No appetite efficacy of a commercial structured lipid emulsion in minimally processed drinks

Background/Objectives:Fabuless (Olibra) is a commercially structured lipid emulsion, claimed to be a food ingredient that is effective for food intake and appetite reduction. The present study assessed its efficacy in a yoghurt-based mini-drink undergoing low or minimal food manufacturing (thermal and shear) processes.Subjects/Methods:Study 1: Twenty-four healthy volunteers (16 female, 8 male; age: 18-47 years; body mass index (BMI): 17-28?kg?m(-2)) took part in a randomised, placebo-controlled, double-blind parallel crossover trial. Consumption of a minimally processed 'preload' mini-drink (containing two different doses of Fabuless or a control fat) at 2?h after breakfast was followed by appetite and mood ratings, and food intake measured in ad libitum meals at 3 and 7?h post consumption of the preload. Study 2: As Study 1 (16 female, 8 male; age: 20-54 years; BMI: 21-30?kg?m(-2)). A chilled, virtually unprocessed, preload breakfast mini-drink (containing minimally processed Fabuless or a control fat) was provided 5?min after a standardised breakfast, followed by appetite and mood ratings, and food intake measured in ad libitum meals at 4 and 8?h post consumption of the preload.Results:The structured lipid emulsion tested had no significant effect on the primary measures of food intake or appetite.Conclusions:Even when exposed to minimal food-manufacturing conditions, Fabuless showed no efficacy on measures of appetite and food intake.     

Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival

Background

Recent registries describe a significant prevalence of pulmonary arterial hypertension (PAH) in the elderly, but little is known of their characteristics. We aimed to examine the features and prognostic factors of long-term survival in elderly (??65?years) PAH patients.

Methods

Clinical, echocardiographic, angiographic, hemodynamic, treatments, and survival data were reviewed in consecutive patients over the course of 20?years. Elderly PAH patients (n?=?47) were compared to younger PAH patients (n?=?107).

Results

At presentation, elderly patients were more likely to have hypertension, diabetes, dyslipidemia, coronary disease, and PAH associated with scleroderma (42.6 vs. 24.3?%; p?=?0.02) than younger patients. Prior to PAH therapy, elderly patients had better right ventricular myocardial performance index (RV-MPI; 0.48?±?0.20 vs. 0.62?±?0.23, p?=?0.006) and lower mean pulmonary arterial pressure (PAP; 45.0?±?11.1 vs. 49.2?±?11.8?mmHg, p?=?0.04). Elderly patients were treated less often with epoprostenol (8.5 vs. 29?%, p?=?0.006) or trepostinil (8.5 vs. 23.4?%, p?=?0.04). The 1, 3, and 5?year survival rates of elderly patients were estimated to be 76.4, 50.5, and 37.6?%, respectively. In comparison, younger patients had survival estimates of 92.2, 74.2 and 64.0?% (p?=?0.002). Baseline right atrial pressure, mean PAP, cardiac index, and RV-MPI were associated with survival in elderly patients; however in these patients, survival was not affected by any PAH subgroup or age (per year) by itself.

Conclusions

The diagnosis of PAH in elderly patients is associated with poorer survival which is in part explained by a greater vulnerability to the hemodynamic disturbances of PAH.     

Th17 and non-Th17 interleukin-17-expressing cells in chronic lymphocytic leukemia: delineation, distribution, and clinical relevance

Background

The levels and clinical relevance of Th17 cells and other interleukin-17-producing cells have not been analyzed in chronic lymphocytic leukemia. The objective of this study was to quantify blood and tissue levels of Th17 and other interleukin-17-producing cells in patients with this disease and correlate blood levels with clinical outcome.

Design and Methods

Intracellular interleukin-17A was assessed in blood and splenic mononuclear cells from patients with chronic lymphocytic leukemia and healthy subjects using flow cytometry. Interleukin-17A-producing cells were analyzed in formalin-fixed, paraffin-embedded spleen and lymph node sections using immunohistochemistry and immunofluorescence.

Results

The absolute numbers of Th17 cells in peripheral blood mononuclear cells and the percentages of Th17 cells in spleen cell suspensions were higher in patients with chronic lymphocytic leukemia than in healthy subjects; in six out of eight paired chronic lymphocytic leukemia blood and spleen sample comparisons, Th17 cells were enriched in spleen suspensions. Circulating Th17 levels correlated with better prognostic markers and longer overall survival of the patients. Two “non-Th17” interleukin-17-expressing cells were identified in chronic lymphocytic leukemia spleens: proliferating cells of the granulocytic lineage and mature mast cells. Granulocytes and mast cells in normal spleens did not express interleukin-17. Conversely, both chronic lymphocytic leukemia and healthy lymph nodes contained similar numbers of interleukin-17+ mast cells as well as Th17 cells.

Conclusions

Th17 cells are elevated in chronic lymphocytic leukemia patients with better prognostic markers and correlate with longer survival. Furthermore, non-Th17 interleukin-17A-expressing cells exist in chronic lymphocytic leukemia spleens as maturing granulocytes and mature mast cells, suggesting that the microenvironmental milieu in leukemic spleens promotes the recruitment and/or expansion of Th17 and other IL-17-expressing cells. The pathophysiology of Th17 and non-Th17-interleukin-producing cells in chronic lymphocytic leukemia and their distributions and roles in this disease merit further study.     

Metastatic Melanoma Presenting as Polymorphic Ventricular Tachycardia

A 41-year-old woman with metastatic melanoma was admitted to the hospital because of syncopal episodes, which had developed after the administration of an experimental chemotherapy agent that targeted Notch signaling, as part of a phase I clinical trial. Cardiac monitoring revealed recurrent episodes of polymorphic ventricular tachycardia correlating with the patient''s syncope. Investigations into the cause of the arrhythmia led to the discovery of metastatic lesions within the left ventricular myocardium. In presenting this case of polymorphic ventricular tachycardia as the antemortem clinical manifestation of metastatic melanoma involving the heart, we discuss the importance of recognizing that cardiac metastases can manifest themselves as arrhythmias in patients with malignant melanoma who are undergoing active anticancer treatment.Key words: Antineoplastic chemotherapy protocols/adverse effects, arrhythmias, cardiac/chemically induced/diagnosis/physiopathology/therapy, coronary disease/complications, heart neoplasms/pathology/secondary, melanoma/pathology, myocardium/pathology, receptors, notch/metabolism, recurrence/prevention & control, syncope/etiology, tachycardia, ventricular/chemically induced/etiologyA woman with metastatic melanoma was admitted to the hospital because of syncope and was diagnosed with episodes of polymorphic ventricular tachycardia (VT). The episodes developed after the administration of an experimental chemotherapy agent that targeted Notch signaling as part of a phase I clinical trial. The patient was found to have metastatic lesions in her myocardium. We present and discuss this case of polymorphic VT as a manifestation of cardiac metastasis in malignant melanoma in a patient who was undergoing active anticancer treatment.