Comparison of the geriatric nutritional risk index and the prognostic nutritional index in determining survival outcome in patients with non-small cell lung cancer undergoing surgical resection: A cohort study.

To assess the clinical feasibility of the geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) as determinants of survival in patients with stage I to III non-small cell lung cancer (NSCLC). This retrospective study included patients with stage I to III NSCLC from all age groups. Hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) were calculated using the Cox regression analysis. The concordance index (C-index) of the models was evaluated following the establishment of the prognostic models for survival. The median patient age was 69 years, and 64.6% of the patients were male. In total, 172 (65.4%) patients were classified as having stage I disease, 52 (19.8%) as stage II disease, and 39 (14.8%) as stage III disease. Using multivariate Cox regression analysis, the HRs of GNRI for OS, CSS, and RFS were 0.37 (P = .003), 0.47 (P = .041), and 0.38 (P < .001), respectively. However, the HRs of the PNI for survival outcomes were not statistically significant. Overall, age, sex, tumor-node-metastasis (TNM) stage, pleural invasion (PI), and GNRI were significant determinants of OS and constituted the OS model (concordance index [C-index], 0.824). In addition, age, TNM stage, PI, and GNRI were significant determinants of CSS and constituted the CSS model (C-index, 0.828). Finally, TNM stage, PI, lymphatic invasion, and GNRI were significant determinants of RFS and constituted the RFS model (C-index, 0.783). Our study showed that GNRI, but not PNI, was a predictor of OS, CSS, and RFS in patients with stage I-III NSCLC across all age groups. Excellent discriminant power was observed for OS, CSS, and RFS models.

Preoperative mean platelet volume is a prognostic biomarker for survival in patients with gastric cancer: A cohort study.

This study aimed to evaluate the prognostic potential of mean platelet volume (MPV) in gastric cancer (GC) patients. Patients with stage I-III GC who underwent gastrectomy were enrolled in this study. Cox regression analysis was performed to evaluate the determinants of overall survival (OS) and disease-free survival (DFS). The discriminative capacity of the model was determined using the Harrell concordance index (C-index). The net benefit of the model was validated using decision curve analysis (DCA). Data from 401 patients were analyzed. Multivariate Cox regression analysis revealed that age, stage, serum albumin level (ALB), perineural invasion (PNI) and MPV were determinants of both OS and DFS. The MPV model consisted of 5 covariates (age, stage, ALB, PNI, and MPV level), and the baseline model constituted the same covariates as the MPV model, except for the MPV level. C-indices for OS and DFS were higher in the MPV model than in the baseline model. When the models were validated using DCA, the MPV model showed a greater net benefit than the baseline model for nearly all the threshold probabilities. Age, stage, ALB, PNI, and MPV are prognostic factors for OS and DFS. The discriminative capacities for OS and DFS in the MPV model were higher than those in the baseline model, thus implying the clinical significance of the MPV level as a determinant of survival in GC.

The Effect of Fermented Porcine Placental Extract on Fatigue-Related Parameters in Healthy Adults: A Double-Blind, Randomized, Placebo-Controlled Trial.

BACKGROUND: Fatigue is one of the major health conditions induced by excessive stress or abnormal immune function or defective antioxidant systems. Placental extract has been reported to have various effects such as immune modulation and cellular regeneration. Fermented porcine placenta (FPP) is a safe nontoxic material, which is highly valuable as a functional food. The aim of this study was to investigate the anti-fatigue effects of FPP supplementation compared with a placebo product. METHODS: In this double-blind, parallel, randomized, and placebo-controlled trial 84 healthy males and females, aged between 30 and 60 years were randomized to 320 mg of FPP once daily or placebo. The main outcome measures included efficacy of fatigue-inducing treadmill exercise on physical fatigue and fatigue-related parameters based on the questionnaire administered. RESULTS: The IL-1ß mRNA expression and fatigue severity scale were changed significantly after 8 weeks of treatment with fermented porcine placenta compared with placebo (p < 0.05). Cortisol levels were significantly improved in participants younger than 45 years following treatment with FPP compared with placebo. Furthermore, the lactate and myoglobin levels were improved significantly in participants with BMI ≥ 23 kg/m2 (p = 0.045 and p = 0.011, respectively) following treatment with FPP versus placebo. CONCLUSIONS: Our study showed that FPP supplementation significantly ameliorated fatigue-related parameters and subjective symptoms in healthy adults. Therefore, our results indicate that FPP supplementation induced anti-fatigue effect by regulating the inflammatory response.

Clinical Significance of Paraspinal Muscle Parameters as a prognostic factor for survival in Gastric Cancer Patients who underwent Curative Surgical Resection.

Background: The quantitative and qualitative skeletal muscle parameters have been proposed to predict the outcome of patients with gastric cancer. However, the evidence for their association with long-term survival is still conflicting. This study aimed to investigate the effect of paraspinal muscle parameters on overall survival (OS) and disease-free survival (DFS) in patients with gastric cancer who underwent curative resection. Methods: Patients with stages I or II gastric cancer who underwent curative resection between October 2006 and June 2016 were identified from electrical medical records. Paraspinal muscle area and attenuation were measured at the level of the third lumbar vertebra using computerized tomography images. For the analysis of OS and DFS, proportional hazards model was used, incorporating demographic, pathologic, laboratory, and radiologic variables. Results: This study enrolled 296 patients (192 men and 104 women). In the multivariate proportional hazards model, total gastrectomy (hazard ratio [HR], 2.65; 95% Confidence interval [CI], 1.36-5.19; p = 0.0044), neutrophil-lymphocyte ratio (NLR) (HR, 1.27; 95% CI, 1.06-1.51; p = 0.0081), serum albumin level (HR, 0.16; 95% CI, 0.07-0.39; p < 0.0001), paraspinal muscle area adjusted for body surface area (PMABSA) (HR, 3.06; 95% CI, 1.65-5.67; p = 0.0004), and mean attenuation in paraspinal muscle (PMMA) (HR, 3.38; 95% CI, 1.75-6.53; p = 0.0003) were prognostic factors for OS. Similarly, total gastrectomy (HR, 2.11; 95% CI, 1.10-4.06; p = 0.0243), NLR (HR, 1.25; 95% CI, 1.06-1.48; p = 0.0071), serum albumin level (HR, 0.22; 95% CI, 0.10-0.51; p = 0.0035), PMABSA (HR, 2.42; 95% CI, 1.34-4.37; p = 0.0035), and PMMA (HR, 3.19; 95% CI, 1.71-5.93; p = 0.0003) were prognostic factors for DFS. Conclusions: The pretreatment paraspinal muscle parameters such as PMABSA and PMMA along with total gastrectomy, NLR, and serum albumin level could predict OS and DFS in patients with stages I or II gastric cancer who underwent curative surgical resection. Because PMABSA and PMMA are newly characterized parameters in gastric cancer, the relationship with the survival of these parameters requires further validation in further studies before they are subjected to clinical applications.

Effects of Progressive Resistance Training on Post-Surgery Incontinence in Men with Prostate Cancer.

We evaluated the efficacy of progressive resistance training of the pelvic floor muscle for post-prostatectomy incontinence. In this prospective study, 59 patients who underwent radical prostatectomy were evaluated preoperatively. Continence was sequentially assessed within 2 weeks postoperatively, and an exercise regimen was initiated at 6- and 12-weeks. The primary outcome was continent status and the secondary outcome was changes in muscle strength and endurance after the exercise intervention. Continence was defined as no urine loss in a 1h pad test. A total of 59 patients participated in this study. Six patients dropped out of the study because of non-compliance and orthopedic problems. Of the remaining 53 patients, 31 (58.5%) achieved pad-free continence at 12 weeks postoperatively. The patients were divided into two groups based on their continence status, and no statistically significant difference was observed in age, body mass index, prostate volume, prostate-specific antigen, pathological Gleason score sum, and pathological T stage. Meanwhile, preoperative maximal urethral closure pressure and change in hip extensor muscle strength and endurance during the 12-week exercise program were significantly higher in the continent group. In multivariate analysis, change in hip extensor muscle strength was the only significant parameter predicting achievement of continence status (Odds ratio, 1.039; p = 0.045). The changes in hip extensor muscle strength in the current exercise program was an independent predictor of continence status after radical prostatectomy. A large-scale prospective study on the relationship between extensor muscle strength and urinary incontinence should be explored in future.

Efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for chronic low back pain: A study protocol for a randomized, controlled, assessor-blinded, multicenter clinical trial.

BACKGROUND: Back pain is one of the most common diseases, and many patients with recurrent pain seek alternative treatment strategies. Thread embedding acupuncture involves thread insertion at the acupuncture point for continuous physical and chemical stimulation. Although thread embedding is widely used in clinical practice, there is no sound evidence of its efficacy for chronic back pain. We describe the protocol for a randomized controlled trial for investigation of the efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for chronic low back pain. METHODS: This randomized, controlled, assessor-blinded, 2-armed, parallel, multicenter clinical trial will include 38 outpatients with chronic low back pain recruited from 4 traditional Korean Medicine hospitals. The patients will be randomly allocated to a treatment group (conventional acupuncture + thread embedding acupuncture) and a control group (only conventional acupuncture) in a 1:1 ratio. The treatment group patients will receive thread embedding acupuncture treatment at 10 acupuncture points (multifidus muscle, 4 points; spinal erector muscles, four points; lumbar quadrate muscle, 2 points) once a week for 8 weeks (8 sessions). In addition, all patients will receive conventional acupuncture treatment at 14 acupuncture points (GV3, EX-B5, and bilateral BL23, BL24, BL25, BL26, BL40, and BL60) twice a week for 8 weeks (16 sessions). The primary outcome will be the change in the visual analog scale score from visit 1 to visit 16, analyzed by independent t tests, in both groups. The groups will also be compared with regard to the clinical relevance (minimal clinically important difference), quality of life (3-level version of Euroqol-5D), disability level (Roland and Morris Disability Questionnaire), global assessment (patient global impression of change), and safety. Cost data for cost-benefit and cost-effectiveness analyses will be collected. DISCUSSION: Our study results will provide evidence of the efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for the management of chronic low back pain. Even though the assessors will be blinded, the patients will not be blinded to treatment because of the lack of a sham embedding acupuncture group; this is a limitation of our study. TRIAL REGISTRATION: Clinical Research Information Service: KCT0002666.