抗菌药物使用情况与手术切口感染的关系。方法回顾性分析了2003年2月-2010年12月收治的547例结直肠癌患者病例资料,按手术切口感染情况分为A组:切口感染组105例,B组:切口无感染组442例,比较2组患者抗菌药物使用时间及联合用药情况,再将所有患者按抗菌药物使用时间分为:>72h组和<72h组,比较2组切口感染率。结果 A组术后用药时间高于B组,差异有统计学意义(P<0.05);2组抗菌药物用药方案差异无统计学意义,抗菌药物使用时间>48h组的切口感染率,高于抗菌药物使用时间<48h组,但差异无统计学意义。结论结直肠癌患者手术切口感染,是一个多因素相互作用的过程,增加抗菌药物的使用时间和多联合用药并不能使切口感染率下降,外科医师应该增强合理用药的意识。