Dietary inflammatory index as a potential determinant of a length of hospitalization among surgical patients treated for colorectal cancer

BACKGROUND/OBJECTIVES: Inflammation is a central process responsible for health outcomes among surgical patients. Immunonutrition has been investigated as a promising modifying factor; however, inflammatory properties of habitual diet have not yet been investigated. The purpose of this study was to describe inflammatory properties of diet measured by the dietary inflammatory index (DII) among surgical patients treated for colorectal cancer and to link inflammatory properties of habitual diet with a duration of hospitalization. SUBJECTS/METHODS: A follow-up study among colorectal cancer patients treated surgically was performed in Krakow, Poland. In total, 689 patients were recruited for the study. Habitual diet was assessed using a standardized semiquantitative food frequency questionnaire. Overall, 23 dietary items (including macro-and micronutrients) were used to calculate individuals' DII. Gender, age, marital status, body mass index, smoking status, lifetime physical activity, taking vitamin supplements, number of chronic diseases, cancer site, Duke's staging and surgery type were considered as potential covariates. RESULTS: Participants were aged 58 years, with the average hospitalization time of 11 days. Higher DII (meaning diet with higher anti-inflammatory properties) was negatively associated with the duration of hospitalization (univariable linear regression: b=−0.59; P=0.005). Multivariable logistic regression has shown the decrease of the risk of longer stays (>7 days) among patients with the DII >−4.25, but only among younger (⩽60 years) patients, irrespective of Duke's staging. CONCLUSIONS: The DII might be used as a potential predictor of longer hospitalization among colorectal cancer patients treated surgically. The study provides evidence for the role of dietary-related low-grade inflammation among surgical patients

Natural history of intra-abdominal fluid collections following pancreatic surgery

Background Little data are available for non-abscess abdominal fluid collections (AFCs) after pancreatic surgery and their clinical implications.We sought to analyze the natural history of such collections in a population of patients subject to routine postoperative imaging. Methods From 1995 to 2011, 709 patients underwent pancreatic resections and routine postoperative monitoring with abdominal ultrasound according to a unit protocol. AFCs were classified as asymptomatic (no interventional treatment), symptomatic (need for percutaneous drainage of sterile, amylase-poor fluid), and pancreatic fistula (drainage of amylase-rich fluid). Results Ninety-seven of 149 AFCs (65 %) were asymptomatic and resolved spontaneously after a median follow-up of 22 days (interquartile range, 9–52 days). Among 52 (35 %) AFCs requiring percutaneous drainage, there were 20 pancreatic fistulas and 32 symptomatic collections. A stepwise logistic regression model identified three factors associated with the need for interventional treatment, i.e., body mass index ≥25 (odds ratio, 3.23; 95 % confidence interval (CI), 1.32 to 7.91), pancreatic fistula (odds ratio, 2.93; 95 % CI, 1.20 to 7.17), and biliary fistula (odds ratio, 3.92; 95 % CI, 1.35 to 11.31). Conclusions One fourth of patients develop various types of non-abscess AFCs after pancreatic surgery. Around half of them are asymptomatic and resolve spontaneously

Low-grade dietary-related inflammation and survival after colorectal cancer surgery

Purpose Prolong inflammation is a central process observed in several chronic conditions and may be responsible for survival. There is an increasing evidence showing the role of diet in inflammation and habitual diet may be responsible for low-grade inflammation. The purpose of our study was to assess the effect of inflammatory properties of habitual diet measured by the Dietary Inflammatory Index (DII) on survival among surgical patients treated for colorectal cancer (CRC). Methods A follow-up study among 689 CRC patients (mean age 58 years, ±8.9; 56.7 % males) treated surgically was performed in Krakow, Poland. Habitual diet was assessed by a standardized semiquantitative food frequency questionnaire. Next, 23 dietary items were used to calculate DIIs. Vital records were verified to determine status of the participants. Results S tudy has shown linear association between DII and survival time among CRC patients with totally removed cancer treated by chemotherapy (b = -0.13, p = 0.024). After adjustment for several important covariates, DII was associated with survival during up to 3 years after surgery, but only in patients without distant metastases (3-year $HR_{DII>-2.27}$ = 0.61, 95 % CI 0.38-0.99). Conclusions T he results of the investigation have shown the usefulness of the DII as a potential predictor of survival among patients without distant metastases treated surgically for CRC

Feasibility and outcomes of early oral feeding after total gastrectomy for cancer

Background Little data are available supporting the feasibility and safety of early oral feeding in patients after total gastrectomy. The aim of this study was to analyze the potential applicability of early provision of oral diet in these settings. Methods Medical records of 353 patients who underwent total gastrectomy for gastric cancer between 2006 and 2012 were retrospectively analyzed. Early oral feeding was defined as clear liquid diet on postoperative day (POD) 1 followed by gradual introduction of solid diet on POD 2 to 3. Late oral feeding was defined as initiation of liquid diet from POD 4 to 6 and gradually advancing to solid diets. Results Early oral feeding was implemented in 185 of 353 (52 %) patients. Prompt provision of food did not increase the risk of anastomotic failure (odds ratio 0.924, 95 % confidence interval 0.609–1.402, P=0.709). The number of reoperations and inhospital mortality rates was unaffected by the timing of nutritional intervention. Early feeding tended to be associated with fewer surgical (15 vs 24 %, P=0.027) and general (8 vs 23 %, P<0.001) complications. However, subsequent multivariate regression models failed to confirm significant correlations between timing of oral meals and postoperative morbidity. Conclusion Our findings suggested that early oral feeding is feasible and safe after total gastrectomy for gastric cancer. However, benefits of such early nutritional interventions require further studies

Mondor's disease in a patient after a mammotome biopsy

Mondor's disease is a rare, benign condition characterised by thrombophlebitis affecting subcutaneous veins of the chest and/or abdomen without an accompanying inflammatory response. The disease has a multifactorial etiology and its course is benign. It is usually self-limiting or it is eliminated by local treatment. Mondor's disease in the thoracoepigastric region may be a rare complication of mammotome biopsy. The case presentation describes a 32-year-old patient with Mondor's disease in the thoracoepigastric region after an ultrasound-guided mammotome biopsy of a breast. In the histopathological examination the lesion was diagnosed as fibroadenoma. Regardless of the disease's etiology, it is recommended to carry out diagnostic examinations to exclude co-occurring breast cancer

Factors predicting adequate lymph node yield in patients undergoing pancreatoduodenectomy for malignancy

BACKGROUND: Most pancreatoduodenectomy resections do not meet the minimum of 12 lymph nodes recommended by the American Joint Committee on Cancer for accurate staging of periampullary malignancies. The purpose of this study was to investigate factors affecting the likelihood of adequate nodal yield in pancreatoduodenectomy specimens subject to routine pathological assessment. METHODS: Six hundred sixty-two patients subject to pancreatoduodenectomy between 1990 and 2013 for pancreatic, ampullary, and common bile duct cancers were reviewed. Predictors of yielding at least 12 lymph nodes were evaluated with a logistic regression model, and a survival analysis was carried out to verify the prognostic implications of nodal counts. RESULTS: The median number of evaluated nodes was 17 (interquartile range 11 to 25), and less than 12 lymph nodes were reported in surgical specimens of 179 (27 %) patients. Tumor diameter ≥20 mm (odds ratio [OR] 2.547, 95 % confidence interval [CI] 1.225 to 5.329, P = 0.013), lymph node metastases (OR 2.642, 95 % CI 1.378 to 5.061, P = 0.004), and radical lymphadenectomy (OR 5.566, 95 % CI 2.041 to 15.148, P = 0.01) were significant predictors of retrieving 12 or more lymph nodes. Lymph node counts did not influence the overall prognosis of the patients. However, a subgroup analysis carried out for individual cancer sites demonstrated that removing at least 12 lymph nodes is associated with better prognosis for pancreatic cancer. CONCLUSIONS: Few variables affect adequate nodal yield in pancreatoduodenectomy specimens subject to routine pathological assessment. Considering the ambiguities related to the only modifiable factor identified, appropriate pathology training should be considered to increase nodal yield rather than more aggressive lymphatic dissection

Quantifying origin and character of long-range correlations in narrative texts

In natural language using short sentences is considered efficient for communication. However, a text composed exclusively of such sentences looks technical and reads boring. A text composed of long ones, on the other hand, demands significantly more effort for comprehension. Studying characteristics of the sentence length variability (SLV) in a large corpus of world-famous literary texts shows that an appealing and aesthetic optimum appears somewhere in between and involves selfsimilar, cascade-like alternation of various lengths sentences. A related quantitative observation is that the power spectra S(f) of thus characterized SLV universally develop a convincing `1/f^beta' scaling with the average exponent beta =~ 1/2, close to what has been identified before in musical compositions or in the brain waves. An overwhelming majority of the studied texts simply obeys such fractal attributes but especially spectacular in this respect are hypertext-like, "stream of consciousness" novels. In addition, they appear to develop structures characteristic of irreducibly interwoven sets of fractals called multifractals. Scaling of S(f) in the present context implies existence of the long-range correlations in texts and appearance of multifractality indicates that they carry even a nonlinear component. A distinct role of the full stops in inducing the long-range correlations in texts is evidenced by the fact that the above quantitative characteristics on the long-range correlations manifest themselves in variation of the full stops recurrence times along texts, thus in SLV, but to a much lesser degree in the recurrence times of the most frequent words. In this latter case the nonlinear correlations, thus multifractality, disappear even completely for all the texts considered. Treated as one extra word, the full stops at the same time appear to obey the Zipfian rank-frequency distribution, however.Comment: 28 pages, 8 figures, accepted for publication in Information Science