Late effects of childhood cancer treatment in long-term survivors diagnosed before the age of 3 years - A multicenter, nationwide study.

BACKGROUND: The effect of age on the incidence of late sequelae that occur after anticancer treatment in childhood is still not fully elucidated. In this multicenter study of long-term survivors diagnosed before age of three, we investigated the prevalence of late effects many years after treatment. METHODS: The study group (n = 561) was selected from the Polish National Childhood Cancer Survivors Registry (n = 1761) created in 2007. A survivor was defined as an individual who has survived at least 5 years after completion of anticancer treatment. All children were diagnosed between 1991 and 2016, mean age at diagnosis was 1.82 years (range 0.03-2.99) and median follow up time - 9.85 years (range 5.0-23.6). They were treated in accordance with international protocols approved by the Polish Pediatric Leukemia and Lymphoma Group and Polish Solid Tumor Group. Chemotherapy alone was used in 192 (34.2%), chemotherapy and radiotherapy - 56 (10%), chemotherapy and surgery - 176 (31.4%), chemotherapy, radiotherapy, and surgery - 79 (14.1%), and surgery alone in 58 patients (10.3%). RESULTS: Of all patients enrolled to the study, only 94 (16.8%) had normal function of all organs. Seventy-six (13.5%) children developed dysfunction in one organ, another 83 (14.8%) had symptoms or complaints suggestive of dysfunction in two organs or systems, 88 (15.7%) had abnormalities in three organs, and 220 (39.2%) had at least four or more dysfunctions. In the entire study group, dysfunctions most frequently (> 20% of cases) involved the following organs/systems: circulatory - 21.8%, urinary - 30.8%, gastrointestinal - 20.8%, immune - 23.5%, vision - 20.7%, hearing - 21.8%, and oral and masticatory dysfunction - 26.9%. We did not find any significant differences in organ dysfunction between children diagnosed under the age of 1 and those diagnosed at the age of 1-3, except for a lower incidence of thyroid abnormalities (p = 0.007) and the higher prevalence of liver dysfunction in youngest patients. In the subset with longer follow-up period (> 10 years) more frequent thyroid abnormalities (p = 0.019), male (p = 0.002) and female (p = 0.026) gonads dysfunction, as well as musculoskeletal problems (p < 0.001) were observed. Among subjects who received radiotherapy compared to those who did not, short stature (p = 0.001), and dysfunction of the following systems/organs - circulatory (p = 0.049), urinary (p = 0.012), thyroid gland (p < 0.0001), nervous (p = 0.007), immunological (p = 0.002), liver (p = 0.03), dental or chewing difficulties (p = 0.001), hearing (p = 0.001) and musculoskeletal (p = 0.026) were more frequently reported. When multimodal therapy was applied (chemotherapy, radiotherapy, and surgery) a higher incidence of short stature (p = 0.007), urinary system disorders (p < 0.0001), thyroid dysfunction (p < 0.0001), hearing loss (p < 0.0001), and skin problems (p = 0.031) were observed. CONCLUSION: This study confirms that radiotherapy and some specific toxicity of cytostatics are the most important factors affecting organ function. Apart from a higher incidence of liver dysfunction in the youngest patients, there were no significant differences in organ and system toxicities between children diagnosed under the age of 1 and those diagnosed at the age of 1-3. We have shown that this group requires systematic, careful and long-term follow-up.

Sensitisation to lipid transfer proteins in pollen - allergic adults with food allergy.

INTRODUCTION: Food allergy affects 6-17% of Europeans and in 60% of the cases it is accompanied by inhalation allergy. This is due to two phenomena, namely co-sensitisation and cross-reactivity, which are caused by panallergens, such as lipid transfer proteins (LTP). These proteins are classified as defence proteins PR-14 and are responsible for protecting the plant from bacterial and fungal infections. Clinically, LTP allergy manifests with severe anaphylactic reactions or milder reactions, such as oral allergy syndrome. AIM: To assess the incidence of specific IgE to components belonging to LTP based on molecular testing. MATERIAL AND METHODS: The study was conducted at the Department of Allergy, Clinical Immunology and Internal Diseases in Bydgoszcz, Poland. A total of 50 subjects participated in the study. Each subject had their asIgE levels determined with ImmunoCap ISAC. RESULTS AND CONCLUSIONS: Antigen-specific IgE antibodies to LTP components were identified in 24% of the subjects. In subjects with LTP allergy, adverse skin reactions were the most common after consumption of sensitising foods. Peach was the most common food allergen triggering these reactions. The Artemisia vulgaris component Art v 3 was the precursor of LTP allergy in our study population: the highest incidence and the highest mean levels of asIgE were demonstrated for this component.

Body Composition in Patients with Atrial Fibrillation.

BACKGROUND: Obesity is a risk factor for cardiovascular diseases, however evidence is mainly based on body mass index (BMI) analysis. The aim of this study was to estimate body composition using bioelectrical impedance analysis (BIA) and its prognostic value in patients with atrial fibrillation (AF) during one year of follow-up. METHODS: Medical history, anthropometric and biochemical examinations, and BIA were performed in 120 inpatients with AF and 240 patients hospitalized due to other cardiovascular disorders. RESULTS: Compared to the control group, the patients with AF had a significantly greater body mass, BMI, excess body mass in relation to ideal body mass, larger waist circumference, higher values of BIA parameters such as fat and fat-free mass, visceral adiposity, total body water (total water content in the body), metabolic rate and age, and lower percentage of skeletal muscle mass. Higher prevalence rates of obesity and sarcopenia were observed in the patients with AF compared to the control group, and in the patients with the paroxysmal form compared to those with the permanent form of AF. In logistic regression analysis, the percentage of fat mass was associated with a higher risk of AF (odds ratio, 1.10; 95% confidence interval, 1.05-1.15; p < 0.001). CONCLUSIONS: Body composition parameters were associated with the occurrence and form of AF in our study cohort. However, further studies are needed to clarify the relationships due to an imbalance in comorbidities.

Leptin, adiponectin, tumor necrosis factor α, and irisin concentrations as factors linking obesity with the risk of atrial fibrillation among inpatients with cardiovascular diseases.

BACKGROUND: The endocrine function of adipose tissue and skeletal muscles mediates the risk of cardiovascular complications of obesity. AIMS: The aim of this study was to determine the associations of leptin, adiponectin (ADA), tumor necrosis factor α (TNF­α), and irisin levels with the diagnosis of atrial fibrillation (AF) on admission to the hospital as well as parameters of transthoracic echocardiography among inpatients with cardiovascular diseases (CVDs). METHODS: The study included 80 consecutive patients hospitalized due to paroxysmal or persistent AF and a control group of 165 age- and sex­matched individuals admitted due to exacerbation of chronic CVD. In all participants, we assessed serum leptin, ADA, TNF­α, and irisin concentrations, body composition determined by bioelectrical impedance analysis, and transthoracic echocardiographic parameters. RESULTS: Compared with controls, patients with AF had greater fat mass (FM), higher serum leptin levels and lower levels of ADA, TNF­α, and irisin when indexed to body surface area, FM, and visceral adiposity. Hyperleptinemia slightly increased the risk of AF (odds ratio [OR], 1.02; 95% CI, 1.01-1.03; P <0.01). The correlation was stronger after indexation to FM (OR, 1.34; 95% CI, 1.01-1.81; P <0.05). The coefficients of significant correlations with echocardiographic parameters were stronger for irisin than for adipocytokines: 0.16 to 0.35 and 0.12 to 0.22, respectively. CONCLUSIONS: Adipocytokines and irisin exert a significant but weak effect on heart chamber size and affect the risk of AF occurrence. Their blood concentrations do not seem to be related simply to body composition but probably depend on individual variations in adipocytokine and myokine secretion as a result of numerous factors.

The influence of different intensity of treatment on hormonal markers of gonadal function in acute lymphoblastic leukemia survivors.

Anti-cancer treatment in children can deteriorate gonadal function and affect future fertility. We analyzed the hormonal markers of gonadal function in adolescent leukemia survivors, treated in childhood with different levels of aggressiveness. We analyzed hormone levels in 69 adolescents and young adults, leukemia survivors stratified into standard (SR), intermediate (IR), and high (HR) risk groups, and in 80 healthy controls (38 men) at a similar age. We assessed follicular stimulating hormone (FSH), luteinizing hormone (LH), and inhibin B in the whole group, testosterone in males, and E2 and anti-Müllerian hormone (AMH) in females. Males classified into HR group presented, in comparison to control, higher levels of FSH, LH, lower inhibin B, and normal testosterone, whereas in SR and IR group, the hormonal values were comparable to the control. In females, in all risk groups, the levels of FSH, LH, E2, and inhibin B were comparable with the control, but the mean AMH levels were slightly lowered. We did not observe the effect of prophylactic cranial irradiation (12 or 18 Gy) or the time of treatment (before vs. during puberty) on hormone levels. In females, a positive correlation was found between the time interval after the end of treatment and AMH levels. Male leukemia survivors having undergone more intensive chemotherapy show the symptoms of disturbed spermatogenesis and need to be followed-up in the future. Women, irrespective of the risk group, can develop the signs of preterm ovarian insufficiency. They should be informed about the impact of the treatment on gonadal function.

Clinical significance of nutritional status in patients with chronic heart failure-a systematic review.

Chronic heart failure (CHF) and nutritional disorders are recognized as major challenges for contemporary medicine. This study aims to estimate the role of nutritional disorders as risk factors for CHF development and prognostic factors for CHF patients and the outcome of nutritional intervention in CHF. Full-text English articles published between January 2013 and February 2019 available in the PubMed and Scopus databases were considered. Seventy-five prospective, retrospective, and cross-sectional studies as well as meta-analyses on patients with CHF, reporting correlation of their nutritional status with the risk and prognosis of CHF and the outcome of nutritional interventions in CHF were all included. Higher BMI increases the risk of CHF by 15-70%, especially when associated with severe, long-lasting and abdominal obesity. Overweight and obesity are associated with the reduction of mortality in CHF by 24-59% and 15-65%, respectively, and do not affect the outcome of invasive CHF treatment. Malnutrition increases the risk of mortality (by 2- to 10-fold) and the risk of hospitalization (by 1.2- to 1.7-fold). Favorable outcome of nutritional support in CHF patients was reported in a few studies. Nutritional disorders are prevalent in patients with CHF and play a significant role in the incidence, course, and prognosis of the disease. The existence of an "obesity paradox" in patients with CHF was confirmed. Further studies on the effect of nutritional support and body weight reduction in patients with CHF are necessary.