Analysis of nutritional status disorders in patients with chronic obstructive pulmonary disease

Introduction: Among the most common extrapulmonary manifestations of COPD are nutritional status disorders. The specific loss of weight, called cachexia, characterized by loss of lean body mass in some COPD patients is observed. The aim of the study was the quantitative and qualitative analysis of COPD patients’ nutritional status disturbances. Material and methods: Fifty-five patients in different stages of COPD - 43 males and 12 females (mean age 62.31 ± 11.08) and 32 subjects from a control group (mean age 57.43 ± 8.79) participated in the study. In both groups nutritional status was assessed using different indicators such as PIBW - percentage of ideal body weight, BMI - body mass index, FFMI - fat-free mass index and FMI - fat mass index. Results: Malnutrition measured by PIBW, BMI, BMI percentiles, and FFMI was observed in 5.45%, 3.64%, 3.64% and 18.18% of COPD patients, respectively, and in the control group 3.12%, 0%, 3.12% and 3.12%, respectively. The BMI mean value did not differ significantly between groups. It was confirmed that cachexia assessed by FFMI occured more frequently in COPD patients than in the control group - 19.05 kg/m2 vs. 20,55 kg/m2 (p = 0.04). Conclusions: 1. Nutritional status disorders pose a serious problem, which concerns about 1/5 of the COPD population. 2. It is necessary to perform quantitative analysis of nutritional status (assessment of lean and fat mass) because indicators of body mass (PIBW, BMI) are not sufficient for cachexia detection. 3. Having normal body mass does not exclude the possibility of nutritional status disorders in COPD patients.Wstęp: Jedną z najczęstszych pozapłucnych manifestacji przewlekłej obturacyjnej choroby płuc (POChP) są zaburzenia stanu odżywienia. U części chorych na POChP obserwuje się specyficzną utratę masy ciała, zwaną kacheksją, charakteryzującą się utratą masy beztłuszczowej. Celem pracy była jakościowa i ilościowa analiza zaburzeń stanu odżywienia chorych na POChP. Materiał i metody: W badaniu uczestniczyło 55 chorych na POChP w różnym stopniu zaawansowania choroby (I-IV° według GOLD) - 43 mężczyzn i 12 kobiet (średnia wieku 62,31 ± 11,08 roku) oraz 32 osoby z grupy kontrolnej. W obu grupach określono stan odżywienia za pomocą parametrów: PIBW - odsetek idealnej masy ciała, BMI - wskaźnik masy ciała, FFMI - wskaźnik masy beztłuszczowej, FMI - wskaźnik masy tłuszczowej. Wyniki: Niedożywienie mierzono następującymi wskaźnikami: PIBW, BMI, wskaźnik percentylowy BMI, FFMI stwierdzano odpowiednio u: 5,45%; 3,64%; 3,64%; 18,18% chorych na POChP. W grupie kontrolnej wskaźniki te wynosiły odpowiednio: 3,12%; 0%; 3,12%; 3,12%. Średnie wartości wskaźnika masy ciała nie różniły się istotnie między grupami. U chorych na POChP stwierdzano istotnie statystycznie częstsze występowanie zaburzeń odżywienia definiowanej średnim wskaźnikiem masy beztłuszczowej niż w grupie osób zdrowych - 19,05 kg/m2 vs. 20,55 kg/m2 (p = 0,04). Wnioski: 1. Zaburzenia stanu odżywienia są istotnym problemem, który dotyczy około 1/5 całej populacji chorych na POChP. 2. U chorych na POChP konieczna jest jakościowa analiza stanu odżywienia (określenie wskaźników masy beztłuszczowej i tłuszczowej), gdyż wskaźniki masy ciała nie są wystarczające dla wykrycia kacheksji. 3. Stwierdzenie prawidłowej masy ciała nie wyklucza istnienia zaburzeń stanu odżywienia u chorego na POChP

Co nowego w raporcie GINA 2023? Omówienie wytycznych astmy.

Astma to jedna z najczęstszych niezakaźnych chorób przewlekłych układu oddechowego. Diagnostyka opiera się na ocenie zmienności objawów oraz obturacji, popartych badaniami czynnościowymi, i różni się w zależności od wywiadu pobierania przez chorego wziewnych glikokortykosteroidów. Po ustaleniu rozpoznania należy określić stopień ciężkości choroby w celu wdrożenia odpowiedniej terapii farmakologicznej, którą następnie można modyfikować w zależności od jej skuteczności zgodnie ze stopniami od 1 do 5. W leczeniu astmy istotne są również strategie niefarmakologiczne, zwłaszcza wykorzystanie technologii cyfrowych przyczyniających się do poprawy przestrzegania zaleceń lekarskich. W maju 2023 ukazał się coroczny raport GINA aktualizujący najnowsze doniesienia naukowe dotyczące profilaktyki, rozpoznawania i leczenia astmy, zebrane w formie wytycznych

Powodzenie terapii rytuksymabem — szansa dla pacjentów chorujących na ziarniniakowatość z zapaleniem naczyń powikłaną schyłkową niewydolnością nerek?

Ziarniniakowatość z zapaleniem naczyń należy do grupy chorób rzadkich, która poprzez martwicze zapalenie małych i średnich naczyń atakuje rozmaite narządy – najczęściej narząd słuchu, jamę nosową, płuca oraz nerki, jednakże objawy choroby pojawiają się również w wielu innych układach. Etiologia schorzenia nie została dokładnie poznana, diagnostyka sprawia wiele trudności, wieloletnie leczenie jest obarczone ryzykiem niepowodzenia i działań niepożądanych. W ostatnich latach alternatywą dla tradycyjnego leczenia cyklofosfamidem i glikokortykosteroidami jest program lekowy z rytuksymabem. W poniższym artykule przedstawiono opis przypadku 43-letniego Pacjenta, u którego w przebiegu choroby doszło do schyłkowej niewydolności nerek, krwawienia pęcherzykowego i natychmiastowej poprawy klinicznej po włączeniu leczenia rytuksymabem. Rzadkim powikłaniem zmian płucnych okazała się odma prężna. Dzięki zastosowaniu rytuksymabu uzyskano wieloletnią remisję choroby

Variant Allele Frequency Analysis of Circulating Tumor DNA as a Promising Tool in Assessing the Effectiveness of Treatment in Non-Small Cell Lung Carcinoma Patients

Despite the different possible paths of treatment, lung cancer remains one of the leading causes of death in oncological patients. New tools guiding the therapeutic process are under scientific investigation, and one of the promising indicators of the effectiveness of therapy in patients with NSCLC is variant allele frequency (VAF) analysis. VAF is a metric characterized as the measurement of the specific variant allele proportion within a genomic locus, and it can be determined using methods based on NGS or PCR. It can be assessed using not only tissue samples but also ctDNA (circulating tumor DNA) isolated from liquid biopsy. The non-invasive characteristic of liquid biopsy enables a more frequent collection of material and increases the potential of VAF analysis in monitoring therapy. Several studies have been performed on patients with NSCLC to evaluate the possibility of VAF usage. The research carried out so far demonstrates that the evaluation of VAF dynamics may be useful in monitoring tumor progression, remission, and recurrence during or after treatment. Moreover, the use of VAF analysis appears to be beneficial in making treatment decisions. However, several issues require better understanding and standardization before VAF testing can be implemented in clinical practice. In this review, we discuss the difficulties in the application of ctDNA VAF analysis in clinical routine, discussing the diagnostic and methodological challenges in VAF measurement in liquid biopsy. We highlight the possible applications of VAF-based measurements that are under consideration in clinical trials in the monitoring of personalized treatments for patients with NSCLC

Analysis of Nutritional Status Disturbances in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Among the most common extrapulmonary manifestations of COPD are nutritional status disorders. The specific loss of weight, called cachexia, characterized by loss of lean body mass in some COPD patients is observed. The aim of the study was the quantitative and qualitative analysis of COPD patients’ nutritional status disturbances. Material and methods: Fifty-five patients in different stages of COPD—43 males and 12 females (mean age 62.31 ± 11.08) and 32 subjects from a control group (mean age 57.43 ± 8.79) participated in the study. In both groups nutritional status was assessed using different indicators such as PIBW—percentage of ideal body weight, BMI—body mass index, FFMI—fat-free mass index and FMI—fat mass index. Results: Malnutrition measured by PIBW, BMI, BMI percentiles, and FFMI was observed in 5.45%, 3.64%, 3.64% and 18.18% of COPD patients, respectively, and in the control group 3.12%, 0%, 3.12% and 3.12%, respectively. The BMI mean value did not differ significantly between groups. It was confirmed that cachexia assessed by FFMI occured more frequently in COPD patients than in the control group—19.05 kg/m2 vs. 20.55 kg/m2 (p = 0.04). Conclusions: 1. Nutritional status disorders pose a serious problem, which concerns about 1/5 of the COPD population. 2. It is necessary to perform quantitative analysis of nutritional status (assessment of lean and fat mass) because indicators of body mass (PIBW, BMI) are not sufficient for cachexia detection. 3. Having normal body mass does not exclude the possibility of nutritional status disorders in COPD patients

The influence of nutritional status, lipid profile, leptin concentration and polymorphism of genes encoding leptin and neuropeptide Y on the effectiveness of immunotherapy in advanced NSCLC patients

Abstract Introduction Neuropeptide Y is a neurotransmitter in the nervous system and belongs to the orexigenic system that increases appetite. Its excessive secretion leads to obesity. Leptin is a pro-inflammatory adipokine (produced in adipose tissue) induced in obesity and may mediate increased antitumor immunity in obesity (including the promotion of M1 macrophages). Leptin and neuropeptide Y gene polymorphisms, causing increased leptin levels and the occurrence of obesity, and lipid profile disorders, may increase the effectiveness of immunotherapy. Materials and methods In 121 patients with advanced NSCLC without mutations in the EGFR gene and rearrangements of the ALK and ROS1 genes, undergoing immunotherapy (1st and 2nd line of treatment) or chemoimmunotherapy (1st line of treatment), we assessed BMI, lipid profile, PD-L1 expression on cancer cells using the immunohistochemical method (clone SP263 antibody), leptin concentration in blood serum by ELISA, polymorphisms in the promoter region of the genes for leptin (LEP) and neuropeptide Y (NPY) by real-time PCR. Results Leptin concentration was significantly higher in obese patients than in patients with normal or low weight (p = 0.00003) and in patients with disease stabilization compared to patients with progression observed during immunotherapy (p = 0.012). Disease control occurred significantly more often in patients with the GA or AA genotype than patients with the GG genotype in the rs779039 polymorphism of the LEP gene. The median PFS in the entire study group was five months (95% CI: 3-5.5), and the median OS was 12 months (95% CI: 8–16). Median PFS was highest in patients with TPS ≥ 50% (6.5 months) and in obese patients (6.6 months). Obese patients also had a slightly longer median OS compared to other patients (23.8 vs. 13 months). The multivariate Cox logistic regression test showed that the only factor reducing the risk of progression was TPS ≥ 50% (HR = 0.6068, 95% CI: 0.4001–0.9204, p = 0, 0187), and the only factor reducing the risk of death was high leptin concentration (HR = 0.6743, 95% CI: 0.4243–1.0715, p = 0.0953). Conclusion Assessment of nutritional status, serum leptin concentration and polymorphisms in the LEP gene may be of additional importance in predicting the effectiveness of immunotherapy and chemoimmunotherapy in patients with advanced NSCLC

MicroRNA-126 selected with broad-spectrum analysis of microRNAs – a new predictive factor for the effectiveness of immunotherapy or chemoimmunotherapy in advanced NSCLC patients?

IntroductionExpression of PD-L1 on cancer cells is the only validated predictive factor for immunotherapy in NSCLC (Non-Small Cell Lung Cancer) patients. However, on this basis, it is difficult to predict the occurrence of resistance to immune checkpoint inhibitors (ICIs). MicroRNAs are widely studied as biomarkers of cancers. Our study was designed to determine whether microRNAs can be sensitive predictive factors in the qualification of NSCLC patients to first-line immunotherapy or chemoimmunotherapy.Material and methodsThe two-stage research on validation group (n=20) and study group (n=35) of patients with advanced NSCLC was conducted. Analysis of microRNAs expression by qPCR in plasma collected prior to the start of immunotherapy (pembrolizumab) or chemoimmunotherapy (combination of pembrolizumab with chemotherapy) was made. Broad-spectrum analysis of microRNAs expression was used in the studied group. Three microRNAs selected in that group as important for the effectiveness of ICIs were then examined in the validation group.ResultsIn the studied group, significantly higher expression of miRNA-126-3p, miR-144-3p and miR-146-5p was observed in patients with long PFS compared to those with short PFS. In the validation group, low miRNA-126 expression indicated lower median progression-free survival and overall survival (2.3 vs. 5.0 months and 5.2 vs 11.2, respectively). These patients had a significantly higher risk of progression (HR= 2.92, 95% CI: 1.01 to 8.40, p=0.04) and death (HR=3.64, 95% CI: 1.22 to 10.84, p=0.02).ConclusionOur study showed that the expression of miR-126 in blood plasma may be a predictive factor for the effectiveness of first-line immunotherapy or chemoimmunotherapy in advanced NSCLC patients