Influence of an elevated nutrition risk score in patients suffering from esophageal cancer following tumor resection

Background: Patients who suffer from malignant tumors of the esophagus and esophagogastric junction have 5-year survival rates of up to 83%, something that is documented in the early stages of cancer. Too often, weight loss is an underestimated sign for patients suffering from cancer on the upper gastrointestinal tract. Weight loss is associated with different adverse outcomes. Even after tumor resection, malnutrition remains a severe problem that still affects long-term disease free survivors.Material and methods: This study included the clinical courses of 205 patients suffering from cancer of the esophagus or the esophagogastric junction who were operated on between July 2007 and December 2009. On admission, the nutrition risk score was evaluated. Follow-up data were collected routinely. The aim of the underlying study was to show the prevalence of an elevated nutrition risk score (NRS) and to demonstrate its influence on perioperative mortality and morbidity. Furthermore, the relevance of an elevated nutrition risk score on the postoperative survival was analyzed.Results: More than a third (35.8%) of the patients included in this study had a nutrition risk score of at least three. A preoperative elevated nutrition risk score did not have a significant influence on perioperative morbidity or on 30-days mortality rate. In patients with early tumor stage UICC stage I a/b, an elevated risk score of 3 or more had a significant influence on postoperative survival. In contrast, in advanced tumor stages an increased NRS did not have a significant negative influence on survival within both UICC II a/b and UICC IIII a/b. Conclusions: Further studies are required to demonstrate whether a nutritional intervention can improve the survival rates of patients suffering from malignant tumors within the esophagus and in whom an operation has to be performed.Keywords: Weight loss, esophageal cancer, NRS

The clinical picture of cachexia: a mosaic of different parameters (experience of 503 patients)

BACKGROUND

Despite our growing knowledge about the pathomechanisms of cancer cachexia, a whole clinical picture of the cachectic patient is still missing. Our objective was to evaluate the clinical characteristics in cancer patients with and without cachexia to get the whole picture of a cachectic patient.

METHODS

Cancer patients of the University Clinic "Klinikum rechts der Isar" with gastrointestinal, gynecological, hematopoietic, lung and some other tumors were offered the possibility to take part in the treatment concept including a nutrition intervention and an individual training program according to their capability. We now report on the first 503 patients at the time of inclusion in the program between March 2011 and October 2015. We described clinical characteristics such as physical activity, quality of life, clinical dates and food intake.

RESULTS

Of 503 patients with cancer, 131 patients (26.0%) were identified as cachectic, 369 (73.4%) as non-cachectic. The change in cachexia were 23% reduced capacity performance (108 Watt for non-cachectic-patients and 83 Watt for cachectic patients) and 12% reduced relative performance (1.53 Watt/kg for non-cachectic and 1.34 Watt/kg for cachectic patients) in ergometry test. 75.6% of non-cachectic and 54.3% of cachectic patients still received curative treatment.

CONCLUSION

Cancer cachectic patients have multiple symptoms such as anemia, impaired kidney function and impaired liver function with elements of mild cholestasis, lower performance and a poorer quality of life in the EORTC questionnaire. Our study reveals biochemical and clinical specific features of cancer cachectic patients.

Experiments on accumulation of phosphorus in the plants Myosotis palustris, Glyceria maxima and Nasturtium officinale

The problem of availability of quality water is highly relevant today, so the technologies of prediction and prevention of water pollution and purification are very important. Biological methods of cleaning, in paticular cleaning water by the so-called method of biosorption, have been increasingly used in the last decade. This method means the removal of dangerous substances and improvement of water condition by using aquatic organisms, in particular plants. Therefore, in view of the rich experience of research conducted in the biosorption sphere, we decided to predict the effectiveness of this method by using the cumulative ability of higher water plants to absorb phosphorus compounds. For this purpose, we selected water and plant samples (Glyceria maxima (C. Hartm.) Holmb., Nasturtium officinale R. Br., Myosotis palustris (L.) L.) from the river Seret (Ternopil, Ukraine). The plants were placed into sterilized glass jars filled with 3 liters of water from the river Seret (control samples) and still tap water with addition of sodium phosphate with phosphorus concentration of 3.5 mg/dm³ (research sample), which were cultured in laboratory conditions for four months. We determined the content of phosphates, permanganate and dichromate oxidation in the water and the total content of phosphorus in the plants. We traced the dynamic of organic substances and the content of phosphates in the water, the accumulation of phosphorus in plants and the rate of accumulation of phosphorus in the plants and in the water. We calculated correlation coefficients to detect the dependence between phosphorus indicators in the aquatic plants and the concentration of phosphate ions in the water. We found that M. palustris had the greatest capacity to accumulate phosphorus and the highest rate of phosphorus accumulation from water, which allows us to consider it the most effective aquatic plant for absorption of elements and decreasing water pollution. We also established that G. maxima is the most effective aquatic plant for removal of phosphates from the soil and silt ponds for cultivation, while M. palustris and N. officinale are the most effective in reducing eutrophication of water bodies. 

Heavy metals in the small rivers of Ternopil region under different types of anthropogenic pressure

The dynamic of content and peculiarities of migration of heavy metals in small rivers of Ternopil region were analyzed (Zn, Mn, Fe, Co, Ni, Pb). It was determined that cobalt does not exceed maximum permissible levels, whereas the content of other metals exceed these levels at rates from 2 to 42 times the emission limit set by the fishing industry. The waters of Ternopil region are the richest in the compounds of iron and manganese by virtue of the lithological content of the researched water basins. The excess in Mn and Fe concentration in river water is caused by occurrence of these elements in abiotic components of river valleys, particularly in areas with iron and manganese, alluvial deposits, clay soils with ferrous metal compounds and leaching of elements from rock, soil and forest litter. As our research showed, increased metal content in water basins is caused by natural factors (river running through areas with ore and where leaching of ore occurs it, reaction of interstitial water, metals appearing in ground water run-off), anthropogenic (waste waters of industrial plants, agricultural outwash, fuel combustion) and hydrochemical factors of the hydroecosystem itself (consumption and releasing of metals by hydrobionts, aquatic habitat pH, metals coming in from ground sediments, metals released from complexes with organic compounds, methylation of non-organic metal compounds). A comparative analysis of the pollution levels of Ternopil region water basins by heavy metals was completed. It was determined that the river most heavily contaminated by the content of nutrients and non-biogenic HM is the Zolota Lypa and the cleanest is the River Strypa, which allows us to recommend the use of water composition as a reference indicator in assessing the ecological state of the region’s surface waters. 

Thyroid hormones, cytokines, physical training and metabolic control

During the acute training response, peripheral cellular mechanisms are mainly metabolostatic to achieve energy supply. During prolonged training, glycogen deficiency occurs; this is associated with increased expression of local cytokines, and decreased insulin secretion and beta-adrenergic stimulation and lipolysis in adipose tissue which looses energy. This is indicated by decrease of adipocyte hormone leptin, which has inhibitory effects on excitatory hypothalamic neurons. Leptin, insulin, and cytokines such as interleukin 6 (IL-6) contribute to the metabolic error signal to the hypothalamus which result in decrease of hypothalamic release hormones and sympathoadrenergic stimulation. Thyroid stimulating hormone (TSH) is correlated to the metabolic hormones leptin and insulin, and may be used as indicator of metabolic control. Because the hypothalamus integrates various error signals (metabolic, hormonal, sensory afferents, and central stimuli), the pituitary's releasing hormones represent the functional status of an athlete. Long-term overtraining will lead to downregulation of hypothalamic hormonal and sympathoadrenergic responses, catabolism, and fatigue. These changes contribute to myopathy with predominant expression of slow muscle fiber type and inadequacy in performance. Thyroid hormones are closely involved in the training response and metabolic control.

Interleukin-4 enhances proliferation of human pancreatic cancer cells: evidence for autocrine and paracrine actions

Interleukin-4 (IL-4) is an immunomodulatory cytokine, which can inhibit the growth of tumour cells. Pancreatic cancer cells and tissues express high levels of IL-4 receptors. The aim of this study was to characterise the effects of IL-4 on the growth and signalling pathways of pancreatic cancer cells. Cell growth was determined by cell counting and MTT assays in association with fluorescence-activated cell sorter analysis, IL-4 expression using ELISA and real-time PCR techniques, and signal transduction using immunoprecipitation or immunoblot analysis. We now report for the first time that IL-4 significantly enhanced the growth of five out of six cultured pancreatic cancer cell lines in a dose-dependent manner in association with an increased fraction of cells in S-phase. Surprisingly, all six cell lines expressed endogenous IL-4, and IL-4 was detectable in the supernatant. Incubating cells with neutralising IL-4 antibodies resulted in a significant inhibition of basal growth in three cell lines, including IL-4-unresponsive MIA PaCa-2 cells, which however expressed the highest endogenous IL-4 levels. Interleukin-4 enhanced activity of MAPK, Akt-1, and Stat3 in IL-4-responsive, but not in IL-4-unresponsive MIA PaCa-2 cells; however, IL-4 enhanced tyrosine phosphorylation of insulin receptor substrate-1 and -2 in all cell lines. Our results demonstrate for the first time that pancreatic cancer cells produce IL-4 and that IL-4 can act as a growth factor in pancreatic cancer cells. Together with the observation that neutralising IL-4 antibodies can inhibit the growth of these cells, our results suggest that IL-4 may act as an autocrine growth factor in pancreatic cancer cells and also give rise to the possibility that cancer-derived IL-4 may suppress cancer-directed immunosurveillance in vivo in addition to its growth-promoting effects, thereby facilitating pancreatic tumour growth and metastasis.