Appropriateness of the 30-day expected mortality metric in palliative radiation treatment: a narrative review

BACKGROUND AND OBJECTIVE The 30-day expected mortality rate is frequently used as a metric to determine which patients benefit from palliative radiation treatment (RT). We conducted a narrative review to examine whether its use as a metric might be appropriate for patient selection. METHODS A literature review was conducted to identify relevant studies that highlight the benefits of palliative RT in timely symptom management among patients with a poor performance status, the accuracy of predicting survival near the end of life and ways to speed up the process of RT administration through rapid response clinics. KEY CONTENT AND FINDINGS Several trials have demonstrated substantial response rates for pain and/or bleeding by four weeks and sometimes within the first two weeks after RT. Models of patient survival have limited accuracy, particularly for predicting whether patients will die within the next 30 days. Dedicated Rapid Access Palliative RT (RAPRT) clinics, in which patients are assessed, simulated and treated on the same day, reduce the number of patient visits to the radiation oncology department and hence the burden on the patient as well as costs. CONCLUSIONS Single-fraction palliative RT should be offered to eligible patients if they are able to attend treatment and could potentially benefit from symptom palliation, irrespective of predicted life expectancy. We discourage the routine use of the 30-day mortality as the only metric to decide whether to offer RT. More common implementation of RAPRT clinics could result in a significant benefit for patients of all life expectancies, but particularly those having short ones

Adherence to Mediterranean Diet of Breastfeeding Mothers and Fatty Acids Composition of Their Human Milk: Results From the Italian MEDIDIET Study

Background and Aims: The content of fatty acids (FA) in human milk may be influenced by maternal nutrition. We evaluated the role of a Mediterranean diet in influencing the content of FA in human milk among 282 breastfeeding mothers participating in the MEDIDIET study. Materials and Methods: Mediterranean Diet Score (MDS), a composite index, was used to evaluate adherence to the Mediterranean diet. It includes 9 components (i.e., vegetables, fruit, cereals, legumes, monounsaturated to saturated FA ratio – MUFA/SFA, fish, dairy products, meat, and alcohol) and therefore potentially ranges from 0 (no adherence) to 9 (complete adherence) points. None of the mothers obtained the highest score due to the low alcohol consumption in the study population. Mothers were categorized in approximate tertiles of adherence: 0–3 (34.4%), 4 (26.2%), and 5–8 points (39.4%). The mean content of FA across categories of MDS was compared using ANOVA and test for trend. Results: A high adherence of breastfeeding mothers to the Mediterranean diet was associated with lower content of SFA in human milk (42.58 ± 4.36 for MDS = 0–3, 42.58 ± 4.89 for MDS = 4, and 40.92 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend = 0.02). Conversely, a high adherence was associated with higher content of MUFA in human milk (43.27 ± 4.27 for MDS = 0–3, 43.27 ± 4.47 for MDS = 4, and 45.24 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), ω-3 FA (1.07 ± 0.25 for MDS = 0–3, 1.22 ± 0.49 for MDS = 4, and 1.31 ± 0.51% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), and the major types of ω-3 FA (i.e., α-linolenic acid – ALA, eicosapentaenoic acid – EPA, docosahexaenoic acid – DHA, docosapentaenoic acid – DPA). These associations were mainly driven by the adherence to the vegetables, MUFA/SFA, fish, and dairy products components of the Mediterranean diet. Conclusion: A high adherence to the Mediterranean diet was associated with human milk showing a lower content of SFA and higher content of MUFA and ω-3 FA, including DHA. The Mediterranean diet may contribute in human milk production with higher content of specific FA which is directly involved in infant’s neural and visual development, as reported by previous studies

The effect with mineral-humine preparations and antioxidants addition to feed on the activity of lysozyme and cystatin in egg white

Celem przeprowadzonych badań było określenie wpływu żywienia niosek paszą standardową, wzbogaconą preparatami mineralno-huminowymi oraz przeciwutleniaczami (wit. A i E) na aktywność lizozymu i cystatyny. Materiałem doświadczalnym były jaja pochodzące od trzech grup niosek linii Tetra SL, które skarmiano: A (grupa kontrolna) paszą standardową zawierającą 17% białka, 2700 kcal/kg; B z dodatkiem witamin A i E (kolejno: 10 000 j/kg i 20 mg/kg paszy); C z dodatkiem 2% humobentofetu (HB) i humokarbowitu (HK) oraz witamin A i E (w ilościach jw.). Doświadczenie przeprowadzono na jajach świeżych oraz przechowywanych przez 4 tygodnie w temperaturze 15°C. Aktywność lizozymu oznaczano spektrofotometrycznie, mierząc zmiany absorbancji roztworu bakterii Micrococcus lysodeicticus podczas enzymatycznej reakcji lizozymu. Inhibitorową aktywność cystatyny oznaczano metodą Nishida i wsp. oraz Siewińskiego. Zróżnicowane żywienie istotnie wpłynęło na poziom aktywności cystatyny w świeżym białku jaja. W wariancie A, stanowiącym grupę kontrolną, aktywność cystatyny była najwyższa i osiągnęła wartość 421 j/100 mg białka. W wariantach B i C, będących grupą statystycznie jednorodną, w których nioski skarmiano paszami wzbogaconymi, uzyskano niższe poziomy inhibitorowej aktywności cystatyny. W grupie C aktywność ta była niższa o 26,2%, a w grupie B o 26% w odniesieniu do próby kontrolnej. Białko to nie wykazało stabilności przechowalniczej. Podczas 4-tygodniowego okresu przechowywania jaj aktywność cystatyny znacznie się obniżyła w obrębie wszystkich badanych grup. Najwyższy spadek aktywności cystatyny oznaczono w wariancie A, poziom ten obniżył się o 35% w porównaniu z białkiem świeżym. Wzbogacanie diety niosek korzystnie wpłynęło na aktywność lizozymu w białku jaj. Poziomy aktywności enzymu w grupach B i C były wyższe niż w grupie kontrolnej. Najwyższą wartość aktywności lizozymu otrzymano w białku jaj pochodzących od kur skarmianych paszą z dodatkiem witamin A i E (wariant B).The aim of this paper was to recognise the effect of feed modification, with standard feeding enriched with mineral-humine preparations and antioxidants (vit. A + E) on the activity of lysozyme and cystatin. Experimental materials were eggs from 3 groups of Tetra SL laying hens: A control group with standard feeding (17% protein, 2700 kcal/kg); B with addition vitamins A (10 000 unit/kg) and E (20 mg/kg); C with addition 2% humobentofet (HB), humocarbovit (HK) and vitamins A +E. Experiment occurred fresh Eggs stored 4 weeks at 15°C. Lysozyme activity was analysed spectrophotometrically by measuring changes in optical density of Micrococcus lysodeicticus solution during enzymatic lysozyme reaction. Inhibitory activity of cystatin was measured according to Nishida et al [7] and Siewiński [8]. Differential feeding significantly affected the level of cystatin activity in fresh egg white. In control group (A) this activity was the highest (421 units/100 mg protein). Lower cystatin activity was estimated in eggs from groups B and C laid by hens with enriched feeding. In group C this activity was lower on about 26.2% and in group B on 26%in comparison to control group. This protein did not have storage stability. The activity of cystatin in all samples decreased during storage for 4 weeks. The highest decrease of cystatin activity (35% related to fresh egg white) was analysed in group A. Feeding modification had a positive effect on lysozyme activity in fresh egg white. The level of lysozyme enzymatic activity was higher in groups B and C than in control group. The highest lysozyme activity was obtained in egg white derivated from layers fed with vitamins A and E (group B)

Effect of diversified hen raising system on lutein content in eggs

Zainteresowanie karotenoidami wynika z ich znaczenia w żywieniu człowieka. Szczególnie luteina oraz zeaksantyna spełniają ważną funkcję w procesie widzenia, a także w profilaktyce chorób cywilizacyjnych. Celem pracy było porównanie zawartości luteiny w jajach pochodzących od niosek ze zróżnicowanego systemu chowu (klatkowy, ściółkowy, wolno wybiegowy) oraz ocena sensoryczna badanych jaj. Największą zawartość luteiny oznaczono w jajach pochodzących od kur z chowu wolnowybiegowego (średnio o ponad 50 % więcej w porównaniu z innymi grupami). Jaja te zostały wyróżnione także przez panel sensoryczny pod względem smaku (4,9 pkt) oraz zapachu (4,8 pkt). Jaja pochodzące z chowu fermowego, wzbogacone w wielonienasycone kwasy tłuszczowe oraz wit. A + E charakteryzowały się najmniejszą zawartością luteiny (0,21 mg/jajo). Surowiec standardowy, pochodzący od niosek z fermy towarowej, cechował się najwyższym stopniem wybarwienia żółtka (14,8) przy jednoczesnym wysokim poziomie oznaczonego karotenoidu (0,37 mg/jajo).The interest in carotenoids results from their importance in human nutrition. Particularly, lutein and zeaxanthin play a vital role in the process of seeing, as well as in the lifestyle disease prophylaxis. The objective of the study was to compare the content of lutein in eggs laid by hens from a diversified raising system (cage, bedding, and free-range system) and to sensory assess the eggs under analysis. The highest content of lutein was determined in eggs laid by hens kept in a free-range system (over 50 % on average compared to other groups). These eggs were also emphasised in the sensory panel as those with the best taste (4.9) and aroma (4.8). The eggs, laid by hens raised in a poultry farming system and enriched with polyunsaturated fatty acids and vitamins A+E, were characterized by the lowest content of lutein (0.21mg/egg). The standard material, obtained from laying hens raised in a commercial farm, was characterized by the highest egg yolk coloration (14.8) and, at the same time, by a high level of carotenoid determined (0.37mg/egg)