Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: a double-blind, randomised controlled trial of two diet plans - one high in protein and one nutritionally balanced

BACKGROUND

Little is known about the relative efficacy of high-protein vs. conventional diet plans that include partial meal replacements on body fat loss in obese subjects with metabolic syndrome.

OBJECTIVE

We aimed to evaluate the efficacy of two low-calorie diets with partial meal replacement plans-a high-protein plan (HP) and a nutritionally balanced conventional (C) plan-on reducing obesity in obese subjects with metabolic syndrome.

DESIGN

In a 12-week, double-blind study, we randomised 75 participants to either the HP- or the C-plan group. We recorded key metrics at 0 and 12 weeks.

RESULTS

The overall mean weight loss was 5 kg in the HP-plan group and 4.9 kg in the C-plan group (p = 0.72). Truncal fat mass decreased 1.6 kg in the HP-plan group (p < 0.05) and 1.5 kg in the C-plan group (p < 0.05), while whole body fat mass decreased 2.5 kg in the HP-plan group (p < 0.05) and 2.3 kg in the C-plan group (p < 0.05). Between-group losses did not differ significantly for truncal (p = 0.52) or whole body (p = 0.77) fat mass. Among subjects with > or = 70% dietary compliance, however, truncal and whole body fat mass decreased more in the HP-plan group (Delta 2.2 kg and Delta 3.5 kg respectively) than in the C-plan group (Delta 1.3 kg and Delta 2.3 [corrected] kg respectively) (p < 0.05).

CONCLUSION

The HP- and C-plans had a similar effect on weight and abdominal fat reduction, but the HP-plan was more effective in reducing body fat among compliant subjects.

Intracellular K(+) inhibits apoptosis by suppressing the Apaf-1 apoptosome formation and subsequent downstream pathways but not cytochrome c release

Cellular ionic homeostasis, fundamentally K(+) homeostasis, has been implicated as a critical regulator of apoptosis. The intracellular K(+) efflux on apoptotic insult and suppression of apoptosis by high concentration of extracellular K(+) or after inhibition of this efflux by K(+) channel blockers have established the crucial role of K(+) in turning on the apoptotic machinery. Several contrasting observations have reported the antiapoptotic effect of intracellular K(+) concentration to be the result of inhibition of cytochrome c release from mitochondria, but the exact inhibitory mechanism remains obscure. However, here we show the blockage of K(+) efflux during apoptosis did not affect cytochrome c release from the mitochondria, still completely inhibited the formation of the apoptosome comprising Apaf-1, cytochrome c, caspase-9 and other accessories. As a consequence of this event, procaspase-9, -3, -8 and other death-related proteins were not processed. Furthermore, physiological concentrations of K(+) also inhibited the processing of procaspase-3 by purified caspase-8 or -9, the nucleosomal DNA fragmentation by purified DFF40/CAD and the nuclear fragmentation to varying extents. Altogether, these findings suggest that the efflux of K(+) is prerequisite not only for the formation of the apoptosome but also for the downstream apoptotic signal-transduction pathways.

Influence of killer cell immunoglobulin-like receptor genotypes on acute graft-vs-host disease after unrelated hematopoietic stem cell transplantation in Koreans

Interactions between killer cell immunoglobulin-like receptors (KIRs) and human leukocyte antigen class I ligands influence the development of the natural killer cell repertoire and the responses to infection, cancer, and allogeneic tissue. In this study, the association of KIR genes with acute graft-vs-host disease (GVHD) was investigated in 44 pairs of leukemia patients and their unrelated donors for hematopoietic stem cell transplantation (HSCT). Donors with more than 12 KIR genes showed significantly decreased frequencies of severe acute GVHD compared with donors with less than 11 KIR genes (P < 0.05). The distribution of KIR genotypes was not different between severe and mild acute GVHD in patients and donors, respectively. These results suggest that the number of KIR genes in donors could influence the occurrence of acute GVHD after unrelated HSCT.

Impact of second hand smoke (SHS) exposure on the likelihood of mutations in epidermal growth factor receptor (EGFR) gene in patients with non-small cell lung cancer (NSCLC) who had never smoked

7633

Background: The presence of EGFR mutations in NSCLC has strongly associated with never-smoking history. SHS exposure is associated with higher risk of lung cancer. We have conducted this study to evaluate the association between SHS exposure and likelihood of mutations in EGFR gene in NSCLC patients who had never smoked. Methods: SHS exposure information from a total of 93 never smokers (<100 lifetime cigarettes) with newly diagnosed primary NSCLC was obtained using a standardized questionnaire. Patients were asked whether they were regularly exposed to SHS at home or work places, respectively. Nucleotide sequencing of the kinase domain of EGFR (exons 18 to 21) was performed using nested PCR amplification of individual exons. Results: Patient characteristics (n=93) included median age 57 years; female (n= 81); adenocarcinoma ± bronchoalveolar carcinoma (n= 82); EGFR mutation (1 mutation in exon 18 G719, 31 in-frame deletions in exon 19, 10 mutations in codon 858 in exon 21). Fifty-two (55.9%) of the patients reported having been exposed to SHS, including 46 (49.5%) exposed at home and 13 (14.0%) exposed at work. The incidence of EGFR mutations was not associated with female gender and adenocarcinoma histology. Patients with SHS exposure showed a trend towards lower incidence of EGFR mutations (36.5% vs. 56.1%, P= 0.060) and a significantly lower incidence of deletion mutations in exon 19 (57.9% vs. 87.0%, P= 0.033). When the incidence of EGFR mutations was compared, no difference between SHS exposure at home and work places was found. No significant differences were found for other clinicopathological factors according to SHS exposure. Conclusions: Our results indicate weak evidence of relationship between likelihood of mutation in EGFR gene and SHS exposure. The deletion mutations in exon 19 were significantly less common in patients with SHS exposure.

No significant financial relationships to disclose.

Clinical outcomes of adjuvant treatments for invasive thymoma: Dose chemotherapy influence prognosis?

7715

Background: The aim of this study was to evaluate therapeutic outcomes and to validate prognostic factors, including adjuvant chemotherapy, in resected thymoma patients who received adjuvant treatment. Methods: One hundred thymoma patients who received post-surgical adjuvant therapy from 1995 to 2005 were retrospectively reviewed. 55 patients received only radiotherapy for the adjuvant therapy, while 45 patients received both radiotherapy and chemotherapy. The total radiation dose was 45–63 Gy, with a median dose of 50.4 Gy. The chemotherapy consisted of 6 cycles of doxorubicin, cisplatin, vincristine, and cyclophosphamide. Treatments were applied every 3–4 weeks. The median follow-up duration was 65 months (range, 5–200 months). Results: The 5-year overall survival (OS) and disease- free survival (DFS) rates were 75.7% (89.2% in stage II, 67.9% in stage III, and 52.1% in stage IVA) and 70.3% (83% in stage II, 62.4% in stage III, and 33.6% in stage IVA) respectively. According to multivariate analysis, the prognostic factors for OS were age, WHO histology, Masaoka stage, and recurrence, while pleural involvement and WHO histology had statistically significant impacts on DFS. Higher radiation dosage, positive resection margins, and adjuvant chemotherapy did not influence survival outcomes. The most common relapse site was the pleura (15 patients, 53.6%). The toxicity from chemotherapy and radiotherapy was manageable, with no deaths due to toxicity. Conclusion: The prognosis of invasive thymoma was poor despite adjuvant treatments with radiotherapy and chemotherapy. In addition to WHO histology, pleural involvement was the most important prognostic factor for recurrence. The pleura was the most common relapse site. Therefore, new modalities to reduce pleural recurrence are warranted.

No significant financial relationships to disclose.

A phase II study of erlotinib treatment in advanced non-small cell lung cancer after failure of gefitinib: Is a clinical benefit still achievable?

7609

Background: To evaluate the efficacy and toxicity of erlotinib in patients (pts) with advanced NSCLC who had progression after treatment with gefitinib. Methods: The study included stage IIIB/IV recurrent or metastatic NSCLC pts who have received 2 or 3 prior chemotherapy regimens and showed documented disease progression during or within 4 months after treatment with gefitinib. Pts received erlotinib 150 mg daily until disease progression or unacceptable toxicity. We analyzed EGFR mutations and other genetic abnormality from available tumor samples. Results: Pts and disease characteristics (n = 21) included median age 56 years; number of prior chemotherapy regimens (two, n=10; three, n=11); male (n=10); adenocarcinoma (n=15); and smoking status (never, n=11; former, n=3; current, n=7). Among the 17 pts with tumor samples available, EGFR mutation were detected in 5 (29.4 %). The DCR and RR for all pts were 28.6% (95% CI, 16.7 to 59.6%) and 9.5% (95% CI, 5.6 to 19.8%). All responders were EGFR nonmutants, with long duration of disease control on prior gefitinib therapy (>180 days). The median duration of disease control was 125 days (95% CI, 73–261 days). The median progression-free survival and overall survival were 60 days (95% CI, 43–77 days) and 158 days (95% CI, 141–175 days), respectively. Pts who had SD on gefitinib showed significantly higher DCR (75% vs. 17.6% in non-SD pts, P= 0.050) and RR (50.0% vs. 0% in non-SD pts, P= 0.029). These pts also showed longer median PFS (140 vs. 37 days in non-SD pts, P= 0.005) and OS (not reached vs. 120 days in non-SD pts, P= 0.043). Among 17 pts with biomarker results available, EGFR nonmutants who had SD on gefitinib showed significantly higher DCR (100% vs. 21.4% in non-SD and/or EGFR mutants, P= 0.029) and RR (RR, 66.7 % vs. 0 % in non-SD and/or EGFR mutants, P= 0.022). Conclusions: Erlotinib seems to be a potential therapeutic option for the treatment of selected pts with gefitinib-nonresponsive, EGFR nonmutant, advanced NSCLC.

No significant financial relationships to disclose.

[Table: see text]

Mobilized circulating endothelial progenitor cells after the first cycle of chemotherapy with prophylactic G-CSF can be used as a predictive biomarker and patient selection marker for anti-angiogenesis combination treatment

4638

Background: We investigated whether the level of circulating endothelial progenitor cells (CEPs) and endothelial cells (CECs) could be used as surrogate predictors of clinical outcome in patients receiving taxotere-based chemotherapy for advanced gastric cancer. Methods: Peripheral blood mononuclear cells were obtained in 49 gastric cancer patients who received taxotere combined with 5-FU and leucovorine (FLT regimen) after chemotherapy and prophylactic G-CSF treatment. To categorize the endothelial cells, immunofluorescent staining for specific endothelial cell markers (CD34, vWF, P1H12, CD31) was used. The changes of CEPs and CECs and their clinical significance on the response prediction and prognosis were analyzed. Results: After the first cycle of chemotherapy, the numbers of CD34+/vWF+, CD34+, vWF+, P1H12+ and CD31+ cells of 49 patients were 19.5 (2.7% of PBMCs), 20.1 (2.7%), 30.0 (4.8%), 12.9 (2.7%) and 214.3 (26.5%) cells/ml, respectively. The number of CD34+/vWF+ and CD34+ cells after the first and second cycle of chemotherapy were found to be higher in non-responders than responders (the first cycle: P=.012 and P=.008, the second cycle: P=.027 and P=.013, respectively). Moreover, the level of CD31+ cells after the second cycle of chemotherapy were significantly decreased compared with the first cycle in the patients who showed response (P=.026). In non-responders, however, the level of CD34+ cells was significantly increased after the second cycle of chemotherapy (P=.034). The level of CD34+ cells significantly related to the median time to progression (TTP) (6.1 and 4.0 months in CD34low and CD34high, respectively, cutoff level: 5.8, P=.046). Conclusion: CD34+/vWF+ and CD34+ cells can be used as a biomarker for prediction and prognosis in taxotere-based chemotherapy. CEP after the first cycle of chemotherapy can be a selection marker for addition of anti-angiogenic treatment after chemotherapy.

No significant financial relationships to disclose.

The number of residual metastatic lymph nodes following neoadjuvant chemotherapy predicts disease-free survival in patients with stage III NSCLC

18024

Background: The prognosis of patients with stage III non-small cell lung cancer (NSCLC) who achieved pathological complete response or downstaging following neoadjuvant chemotherapy is better than those with residual metastatic lymph node (LN). However, the prognostic significance of the number of residual metastatic LNs remains unclear. Methods: From January 2001 to January 2006, 42 consecutive patients with stage IIIAN2 (22 patients) and IIIB without pleural effusion (20 patients) were treated with neoadjuvant chemotherapy. Thirty four of 42 patients were pathologically staged by mediastinoscopy. Neoadjuvant chemotherapy consisted of 3 cycles of platinum based doublet (21 patients with gemcitabine, 15 with paclitaxel, and 6 with docetaxel). Results: After neoadjuvant chemotherapy, pathological complete response and downstaging was achieved in one patient and 24 patients, respectively. No pathological LN metastasis was present in 9 patients (21.4%), and LN metastasis was present in 33 patients (78.6%). With a median follow up of 23 months, the 2-year disease free survival (DFS) rate of patients without residual LN metastasis was statistically better than that of patients with residual LN metastasis (46% and 18% in patients with residual LN, p=0.03). Among 33 patients with residual LN metastasis, age (p=0.01), pathological downstaging (p=0.09) and number of residual metastatic LNs (median 14 months in LN =4 vs median 5 months in LN =5; p=0.01) were significant predictors of DFS in univariate analysis. In multivariate analysis, number of residual metastatic LNs was an independent predictor of DFS among patients with residual LN metastasis, irrespective of pathological downstaging. Conclusions: The number of residual metastatic lymph nodes following neoadjuvant chemotharpy is an independent predictor of DFS in patients with stage III NSCLC.

No significant financial relationships to disclose.

Post-marketing surveillance study of the efficacy and safety of vardenafil among patients with erectile dysfunction in primary care

To evaluate the safety and efficacy of vardenafil in primary care, we undertook a post-marketing surveillance study in 384 men with erectile dysfunction (ED), enrolled by 22 family physicians in Korea, from July 2004 to August 2005. Of the 384 patients enrolled, 343 (89.3%) returned for efficacy assessment and safety evaluation. Among the latter, 279 patients (81.3%) reported that their erectile function improved, 292 (92.1%) showed enhanced IIEF (International Index of Erectile Function)-5 scores and 265 (77.9%) responded that they were 'very satisfied' or 'satisfied' with vardenafil treatment. The most frequent reason for patient satisfaction with vardenafil was erectile potency (62.4%), followed by safety (42.4%), rapid onset (35.3%), adequate duration of efficacy (28.5%) and easy administration (25.9%). A total of 23 adverse events were observed in 18 patients, with the most frequent being hot flushes (3.2%), followed by headache (1.2%), nasal congestion (0.6%), color vision disturbance (0.3%), dizziness (0.3%), dry mouth (0.3%), dyspepsia (0.3%), nausea (0.3%) and diarrhea (0.3%). Only one patient discontinued vardenafil as a direct result of an adverse event. These results suggest that vardenafil prescribed by primary care physicians improved erectile function and was well tolerated by patients with ED.

Continuous measurement of systolic blood pressure using the PTT and other parameters

In this paper, we proposed the regression model which could estimate unspecified people's systolic blood pressure (SBP) conveniently and continuously and checked its accuracy through clinical experiments. The method for estimating each individual SBP by using only pulse transit time (PTT) has been studied, but it is difficult to estimate unspecified people's SBP with the method using only PTT. Thus we researched several physical characteristic parameters which might affect blood pressure (BP) with the standard that we can measure them easily and conveniently, chose valid physical characteristic parameters through a clinical testing and correlation analysis, and made the regression model using PTT and valid physical characteristic parameters for estimating unspecified people's SBP. Comparing the result of the proposed method with American National Standards Institute of the Association of the Advancement of Medical Instrument (ANSI/AAMI), we know that the proposed regression model gives an acceptable result.

Chemoradiation and maintenance chemotherapy with cisplatin and 5-fluorouracil in anal squamous cell carcinoma

14057

Background: Chemoradiation is the standard treatment for anal carcinoma. Mitomycin-C (MMC) with 5-fluorouracil (5-FU) is the widely used regimen, but MMC is not a radiation sensitizer and has significant toxicities. This study was conducted to update our experience in treating anal carcinomas with an external beam radiation and continuous infusion of 5-FU with cisplatin. Methods: Twenty-eight patients with locally advanced squamous cell carcinoma of the anus were treated between 1995 and 2005. The primary tumor and involved lymph nodes received a total of 41.4–64.8 Gy and 39.6–60.4 Gy, respectively. Chemotherapy consisted of 5-FU (1,000 mg/m2 CI, D1–5 and D36–40) and cisplatin (80 mg/m2 IVF, D2 and D37) q 4weeks for 4 courses. Results: One patients had T1 lesions, 15 had T2, 7 had T3, and 5 patients had T4 disease. Seventeen patients presented with clinically detectable lymphadenopathy. Eight patients failed to start maintenance chemotherapy due to events during chemoradiation. Of the 19 patients who started maintenance chemotherapy, 3 failed to complete all four courses due to intolerance to chemotherapy. With a median follow-up duration of 68.5 months, the actuarial 5-year OS rate was 83.2 %, the DFS rate 80.7%, and the colostomy-free survival was 91.7%. Patterns of recurrence were local relapses in 3 patients, distant metastases in 2, and both in 1, respectively. Seventeen patients (60.7%) developed moist skin reaction, which frequently caused the interruption of radiotherapy. Principal grade 3/4 hematologic toxicities were neutropenia in 10 patients (35.8%) and thrombocytopenia in 4 (14.2%). The most common late complications were lymphedema (14.3%). Conclusions: Our results demonstrate that combined modality therapy with external beam radiation, cisplatin and 5-FU yields an excellent outcome in terms of survival and sphincter preservation which is comparable to the results of MMC regimens.

No significant financial relationships to disclose.

Phase II study of oral S-1 monotherapy in metastatic colorectal cancer after failure of both irinotecan and oxaliplatin-containing regimen

3597

Background: There has been a considerable increase in the number of patients (pts) with mCRC pretreated with both irinotecan and oxaliplatin. Little is known about third-line therapy in this group of pts. We conducted a phase II trial of oral S-1 in pts with advanced colorectal cancer who failed on both irinotecan and oxaliplatin. Methods: This phase II study was designed to evaluate the activity and toxicity of S-1 monotherapy in 31 advanced colorectal cancer pts (P0 = 3%, P1 = 15%; α = 0.05, power = 80%, drop-out rate 10 %). S-1 was administered orally twice daily, 70 mg/m2/day for 14 days followed by 1-week rest. Eligibility criteria included ECOG 0–2; measurable lesion; adequate organ functions; signed informed consent. Results: As of 1st September 2005, 21 pts were enrolled. Median age of all pts 55 years. There were 10 male and 11 females. Thirteen of 21 patients were treated with oxaliplatin-containing regimens as a first-line therapy for metastatic diseases. The median number of treatments was 3 courses (range, 1–10). The relative dose intensity was 1.0 (0.83 - 1.0) with a median dose of120 mg (100 -140 mg). Nineteen out of 21 patients were evaluable. The confirmed response rate was 21.1% (4/19, 1 CR, 3 PR). The median PFS was 11 weeks, and median OS was not reached. The most frequent adverse reaction was skin pigmentation (47.6%). Grade 3 toxicities was skin pigmentation in 1 patients (4.8%), neutropenia in 1 (4.8%), and anemia in 1 (4.8%), respectively. Conclusion: This results shows that S-1 produces a promising response rate with an acceptable safety profile in refractory, mCRC. S-1 has the potential to become a valuable option as a third-line salvage regimen in irinotecan and oxaliplatin pretreated mCRC pts. Clinical trial of combination therapy with S-1 will be warranted.

No significant financial relationships to disclose.