Low phase angle is associated with the development of hepatic encephalopathy in patients with cirrhosis

AIM Evaluate the association between phase angle and the development of hepatic encephalopathy in the longterm follow-up of cirrhotic patients.METHODS This was a prospective cohort study. Clinical, nutritional and biochemical evaluations were performed. MannWhitney's U and χ2 tests were used as appropriate. Kaplan-Meier curves and Cox proportional Hazards analysis were used to evaluate the prediction and incidence of hepatic encephalopathy.RESULTS Two hundred and twenty were included; the most frequent etiology of cirrhosis was hepatitis C infection, 52% of the patients developed hepatic encephalopathy(18.6% covert and 33.3% overt); the main precipitating factors were infections and variceal bleeding. KaplanMeier curves showed a higher proportion of HE in the group with low phase angle(39%) compared to the normal phase angle group(13%)(P = 0.012). Furthermore, creatinine and phase angle remained independently associated to hepatic encephalopathy in the Cox regression multivariate analysis [hazard ratio = 1.80(1.07-3.03)]. CONCLUSION In our cohort of patients low phase angle was associated with an increased incidence of hepatic encephalopathy. Phase angle is a useful nutritional marker that evaluates cachexia and could be used as a part of the integral assessment in patients with cirrhosis.     

Muscle weakness caused by cancer and chemotherapy is associated with loss of motor unit connectivity

Skeletal muscle wasting and weakness caused by cancer and its treatments (known as “cachexia”) drastically impair quality of life and worsen survival outcomes in cancer patients. There are currently no approved treatments for cachexia. Hence, further investigation into the causes of cachexia induced by cancer and chemotherapy is warranted. Here, we sought to investigate skeletal muscle wasting, weakness and loss of motor unit function in mice bearing cancers or administered chemotherapeutics. Mice bearing colorectal cancers, including C26, MC38 and HCT116, and mice receiving the chemotherapeutics folfiri and cisplatin were assessed for in vivo and ex vivo muscle force, and for in vivo electrophysiological indices of motor unit connectivity, including compound muscle action potential and motor unit number estimation (MUNE). In vivo and ex vivo muscle force, as well as MUNE were reduced in C26, MC38, HCT116 hosts, and in mice receiving folfiri and cisplatin compared to their respective experimental controls. In addition, MUNE was correlated with muscle force and muscle mass in all experimental conditions, while assessment of neuromuscular junction (NMJ) protein expression and changes in presynaptic morphology suggested that cancer and chemotherapy significantly alter muscle innervation. The present results demonstrate that the loss of motor unit connectivity may contribute to skeletal muscle wasting and weakness that occur with cancer and chemotherapy.     

得力生注射液抗癌症恶病质的临床研究

目的观察得力生注射液对癌性恶病质状态的影响。方法给予癌症恶病质患者3周得力生注射液,每天50ml,观察治疗前后体重、症状及恶病质相关因子的变化。结果治疗后与治疗前相比,患者在食欲、体重、体能评分方面明显改善,细胞因子TNF-α、IL-6、IL-1均有不同程度下降。结论得力生在一定程度上可能通过下调恶病质细胞因子,从而改善患者的生存质量。     

中药用于改善化疗所致消化道副作用的研究现状

概述中药用于改善化疗所致消化道副作用的临床与动物实验研究进展，探讨其作用机制，并提出目前相关研究的不足及今后的发展方向。临床上大多数化疗药物均会引起癌症病人不同程度及不同类型的消化道副作用，最终导致恶性营养不良及恶病质，直至死亡，而中药方剂在调理消化道功能紊乱方面明显优于西药。     

癌症相关代谢紊乱综合征

临床上晚期癌症患者多表现为厌食、体重下降、早饱感、虚弱乏力及免疫力下降,这是癌症相关的代谢紊乱综合征所引起的,即恶病质,成为癌症患者死亡的主要原因之一。癌症代谢紊乱综合征与饥饿所引发的代谢紊乱是不同的,后者消耗大量的脂肪组织来维持肌肉组织中的蛋白含量,而前者脂肪和蛋白质都大量消耗,其中以蛋白质的消耗最为严重,使机体功能受损。现在有许多机制来解释癌症代谢紊乱综合征的病因,主要认为是由机体反应细胞或肿瘤细胞自身所产生的多种代谢因子所导致的,如TNF-α、IL-1、IL-6等。一些激素如糖皮质激素、瘦素、Ghrelin等也越来越受到研究者的重视。研究发现在癌症代谢紊乱综合征中这些激素水平发生了变化,但这种变化在该代谢紊乱病因中所起的作用还不清楚。这些因素在癌症代谢紊乱综合征中所起的作用不是十分确定,而且对该综合征所涉及的信号通路的研究也尚无定论。这些都给临床治疗带来了很大困难,仅靠补充营养并不能有效地增加癌症患者骨骼肌的蛋白含量。约三分之一的癌症患者最终因代谢紊乱死亡而非肿瘤本身。因此需要对癌症代谢紊乱的病因及其发生、发展过程进行更深入的研究,这些问题的解决不仅将有助于提高癌症患者的生活质量,对临床治疗也会有较大的帮助。     

Reciprocal changes in hypothalamic receptor binding and circulating leptin in anorectic tumor-bearing rats

Although reduced biological activity of the obese gene product, leptin, has been associated with obesity, little information is available concerning leptin alterations during anorexia. Therefore, we measured circulating leptin concentrations and hypothalamic leptin binding in anorectic tumor-bearing and pair-fed control rats. Plasma concentrations of leptin decreased in tumor-bearing rats early in the course of tumor growth, and fell to nearly non-detectable levels during severe anorexia. The pair-fed control rats that ate the same amount of food as did the anorectic tumor-bearing rats exhibited a 50% decrease in plasma leptin concentration. Concentrations of free fatty acids were elevated in both tumor-bearing and pair-fed groups, while circulating levels of triglycerides were increased only in anorectic tumor-bearing rats. Leptin receptor density was doubled in the hypothalamus of tumor bearing rats, while binding affinity was decreased by 50%. These results suggest that peripheral leptin production is down-regulated, perhaps due to increased lipolysis in tumor-bearing rats. It appears that hypothalamic leptin systems up-regulate receptor numbers in response to decreased blood leptin level, however, the decrease in binding affinity may compensate for these alterations. Therefore, the influence of leptin on hypothalamic neuropeptide Y feeding systems may be minimal in anorectic tumor-bearing rats.     

A questionnaire study of the approach to the anorexia–cachexia syndrome in patients with cancer by staff in a district general hospital

Goals of work  This questionnaire study was designed to investigate understanding, assessment and management of cancer-related anorexia–cachexia syndrome (ACS) amongst hospital staff. Methods  Qualified nurses and doctors on general medical and surgical wards within a district general hospital were asked to complete a questionnaire enquiring about understanding of the term cachexia, routine assessment of commonly associated symptoms and approaches to management of three commonly associated symptoms (poor appetite, early satiety and dry mouth). Main results  One hundred seventeen questionnaires were distributed with 100 returned (86% response rate). Cachexia was most frequently described as weight loss (79%) and anorexia (49%). Some symptoms (including altered appetite, constipation, nausea and vomiting) were routinely assessed during admission or review of these patients. Some common symptoms (including mouth problems, early satiety) were much less likely to be enquired about. Management of the three key symptoms demonstrated a range of approaches with little consistency. Early satiety was particularly poorly managed, with 29% of staff being unable to recognise or treat it. Conclusions  The study highlights the variable understanding of ACS and the lack of standardised assessment and management tools amongst staff in an acute hospital setting. This is likely to lead to inconsistent, and perhaps inadequate, care of patients with palliative care needs. Greater awareness and basic pathways of care may help to improve the experience of ACS for patients with cancer. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.