| 1. |
- Hyltander, Anders, 1954, et al.
(författare)
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Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study
- 2005
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Ingår i: Clinical gastroenterology and hepatology. - 1542-3565. ; 3:5, s. 466-74
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity. METHODS: One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life. RESULTS: Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively. CONCLUSION: After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.
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| 2. |
- Jabbar, Karolina S., et al.
(författare)
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Response.
- 2014
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 106:11
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Bjerså, Kristofer, et al.
(författare)
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Osteopathic intervention for chronic pain, remaining thoracic stiffness and breathing impairment after thoracoabdominal oesophagus resection: A single subject design study.
- 2013
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Ingår i: International Journal of Osteopathic Medicine. - : Elsevier BV. - 1746-0689 .- 1878-0164. ; 16:2, s. 68-80
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Tidskriftsartikel (refereegranskat)abstract
- Background Thoracic surgery can cause negative effects such as chronic pain, impaired thorax movement and/or impaired breathing. There are indications that manual therapies, such as osteopathy, may be beneficial for these conditions. Objective To investigate effects of osteopathic intervention on chronic pain and remaining limitations to thoracic range of motion and breathing in patients who had undergone thoracoabdominal resection of the oesophagus. Design In a single-subject research design (Aa-B-Ab), 8 participants with chronic postoperative thoracic pain, stiffness and/or breathing impairment after standardized oesophagus resection were given 10 sessions of osteopathic treatment of 45 min. Expiratory vital capacity, thorax mobility, pain experience, and subjective perception of treatment were measured on three occasions during each phase. The two-standard deviation band method was used to indicate significant change. Results A significantly increased range of motion in the thorax was observed in thoracic excursion and in lateral flexion. A positive change in pain was also noted. The results in expiratory vital capacity were contradictory. The participants were generally positive toward the treatment given. Conclusion Osteopathic intervention may affect thoracic impairment and pain among people with chronic pain and impaired thoracic range of motion after thoracoabdominal resection of the oesophagus.
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| 4. |
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| 5. |
- Copland, Lotta, 1969, et al.
(författare)
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Muscle mass and exercise capacity in cancer patients after major upper gastrointestinal surgery.
- 2010
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Ingår i: e-SPEN, the European e-journal of Clinical Nutrition and Metabolism. - 1751-4991. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims Nutritional therapy has traditionally been evaluated by changes in weight and in food intake, while body composition and function may be of greater clinical significance. We investigated relationships between total body skeletal muscle mass (TBSMM), energy balance and exercise capacity in 41 patients before, 6 and 12 months after curatively intended major upper gastrointestinal surgery. Methods TBSMM and body energy content were assessed by DXA. Exercise capacity was measured on a treadmill. Energy balance was defined as the difference in body energy content at two points in time. Results During the first postoperative year average weight loss was 7% although 1 our of 3 patients remained weight stable (WS). Average TBSMM decreased significantly at 6 months (0.9 kg, p < 0.01), but was regained at 12 months, as was exercise capacity. 72% of weight losing patients (WL) lost TBSMM compared to 17% of WS patients, p < 0.01. Both TBSMM and changes in TBSMM, but not changes in energy content, were correlated to exercise capacity, r2 = 0.49, p < 0.001 and r2 = 0.15, p < 0.05 respectively. Conclusions TBSMM and exercise capacity were clearly related in cancer patients after major upper gastrointestinal surgery, as were changes in TBSMM and exercise capacity. Energy balance was not directly correlated to exercise capacity, but more WS than WL patients increased their TBSMM indicating a possible influence by energy balance.
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| 6. |
- Dambrauskas, Zilvinas, et al.
(författare)
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Expression of major histocompatibility complex class I-related chain A/B (MICA/B) in pancreatic carcinoma.
- 2014
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Ingår i: International Journal of Oncology. - : Spandidos Publications. - 1019-6439 .- 1791-2423. ; 44:1, s. 99-104
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Tidskriftsartikel (refereegranskat)abstract
- Major histocompatibility complex classI-related chain A and B (MICA/B) are two stress-inducible ligands that bind to the immunoreceptor NKG2D and play an important role in mediating cytotoxicity of NK and Tcells. Release of MIC molecules from the cell surface is thought to constitute an immune escape mechanism of tumor cells and thus could be associated with more aggressive course of tumor growth. In this study, we investigated the expression of MICA/B in ductal pancreatic carcinoma and serum in relation to tumor stage, differentiation and survival. MICA/B expression in tumor tissues and sera from patients with pancreatic cancer were analyzed by immunohistochemical staining (IHC), western blotting and ELISA, respectively. MICA/B expression was present in 17 of 22 (77%) of the tumors but not in normal pancreatic ductal epithelial cells. Poorly differentiated tumors showed more pronounced MICA/B expression compared to differentiated tumors, but did not correlate significantly to other tumor characteristics. MICA/B-negative tumors displayed significantly lower incidence of lymph node metastases (p<0.01), and less mortality within 3 years following resection (p<0.02). In conclusion, tissue levels of MICA/B expression were elevated in pancreatic cancer cells without elevated levels in serum, despite well-recognized acute phase reactants in serum. Poorly differentiated tumors showed high MICA/B expression, which was related to extended tumor lymph node metastases and less frequent long-term survival.
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| 7. |
- Fouladiun, Marita, 1963, et al.
(författare)
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Body composition and time course changes in regional distribution of fat and lean tissue in unselected cancer patients on palliative care--correlations with food intake, metabolism, exercise capacity, and hormones
- 2005
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Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 103:10, s. 2189-98
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several investigations that yielded different results in terms of net changes in body composition of weight-losing cancer patients have been reported that employed a variety of methods based on fundamentally different technology. Most of those reports were cross-sectional, whereas to the authors' knowledge there is sparse information available on longitudinal follow-up measurements in relation to other independent methods for the assessment of metabolism and performance. METHODS: For the current report, the authors evaluated time course changes in body composition (dual-energy X-ray absorptiometry) with measurements of whole body and regional distribution of fat and lean tissue in relation to food and dietary intake, host metabolism (indirect calorimetry), maximum exercise capacity (walking test), and circulating hormones in cancer patients who were receiving palliative care during 4-62 months of follow-up. The entire cohort comprised 311 patients, ages 68 years +/- 3 years who were diagnosed with solid gastrointestinal tumors (84 colorectal tumors, 74 pancreatic tumors, 73 upper gastrointestinal tumors, 51 liver-biliary tumors, 3 breast tumors, 5 melanomas, and 21 other tumor types). RESULTS: Decreased body weight was explained by loss of body fat, preferentially from the trunk, followed by leg tissue and arm tissue, respectively. Lean tissue (fat-free mass) was lost from arm tissue, whereas trunk and leg tissue compartments increased, all concomitant with declines in serum albumin, increased systemic inflammation (C-reactive protein, erythrocyte sedimentation rate), increased serum insulin, and elevated daily caloric intake; whereas serum insulin-like growth factor 1 (IGF-1), resting energy expenditure, and maximum exercise capacity remained unchanged in the same patients. Serum albumin levels (P < 0.001), whole body fat (P < 0.02), and caloric intake (P < 0.001) predicted survival, whereas lean tissue mass did not. Daily intake of fat and carbohydrate was more important for predicting survival than protein intake. Survival also was predicted by serum IGF-1, insulin, leptin, and ghrelin levels (P < 0.02 - P < 0.001). Serum insulin, leptin, and ghrelin (total) levels predicted body fat (P < 0.001), whereas IGF-1 and thyroid hormone levels (T3, free T3) predicted lean tissue mass (P < 0.01). Systemic inflammation primarily explained variation in lean tissue and secondarily explained loss in body fat. Depletion of lean arm tissue was related most to short survival compared with the depletion of lean leg and trunk tissue. CONCLUSIONS: The current results demonstrated that body fat was lost more rapidly than lean tissue in progressive cancer cachexia, a phenomenon that was related highly to alterations in the levels of circulating classic hormones and food intake, including both caloric amount and diet composition. The results showed importance in the planning of efficient palliative treatment for cancer patients.
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| 8. |
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| 9. |
- Iresjö, Britt-Marie, 1963, et al.
(författare)
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Initiation factors for translation of proteins in the rectus abdominis muscle from patients on overnight standard parenteral nutrition before surgery.
- 2008
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Ingår i: Clinical science (London, England : 1979). - 1470-8736. ; 114:9, s. 603-10
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have provided conflicting conclusions concerning the efficacy of improving protein balance in patients by standard intravenous nutrition [TPN (total parenteral nutrition)], which is either explained by suboptimal nutritional regimens or insensitive clinical methods. The aim of the present study was therefore to evaluate the effects on the initiation of translation of skeletal muscle proteins by standard overnight TPN. A total of 12 patients who underwent standard surgery were included. TPN was provided as an all-in-one treatment by constant infusion [0.16 gN.kg(-1) of body weight.day(-1) (30 kcal.kg(-1) of body weight.day(-1))]. Saline-infused patients served as controls. Rectus abdominis muscle biopsies were taken at the time of the operation. The phosphorylation state of the proteins for initiation of translation was quantified. Plasma glucose, and serum insulin, glycerol, triacylglycerols (triglycerides) and NEFAs (non-esterified fatty acids; 'free fatty acids') were not significantly altered during TPN infusion, whereas total plasma amino acids increased, as shown by increases in methionine, phenylalanine, threonine, alanine, arginine, aspartic acid, glycine and histidine (P<0.05). Overnight TPN increased the formation of active eIF4G-eIF4E (where eIF is eukaryotic-initiation factor) complexes (P<0.05), whereas the inhibitory complex 4E-BP1 (eIF4E-binding protein)-eIF4E was moderately decreased (P<0.06). TPN increased the amount of the most phosphorylated form of 4E-BP1 (P<0.05), and increased the amount (P<0.04) and phosphorylation (P<0.01) of p70(S6K) (70 kDa ribosomal protein S6 kinase). In conclusion, an overnight pre-operative constant infusion of standard TPN altered initiation factor complexes, indicating activation of the initiation of protein translation in rectus abdominis muscle in the presence of increased plasma amino acid levels, but without a concomitant increase in energy substrates and insulin. In contrast with our results from previous studies, the methodology used in the present study appears to be more sensitive in reflecting directional changes in human muscle protein synthesis compared with traditional methods, particularly based on measurements of amino acid flux.
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| 10. |
- Jabbar, Karolina S., et al.
(författare)
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Proteomic Mucin Profiling for the Identification of Cystic Precursors of Pancreatic Cancer
- 2014
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Ingår i: Jnci-Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 106:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Pancreatic cystic lesions (PCLs) are increasingly frequent radiological incidentalomas, with a considerable proportion representing precursors of pancreatic cancer. Better diagnostic tools are required for patients to benefit from this development. Methods To evaluate whether cyst fluid mucin expression could predict malignant potential and/or transformation in PCLs, a proteomic method was devised and prospectively evaluated in consecutive patients referred to our tertiary center for endoscopic ultrasound-guided aspiration of cystic lesions from May 2007 through November 2008 (discovery cohort) and from December 2008 through October 2012 (validation cohort). Cytology and cyst fluid carcinoembryonic antigen (CEA; premalignancy > 192 ng/mL, malignancy > 1000 ng/mL) were routinely analyzed, and samples were further processed as follows: one-dimensional gel electrophoresis, excision of high-mass areas, tryptic digestion and nano-liquid chromatography-tandem mass spectrometry, with peptide identification by Mascot software and an in-house mucin database. All diagnostic evaluations were blinded to proteomics results. Histology was required to confirm the presence/absence of malignant transformation. All statistical tests were two-sided. Results Proteomic mucin profiling proved statistically significantly more accurate (97.5%; 95% confidence interval [CI] = 90.3% to 99.6%) than cytology (71.4%; 95% CI = 59.8% to 80.9%; P < .001) and cyst fluid CEA (78.0%; 95% CI = 65.0% to 87.3%; P < .001) in identifying the 37 (out of 79; 46.8%) lesions with malignant potential (ie, premalignant or malignant tumors). The accuracy of proteomics was nearly identical (96.6% vs 98.0%) between the discovery (n = 29) and validation (n = 50) cohorts. Furthermore, mucin profiling predicted malignant transformation, present in 16 out of 29 (discovery cohort: 9, validation cohort: 20) lesions with available histology, with 89.7% accuracy (95% CI = 71.5% to 97.3%) (for the validation cohort only: 95.0%; 95% CI = 73.1% to 99.7%). This markedly exceeded corresponding results for cytology (51.7%; 95% CI = 32.9% to 70.1%; P = .003) and CEA (57.1%; 95% CI = 34.4% to 77.4%; P = .02). Conclusions Proteomic cyst fluid mucin profiling robustly discriminates benign, premalignant, and malignant PCLs. Consequently, it may improve pancreatic cancer prevention and reduce the morbidity burden of unwarranted pancreatic surgery.
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