Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 5 Articles
Malnutrition in Head and neck cancer (HNC) patients can be present at the\nmoment of diagnosis. The nutritional status is determinant for the treatment\nsuccess and quality of life of the patients. The nutritional status gradually declines\nduring treatment and the majority of patients undergoing treatment\nwill need nutritional therapy. On the other hand, HNC, like other cancers,\ncan induce a paraneoplastic syndrome that leads to cachexia. This cachexia\nstatus is most of the times the cause of death or the cause of treatment failure.\nSo, early identification of malnutrition high risk patients is crucial to start an\nadequate nutrition support intervention in HNC patients. This study aims to\nidentify HNC patients who present malnutrition or higher risk of malnutrition;\nto signalize variables that support early identification of high-risk patients\nof becoming malnourished and to establish a dynamic relationship between\nmalnutrition risk in these patients and Quality of Life (QoL) impacts.\nFor six months consecutive outpatients with HNC admitted at the Head &\nNeck Unity of Oncology Portuguese Institute--Porto were asked to participate\nin the research (n = 114). The European Organisation for Research and Treatment\nof Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30\nand Malnutrition Universal Screening Tool, MUST were used. At the moment\nof first presentation, 32 patients (28.1%) presented high-risk of malnutrition.\nHNC patients with oral cavity and oropharynx tumour locations,\nolder, with low literacy or with BMI under 18.5 at the moment of diagnosis,\nrepresent a high-risk group. When HNC is considered, a dynamic and bi-directional\nconnection between malnutrition and QoL is observed. A significant (p\n< 0.001) difference in the scores of Global health status/QoL according to the\nmalnutrition risk group was found: 62.96, 53.33, 42.71 for low, medium and\nhigh malnutrition risk respectively. Also, Emotional and social functional scales\nand all symptom scales--including pain, presented significant differences\nbetween high and medium risk of malnutrition patients. Fatigue , pain, insomnia\n, appetite loss and financial difficulties were domains directly related\nto high risk of malnutrition patients. Pain scores were significantly higher\n(43.23) in the high-risk patients when compared to medium risk patients\n(11.67). Nutrition support should be considered at any stage of the pathway\n--specially in high risk group--in order to optimize tumour treatment results,\nreduction of adverse effects of therapy and improving both QoL and\nsurvival....
Background: Hypoxic preconditioning (HPC) may protect multiple organs from various injuries. We hypothesized\nthat HPC would reduce lung injury in patients undergoing thoracoscopic lobectomy.\nMethods: In a prospective randomized controlled trial, 70 patients undergoing elective thoracoscopic lobectomy\nwere randomly allocated to the HPC group or the control group. Three cycles of 5-min hypoxia and 3-min\nventilation applied to the nondependent lung served as the HPC intervention. The primary outcome was the PaO2/\nFiO2 ratio. Secondary outcomes included postoperative pulmonary complications, pulmonary function, and duration\nof hospital stay.\nResults: HPC significantly increased the PaO2/FiO2 ratio compared with the control at 30 min after one-lung\nventilation and 7 days after operation. Compared with the control, it also significantly improved postoperative\npulmonary function and markedly reduced the postoperative hospital stay duration. No significant differences\nbetween groups were observed in the incidence of pulmonary complications or overall postoperative morbidity.\nConclusions: HPC improves postoperative oxygenation, enhances the recovery of pulmonary function, and reduces\nthe duration of hospital stay in patients undergoing thoracoscopic lobectomy....
Case 1 was a 49-year-old woman who visited with a dry cough. She had an\nunderlying disease of lung adenocarcinoma and received cancer immunotherapy\nbecause of an ALK-positive response and several cancer chemotherapies.\nThe clinical effect was a complete response. Chest CT was performed because\nof continuous dry cough, and a new tumor shadow was recognized in the\nlingula portion of the left upper lobe. We performed CT-guided lung biopsy\nand could aspirate pus-fluid. The culture test for acid-fast bacilli was positive\nand the causative microorganism was identified as Mycobacterium avium by\nthe DDH method. The final diagnosis was pulmonary abscess due to M.\navium. Treatment using combined chemotherapy including CAM was performed\nand a good clinical response was obtained. Case 2 was a 67-year-old\nman who had a past history of surgical resection of lung adenocarcinoma\neight and two years ago and received several cancer chemotherapies and radiation\ntherapy. Because a new nodular shadow appeared in the right middle\nlobe one year ago and showed strong positivity on PET/CT, surgical resection\nwas performed with the suspected recurrence of lung cancer. Subsequently,\nthe histological diagnosis was epithelioid granuloma and a culture test of acid-\nfast bacilli was positive, with the identification of Mycobacterium intracellulare\nby the DDH method. Combined chemotherapy was not performed because\nthe lesion was completely resected. Afterwards, a new nodular shadow\nappeared in the left lower lobe again and bronchoscopy was performed. Because\nM. intracellulare was isolated from the local specimen, we diagnosed\nthe patient with recurrence of pulmonary MAC disease and combined chemotherapy\nincluding CAM was performed for one year. Finally, the nodular\nlesion disappeared. It is difficult to differentiate pulmonary MAC disease\nfrom lung cancer. Therefore, careful follow-up of patients with lung cancer\nwhile keeping in mind the possible complication of pulmonary MAC disease\nis necessary....
Background: Some prospective studies have observed associations between periodontal disease and breast cancer.\nTherefore, the aim of the present study was to investigate the composition of the subgingival biofilm of women\ndiagnosed with breast cancer, who also presented with chronic periodontitis.\nMethods: All subjects underwent clinical and microbiological assessment. Subgingival biofilm samples were taken\nfrom at least three sites of 44 women who had breast cancer. The mean levels and proportions of 40 bacterial\nspecies were determined by checkerboard DNA-DNA hybridization. Spearman correlation was used to assess\npossible associations between the mean levels of bacterial species and clinical conditions.\nResults: The five species found at the highest levels were Prevotella nigrescens, Actinomyces gerencseriae, Neisseria\nmucosa, Porphyromonas gingivalis and Tannerella forsythia. The species detected in the lowest counts were\nPropionibacterium acnes, Streptococcus constellatus, Streptococcus intermedius, Eubacterium saburreum and\nStreptococcus anginosus. No significant association between levels and proportion of bacterial species and clinical\nparameters were found.\nConclusion: In conclusion, the results of the present study found no direct association between the subgingival\nmicrobiota and breast cancer and an indirect pathway should be addressed in further studies....
Background: The 8th edition of the American Joint Committee on Cancer (AJCC) staging has introduced\nprognostic stage based on anatomic stage combined with biologic factors. We aimed to validate the prognostic\nstage in HER2-positive breast cancer patients enrolled in the ShortHER trial.\nMethods: The ShortHER trial randomized 1253 HER2-positive patients to 9 weeks or 1 year of adjuvant trastuzumab\ncombined with chemotherapy. Patients were classified according to the anatomic and the prognostic stage. Distant\ndisease-free survival (DDFS) was calculated from randomization to distant relapse or death.\nResults: A total of 1244 patients were included. Compared to anatomic stage, the prognostic stage downstaged\n41.6% (n = 517) of patients to a more favorable stage category.\nFive-year DDFS based on anatomic stage was as follows: IA 96.6%, IB 94.1%, IIA 92.4%, IIB 87.3%, IIIA 81.3%, IIIC\n70.5% (P < 0.001). Five-year DDFS according to prognostic stage was as follows: IA 95.7%, IB 91.4%, IIA 86.9%, IIB\n85.0%, IIIA 77.6%, IIIC 67.7% (P < 0.001). The C index was similar (0.69209 and 0.69249, P = 0.975).\nWithin anatomic stage I, the outcome was similar for patients treated with 9 weeks or 1 year trastuzumab (5-year\nDDFS 96.2% and 96.6%, P = 0.856). Within prognostic stage I, the outcome was numerically worse for patients\ntreated with 9 weeks trastuzumab (5-year DDFS 93.7% and 96.3%, P = 0.080).\nConclusions: The prognostic stage downstaged 41.6% of patients, while maintaining a similar prognostic\nperformance as the anatomic stage. The prognostic stage is valuable in counseling patients and may serve as\nreference for a clinical trial design. Our data do not support prognostic stage as guidance to de-escalate treatment....
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