A clinical study on the nutritional status of patients with locally advanced rectal cancer during chemo-radiotherapy.

BACKGROUND: Rectal cancer is one of the most common gastrointestinal malignancies, and most cases include locally advanced cancers at the time of diagnosis (stage II/III). OBJECTIVES: The purpose of this study is to observe the dynamic changes in the nutritional status of patients with locally advanced rectal cancer during concurrent radiation therapy and chemotherapy and to evaluate the nutritional risk and incidence of malnutrition in these patients. METHODS: A total of 60 patients with locally advanced rectal cancer were enrolled in this study. The 2002 Nutritional Risk Screening and Patient-Generated Subjective Global Assessment Scales (PG-SGA) were used to assess nutritional risk and status. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) - C30 and QLQ-CR38 scales were used for the quality of life evaluation. Toxicity was evaluated using the CTC 3.0 standard. RESULTS: The incidence of nutritional risk among these 60 patients was 38.33% (23 of 60) before and 53% (32 of 60) after concurrent chemo-radiotherapy. There were 28 patients in the well-nourished group, with a PG-SGA score of <2 points, and 17 patients in the nutrition-changed group, with a PG-SGA score of <2 points before and 2 points during and after chemo-radiotherapy. In the well-nourished group, the incidence of nausea, vomiting and diarrhea mentioned in the summary was lower and the expectations for the future (according to the QLQ-CR30 and QLQ-CR28 scales) were higher than in the undernourished group. The undernourished group required delayed treatment more often and experienced nausea, vomiting and diarrhea earlier and for longer than the well-nourished group. These results show that the quality of life of the well-nourished group was better. CONCLUSIONS: There is a degree of nutritional risk and deficiency in patients with locally advanced rectal cancer. Chemoradiotherapy increases the incidence of nutritional risk and deficiencies. KEY WORDS: Enteral nutrition, Colorectal neoplasms, Quality of life, Chemo-radiotherapy, EORTC.

[Characterization of VOCs Emissions from Caged Broiler House in Winter].

Volatile organic compound (VOCs) emissions from poultry and livestock facilities affect the surrounding environmental quality and human health. However, VOCs emissions from broiler houses have been less characterized, and studies of related dominant odorants, carcinogenic risk, and ozone formation potential are still lacking. To fill this research gap, VOCs pollutants emitted from a broiler house were investigated in this study. The VOCs emission characteristics of the broiler house during three different periods of broiler growth (early, middle, and later) were analyzed using gas chromatography-mass spectrometry. The results showed that 77 types of VOCs were detected, including 16 types of halogenated hydrocarbons, 21 types of alkanes, 5 types of olefins, 12 types of aromatic hydrocarbons, 15 types of oxygenated volatile organic compounds (OVOCs), and 8 types of sulfides. During the entire 42-day growth period, the concentrations of halogenated hydrocarbons, alkanes, olefin, aromatic hydrocarbons, and OVOCs in the broiler house showed few changes. However, with the growth of broilers, the intake of sulfur-containing amino acids and the fecal emission coefficient increased, resulting in the gradual conversion of the VOCs to sulfide. Therefore, emissions of sulfur-containing VOCs increased in the early and middle growth periods. Moreover, the increase in ventilation in the house during the later growth period resulted in a decrease in the sulfur-containing VOCs concentrations. The dominant odorants in the broiler house were naphthalene, ethyl acetate, acetaldehyde, carbon disulfide, dimethyl disulfide, methanethiol, methanethiol, and thiophene. Methanethiol had the highest odorous values, ranging from 2172.4 to 19090.9. Meanwhile, there were acceptable levels of carcinogenic risk in the early and middle growth periods, with a lifetime cancer risk (LCR) of 7.7×10-6 and 4.5×10-6, respectively. The average ozone formation potential (OFP) was (1458.9±787.4) µg·m-3. The results of this study can provide a scientific basis for the monitoring of malodorous substances and formulation of emission reduction strategies in broiler production.

The number of cycles of adjuvant chemotherapy in stage III and high-risk stage II rectal cancer: a nomogram and recursive partitioning analysis.

OBJECTIVE: The prognostic role of the number of cycles of adjuvant chemotherapy (ACT) after total mesorectal excision in stage III and high-risk stage II rectal cancer is unknown. As a result of this, our study was designed to assess the effect of the number of cycles of ACT on the prediction of cancer-specific survival. METHODS: Four hundred patients that were diagnosed as stage III and high-risk stage II rectal cancer from January 2012 to January 2018 and who had received total mesorectal excision were enrolled in this study. A nomogram incorporating the number of cycles of ACT was also developed in this study. For internal validation, the bootstrap method was used and the consistency index was used to evaluate the accuracy of the model. The patients were stratified into risk groups according to their tumor characteristics by recursive partitioning analysis. RESULTS: We found that the risk of death was decreased by 26% (HR = 0.74, 95% CI: 0.61-0.89, P = 0.0016) with each increasing ACT cycle. The N stage, positive lymph node ratio (PLNR), carcinoembryonic antigen, neutrophil-to-lymphocyte ratio, and the number of cycles of ACT were chosen and entered into the nomogram model. Recursive partitioning analysis-based risk stratification revealed a significant difference in the prognosis in rectal cancer patients with high-risk, intermediate-risk, and low-risk (3-year cancer-specific survival: 0.246 vs. 0.795 vs. 0.968, P < 0.0001). Seven or more cycles of ACT yielded better survival in patients with PLNR ≥ 0.28 but not in patients with PLNR < 0.28. CONCLUSION: In conclusion, the nomogram prognosis model based on the number of cycles of ACT predicted individual prognosis in rectal cancer patients who had undergone total mesorectal excision. These findings further showed that in patients with PLNR ≥ 0.28, no fewer than 7 cycles of ACT are needed to significantly reduce the patient's risk of death.

Development and Internal Validation of a Nomogram-Based Model to Predict Three-Year and Five-Year Overall Survival in Patients with Stage II/III Colon Cancer.

OBJECTIVE: The aim of this study was to develop a nomogram-based model to predict the three-year and five-year overall survival (OS) of patients with stage II/III colon cancer following radical resection. METHODS: A total of 1156 patients with stage II/III colon cancer who underwent radical resection at the Affiliated Hospital of Guizhou Medical University between December 2012 and December 2018 were enrolled. Lasso regression was used to screen out 12 variables: age, prealbumin, albumin, degree of differentiation, total tumor-node-metastasis (TNM) stage, T stage, N stage, prognostic nutritional index (PNI), platelet/lymphocyte count, carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9), and postoperative adjuvant chemotherapy. The data set was then randomly split into a modeling set and a validation set, and the bootstrap method was used to verify the internal validity of the final model. A nomogram was then used to present the model, and the risk groups were categorized according to the total score in the nomogram. RESULTS: This study established and developed a simple, easy-to-use predictive model that included age, degree of differentiation, N stage, CA19-9, PNI, and postoperative chemotherapy as variables. In the multivariate Cox regression analysis, only postoperative chemotherapy was identified as an independent risk factor for death in patients with colon cancer. The receiver operating characteristic curve showed that the model demonstrated good resolution, with an area under the curve of 0.803. Decision curve analysis indicated that the model had a good positive net gain, and the bootstrap method was used to verify its stability. In the OS rate, the C-index was 0.78. According to the total score of the nomogram, the risk group was layered by drawing the Kaplan-Meier (K-M) curve. In the three-year OS K-M curve, the survival rates of the low-risk group, the medium-risk group, and the high-risk group were 96%, 93%, and 82%, respectively. In the five-year OS K-M curve, the survival rates of the low-risk group, the medium-risk group, and the high-risk group were 94%, 90%, and 73%, respectively. CONCLUSION: The nomogram-based prediction model developed in this study is stable and has good resolution, reliability, and net gain. It will therefore be useful for clinicians performing risk stratification and postoperative monitoring and in the development of personalized treatment options for patients with stage II/III colon cancer.

The Effect of the Prognostic Nutritional Index on the Toxic Side Effects of Radiochemotherapy and Prognosis After Radical Surgery for Gastric Cancer.

OBJECTIVE: A retrospective analysis was conducted to investigate the effect of the preoperative prognostic nutritional index (PNI) on the severity of toxic side effects of radiochemotherapy and the survival prognosis of patients with gastric cancer to guide the clinical nutritional support for patients with gastric cancer. METHODS: Data of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of Guizhou Cancer Hospital and the Affiliated Hospital of Guizhou Medical University between January 2008 and December 2018 were analyzed retrospectively. Patients were allocated to the high PNI group (with PNI ≥47.7) and the low PNI group (with PNI <47.7) according to the PNI cutoff value, and the incidence of severe toxic side effects of radiochemotherapy and the overall survival time were compared between the high PNI group and low PNI group. In addition, prognostic factor analysis was performed. RESULTS: The severe hematologic side effects of radiochemotherapy and shorter postoperative survival time were more likely to occur in the low PNI group than in the high PNI group. The multifactor analysis showed that TNM stage (p = 0.000) and PNI (p = 0.001) were the independent risk factors for the overall postoperative survival time in patients with gastric cancer. CONCLUSION: Preoperative PNI might predict the severity of hematologic toxic side effects of adjuvant chemotherapy/radiochemotherapy in patients with gastric cancer after surgery. Patients in the low PNI group were more likely to have severe hematologic toxic side effects, and therefore a low PNI might be one of the important factors affecting the prognosis of gastric cancer.

The Correlation Between UGT1A1 Gene Phenotypes and the Clinical Prognosis of Advanced Colorectal Cancer After FOLFIRI Therapy.

Objective: This study investigated the correlations between the different phenotypes of the uridine diphosphate glucuronyl transferase (UGT) 1A1 gene and the treatment of advanced colorectal cancer after the FOLFIRI regimen. Materials and Methods: A total of 240 advanced colorectal cancer patients with stage IV colon cancer or recurrence after radical surgery between January 2014 and December 2018 were included in a retrospective study. All participants were treated with the FOLFIRI regimen until the disease progressed or an intolerable level of toxicity occurred. Results: In this study, three phenotypes of the UGT1A1 gene promoter were found: the homozygous wild type (TA6/6 type, 78.3%), the heterozygous mutant type (TA6/7 type, 19.6%), and the homozygous mutant type (TA7/7 type, 2.1%). Compared with TA6/7 and TA6/6, the risk of nonresponse to FOLFIRI chemotherapy increased by 16%, but the difference was not significant. The risk of death increased by 24%, and there was no significant difference. There was a risk of hematologic and nonhematologic adverse reactions occurring in TA6/7 and TA6/6, and the total risk of adverse reactions increased by 9.3773 times among patients with more than two metastatic organs. Compared with patients with TA6/6, the risk of toxic side-effects increased by 42.8066 times (p = 0.0259) for patients with TA6/7. Among patients who received FOLFIRI chemotherapy for more than four cycles, the proportion with TA6/7 was greater than that with TA6/6. Compared with those with TA6/6, patients with TA6/7 showed a higher risk of hematologic toxicity (22.3246 times, p = 0.0035). Conclusion: The TA6/7 in patients with advanced colorectal cancer had more than two metastatic organs, and received FOLFIRI chemotherapy for more than four cycles compared with TA6/6 patients. Furthermore, the risk of hematologic and nonhematologic adverse reactions significantly increased, and the risk of digestive-tract and hematologic toxicity was more significant.

A clinical analysis of systemic chemotherapy combined with radiotherapy for advanced gastric cancer.

This study aims to investigate the clinical efficacy of systemic chemotherapy combined with radiotherapy for advanced gastric cancer.A total of 194 advanced gastric cancer patients who were treated from 2006 to 2016 were included in this study. These patients were divided into 2 groups: chemotherapy group (n = 92) and combined chemoradiotherapy group (n = 102). The clinical efficacy of these 2 groups was compared and analyzed to explore the advantageous population and duration of radiotherapy.The remission rates in the chemotherapy group and combined chemoradiotherapy group were 73.5% and 90.6%, respectively, and median survival time was 6.7 versus 10.6 months. Furthermore, the 6-month, 1-year, and 2-year survival rates were 62% versus 83.3%, 22.8% versus 38.2%, and 7.6% versus 13.7%, respectively. All the differences were statistically significant (P < .05). In patients with distant lymph node metastasis, local advanced cancer and organ metastasis, who underwent chemotherapy + radiotherapy, the median survival time was 12.6, 11.1, and 9.8 months, respectively; and the differences were statistically significant compared with the chemotherapy group (P < .05). The median survival time in patients who received concurrent chemoradiotherapy and sequential chemoradiotherapy was 11 and 9.5 months, respectively, and the difference was not statistically significant (P > .05).Combined chemoradiotherapy significantly improved the clinical remission rate, median survival time, and the 6-month, 1-year, and 2-year survival rates in patients with advanced gastric cancer. Furthermore, the survival rate of patients with simple distant lymph node metastasis was better. Concurrent chemoradiotherapy did not significantly improve survival rate compared with sequential chemoradiotherapy.

Positioning error and expanding margins of planning target volume with kilovoltage cone beam computed tomography for prostate cancer radiotherapy.

OBJECTIVE: In this study, prostate cancer patients were treated with image-guided radiotherapy (IGRT). The translational positioning errors were discussed to provide the basis for determining margins of the planning target volume (PTV). METHODS: Thirty prostate cancer patients were treated with radical radiotherapy using the IGRT system. Patients were placed in the supine position and underwent kilovoltage cone beam computed tomography (KVCBCT) scans before radiotherapy. A total of 447 images were acquired. The translational positioning errors were obtained in three linear directions which were X (left-to-right), Y (superior-to-inferior) and Z (anterior-to-posterior) axes (denoted as Lx, Ly and Lz) through the contrast between images adjusted with gray and manual registrations and the planning CT images. Rotational errors were denoted as Rx, Ry and Rz. RESULTS: Uncorrected translational errors Lx, Ly and Lz in the 251 positioning images were all higher than those after correction, and the differences were all statistically significant (P=0.000, 0.037 and 0.004, respectively). For rotational errors Rx, Ry and Rz, only Rx had a significant difference before and after correction (P=0.044). Before correction, PTV margins in the X, Y and Z directions were 0.61, 0.78 and 0.41 cm, respectively; after correction, these were 0.17, 0.12 and 0.17 cm, respectively. CONCLUSION: KVCBCT can be applied to measure positioning errors in prostate cancer radiotherapy and correct these errors in real time through the 6° robotic patient positioning system, in order to improve patient positioning accuracy. The application of IGRT with KVCBCT may reduce PTV margins.

[NH3, N2O, CH4 and CO2 emissions from growing process of caged broilers].

To obtain Ammonia and greenhouse gas (GHG) emission factors of caged broilers, ammonia (NH3), methane (CH4), nitrous oxide (N2O) and carbon dioxide (CO2) emissions of broilers aged 0 d to 42 days were monitored in caged broilers production systems located in Shandong province. Gas concentrations of incoming and exhaust air streams were measured by using INNOVA 1312 multi-gas monitor with multi-channel samplers. Building ventilation rates were determined by on site FANS (Fan Assessment Numeration System) measurement systems. The NH3 emission factors showed a trend of increase at the beginning and then decreased with the broiler ages. The NH3 emission rates were 8.5 to 342.1 mg x (d x bird)(-1) and the average daily emission rate was 137.9 mg x (d x bird)(-1) [48.6 g x (d x AU)(-1)] over the 42-d period. The GHGs emission rates were 19.5-351.9 mg x (d x bird)(-1) with an average of 154.5 mg x (d x bird)(-1) [54.4 g x (d x AU)(-1)] for CH4, and 2.2- 152.9 g x (d x bird)(-10 with an average of 65.9 g x (d x bird)(-1) [23.2 kg x (d x AU)(-1)] for CO2. No emission of N2O was observed. The CH4 and CO2 emission rates increased with the increase of broilers ages. The total NH3 emission over the 42 d growing period averaged (5.65 +/- 1.02) g x (bird x life cycle)(-1). The NH3 emission contribution in different growth phase to the total emission were 33.6% in growth phase 1 (0-17 day, GP1), 36.4% in GP2 (18-27 days), and 29.9% in GP3 (28-42 days), respectively. The NH3 emission in GP2 was significantly higher than emission in GP1 and GP3. CH4 and CO2 cumulative emission rates were (6.30 +/- 0.16) g x (bird(-1) x life cycle)(-1) and (2.68 +/- 0.18) kg x (bird x life cycle)(-1), respectively. The cumulative emission rates of CH4 and CO2 in GP3 were significantly higher than emission rates in GP2 and in GP1, accounting for 50% of total emissions. The results of this study could provide the data support for mitigation of gas emission from broilers production.