Predicting recurrence after curative resection for gastric cancer: External validation of the Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system.

BACKGROUND: Most nomograms for Gastric Cancer (GC) were developed to predict overall survival (OS) after curative resection. The Italian Research Group for Gastric Cancer (GIRCG) prognostic scoring system (PSS) was designed to predict the recurrence risk after curative treatment based on pathologic tumor stage and treatment performed (D1-D2/D3 lymphadenectomy). This study was carried out to externally validate the GIRCG's PSS. PATIENTS AND METHODS: Adopting the same criteria used by GIRCG to build the PSS, 185 patients with GC operated with curative intention were selected. The median follow-up period was 77.8 months (1.93-150.8) for all patients and 102.5 months (60.9-150.8) for patients free of disease. The NRI (net reclassification improvement) was calculated to estimate the overall improvement in the reclassification of patients using the PSS in place of the TNM stage system. RESULTS: GC recurrence occurred in 70 (37.8%) patients. The mean time to recurrence was 22.2 (range 1.9-98.1) months. For patients with recurrence, the gain in the proportion of reclassification was 0.257 (p < 0.001), indicating an improvement of 26%. For patients without recurrence, the gain in the proportion of reclassification was -0.122 (p < 0.001), indicating a worsening of 12%. The NRI calculated was 0.135 (p = 0.0527). CONCLUSION: The GIRCG's PSS, which predicts the likelihood of recurrence after radical surgical treatment for GC, is more accurate than TNM system to predict recurrence mainly for high-risk patients. Yet, the PSS does not have the same effectiveness for low-risk patients, overestimating the chance of recurrence occurs even for disease-free patients.

Pharmacological nutrition in inflammatory bowel diseases.

Inflammatory Bowel Diseases--ulcerative colitis and Crohn's disease--are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted. Total parenteral nutrition has been used to correct and prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with a high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission of disease in adults and promoting growth in children. Recent research has focused on the use of specific nutrients as primary treatment agents. Although some reports have indicated that glutamine, short-chain fatty acids, antioxidants and immunonutrition with omega-3 fatty acids are an important therapeutic alternative in the management of inflammatory bowel diseases, the beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these nutrients still need further evaluation through prospective and randomized trials.

Protective effects of glutamine enriched diets on acute actinic enteritis.

Radiotherapy plays an important role in cancer treatment, although it may cause collateral effects and sever complications due to cellular damage of peritumoral tissues. Recently different nutritional resources have been indicated to achieve intestinal protection during cancer irradiation. The aim of this study was to set the role of glutamine in acute actinic enteritis prevention. Sixty-five Wistar male rats (200 g) were maintained in individual metabolic cages, where body weight and food ingestion were carefully monitored daily. The animals were chosen at random in three groups and fed isocaloric and isoproteid diets: 1) CRt (23)-polymeric-casein diet (CD); 2) GRt (22)-polymeric-casein diet supplemented with 2% glutamine (GD), and 3) ERt (20)--elemental diet supplemented with 2% glutamine (ED). After an adaptation period (seven days), all rats received 1500 cGy of abdominal radiation in five equal daily doses of 300 cGy. After three days post radiation the rats were submitted to jejunal perfusion test with polyethylene-glicol 4000. Finally, small bowel and colon were resected for histological evaluation. It was observed that ERt group had greater average daily food intake than CRt and GRt groups during all periods (p < 0.05). All rats had equal weight gain during adaptation period; during irradiation all the animals had weight loss, but ERt group had smaller weight loss than CRt. All rats recovered weight after irradiation, and ERt group presented better results than the others (p < 0.05). Sodium transepithelial transport average values (mEq/min/cm) were negative and not statistically different in all groups. Small bowel histological evaluation in ERt and GRt rats were better than CRt rats, by preserving mucosal cellularity and increasing mitosis number and villi length (p < 0.05). Simultaneously, ERt group had greater number of rats with normal villuscrypt relation than CRt of CRt groups (p < 0.05). Large bowel histological data showed that the average crypt's length in ERt and GRt rats were greater than in CRt ones (p < 0.05). By the present work, an elemental diet enriched with 2% glutamine favored greater food ingestion and lessened weight loss during and after radiotherapy. Glutamine-supplemented polymeric or elemental diets given to rats before, during and after abdominal radiotherapy showed protective effects against radiation injury, by supporting mucosal structure and recovery.

Small bowel adaptation with growth hormone and glutamine after massive resection of rat's small bowel.

The use of glutamine (GLN) and growth hormone (GH) improves intestinal adaptation in short bowel syndrome (SBS). The present study aimed to assess the effect of a diet rich in glutamine and the use of GH on intestinal adaptation in experimental SBS. 80 Wistar rats (240 g) were randomized into 6 groups: 1) RGLN (20)--95% small bowel resection and fed on GLN diet; 2) RGLNGH (20)--95% SBR, GLN diet and GH; 3) RC (10)--95% SBR and fed on a low GLN control diet (C); 4) RCGH (10)--95% SBR and C diet and GH; 5) TAGLIN (10)--intestinal transection and anastomosis (Ta) and fed on a GLN diet; 6) TAGLNGH (10)--Ta and GLN diet and GH. GH was given SC at a dose of 0.14 mg/kg/day. The rats were weighed daily and nitrogen balance was made. Rats were sacrificed after 15 days and mucosa cell proliferation was studied with PC10 antibody. Statistical analysis was performed. All SBR rats lost weight as compared to their initial weight (8% to 13%). GH improved Ta rats weight (18.98 x 5.04%). The use of GLN diet and GH improved nitrogen balance and bowel growth on SBR groups, as compared to controls, but not cell proliferation. In conclusion, the use of GLN enriched diet and GH improves intestinal adaptation after massive resection of the small bowel in rats.

[The role of glutamine in nutrition in clinical practice]. / Importância da glutamina em nutrição na prática clínica.

Nutritional therapy using nutrients with pharmacological properties has been intensively discussed in the recent literature. Among these nutrients, glutamine has gained special attention. Glutamine is the most abundant amino acid in the blood stream of the mammals and, besides it has been considered a non-essential amino acid, glutamine is a non-dispensable nutrient in catabolic states. In this situation, there are alterations in its inter-organic flux, leading to lower plasmatic concentrations. Glutamine is the main fuel to enterocytes and it has an important role in the maintenance of intestinal structure and functions. Moreover, supplementation with glutamine has proved to be beneficial to the immunological system functions, improves nitrogen balance and nutritional parameters in the post-operative period and lessens protein loss in severe catabolic states. For these reasons, glutamine enriched-diets must be considered in the nutritional support of many diseases; new controlled, prospective and randomized studies will help to define what group of patients can really benefit from glutamine supplementation.

[Protective effects of glutamine and elemental diet in acute actinic enterocolitis: histological evaluation]. / Efeitos protetores da glutamina e dieta elementar na enterocolite actínica aguda: avaliação histológica.

Radiotherapy plays nowadays an important role in malignancies treatment. However, collateral effects and severe complications owing to cellular damage of peritumoral tissues may occur. Different nutritional resources have been recently indicated to achieve intestinal protection during cancer irradiation. PURPOSE--The aim of this study was to set the role of glutamine and elemental diets in acute actinic enteritis prevention. METHOD--Sixty-five adult male Wistar rats with average weight of 200g were maintained in individual metabolic cages; daily body weight and food ingestion were carefully monitored. The animals were randomized into three groups and fed isocaloric and isonitrogenous diets: 1) CRt-polymeric-casein diet; 2) GRt-polymeric-casein diet supplemented with 2% glutamine and 3) ERt-elemental diet supplemented with 2% glutamine. After an adaptation period (seven days), all rats received abdominal radiation in five daily doses of 300cGy. Four days after the rats were operated on to resect the small intestine and colon for histological evaluation. RESULTS--Small intestine histological data in ERt and GRt rats were better than CRt rats, by preserving mucosal cellularity and increasing mitosis number and villi length. Simultaneously, ERt group had greater number of rats with normal villus-crypt relation than CRt or GRt groups. Large intestine histological data showed that the average crypts length in ERt and GRt rats were greater than in CRt ones. CONCLUSION--Glutamine-supplemented polymeric or elemental diets given to rats before, during and after abdominal radiotherapy showed protective effects against radiation injury, by supporting mucosal structure and recovery.

[Nutritional and energy metabolism changes in abdominal irradiation--experimental study]. / Alterações nutricionais e do metabolismo anergético na irradiação abdominal-estudo experimental.

In this study the effects on nutritional status and energetic metabolism due to abdominal irradiation were analysed. Adult male Wistar rats (48), were divided in two groups Control (C) and Radiated (R). The rats were maintained all time in metabolic cages. The study was done in two periods: Period 1 begun at 0 day, where rats adapted to cages and oral diet, had food and water "ad libitum". At the day 4 indirect calorimetric measurements were performed (calorimetry I). At Period 2, group R rats abdominal radiation at a 300cGy/day rate, for 5 consecutive days, and group C started a pair feeding process linked individually to R rats and suffered application of simulated-radiation. Two other calorimetric measurements (II,III) were performed during Period 2. After radiation the last calorimetry was performed (IV). At sacrifice (day 14) blood was collected for determination of hemoglobin, haematocrit, albumin and transferrin. There were no statistical differences among groups C and R during Period 1 (p < 0.05). Great reduction in food intake and weight variation were found in Period 2, but weight loss was significantly higher in R rats. Nitrogen balance decreased in Period 2, but without difference among the groups (p < 0.05). Serum albumin was significantly lower in R rats. Respiratory quotient decreased in both groups during Period 2, but R rats kept it lower (p < 0.05). The energy expenditure level decreased after radiation in Group R. During Period 2 total substrate oxidation decreased in R rats. Radiation decreased glucose and protein oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)

Efeitos protetores da glutamina e dieta elementar na enterocolite actínica aguda: avaliaçäo histológica / Protective effects of glutamine and elemental diet in acute actinic enterocolitis: histological evaluation

O emprego da radioterapia abdominal pode ocasionar a enterite actínica aguda. A utilizaçäo de formulaçöes nutricionais especiais tem sido proposta a fim de proteger o intestino durante e após a irradiaçäo. OBJETIVO. Avaliar histologicamente o efeito protetor de dietas polimétricas e elementares enriquecidas com glutamina na prevençäo da enterite actínica aguda. MÉTODOS. Foram estudados 65 ratos machos, adultos, da raça Wistar, monitorizados diariamente quanto à ingestäo e às variaçöes de peso corpóreo. Os animais foram randomizados em três grupos e alimentados com dietas isocalóricas e isonitrogenadas: 1) CRt - dieta polimérica com caseína enriquecida com glutamina a 2 por cento; e 3) ERt - dieta elementar enriquecida com glutamina a 2 por cento. O experimento constou de períodos de adaptaçäo (7 dias), de irradiaçäo (5 dias) e de recuperaçäo (3 dias). Após a adapataçäo alimentar, todos os ratos receberam irradiaçäo abdominal fracionada em 5 doses diárias de 300cGy.quatro dias após o término da irradiaçäo, os ratos foram operados para ressecar o intestino delgado e o cólon para estudo histopatológico. RESULTADOS. Os grupos ERt e GRt apresentaram número significativamente maior de ratos com aumento da celularidade, do número de mitoses e médias superiores de altura das vilosidades em comparaçäo à CRt no intestino delgado. O grupo ERt apresentou, ainda maior número de ratos com relaçäo das alturas vilosidade-cripta normal do que os grupos CRt ou GRt, que näo apresentaram diferença estatística entre si. No intestino grosso, as médias de altura das criptas dos grupos ERt e GRt foram iguais e superiores às de CRt; os três grupos näo apresentaram, porém, diferença significante em relaçäo à celularidade epitelial e ao número de mitoses nas criptas do cólon. CONCLUSAO. Nas condiçöes do presente trabalho, a suplementaçäo alimentar com glutamina antes, durante e após a irradiaçäo abdominal em ratos, em dieta polimérica ou elementar, determinou efeitos protetores sobre o intestino irradiado, preservando sua arquitetura morfológica e a capacidade de recuperaçäo, sobretudo no intestino delgado