In recent years,the tumor microenvironment(TME)has garnered significant attention from scientists.It is a com-plex system composed of tumor cells,cancer-associated fibroblasts(CAFs),immune cells,blood vessels,extracellular matrix,sur-rounding supportive tissues and their metabolic environment.Two fundamental characteristics of this system are immune escape and metabolic changes(the shift from aerobic to anaerobic metabolism of glucose,leading to lactate production).Although lactate has tra-ditionally been considered a metabolic"waste"product in the TME,it is now widely recognized that the increase in lactate and the acidification of the tumor microenvironment play key roles in tumor development and progression,including immune escape,tissue in-vasion/tumor metastasis,angiogenesis and tumor drug resistance.Therefore,studying the regulatory mechanisms of lactate metabo-lism,immune suppression,angiogenesis,and tumor drug resistance in the TME can provide a theoretical basis and practical evidence for new therapeutic strategies targeting the TME.

Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.

Overweight and obesity are main risk factors for chronic metabolic diseases, and are strongly associated with the increased risk of premature death. Low carbohydrate diet (LCD) has been proven to effectively control body weight and fat mass in overweight and obese patients by short-term (≤6 months) dietary intervention studies. The mechanisms include regulation of energy metabolism, anti-inflammatory, antioxidant, alteration in expression of lipid metabolic-related genes and modulation of intestinal flora. However, the conclusions are inconsistent on whether LCD can cause durable weight loss and reduce the risk of overweight and obesity. This review summarizes the current research progress on the mechanisms, epidemiological studies, intervention studies and potential risks of LCD in controlling overweight and obesity, providing a reference for the future research and clinical application.

Diet management is the key part in the prevention and treatment of chronic kidney disease (CKD). A plant-based diet is a diet consisting mostly or entirely of foods derived from plants, with little or no animal foods. In recent years, research on plant-based diets for chronic kidney disease has been increasing. Large-scale epidemiological studies and interventional studies consistently suggest that plant-based diets could reduce the risk of CKD and related complications and slow down CKD progression. This article reviews the research progress of plant-based diets in the prevention and control of CKD.

Objective:To explore the effects of nutrition guidance combined with exercise intervention among elderly patients with sarcopenic obesity in community.Methods:From January 2014 to November 2015, we selected 120 elderly patients with sarcopenic obesity of Xixi Street Community Health Service Center in Hangzhou as subjects by convenience sampling. All of patients were divided into control group and intervention group according to the odd and even of visit number, 60 cases in each group. Control group carried out the routine health education, while intervention group implemented the balanced diet combined with exercise intervention as well as increase whey protein appropriately. Six months after intervention, we compared the body mass index (BMI) , grip, calf girth, leg speed, 5 times sitting up test, human muscle percentage and body fat percentage of patients between two groups.Results:Before intervention, there were no statistical differences in the indexes of patients between two groups ( P>0.05) . Six months after intervention, the BMI of intervention group and control group was (25.39±0.95) kg/m 2 and (25.46±0.93) kg/m 2 respectively with no statistical difference ( t=0.36, P>0.05) . The six indexes, grip, calf girth, leg speed, 5 times sitting up test, human muscle percentage and body fat percentage, of intervention group were (23.43±2.04) kg, (32.60±1.34) cm, (0.83±0.10) m/s, (11.05±1.50) s, (47.69±2.87) % and (33.68±2.20) % respectively, all better than those of control group with statistical differences ( t=-4.62, -2.06, -2.62, 2.46, -3.68, 2.46; P<0.05) . Conclusions:Nutrition guidance combined with exercise intervention can improve the functional indexes of elderly patients with sarcopenic obesity in community, such as muscle strength, and delay the functional decline caused by sarcopenia.

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization.Methods A prospective,multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology,respiratory medicine,general surgery,geriatrics,thoracic surgery,neurology,orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014.On admission and within 24 hours after discharge,the clinical data were recorded,physical indices were measured,and laboratory examination were conducted.NRS 2002 and SGA were used to make an evaluation.The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed.Results A total of 2558 patients above 65 years old were included into the study.Compared with their status on admission,their grip strength,upper arm circumference and crural circumference were reduced significantly at discharge (P＜0.05).The total protein,albumin and hemoglobin levels were significantly lower than those on admission (P＜0.05).The incidence of nutritional risk (NRS 2002 score ≥ 3) and malnutrition (SGA B + C) on admission were lower than those at discharge (51.1％ vs 53.0％,32.6％ vs 35.6％).The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes.The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses.61.3％ patients having nutritional risk did not take nutritional support during the hospital stay,while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6％ vs 11.9％).Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission,these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge.Therefore,the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes.

Objective To discuss the effects of nutritional intervention combined with exercise therapy on the prevention and treatment of sarcopenia for aged in the community.Methods We selected 114 patients with sarcopenia from outpatient elderly patients in the health service center of street community in Xihu district of Hangzhou from April 2014 to October 2015. 114 patients with sarcopenia were randomly divided into three groups (health education group,health education and full nutrition formula powder group,health education and whey protein group) by using method of digital drawing in male and female separately. Before the intervention, patients in three groups were investigated in following aspects:basic data,self health evaluation,living habits, functional status. After 100 days of intervention,body mass index (BMI),grip strength,walking speed,five times sit experiment,rate of human muscle,body fat rate were compared among three groups.Results Before the intervention,there was no difference in the basic data,self health evaluation,living habits,functional status of patients in three groups (P>0.05). After 100 days of group intervention,health education group had significant difference in BMI (t=-4.46;P<0.01),walking speed and body fat rate (t=-2.55,-2.48;P<0.05) compared with the data before intervention;health education and full nutrition formula powder group had significant difference in BMI,grip strength,walking speed and body fat rate (t=-6.58,-7.34,-4.15,-3.13;P<0.01), which had statistical significance in five times' sit experiment (t=-3.06,P<0.05);Health education and whey protein group had significant difference in BMI,grip strength,walking speed and five times' sit experiment (t=-3.39,-8.49,-8.20,5.40;P<0.01),which had statistical significance in calf circumference and rate of human muscle (t=-2.45,-2.63;P<0.05;).Conclusions On the basis of nutritional intervention methods combined with exercise therapy,adding full nutrition formula powder or whey protein can improve the BMI, grip strength and walking speed of aged patients with sarcopenia. The combination of nutrition and exercise intervention is beneficial to prevent and control the sarcopenia.

Objective To explore the effect of calories supplement or protein supplement on the skeletal muscle in the elderly.Methods The ambulatory elderly (≥65 yrs) with reduced handgrip strength and/or gait speed were enrolled,who did not suffer from any neurological or arthritic disease impairing mobility,or any severe pulmonary or heart disease,or chronic kidney failure.The subjects were recruited with their written informed consent from clinical practices in five hospitals in China.The subjects were randomized to control group(n=26),nutrition supplementation (Nutren 400 kcal/ d) group (n=27) or protein supplementation(Biopro Protein 20 g/d) group (n=21).All the subjects were given healthy lifestyle education.The physical performances i.e.gait speed and handgrip strength were measured at baseline and at 2 and 3 months of followed up.Lean soft tissue mass (muscle mass) was measured by BIA at baseline and at 3 months of follow-up.Results A total of 74 subjects completed the trial,including 26 in controls,27 in Nutren,and 21 in protein group.At the end of the trial,the changes from baseline in appendicular muscle mass were-490.0 g (95％CI:-801.9--245.5,P=0.001)in control group,90.0 g (95％CI:-346.8--442.0,P=0.241) in Nutren group,and 290.0 g (95％CI:-746.6-20.1,P=0.007) in protein group.There were no significant difference in above indices among the three groups (P=0.051),except between Nutren group and control group (P=0.020).The handgrip strength and gait speed in the three groups were improved obviously as compared with those at baseline,but not statistically significant between different groups.Conclusions Caloric supplementation group may have greater effect in maintaining muscle mass than the protein supplement group in the elderly.Both the caloric supplement and the protein supplement produce no additional effect on muscular function as compared with healthy lifestyle education.

Objective To evaluate the effectiveness of "stratified progressive" comprehensive intervention on prevention and treatment of metabolic syndrome ( MS) in community people. Methods The health examination data of the enterprise retiree, who had health check from August to September 2012 in the Health Service Center of Street Community in Xihu District in Hangzhou and lived in the two communities of same street, were collected. The retirees were divided into observation group and control group by coin toss method. All people of two groups were divided into the general population, MS high risk population and MS patients. The people of observation group were taken"stratified progressive" comprehensive intervention, while the people of control group received routine health guidance. We evaluated 8 related indexes changes before and after the intervention, including systolic blood pressure ( SBP) and diastolic blood pressure ( DBP) , body mass index ( BMI ) , waist circumference, low density lipoprotein ( LDL-C ) , triglycerides ( TG ) , fasting plasma glucose (FPG), total cholesterol (TC). Results Before intervention, there were no statistical differences of 8 indexes in general population, MS high risk population and MS patients ( P > 0. 05 ). After 2 years intervention, the 8 indexes of MS patients between two groups had significant differences ( t =8. 24, 6. 37, 6. 44, 3. 84, 8. 06, 10. 89, 8. 32, 7. 99;P <0. 05 ); the indexes differences of SBP, DBP, BMI, waist circumference, LDL-C, TG, FPG had statistical significance in MS high risk population of two groups ( t =2. 91,5. 47,3. 02,3. 77,7. 54, 6. 46, 7. 77;P <0. 05); in general population of two groups, the indexes differences were statistical significant in SBP, DBP, LDL-C and TG (t=5. 52, 4. 58, 8. 56, 5. 95;P<0. 05). Conclusions Lifestyle intervention is an effective method and a key method to prevent and treat MS, and"stratified progressive" can efficiently reduce the indexes of MS in community populations.

Objective To evaluate the effectiveness of “dietary traffic lights” on nutritional intervention for high-risk metabolic syndrome ( MS ) patients in the community .Methods Selected 272 high-risk MS patients over 50 years old from 2 communities, who had completed physical examination data from August to September , 2012 .They were divided into the the nutrition group ( n=133 ) and the control group ( n=139 ) , by tossing a coin.The control group was received routine health education , while the nutrition group was given one-to-one nutritional intervention .We evaluated the mastering of health diet after one month and 8 related index changes before and after intervention at one year after the nutrition education .Results The mean score of the nutrition group was (11.61 ±1.04), which was significantly higher than the control group of (7.27 ±3.73) (t=12.92, P<0.01).After one year of intervention , the systolic blood pressure , diastolic blood pressure, body mass index, fasting glucose, triglycerides, total cholesterol and LDL were (128.49 ±9.24) mmHg, (23.74 ±2.24)kg/m2, (5.85 ±1.16) mmol/L, (1.96 ±0.88) mmol/L, (4.47 ±1.10) mmol/L and (2.80 ±0.86)mmol/L, respectively;which were significantly better than (140.65 ±13.11)mmHg, (24.51 ± 3.16) kg/m2, (6.76 ±1.07) mmol/L, (2.42 ±0.89) mmol/L, (5.16 ±0.95) mmol/L and (3.23 ± 0.69)mmol/L.The differences were statistically significant (t=-8.81, -2.30, -6.73, -4.25, -5.36,-4.58, respectively; P<0.01).Conclusions Nutritional intervention with “dietary traffic lights”-focused can effectively reduce 8 related index for the community high-risk patients with MS .