Inflammation, organomegaly, and muscle wasting despite hyperphagia in a mouse model of burn cachexia.

BACKGROUND: Burn injury results in a chronic inflammatory, hypermetabolic, and hypercatabolic state persisting long after initial injury and wound healing. Burn survivors experience a profound and prolonged loss of lean body mass, fat mass, and bone mineral density, associated with significant morbidity and reduced quality of life. Understanding the mechanisms responsible is essential for developing therapies. A complete characterization of the pathophysiology of burn cachexia in a reproducible mouse model was lacking. METHODS: Young adult (12-16 weeks of age) male C57BL/6J mice were given full thickness burns using heated brass plates or sham injury. Food and water intake, organ and muscle weights, and muscle fiber diameters were measured. Body composition was determined by Piximus. Plasma analyte levels were determined by bead array assay. RESULTS: Survival and weight loss were dependent upon burn size. The body weight nadir in burned mice was 14 days, at which time we observed reductions in total body mass, lean carcass mass, individual muscle weights, and muscle fiber cross-sectional area. Muscle loss was associated with increased expression of the muscle ubiquitin ligase, MuRF1. Burned mice also exhibited reduced fat mass and bone mineral density, concomitant with increased liver, spleen, and heart mass. Recovery of initial body weight occurred at 35 days; however, burned mice exhibited hyperphagia and polydipsia out to 80 days. Burned mice had significant increases in serum cytokine, chemokine, and acute phase proteins, consistent with findings in human burn subjects. CONCLUSIONS: This study describes a mouse model that largely mimics human pathophysiology following severe burn injury. These baseline data provide a framework for mouse-based pharmacological and genetic investigation of burn-injury-associated cachexia

Will Patients Benefit from Regionalization of Gynecologic Cancer Care?

OBJECTIVE: Patient chances for cure and palliation for a variety of malignancies may be greatly affected by the care provided by a treating hospital. We sought to determine the effect of volume and teaching status on patient outcomes for five gynecologic malignancies: endometrial, cervical, ovarian and vulvar carcinoma and uterine sarcoma. METHODS: The Florida Cancer Data System dataset was queried for all patients undergoing treatment for gynecologic cancers from 1990-2000. RESULTS: Overall, 48,981 patients with gynecologic malignancies were identified. Endometrial tumors were the most common, representing 43.2% of the entire cohort, followed by ovarian cancer (30.9%), cervical cancer (20.8%), vulvar cancer (4.6%), and uterine sarcoma (0.5%). By univariate analysis, although patients treated at high volume centers (HVC) were significantly younger, they benefited from an improved short-term (30-day and/or 90-day) survival for cervical, ovarian and endometrial cancers. Multivariate analysis (MVA), however, failed to demonstrate significant survival benefit for gynecologic cancer patients treated at teaching facilities (TF) or HVC. Significant prognostic factors at presentation by MVA were age over 65 (HR = 2.6, p<0.01), African-American race (HR = 1.36, p<0.01), and advanced stage (regional HR = 2.08, p<0.01; advanced HR = 3.82, p<0.01, respectively). Surgery and use of chemotherapy were each significantly associated with improved survival. CONCLUSION: No difference in patient survival was observed for any gynecologic malignancy based upon treating hospital teaching or volume status. Although instances of improved outcomes may occur, overall further regionalization would not appear to significantly improve patient survival

Obesity and Weight Loss at Presentation of Lung Cancer are Associated with Opposite Effects on Survival

BACKGROUND: Lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States. In cancer, weight loss and obesity are associated with reduced survival. However, the effect of obesity or weight loss at presentation on lung cancer survival has not been well studied. MATERIALS AND METHODS: Using an extensive cancer dataset, we identified 76,086 patients diagnosed with lung cancer during the period of 1998–2002, of which 14,751 patients presented with obesity and/or weight loss. We examined the relationship between survival and weight loss or obesity at diagnosis using univariate and multivariate analysis. RESULTS: Median survival time (MST) for all lung cancer patients was 8.7 months. Patients presenting with weight loss (15.8%) had shorter MST versus those who did not (6.4 vs. 9.2 months, p<0.001) and patients with weight loss had significantly shortened MST for all stages and histological subtypes. In contrast, obese patients at presentation (5.4%) had longer MST relative to non-obese patients (13.0 vs. 8.6 months, p<0.001), which was significant across all stages and histological subtypes. Multivariate analysis revealed that the absence of weight loss was an independent, positive predictor of improved survival (HR=0.087, p<0.001), while the absence of obesity was an independent predictor of worsened survival in lung cancer (HR=1.16, p<0.001). CONCLUSIONS: Our results demonstrate an inverse relationship between survival and weight loss at presentation and a potentially protective effect of obesity in lung cancer survival, which could be due to greater physiologic reserves, thereby prolonging life by slowing the progress of cancer cachexia

A comprehensive evaluation of outcomes for inflammatory breast cancer

Inflammatory breast cancer (IBC) remains the breast malignancy with the worst prognosis. We sought to determine the effects of race, socioeconomic status and treatment on outcomes for women with IBC. Study design The Florida cancer registry, inpatient and ambulatory data were queried for patients diagnosed from 1998 to 2002. A total of 935 patients with IBC were identified (1.5% of all breast cancers). Overall, 83.1% were Caucasian, 13.9% African American (AA), and 15.7% Hispanic. The mean age of diagnosis was 57 years old. AA patients presented at a younger age, with higher tumor grade, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 32 months, while MST for AA patients was 20 months. Patients who received chemotherapy before surgery, surgery without chemotherapy, and surgery before chemotherapy demonstrated an independent, significantly improved outcome in comparison to patients who underwent chemotherapy without surgical extirpation. The administration of radiation therapy did not demonstrate an improvement in survival. By multivariate analysis, AA race (HR = 2.19) and failure to provide surgery (HR = 2.3) were independent predictors of worse prognosis. No effect of poverty or ethnicity on outcome was observed. IBC carries a poor prognosis for all patients with significantly worse outcomes for AA women. Multimodality therapy provided the best survival rates

Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities?

We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care. The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried. A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P < 0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n = 2,248) derived a treatment benefit at a TF (HR = 1.35, P = 0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P < 0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR = 1.01, P = 0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P = 0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not. These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA

Chemical profiling of African leaves (Vernonia amygdalina Delile) and Kenikir leaves (Cosmos caudatus Kunth) extracts using Thin Layer Chromatography (TLC)

African leaves (Vernonia amygdalina Delile) and kenikir leaves (Cosmos caudatus Kunth) are plants that belong to the asteraceae family. Members of asteraceae have been used in food and medicine for centuries. This study aims to determine the secondary metabolite compounds contained in African leaves extracts and kenikir leaves through phytochemical screening using Thin-layer chromatography (TLC) method detected using UV 254nm and UV 366 nm light, as well as spot revealers that match the chemical group. The results of phytochemical screening using KLT show that African leaves contain flavonoids, terpenoids. And kenikir leaf extract is positive for steroids and flavonoids, one of them which is isocuesitrin.Daun afrika (Vernonia amygdalina Delile) dan daun kenikir (Cosmos caudatus Kunth) merupakan tanaman yang termasuk kedalam keluarga asteraceae. Anggota asteraceae&nbsp;telah&nbsp;digunakan dalam makanan dan pengobatan selama berabad abad. Penelitian ini bertujuan untuk mengetahui senyawa metabolit sekunder yang terkandung pada ekstrak daun afrika dan daun kenikir melalui skrining fitokimia dengan menggunakan metode KLT yang dideteksi dengan menggunakan sinar UV254nm dan sinar UV366 nm, serta penampak bercak yang sesuai dengan golongan kimianya. Hasil skiring fitokimia menggunakan KLT menunjukan bahwa daun afrika mengandung flavonoid, terpenoid. Dan ekstrak daun kenikir mengandung flavonoid yang salah satunya adalah isokuesitrin dan steroid. &nbsp

Obesity and Weight Loss at Presentation of Lung Cancer are Associated with Opposite Effects on Survival

BACKGROUND: Lung cancer is the second most common neoplasm and the leading cause of cancer deaths in the United States. In cancer, weight loss and obesity are associated with reduced survival. However, the effect of obesity or weight loss at presentation on lung cancer survival has not been well studied. MATERIALS AND METHODS: Using an extensive cancer dataset, we identified 76,086 patients diagnosed with lung cancer during the period of 1998–2002, of which 14,751 patients presented with obesity and/or weight loss. We examined the relationship between survival and weight loss or obesity at diagnosis using univariate and multivariate analysis. RESULTS: Median survival time (MST) for all lung cancer patients was 8.7 months. Patients presenting with weight loss (15.8%) had shorter MST versus those who did not (6.4 vs. 9.2 months, p<0.001) and patients with weight loss had significantly shortened MST for all stages and histological subtypes. In contrast, obese patients at presentation (5.4%) had longer MST relative to non-obese patients (13.0 vs. 8.6 months, p<0.001), which was significant across all stages and histological subtypes. Multivariate analysis revealed that the absence of weight loss was an independent, positive predictor of improved survival (HR=0.087, p<0.001), while the absence of obesity was an independent predictor of worsened survival in lung cancer (HR=1.16, p<0.001). CONCLUSIONS: Our results demonstrate an inverse relationship between survival and weight loss at presentation and a potentially protective effect of obesity in lung cancer survival, which could be due to greater physiologic reserves, thereby prolonging life by slowing the progress of cancer cachexia