Impairment of Nutritional Status and Quality of Life Following Minimal-Invasive Esophagectomy-A Prospective Cohort Analysis.

Minimal-invasive resection of the esophagus for esophageal cancer has led to a relevant decrease in postoperative morbidity. Postoperatively, patients still suffer from surgical and adjuvant therapy-related symptoms impairing nutrition and quality of life. The aim of this study was to evaluate the nutritional status and associated symptoms six months after esophagectomy. Patients who attended follow-up examination six months after minimal-invasive esophagectomy were included. Blood and fecal tests, quality of life surveys (QLQ-C30 and QLQ-OG25) and nutritional risk screening (NRS) were performed. Twenty-four patients participated. The mean weight loss was 11 kg. A significant decrease in vitamin B12 (737 to 467 pg/mL; p = 0.033), ferritin (302 to 126 ng/mL; p = 0.012) and haptoglobin (227 to 152 mg/dL; p = 0.025) was found. In total, 47% of the patients had an impaired pancreatic function (fecal elastase < 500 µg/g). Physical (72 to 58; p = 0.034) and social functioning (67 to 40; p = 0.022) was significantly diminished, while self-reported global health status remained stable (52 to 54). The number of patients screened and found to be in need of nutritional support according to NRS score decreased slightly (59% to 52%). After MIE, patients should be meticulously monitored for nutritional status after surgery.

Sorafenib Treatment and Modulation of the Sphingolipid Pathway Affect Proliferation and Viability of Hepatocellular Carcinoma In Vitro.

Hepatocellular carcinoma (HCC) shows a remarkable heterogeneity and is recognized as a chemoresistant tumor with dismal prognosis. In previous studies, we observed significant alterations in the serum sphingolipids of patients with HCC. This study aimed to investigate the in vitro effects of sorafenib, which is the most widely used systemic HCC medication, on the sphingolipid pathway as well as the effects of inhibiting the sphingolipid pathway in HCC. Huh7.5 and HepG2 cells were stimulated with sorafenib, and inhibitors of the sphingolipid pathway and cell proliferation, viability, and concentrations of bioactive metabolites were assessed. We observed a significant downregulation of cell proliferation and viability and a simultaneous upregulation of dihydroceramides upon sorafenib stimulation. Interestingly, fumonisin B1 (FB1) and the general sphingosine kinase inhibitor SKI II were able to inhibit cell proliferation more prominently in HepG2 and Huh7.5 cells, whereas there were no consistent effects on the formation of dihydroceramides, thus implying an involvement of distinct metabolic pathways. In conclusion, our study demonstrates a significant downregulation of HCC proliferation upon sorafenib, FB1, and SKI II treatment, whereas it seems they exert antiproliferative effects independently from sphingolipids. Certainly, further data would be required to elucidate the potential of FB1 and SKI II as putative novel therapeutic targets in HCC.

[Nutrition Support Therapy in Critically Ill Patients]. / Ernährungstherapie des Intensivpatienten.

Nutritional therapy is an elemental component of intensive care treatment. Therapeutic goals are the enteral or parenteral provision of calories, protein, electrolytes, vitamins and trace elements. Pathophysiologically, metabolism in critical illness is characterized by a catabolic stress status. This results from an underlying systemic inflammatory response and is associated with increased rate of infections, multiple organ failure and unfavourable outcome. In this article, the principles and strategies of nutrition support therapy in critically ill patients are presented, based on current guidelines.

[Current Developments in Nutritional Therapy of Intensive Care Patients]. / Aktuelle Entwicklungen in der Ernährungstherapie von Intensivpatienten.

The goals of nutritional therapy for critically ill patients are the enteral or parenteral provision of calories, proteins, electrolytes, vitamins, trace elements and fluids. The metabolism of critically ill patients is characterized by a catabolic stress condition, which is caused by a systemic inflammatory response and is associated with an increased infection rate, occurrence of multiple organ failure and increased mortality.Traditionally, nutritional therapy has been considered as an "adjunctive" therapy for critically ill patients with the primary goal of providing energy to maintain muscle mass. Based on the scientific developments of recent years, it became evident that adequate nutritional therapy can favorably influence stress-related metabolic processes, reduce oxidative cell damage and modulate the immune response of the body. Important measures that can positively influence the clinical course of intensive care patients include early enteral nutrition, adequate intake of macro- and micronutrients, and blood glucose control.

Vitamin D Supplementation Enhances C18(dihydro)ceramide Levels in Type 2 Diabetes Patients.

Sphingolipids are characterized by a broad range of bioactive properties. Particularly, the development of insulin resistance, a major pathophysiological hallmark of Type 2 Diabetes mellitus (T2D), has been linked to ceramide signaling. Since vitamin D supplementation may slow down T2D progression by improving glucose concentrations and insulin sensitivity, we investigated whether vitamin D supplementation impacts on plasma sphingolipid levels in T2D patients. Thus, plasma samples of 59 patients with non-insulin-requiring T2D from a placebo-controlled, randomized, and double-blind study were retrospectively analyzed. Once per week, patients received either 20 drops of Vigantol oil, corresponding to a daily dose of 1904 IU/d vitamin D (verum: n = 31), or a placebo oil consisting of medium chain triglycerides (placebo: n = 28). Blood samples were taken from all of the participants at three different time points: 1) at the beginning of the study (baseline), 2) after 6 months supplementation, and 3) after an additional 6 months of follow-up. Plasma sphingolipids were measured by high-performance liquid chromatography tandem mass spectrometry. At baseline and 6 months follow-up, no significant differences in plasma sphingolipid species were detected between the placebo and verum groups. After 6 months, vitamin D supplementation significantly enhanced plasma C18dihydroceramide (dhCer; N-stearoyl-sphinganine (d18:0/18:0)) and C18ceramide (Cer; N-stearoyl-sphingosine (d18:1/18:0)) levels were observed in the verum group compared to the placebo group. This was accompanied by significantly higher 25-hydroxyvitamin D3 (25(OH)D3) blood levels in patients receiving vitamin D compared to the placebo group. Taken together, vitamin D supplementation induced changes of the C18 chain-length-specific dhCer and Cer plasma levels in patients with T2D. The regulation of sphingolipid signaling by vitamin D may thus unravel a novel mechanism by which vitamin D can influence glucose utilization and insulin action. Whether this acts favorably or unfavorably for the progression of T2D needs to be clarified.

Taurine supplementation improves economy of movement in the cycle test independently of the detrimental effects of ethanol.

Taurine (TA) ingestion has been touted as blunting the deleterious effects of ethanol (ET) ingestion on motor performance. This study investigated the effects of ingestion of 0.6 mL·kg-1 of ET, 6 grams of TA, and ethanol in combination with taurine (ET+TA) on economy of movement (EM) and heart rate (HR). Nine volunteers, five female (22 ± 3 years) and four male (26 ± 5 years), participated in a study that used a counterbalanced experimental design. EM and HR were measured for 6 min while the subjects were pedalling at a fixed load 10% below the anaerobic threshold. The blood alcohol concentration (BAC) was similar between ET and ET+TA treatments at 30 min after ingestion and after exercise (12.3 mmol·L-1 vs. 13.7 mmol·L-1, and 9.7 mmol • L-1 vs 10.9 mmol·L-1, respectively). EM was significantly different among treatments, with lower mL·W-1 following ingestion of TA (-7.1%, p<0.001) than placebo and ET+TA (-2.45%, p=0.001) compared to ET. HR (bpm) was significantly (p<0.05) higher for ET (137 ± 14 bpm) than the other three treatments (placebo = 129 ± 14 bpm; TA = 127 ± 11 bpm; TA+ET = 133 ± 12 and ET = 137 ± 14 bpm). Taurine improved EM when compared to placebo or ET, and reduced HR when compared to ET. The combination of ET+TA also enhanced EM compared to placebo, and reduced HR in comparison to ET alone. Therefore, these findings indicate that taurine improves EM and counteracts ethanol-induced increases in HR during submaximal exercise.

Nonpharmacological Alternatives to Benzodiazepine Drugs for the Treatment of Anxiety in Outpatient Populations: A Literature Review.

Overuse of benzodiazepine drugs to treat anxiety, mood, and sleep disorders is a growing problem in clinical practice. GABAergic medications (benzodiazepine drugs in particular) have side effects, drug interactions, and the potential to create tolerance and dependence in users. GABA-enhancing dietary supplements have similar and unique risks. Natural, non-chemical, anxiolytic treatments exist and can be safely recommended to patients. Three such treatments have been the focus of study in the past 20 years: mindfulness, meditation, and yoga. Growing evidence exists that these treatments can be safely recommended to patients with anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 54(8), 35-42.].

Oral creatine supplementation augments the repeated bout effect.

PURPOSE: We examined the effects of creatine supplementation on the response to repeated bouts of resistance exercise. METHODS: Young men (24.1 ± 5.2 yr) were divided into Creatine (CM, n = 9) and Placebo (PL, n = 9) groups. On day (D) 1 and D15, subjects performed four sets of bicep curls at 75% 1-RM to concentric failure. On D8-D13, subjects consumed either 20g/d creatine monohydrate or placebo. Muscle soreness and elbow joint range of motion (ROM) were assessed on D1-D5 and D15-D19. Serum creatine kinase activity (CK) was assessed on D1, D3, D5, D15, D17, and D19. RESULTS: The first exercise bout produced increases in muscle soreness and CK, and decreases in ROM in both groups (p < .001). The second bout produced lesser rises in serum CK, muscle soreness, and a lesser decrease in ROM (bout effect, p < .01 for all), with greater attenuation of these damage markers in CM than PL. CK levels on D17 were lower (+110% over D15 for CM vs. +343% for PL), muscle soreness from D15-19 was lower (-75% for CM vs. -56% for PL compared with first bout), and elbow ROM was decreased in PL, but not CM on D16 (p < .05 for all). CONCLUSIONS: Creatine supplementation provides an additive effect on blunting the rise of muscle damage markers following a repeated bout of resistance exercise. The mechanism by which creatine augments the repeated bout effect is unknown but is likely due to a combination of creatine's multifaceted functions.

Evidence for functional divergence in arbuscular mycorrhizal fungi from contrasting climatic origins.

A considerable amount of phenotypic, genetic and symbiotic functional variability has been documented in arbuscular mycorrhizal fungi (AMF). However, little is known about whether distinct AMF ecotypes have evolved within their geographic range. We tested the hypothesis that AMF growing at temperatures closer to those prevalent within their origin would benefit their host and grow more than isolates distant from their native conditions. For each of six AMF species, we chose pairs of isolates that originated from distant areas with contrasting climates. Each isolate was grown in association with two grass species of different thermal optima at two temperature settings. Thus, we also tested whether AMF from different climatic origins were dependent on the thermal adaptation of the host plant species or to temperature per se. Although fungal growth was not directly affected by temperature, we found that AMF isolates originating from contrasting climates consistently and differentially altered plant growth. Our results suggest that AMF from contrasting climates have altered symbiotic function, thus linking an abiotic factor to ecotypic differentiation of putatively important symbionts.

Changes in arbuscular mycorrhizal fungal phenotypes and genotypes in response to plant species identity and phosphorus concentration.

* Arbuscular mycorrhizal fungi (AMF) are plant symbionts that improve floristic diversity and ecosystem productivity. Many AMF species are generalists with wide host ranges. Arbuscular mycorrhizal fungi individuals are heterokaryotic, and AMF populations are genetically diverse. Populations of AMF harbor two levels of genetic diversity on which selection can act, namely among individuals and within individuals. Whether environmental factors alter genetic diversity within populations is still unknown. * Here, we measured genetic changes and changes in fitness-related traits of genetically distinct AMF individuals from one field, grown with different concentrations of available phosphate or different host species. * We found significant genotype-by-environment interactions for AMF fitness traits in response to these treatments. Host identity had a strong effect on the fitness of different AMF, unearthing a specificity of response within Glomus intraradices. Arbuscular mycorrhizal fungi individuals grown in novel environments consistently showed a reduced presence of polymorphic genetic markers, providing some evidence for host or phosphate-induced genetic change in AMF. * Given that AMF individuals can form extensive hyphal networks colonizing different hosts simultaneously, contrasting habitats or soil properties may lead to evolution in the population. Local selection may alter the structure of AMF populations and maintain genetic diversity, potentially even within the hyphal network of one fungus.

A double blind, single centre, sub-chronic reperfusion trial evaluating FX06 following haemorrhagic shock in pigs.

OBJECTIVE: Haemorrhagic shock causes ischaemia and subsequent fluid resuscitation causes reperfusion injury, jointly resulting in high morbidity and mortality. We tested whether the anti-inflammatory fibrin-derived peptide, Bbeta(15-42), also called FX06, is tissue protective in a model of haemorrhagic shock. METHODS: In a pig model, we standardised the severity of haemorrhagic shock by achieving a cumulative oxygen deficit of approximately 100ml/kg body weight by withdrawing blood over a period of 1h. This was followed by resuscitation with shed blood and full electrolyte solution, and pigs were monitored for 3 days. At reperfusion, 17 pigs were randomly assigned to FX06 or solvent treatment. RESULTS: FX06-treated pigs demonstrated improved cardiac function (stroke volume index: 67ml/m(2) versus 33ml/m(2)), decreased troponin T release in the early reperfusion (0.24ng/ml versus 0.78ng/ml), decreased AST levels after 24h (106U/l versus 189U/l) and decreased creatinine levels after 24h (108micromol/l versus 159micromol/l). Furthermore, FX06-treated pigs demonstrated preservation of the gut/blood barrier, while controls demonstrated high endotoxin plasma levels indicating translocation of bacteria and/or its products (0.2EU/ml versus 24.3EU/ml) after 24h. This study also demonstrates a significantly improved neurological performance in the FX06 group as determined by S100beta serum levels (0.72microg/l versus 1.25microg/l) after 48h and neurological deficit scores (11 versus 70) after 24h. CONCLUSION: FX06 - when administered as an adjunct to fluid resuscitation therapy - is organ protective in pigs. Further investigations are warranted to reveal the protective mechanism of FX06.

Glycine-arginine-alpha-ketoisocaproic acid improves performance of repeated cycling sprints.

PURPOSE: The purpose of this study was to determine the effect of glycine-arginine-alpha-ketoisocaproic acid (GAKIC) supplementation on repeated bouts of anaerobic cycling performance. METHODS: Ten men completed a randomized, double-blinded, placebo-controlled exercise protocol of two sessions separated by 7 d. Plasma lactate was analyzed in blood collected 45 min before exercise (REST) and 5 min postexercise (POST). Subjects consumed either 11.2-g GAKIC or placebo (PLC) during a 45-min period between the REST and exercise. Mean power, peak power, and fatigue values were assessed from five supramaximal, 10-s cycle ergometer sprints, separated by 1-min rest intervals. Data were analyzed using repeated measures ANCOVA. RESULTS: A significant treatment x time interaction (P = 0.039) was observed for the change in mean power output over the five sprints between the GAKIC and PLC treatments. Post hoc analyses revealed a greater retention of mean power (P = 0.038) between sprints 1 and 2 after GAKIC (-1 +/- 9 W) versus PLC treatment (-47 +/- 18 W). No other performance variables differed between PLC and GAKIC. POST lactate was increased (P < 0.001) above REST, but there was no difference between treatments (P = 0.936). CONCLUSION: These data support an ergogenic effect of GAKIC for attenuating the decline in mean power during repeated bouts of supramaximal exercise.

Influence of carbohydrate ingestion on cytokine responses following acute resistance exercise.

The effect of carbohydrate supplementation (CHO) on interleukin 2 (IL-2) and interleukin 5 (IL-5) secretion following acute resistance exercise was examined in 9 resistance-trained males. Subjects completed a randomized, double-blind protocol with exercise separated by 14 days. The exercise consisted of a high-intensity, short rest interval squat workout. Subjects consumed 1.0 g x kg body mass(-1) CHO or an equal volume of placebo (PLC) 10 min prior to and 10 min following exercise. Blood was collected at rest (REST), immediately post exercise (POST), and at 1.5 h of recovery (1.5 h POST). Isolated peripheral blood mononuclear cells were stimulated with PHA and assayed for IL-2 and IL-5 secretion. IL-2 secretion was significantly decreased at POST for both the PLC and CHO groups. However, the degree of decrease was less in the CHO group (16%) than in the PLC group (48%), and this difference was statistically significant. These responses were transient, and the values returned to normal by 1.5 h POST. A mild and transient but significant decrease in IL-5 secretion by the PLC group was observed at POST (26%) compared to REST. No significant decrease was observed in IL-5 secretion for CHO from REST to POST (12%). These data support a possible effect of carbohydrate supplementation on IL-2 and IL-5 secretion following high-intensity resistance exercise.