Characteristics of growth disturbances in patients with intracranial germinomas of different origins.

PURPOSE: To explore the characteristics of growth disturbance in patients with intracranial germinoma with different origins. METHODS: Clinical data of 151 patients with single-origin germinomas were studied retrospectively. Z-score of height (ZSOH) at both diagnosis and the last follow-up was calculated using the WHO AnthroPlus software. Linear regression was used to analyse the correlation between the absolute change in ZSOH (|ZSOH last follow-up - ZSOH diagnosis|) and clinical factors. RESULTS: The mean ZSOH decreased significantly in every origin subgroup at the last follow-up. In patients with sellar germinoma (n = 62), the mean ZSOH values at both diagnosis and the last follow-up were significantly lower than those in patients with pineal (n = 30) (p < 0.001) or basal ganglia germinomas (n = 59) (p < 0.001), respectively. In patients with basal ganglia germinoma, the mean absolute change in ZSOH decreased significantly compared to that in the patients with sellar (p = 0.006) or pineal germinomas (p = 0.04). Linear analysis revealed that sex (male vs female; p = 0.003) and age at diagnosis (≤10 years vs >10 years; p = 0.026) had negative correlations, while radiation dose at the hypothalamic-pituitary axis (HPA) (≤40 Gy vs >40 Gy; p = 0.085) had a marginally positive correlation, with absolute change in ZSOH. CONCLUSIONS: Patients with germinoma experienced growth retardation after treatments. The growth disturbance was consistent and more severe in patients with germinoma of sellar origin, while the greatest aggravation was observed in patients with germinoma of basal ganglia origin. Decreasing radiation dose to the HPA may minimize the negative impact of radiotherapy on growth.

Comparison between Craniospinal Irradiation and Limited-Field Radiation in Patients with Non-metastatic Bifocal Germinoma.

PURPOSE: Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. MATERIALS AND METHODS: Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. RESULTS: In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. CONCLUSION: In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Body Composition Analysis by Using Bioelectrical Impedance in a Young Healthy Chinese Population: Methodological Considerations.

OBJECTIVE: To develop a new bioelectrical impedance analysis (BIA) model for analyzing body composition by using isotope dilution, magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DEXA) as the reference methods in young healthy Chinese populations. METHODS: Thirty healthy participants were enrolled. Their body composition was analyzed using BIA and 3 reference methods. We established a model that uniformed data from 3 references methods (isotope, MRI, and DEXA) into 1 formula. This model was further validated with 209 participants. RESULTS: The following BIA body composition adjustment model was developed: [Formula: see text], where X represents the impedance index; when K = 1, 2, and 3, Y represents total body water, fat mass, and bone mass, respectively. The prediction accuracy of this formula was 93.3%. By incorporating the data matrix, the protein mass was calculated using BIA: [Formula: see text]. In the verification part of this study, the lean body mass measured using DEXA and BIA was 43.02 ± 8.34 kg and 45.85 ± 8.81 kg, respectively. Analysis indicated that the model fit was extremely favorable ( R2 = .9997, P < .001). CONCLUSIONS: The accuracy of BIA measurement on body composition and protein mass is significantly improved by our work.

The Effect of Protein-Enriched Meal Replacement on Waist Circumference Reduction among Overweight and Obese Chinese with Hyperlipidemia.

OBJECTIVE: In China, high-fat diets and excessive energy intake have led to an increasing prevalence of obesity which was previously uncommon. The current study examined the effects of meal replacement (MR) on weight control in overweight or obese Chinese individuals with hyperlipidemia. METHODS: Patients, 18-65 years, with body mass index 25-35 kg/m(2) and triglycerides >1.7 and <5.4 mmol/L were enrolled. Major exclusion criteria were: type II diabetes, fasting glucose ≥7.0 mmol/L, glycosylated hemoglobin ≥6.5%; weight loss surgery or use of weight loss drugs; weight fluctuations >2%; use of cholesterol-lowering drugs. Eligible patients were randomized 1:1 to a high-protein (HP) diet (2.2 g protein/kg/day) or a standard-protein (SP) diet (1.1 g protein/kg/ day) provided twice daily for 3 months. Assessments included body weight, waist-hip ratio, body fat percentage, blood lipids, blood glucose, insulin, liver and kidney function. RESULTS: Although mean weight loss and percent BMI reduction were greater with HP than SP at 12 weeks, the differences were not significant. There was, however, a significantly greater decrease in waist-hip ratio with HP versus SP (-0.03 ± 0.03 vs. -0.01 ± 0.04; p < 0.05). Triglycerides decreased from baseline in both groups; however, the difference was not significant. Both HP and SP were well tolerated. This study demonstrated that in obese Chinese patients with hyperlipidemia, a protein-enriched MR diet resulted in significantly reduced waist circumference compared to a standard protein diet. CONCLUSION: This first study of protein-enriched partial meal replacement in a free-living Chinese population suggests a new and promising strategy for reducing abdominal obesity in China.