A novel orthotopic mouse model of head and neck cancer and lymph node metastasis

Prognosis of head and neck squamous cell carcinoma (HNSCC) is largely determined by the extent of lymph node (LN) metastasis at diagnosis, and this appears to be controlled by cancer cell genetics. To examine the role of these genes in LN metastasis, we created a human-in-mouse orthotopic model of HNSCC and performed comparative microarray analysis of gene expression between populations of HNSCC cell lines derived before and after serial transplantation and in vivo metastasis in mice. Microarray analysis comparing the USC-HN3-GFP, USC-HN3-GFP-G1 and USC-HN3-GFP-G2 cell lines identified overexpression of genes implicated in epithelial-to- mesenchymal transition and the formation of cancer stem cells, including CAV-1, TLR-4 (Toll-like receptor 4), MMP-7 (matrix metalloproteinase 7), ALDH1A3, OCT-4 and TRIM-29. Ingenuity Pathway Analysis confirmed upregulation of respective gene signaling pathways in the USC-HN1-GFP-G2 cell line. Patient HNSCC samples from advanced stages overexpressed ALDH1A3, CAV-1 and MMP-7. Our results show that CAV-1, TLR-4, MMP-7, ALDH1A3, OCT-4 and TRIM-29 have increased expression in HNSCC cells selected for an enhanced metastatic phenotype and suggest that these genes may have an important role in the metastatic potential of HNSCC cells. Inhibition of these genes may therefore have prognostic and therapeutic utility in HNSCC.

Teaching older adults by adapting for aging changes

Few teaching programs are geared to meet the special learning needs of the elderly. This pilot study used a quasi-experimental pretest-posttest design to measure the effect of the Adaptation for Aging Changes (AAC) Method on fecal occult blood screening (FOBS) at meal sites for the elderly in the South. The AAC Method uses techniques that adjust the presentation to accommodate for normal aging changes and includes a demonstration of the procedure for collection of the stool blood test, memory reminders of the date to return the stool blood test, and written materials adapted to the 5th grade reading level. In addition, actual practice of the FOBS with the use of peanut butter was added to the AAC Method, making it the AAC with Practice Method (AACP) in two sites. The American Cancer Society's colorectal cancer educational slide-tape show served as the basis for all of the methods. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data from 135 Council on Aging meal sites' participants. The average age of the participants was 72 years; the average educational level was 8th grade; over half the sample was African-American; and half of the participants had incomes below the poverty level. Results support a significant increase in participation in FOBS in participants taught by the AACP Method [chi 2 (1, n = 56) = 5.34, p = 0.02; odds ratio = 6.2]. This research provides support for teaching that makes adaptations for aging changes, especially adaptations that include actual practice of the procedure.

[Thrombocytes as an indicator of activity in Crohn's disease treated with total parenteral and/or enteral nutrition]

Inflammatory bowel disease can be associated with increased platelet count. Aim of our study was focused on assessing thrombocyte count in evaluation of the activity in Crohn's disease (CD). The study included a total of 19 patients [6 men, 13 women (aged 18-57 years, mean 33, median 28]. All patients were malnourished in active stage of the disease on total parenteral and/or enteral nutrition (TP/EN). Thrombocytes were estimated at the beginning and after 3 weeks of TP/EN in venous blood sample using automatic analyser Coulter Counter JT3 (normal range: 130-380.10(9)/l). Serum prealbumin, transferrin, haptoglobin, alpha 1-orosomucoid and C-reactive protein were measured simultaneously. Thrombocytes count below 400.10(9)/l was found only in 1/19 at the beginning and in 7/19 patients in the end of the study. After 3 weeks of TP/EN a significant platelet count fall was found (mean +/- sd: 472 +/- 98 vs. 354 +/- 110, p < 0.01). A correlation was found between thrombocytes and serum prealbumin (r = -0.3871, p < 0.05), haptoglobin (r = 0.5247, p < 0.001), alpha 1-orosomucoid (r = 0.4857, p < 0.01) a C-reactive protein (r = 0.4354, p < 0.01).

CONCLUSION

Thrombocyte count helped in the assessing of disease activity in CD on 3-week-TP/EN. Improvement of clinical status, increase of nutritional parameters and decrease of positive acute phase reactants were associated with a fall of platelet count in 15/19 patients.

[Microbiological study of patients with enterocutaneous fistulae treated with long-term total parenteral nutrition]

The authors followed up 12 patients with dehiscences of surgical wounds and postoperative enterocutaneous fistulas treated by on a long-term basis by complete parenteral nutrition. Previous operations were performed on account of different non-tumorous (11/12) and tumourous (1/12) diseases of the gastrointestinal tract. Microbiological examinations were made in every patient on admission and during total parenteral nutrition, always once a week for a total period of 2-8 weeks (mean 4.4; median 4.5). The authors examined aerobic and facultatively anaerobic bacteria in smears from the fistulas, stomies, dehiscent surgical wounds and from the rectum. The findings did not confirm the suspicion of local nosocomial infection. Strikingly often bacteria producing indole were found (in 8/12 examined subjects) and/or bacteria with positive urease (12/12) and lecithinase activity (9/12 patients). In the detected strains of Pseudomonas aeruginosa (in 8/12 examined patients) lecithinase activity was confirmed in all. It cannot be ruled out that the above described enzymatic bacterial activities may have contributed to the failure of conservative therapy in the majority of patients (10/12).

[Changes in plasma lipids, lipoproteins and utilization of energy substrates during continuous enteral nutrition with 50% medium chain triacylglycerols (Preciten MCT 50)]

Enteral nutrition (EN) containing part of the energy substrates in the form of triacylglycerols with medium chain fatty acids (MCT) has a number of advantages in particular in patients with an impaired utilization of energy and impaired nutrient absorption from the small intestine. The increased MCT supply reduces the risk of the development of shock lung, consumption coagulopathy and has a very favourable effect in patients with severe catabolism associated with Crohn's disease. On the other hand EN containing MCT may produce also some undesirable effects such as deterioration of glucose utilization in the liver, changes, on the composition of plasma lipids and lipoproteins and an undesirable thermogenic effect. Investigations of the effect of EN containing 50% of fat in the form of MCT (Preciten MCT 50R, Sandoz Nutrition-Wander) indicate that even an energy supply corresponding to 1.7 X REE in the form of EN with 50% MCT does not lead to a statistically significant rise of REE, does not produce a marked thermogenic effect and the value of the respiratory quotient (RQ) does not increase significantly. Already after 8 days of EN significant changes occur in the spectrum of lipids and lipoproteins characterized by a decline of high density lipoproteins HDL3 (p less than 0.05). The parallel decline of low density lipoproteins LDL and VLDL, however, is the reason why adverse changes of the atherogenic index do not occur.

[Excretion of phenol and p-cresol in the urine in fasting obese individuals and in persons treated with total enteral nutrition]

In the literature it is maintained that phenol and p-cresol are produced in humans in the gut by bacteria from dietary protein. Both substances are absorbed from the small intestine and excreted in the urine. If the urinary output of phenol and p-cresol depends really on the dietary protein intake it should decline to zero values during fasting and correlate with the protein supply into the gut. The objective of the present work was therefore to investigate the urinary phenol and p-cresol excretion in fasting obese subjects (21 fasting subjects, 7 subjects with modified fasts--Nutramine R-350) and in subjects treated by complete enteral nutrition by a nasojejunal tube (8 patients with Crohn's disease, 8 with another disease of the gastrointestinal tract). Phenol and p-cresol in 24-hour urine specimens were assessed by gas chromatography in all four groups always on the 1st, 7th and 14th day. In fasting obese subjects the phenol and p-cresol values did not decline (the difference of values from the assumed zero value is significant z = 0.000055). There was no difference between patients with a complete and modified fast. The phenol and p-cresol values did not correlate mutually, nor with the protein intake, nitrogen balance and cumulated nitrogen balance. There are great individual differences in the urinary phenol and p-cresol excretion and it does not depend on the oral dietary protein intake, as hitherto assumed. It has most probably more complex causes and the decisive factor seems to be the metabolic activity of the intestinal bacterial microflora.

[Urinary excretion of phenol in Crohn disease during total parenteral nutrition]

Urinary phenol is a product of dietary tyrosine metabolism generated in the gut by bacteria. In our previous study we found in 42 patients with Crohn's disease a significantly higher level of urinary phenol in terminal ileitis and ileal resection when compared with Crohn's segmental colitis. Urinary phenol is believed to be extensively influenced by diet. For this purpose our present paper investigated urinary phenol in Crohn's disease before and after two weeks of total parenteral nutrition. Spectrophotometric analysis of urinary phenol was carried out in 10 patients (7 males, 3 females). They ranged from 24 to 40 (average 34.9) years of age. The patients received on an average 1.45 g of amino acids/kg/day (no tyrosine; 0.022 g of L-phenyl-alanine/kg/day), 25-30 kcal/kg/day (105-125 kJ/kg/day) in non-protein sources of energy, and fat-emulsions (80 g/day) twice a week. There was a significant decrease in the urinary phenol after two weeks of total parenteral nutrition (median 79.5, interquartile range 41.5 to 288.5 mumols/24 hours vs. median 37.5, interquartile range 0-93.5 mumols/24 hours), p = 0.032 using the paired t-test. In two patients with severe involvement of the gut, urinary phenol, though decreased, remained at higher levels (above 300 mumols/24 hours). A significant decrease of the urinary phenol can be explained in particular by exclusion of dietary proteins, although clinical and nutritional improvement was observed, too. However, persisting higher levels of urinary phenol in some patients with serious involvement of the gut may reflect the severity of Crohn's disease.