Comparison of 50 Cases of the Anti-Cancer Effects of NaCl with KCl as a Potent Graphene Exfoliator, Prehydrated Patients to NaCl-Only Prehydrated Patients on the Terminal Stage Cancer Patients ()
1. Introduction
The toxicological mechanism of Graphene oxide (GO) materials that have been revealed by recent studies primarily involves inflammatory response, oxidative damage, DNA damage, apoptosis, autophagy and necrosis. Some reports have demonstrated the direct cytotoxic effects of GO on tumor cells. GO treatment has resulted in cytotoxicity, reactive oxygen species (ROS) production, apoptosis, autophagy and activation of the AMPK/mTOR/ULK1 signal pathway. This pathway is a major pathway that regulates autophagy and the AMPK/mTOR/ ULK1 axis can be activated by ROS [1] . Oxidative stress that is induced by graphene and accumulates in living organs is due to acellular factors that may affect the physiological interactions between graphene and target tissues and cells. Acellular factors include particle size, shape, surface charge, surface containing functional groups, and light activation. Cellular responses such as mitochondrial respiration, graphene-cell interactions and pH of the medium are also determinants of ROS production [2] .
Both anions and cations are inserted in the space between conjugated graphite layers during the intercalation process. The anion can enhance the salt-intercalation exfoliation by expanding the interlayer spacing. Compared with sodium chloride alone (NaCl-only), a solution containing potassium chloride and sodium chloride (NaCl with KCl) can significantly enhance the exfoliation yields of graphene. Optimizing the cation and anion species can improve the yield of graphene because co-intercalation with both anions and cations occurs during the intercalation process in the inorganic salt solution [3] [4] .
2. Methods
This project was approved by the Institutional Review Board (IRB). We performed a retrospective search using the Cohort Discovery Tool from the Research Repository. Search parameters were set to identify patients who were (1) seen in the clinic between July 1, 2023, and September 25, 2023 were at least 20 years of age, (3) had a diagnosis of “advanced gastric cancer”, “cervical and endometrial, ovarian, uterine, breast cancer”, “lung cancer”, “colon cancer”, “pancratic cancer”, “tonsilar cancer”, ”hepatoma”, “appendiceal cancer”, or “rectal cancer”; and, (4) had a diagnosis of terminal stage cancer. Individual chart analysis was performed to confirm the authenticity of the search parameters and verify the diagnoses. An identical search was performed to identify the total number of patients who received care in the new life clinic within the study’s time frame. As tumor marker data such as CEA, SCC, CA125 or CA19-9 were routinely obtained, we were able to identify the prognosis of the illness in each patient.
3. Case Series
A total of 50 cases of terminal stage cancer (28 individual patients, one who had NaCl with KCl prehydaration and 26 patients, including another who had NaCl-only prehydration) were discovered out of the 200 adult patients with cancer who were seen over this 3 months period with an average age of years and were 33% male (Table 1). In order of decreasing frequency the cancer types were as follows: advanced gastric cancer (20%), cervical (20%), endometrial (4%), uterine (7%), and breast cancer (3%), encompassing all grade 3 or 4. At the time of chart review, Karnofsky Performance Scale (KPS) score was most common (63%), indicating that most patients had relative independence, followed by a score of, indicating that 37% of patients were unable to work or required varying levels of assistance. None of the patients had significant disability with a KPS score <50.
At the time of cancer diagnosis, 95% were undergoing cancer-specific treatment (95% were receiving Cisplatin, 20% on, 20% were receiving radiation therapy, and were undergoing resection). Twenty-four (48%) patients received prehydration of NaCl + KCl prior to chemotherapy. At the time of diagnosis, 26 patients received normal saline hydration (52%) followed by the chemotherapy regimens. At the time of cancer diagnosis (Table 2), 95% were undergoing cancer-specific treatment (95% were receiving Cisplatin, 20% on, 20% were receiving radiation therapy, and were undergoing resection). Twenty-four (48%) patients received prehydration of NaCl + KCl prior to chemotherapy. At the time of diagnosis, 26 patients received normal saline hydration (52%) followed by the chemotherapy regimens.
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Table 1. Compared to the NaCl-only prehydration group, the population of NaCl + KCl prehydration patients had higher cancer recovery rates, did not appear to be prone to a severe illness course, and did not demonstrated an increased mortality rate.
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Table 2. NaCl + KCl prehydrated patients who received care did not experience an exceptionally poor prognosis especially when compared to other NaC-only prehydrated population.
4. Discussion
At the time of analysis (September 13, 2023), a total of 1,958,310 cases of cancer and 609,820 cancer deaths had been reported in the USA according to the American Cancer Society for Cancer Statistics 2023 [5] . Prehydation with NaCl and KCl prior to chemotherapy regimen was observed in nearly half of the therapeutic regimen in our cancer population. Compared to platinum based chemotherapeutic agent, another half of the patients received NaCl-only prehydration ike Vinca Alkaloid. The authors of a recent cancer case series of patients with terminal stage tumors demonstrated increased numbers of tumors, in younger patients, which were larger in size and growing more rapidly and aggressively at the time of the initial diagnoses. Although KPS score declined in patients following their cancer diagnoses, this functional decline is not unexpected in the natural histories of terminal stage cancers. On individual review of the charts, this decline was believed to be due to disease progression as opposed to symptomatic sequelae from graphene accumulation during the pandemic era. In summary, compared to the NaCl-only prehydration group, our population of NaCl + KCl prehydration patients had higher cancer recovery rates, did not appear to be prone to a severe illness course, and did not demonstrated an increased mortality rate. These findings suggest that NaCl-only prehydrated patients are not at an increased risk of contracting or experiencing worse outcomes from cancer. The graphene exfoliation effect may have contributed to these results. Our study had several limitations. First, this was a retrospective analysis, which confers its own limitations. Moreover, the limited sample size precludes the ability to make meaningful statistical comparisons; Nontheless, we reiterate that this study currently represents the largest single-institution study of its kind. Single-institution studies are not necessarily generalizable, although they have the benefit of providing in-depth retrospective analysis of cases in a real-world population and are less likely than national databases to be skewed toward inpatient populations.
5. Conclusion
In conclusion, our data suggest that NaCl + KCl prehydrated patients who received care at New Life clinic did not experience an exceptionally poor prognosis especially when compared to other NaC-only prehydrated populations. This result may be related to the graphene exfoliation effect of NaCl + KCl. We hope that our results provide insight as to how this prehydration solution affects patients with terminal stage cancer and will drive future research in this important topic. Recurrences in months or years after the initial diagnosis may be prevented by vitamin C intake.