Nutritional management for surgery patients is recognized as an important preventive step against postoperative complications. Immunonutrition is a nutritional approach that can control the immune system by modifying the release of mediators from immune cells and attenuating tissue and organ damage through the administration of specific nutrients. Recently, it has been a challenge to not only supplement the shortage of required energy and major nutrients, i.e., carbohydrates, proteins and lipids, but also to control the immune system and inflammatory responses by using immuno-nutrition in critically ill patients and surgical patients. There are a number of immunonutrients, including arginine, glutamine, n-3 poly-unsaturated fatty acids, nucleotides, etc. These substrates have been revealed to up-regulate host immune responses and to control inflammatory responses, and can thus be applied to the clinical benefit and decrease the incidence of postoperative infectious complication and length of hospital stays. In particular, an immune-enhancing diet that includes n-3 poly-unsaturated fatty acids, arginine and nucleotides has been associated with significantly fewer infectious complications in elective gastrointestinal surgical patients. Although some reports have described the effects and application of an immune-enhancing diet in surgical patients, administration of each immunonutrient alone has few clinical benefits. We expect that new immune-enhancing or -modulating diets that can control the host immune response and inflammatory response in surgical stress, will be developed by a combination of adequate immunonutrients.
Purpose: 124Iodine-isotope labeled porphyrin pyropheophorbide HPPH (124I-HPPH) has been developed for photodynamic therapy (PDT) and positron emission tomography (PET) imaging. We hypothesize that HPPH with cold iodine (127I-HPPH, 717), which occurs as an intermediate product in 124I-HPPH synthesis, can act as a new specific and selective radiosensitizer, because iodine is used as a contrast agent in clinical X-ray imaging. The peak X-ray energy was set at 33keV (the K-edge absorption energy of iodine), with the advantages of both PDT and Photon Activation Therapy (PAT). In this study, we evaluated the radiosensitizing activity of 717 in a human bladder cancer cell line. Methods and Materials: The in vitro radiosensitization activity of 717 was tested in T24 human bladder cancer cell lines using the WST and colony formation assays. Subcellular localization of 717 was investigated using confocal microscopy with organelle probes and High Performance Liquid Chromatography (HPLC). Generation of reactive oxygen species (ROS) after 717 treatment combined with X-ray irradiation was measured by hydroxyl radical (OH.) detection using the fluorescence reagent 2-(6-(4-amino)phenoxy-3H-xanthen-3-on-9-yl) benzoic acid (APF). To evaluate the radiosensitizing effect of 717 in vivo, X-ray irradiation with or without prior injection of 717 was applied to mice treated with subcutaneous injection of T24 cells on their back. Results: T24 cells treated with 717 prior to radiation showed lower cell survival than cells irradiated without 717 treatment with the WST8 assay. In the colony formation assay, only treatment with 717 prior to radiation exhibited any radiosensitization effect. 717 was localized mainly in the Golgi apparatus and mitochondria. Under X-ray irradiation, APF with 717 showed a greater increase of fluorescence compared with APF without 717, indicating that 717 could generate ROS in response to X-ray irradiation. Conclusions: 717 can enhance tumor radiosensitivity based upon the WST and colony formation assays. Iodine may play a crucial role in the radiosensitizing activity of 717. The radiosensitizing effect of 717 may be caused by ROS generation following X-ray irradiation. 717 is oncotropic with minimal toxicity. Thus, utilization of 717 has a great advantage as a radiosensitizer.
Patients undergoing chemotherapy for advanced and recurrent gastric cancer tend to worsen their nutrition due to chemotherapy toxicity. We examined the relationship between serum albumin levels, weight loss and chemotherapy toxicity in 7 cases that were treated with S-1 and Cisplatin. We recognized that the grade of hematological toxicity tended to be higher in proportion to weight loss of more than 3 kg. In general, the nutritional status of patients can influence the efficacy and safety of anti-cancer drugs and continuation of chemotherapy. Therefore these findings suggest that active nutritional management can allow for the continuation of chemotherapy, thus supporting the patientÅfs quality of life.
Atherosclerotic progression is commonly diagnosed among long-term hemodialysis patients, and oxidative stress is considered to be one of the causes of arteriosclerosis. However, changes of oxidative stress are less well-defined in hemodialysis therapy. It has been reported that hyperthermia therapy, i.e., xenon light treatment, is effective for patients with arteriosclerosis, but there have only been a few reports of its effectiveness in hemodialysis patients. Therefore, we measured Biological Antioxidant Potential (BAP) as a marker of antioxidant power, diacron-Reactive Oxygen Metabolites (d-ROMs) as a marker of oxidative stress, malondialdehyde-modified low-density lipoprotein (MDA-LDL), which is an oxidative low density lipoprotein, and brachial-ankle Pulse Wave Velocity (baPWV) obtained during non-invasive arteriosclerosis testing, in thirteen hemodialysis patients, before and after hemodialysis. BAP decreased by approximately 24%, and d-ROMs, MDA-LDL, and baPWV significantly increased by approximately 25%, 62%, and 15%, respectively. All of these parameters decreased after additional xenon light treatment. The changes for BAP, d-ROMs, MDA-LDL and baPWV were from 24% to 17%, 25% to 15%, 62% to 18% and 15% to 4%, respectively. As noted above, BAP decreased, and d-ROMs, MDA-LDL and baPWV were increased by hemodialysis, and these changes were prevented by xenon light treatment. We suggest that oxidative stress is increased by hemodialysis and that xenon light treatment may suppress the oxidative stress.
A 46-year-old Turkish male with fever of 39｡C, lower abdominal pain and vomiting associated with a frequent history of urinary tract infection was referred to our hospital by his family doctor. Enhanced CT identified significant hydronephrosis of the left kidney. Blood examination showed elevated WBC counts and CRP level, and urinary culture identified Group B Streptococcus. Under the diagnosis of left pelvic kidney with pyelonephritis, we performed left nephrectomy. The pathological diagnosis was consistent with hydronephrosis and pyelonephritis.
The spleen is an important part of the human immune system. After splenectomy, a patient can easily become infected and the symptoms can often be severe, which is known as overwhelming postsplenectomy infection (OPSI). We report a case of a girl who had two episodes of high fever twice following splenectomy. She was diagnosed with hereditary spherocytosis at forty days of age and underwent splenectomy when she was six years old. At both times, we assumed that she was infected with OPSI and immediately treated her with antibiotics. With the appropriate treatment, the symptoms did not worsen and she left hospital within a week. To prevent OPSI, it is necessary for the patient to understand the importance of prevention of infection, and prompt and appropriate treatment should be administered if the patient is suspected of having a bacterial infection.