Outcomes of patients with oesophageal cancer treated with preoperative chemoradiotherapy, followed by tumor resection: influence of nutritional factors

PURPOSE

To assess the impact of clinical and nutritional factors on overall survival (OS) and time to disease progression of oesophageal cancer patients treated with neoadjuvant chemoradiotherapy (CRT) and surgery.

METHODS

We retrospectively studied and analysed several clinical and nutritional factors, such as performance status, weight changes before and during CRT, dysphagia, nutritional support, and serum albumin to see whether they exerted any impact on OS and time to disease progression.

RESULTS

In 107 patients the average weight loss was 9.7% from the onset of signs of disease to the beginning of therapy and 3% during CRT. In univariate analysis, significant unfavorable impact on survival was proved for low performance status, severe dysphagia, need for nasogastric tube insertion, above-average weight loss before treatment, weight loss >5% during CRT, and serum albumin ≤ 35 g/l before or after CRT. Patients supported by oral nutritional supplements (ONS) had higher probability to attain full dosage of CRT and radical resection than did those obtaining dietary advice alone. In multivariate analysis, serum albumin level, nasogastric (NG) tube insertion and pretreatment body weight loss were independent prognostic factors for OS, while serum albumin level after CRT and NG tube insertion were prognosticators for time to progression.

CONCLUSION

Serum albumin level can serve as a useful prognostic factor for the outcome of patients with oesophageal cancer treated with neoadjuvant CRT and surgery. Appropriate nutritional support of these patients increased the probability of attaining full dosage of CRT and radical disease resection.

Protein Kinase C Activity and Isoform Expression During Early Postnatal Development of Rat Myocardium

Total protein kinase C (PKC) activity, its isoform expression, and concentration and fatty acid (FA) composition of diacylglycerol (DAG) were determined in the left ventricular myocardium of the rat during early postnatal development (d 2, 3, 5, 7, and 10). PKC activity measured by the incorporation of 32P into histone IIIS decreased between d 2 and 10 in the homogenate as well as in cytosolic, membrane (100,000 g), and nuclear-cytoskeletal-myofilament fractions (1000 g). Likewise, the expression of PKC isoforms (alpha, delta, and epsilon) determined by immunoblotting generally declined during the period analyzed, although with a variable pattern. In the membrane and nuclear cytoskeletal myofilament fractions, PKCdelta and PKCepsilon expression decreased markedly by d 3, returning to or close to the d 2 level immediately on d 5. PKCalpha expression in the membrane fraction remained almost unchanged by d 7, declining thereafter. PKCdelta and PKCepsilon were associated predominantly with particulate fractions, whereas PKCalpha was more abundant in the cytosolic fraction. DAG concentration exhibited a significant decline by d 5, consistent with the decrease in maximal PKC activity. The unsaturation index of FA in DAG tended to decrease on d 3 owing to the lowered proportion of all polyunsaturated FA of n-6 and n-3 series. These results demonstrate that the developmental decrease in PKC activity and expression in the rat myocardium is not linear and that subcellular localization of the enzyme exhibits isoform-specific day-by-day changes during the early postnatal period. These changes are compatible with the view that PKC signaling may be involved in the control of a rapid switch of myocardial growth pattern during the first week of life.

Should immunonutrition become routine in critically ill patients? A systematic review of the evidence

CONTEXT

Several nutrients have been shown to influence immunologic and inflammatory responses in humans. Whether these effects translate into an improvement in clinical outcomes in critically ill patients remains unclear.

OBJECTIVE

To examine the relationship between enteral nutrition supplemented with immune-enhancing nutrients and infectious complications and mortality rates in critically ill patients.

DATA SOURCES

The databases of MEDLINE, EMBASE, Biosis, and CINAHL were searched for articles published from 1990 to 2000. Additional data sources included the Cochrane Controlled Trials Register from 1990 to 2000, personal files, abstract proceedings, and relevant reference lists of articles identified by database review.

STUDY SELECTION

A total of 326 titles, abstracts, and articles were reviewed. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of enteral nutrition supplemented with some combination of arginine, glutamine, nucleotides, and omega-3 fatty acids on infectious complication and mortality rates compared with standard enteral nutrition, and included clinically important outcomes, such as mortality.

DATA EXTRACTION

Methodological quality of individual studies was scored and necessary data were abstracted in duplicate and independently.

DATA SYNTHESIS

Twenty-two randomized trials with a total of 2419 patients compared the use of immunonutrition with standard enteral nutrition in surgical and critically ill patients. With respect to mortality, immunonutrition was associated with a pooled risk ratio (RR) of 1.10 (95% confidence interval [CI], 0.93-1.31). Immunonutrition was associated with lower infectious complications (RR, 0.66; 95% CI, 0.54-0.80). Since there was significant heterogeneity across studies, we examined several a priori subgroup analyses. We found that studies using commercial formulas with high arginine content were associated with a significant reduction in infectious complications and a trend toward a lower mortality rate compared with other immune-enhancing diets. Studies of surgical patients were associated with a significant reduction in infectious complication rates compared with studies of critically ill patients. In studies of critically ill patients, studies with a high-quality score were associated with increased mortality and a significant reduction in infectious complication rates compared with studies with a low-quality score.

CONCLUSION

Immunonutrition may decrease infectious complication rates but it is not associated with an overall mortality advantage. However, the treatment effect varies depending on the intervention, the patient population, and the methodological quality of the study.

Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial

OBJECTIVE

To determine the extent to which postpyloric feeding reduces gastroesophageal regurgitation and pulmonary microaspiration in critically ill patients.

DESIGN

Randomized trial.

SETTING

A medical/surgical intensive care unit at a tertiary care hospital.

PARTICIPANTS

Intensive care unit patients were expected to remain ventilated >72 hrs. We excluded patients with esophageal, gastric, or small bowel surgery in the last week and patients with overt or clinically significant gastrointestinal bleeding. We studied 33 patients; 42.4% were female, mean age (sd) was 59.2 (+/- 16.8) yrs, and mean Acute Physiology and Chronic Health Evaluation II score was 22.5 (7.8).

INTERVENTIONS

Patients were randomized to gastric or postpyloric enteral feeds. Technetium 99-sulphur colloid was added to the feeds for 6 hrs of each of the first 3 days on study.

MEASUREMENTS AND RESULTS

We sampled the oropharynx and trachea hourly for the 6 hrs per day that patients received radioisotope-labeled enteral feeds, and the level of radioactivity in these specimens was measured. We defined an episode of gastroesophageal regurgitation and microaspiration as an increase in radioactivity >100 counts per minute/g. Patients fed into the stomach had more episodes of gastroesophageal regurgitation (39.8% vs. 24.9%, p =.04) and trended toward more microaspiration (7.5% vs. 3.9%, p =.22) compared with patients fed beyond the pylorus. When the logarithmic mean of the radioactivity count was compared across groups, there was a trend toward an increase in gastroesophageal regurgitation (3.7 vs. 2.9 counts/g, p =.22) and a trend toward increased microaspiration (1.9 vs. 1.4 counts/g, p =.09) in patients fed into the stomach. Patients who had gastroesophageal regurgitation were much more likely to aspirate than patients who did not have gastroesophageal regurgitation (odds ratio: 3.2; 95% confidence interval: 1.36, 7.77).

CONCLUSIONS

Feeding beyond the pylorus is associated with a significant reduction in gastroesophageal regurgitation and a trend toward less microaspiration.

Lack of essential enzymes for the biosynthesis of C19 and C18 steroids in gonads of the migratory locust, Locusta migratoria

Ovaries and testes of the African migratory locust, Locusta migratoria migratorioides, were incubated in vitro with six tritiated steroid precursors. Three developmental stages were investigated--1 day, 14 days, and 6 weeks after adult moulting. 20 alpha-Hydroxysteroid dehydrogenase (HSD), 20 beta-HSD, 17 beta-HSD, 3 beta-HSD/isomerase, C17-C20 lyase, glucuronyl-transferase, sulfotransferase, and acyltransferase were identified in both sexes. A synthesis of androgens or estrogens comparable to the vertebrate type, however, was not apparent in the locust gonads. 20 alpha-HSD, 20 beta-HSD, and 17 beta-HSD activities were high, while more important steps in steroid synthesis such as 3 beta-HSD and C17-C20 lyase were far less intense. Ovarian 17 alpha-hydroxylase activity was slight. Aromatase activity was not demonstrated. Water-soluble conjugate formation was high in the incubations of "14th-day" and "6th-week" gonads but was absent in "1st-day" ovaries and testes. Active ester formation of pregnenolone was demonstrated in "6th-week" testes. The other steroid conversions were similar in all developmental stages investigated. Major differences between testes and ovaries were not observed. The gonads of the migratory locust are concluded not to produce androgens or estrogens.

Distribution, Kinetics and Immunoscintigraphy of 131-I Labelled Intact Antifibrinogen-fibrin Antibody (AbFbg) and its F(ab')2 Fragment

131-I-labelled anti fibrin-fibrinogen antibody (AbFbg) was compared with its F(ab')2 fragment in distribution studies and by immunoscintigraphy with a view to tumour visualization in tumour bearing rats. The distribution studies indicated that the intact antibody is more concentrated in tumour tissue than the F(ab')2 fragment. By 168h after injection, when tumour-to-tissue ratios were highest in the majority of tissues, the tumour concentration of intact antibody was 3 to 4 times that of the F(ab')2 fragment. The intact antibody is more suitable than the F(ab')2 fragment for tumour imaging especially in the abdominal region where the highest tumour-to tissue ratios were obtained with intact antibody in liver, spleen, intestines and kidneys.

The presence of a pregnenolone-binding factor in the copulatory organ of the migratory locust, Locusta migratoria migratorioides R. & F

The presence of binding sites for nonecdysteroid steroids was investigated in the cytosol of several tissues of the migratory locust, Locusta migratoria migratorioides. Binding of androgens was not observed. Most tissues, however, showed nonsaturable binding of estrogens and in some tissues saturable progestin binding could be demonstrated. A pregnenolone binder, that was found to be present in the male copulatory organ, was further studied. It showed a dissociation constant of 4.4 (+/- 1.6) X 10(-8) M. This is the first report of a nonecdysteroid steroid-binding factor in an insect tissue.

Thaumetopoein: an urticating protein from the hairs and integument of the pine processionary caterpillar (Thaumetopoea pityocampa Schiff., Lepidoptera, Thaumetopoeidae)

Hairs of the Thaumetopoea pityocampa caterpillar (Lepidoptera) cause a cutaneous reaction in man and animals. The irritating fraction extracted from hairs contains soluble proteins which were separated by various electrophoretic and immunoelectrophoretic techniques. Some of these proteins are present also in cuticle and haemolymph. One protein of 28,000 mol. wt is hair specific and caused a reaction in pig skin identical to that produced by hair extract. It is therefore an urticating protein which we have named thaumetopoein. This protein is formed of two subunits of molecular weights 13,000 and 15,000. It is present in large quantities in the glands producing urticating hairs.

Bioavailability for rats of thiamin in whole wheat and thiamin-restored white bread

The relative biological value of thiamin in leavened bread (whole wheat and thiamin-restored white) and thiamin mononitrate was examined by using thiamin-deficient rats as the test model. Erythrocyte transketolase (ETK) activities and liver thiamin content responded positively to graded but suboptimal levels of dietary thiamin in these rats. Biological values were calculated (slope ratio assay) by using these response parameters, which may depict the body's thiamin status, at least in the deficient rats. Compared to thiamin in thiamin mononitrate (100%), the biological value of thiamin in breads measured 88% (white bread) and 91% (whole wheat bread) based on ETK activity and 68% (white bread) and 75% (whole wheat bread) based on liver thiamin response. Thus, diets high in fermented cereal foods (thiamin enriched or not) may require a generous allowance of thiamin to compensate for reduced biological value.

The treatment of invasive carcinoma of the cervix at the Department of Gynecology and Obstetrics in Ljubljana

In this report the treatment of carcinoma of the cervix in the period from 1965 through 1972 at the Department of Gynecology and Obstetrics in Ljubljana, is presented. In that period 651 patients were admitted for treatment and 488 were operated; the operability was 73.8%. The primary mortality rate was 1.02% and the frequency of ureteral fistulas 1.93%. The 5-year survival rate were: for stage I 81.8%-94.5% for stage Ia and 76.2% for stage Ib, for stage II 57.83% and for stage III 28.38%. The treatment and mortality for cases with positive lymph-nodes is discussed, and the results of treatment are also presented.