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Inflammation plays a key role in cancer development. As an important modulator of inflammation, the role of diet should be explored. The purpose of this study was to determine the association between diets with a higher inflammatory potential, as measured by the Dietary Inflammatory Index (DII®), and cancer development in a cohort of rural post-menopausal women. Dietary intake from a randomized controlled trial cohort of rural, post-menopausal women in Nebraska was used to compute energy-adjusted DII (E-DIITM) scores at baseline and four years later (visit 9). A linear mixed model analysis and multivariate logistic regression evaluated the association between E-DII scores (baseline, visit 9, change score) and cancer status. Of 1977 eligible participants, those who developed cancer (n = 91, 4.6%) had a significantly larger, pro-inflammatory change in E-DII scores (Non-cancer: Δ 0.19 ± 1.43 vs. Cancer: Δ 0.55 ± 1.43, p = 0.02). After adjustment, odds of cancer development were over 20% higher in those with a larger change (more pro-inflammatory) in E-DII scores than those with smaller E-DII changes (OR = 1.21, 95% CI [1.02, 1.42], p = 0.02). Shifting to a more pro-inflammatory diet pattern over four years was associated with increased odds of cancer development, but not with E-DII at baseline or visit 9 alone.

Cancer-related cognitive impairment is an understudied long-term effect of cancer treatment, with no standard way to mitigate the impact on cancer survivors. Dietary patterns, like the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) diet may improve cognition in aging populations, warranting further evaluation in post-treatment cancer patients who suffer from cognitive dysfunction. Therefore the purpose of this study was to determine the relationship between adherence to the MIND diet and cognitive dysfunction in cancer survivors. This was a secondary cross-sectional analysis of adult cancer survivors who were at least six months post-primary treatment. Subjective cognition was assessed via the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog) questionnaire, with perceived cognitive impairment (PCI) used as the primary score. MIND diet scores were calculated from dietary intake via the Diet History Questionnaire III (DHQIII). T-tests and linear regression models examined the relationship between MIND diet score and cognition. Regression models were adjusted for age, body mass index (BMI), physical activity, total caloric intake, and number of cancer treatments. Of 24 participants, all were White females with an average age of 58.5 ± 13.7 years and BMI of 29 ± 7.1 kg/m2. Most participants were breast cancer survivors (63%) and 50% of all participants underwent at least three treatments, where surgery (79%), chemotherapy (67%), and radiation (54%) were most common. The average MIND diet score was 6.3 ± 2.0 (range: 3.0-9.5) and mean PCI score was 21.67 ± 14.2 (range: 0-53), showing low to moderate MIND diet adherence and more cognitive impairment. There were no statistical differences in PCI between those with a low versus high MIND diet score (p = 0.29). MIND diet score was not a predictor of PCI status after adjustment (p = 0.39). Discussion and Implications: While subjective cognitive impairment was evident in the cohort, there was no significant relationship between the MIND diet score and cognitive status. Larger, more diverse studies are needed to observe the association between diet and cognition in cancer survivors. Interventional trials with additional quantitative assessments are warranted to investigate how diet can improve cognition in cancer survivors. The MIND diet has yet to be fully explored in cancer survivors, a population at risk for cognitive dysfunction.

Malnutrition is prevalent among cancer patients and can lead to poor patient outcomes, like higher hospital admission rates. The Malnutrition Screening Tool (MST), a validated tool in the outpatient oncology setting, has been associated with improved patient outcomes when used in conjunction with early nutrition interventions. This study aimed to evaluate the relationship between MST scores and 30-day hospital admissions. A retrospective chart review of oncology patients at a midwestern cancer center was conducted between February-May 2023. The primary outcome was 30-day hospital admissions from the time of MST evaluation at the initial outpatient oncology visit. Patients were grouped based on the MST risk score (<3 or ≥3), where those with a score ≥3 were deemed at high malnutrition risk. Secondary analyses examined differences in patient characteristics between groups. Fisher's exact test and independent t-tests were used. Findings and Interpretation: Of 33 patients, the majority were White (76%) and male (61%), with a mean age of 60.4 ± 12.9 years, and BMI of 26.5 ± 6.7 kg/m2. Most patients had a diagnosis of gastrointestinal cancer (55%), stage IV (36.4%), with 58% receiving chemotherapy treatment. There was a high overall 30-day admission rate of 64% and high malnutrition risk prevalence of 37%. There was no statistically significant association between MST scores and 30-day hospital admissions, where in the MST <3 group, 58% of patients had a 30-day hospital admission, compared to 78% in the MST >3 group (p=0.43). Race was significantly different between MST groups, where 80% of those identifying as races other than White or Black were at high risk of malnutrition (p=0.03). Higher MST scores were not statistically associated with higher 30-day hospital admission rates, although the prevalence of admission among those with an MST >3 was 20% higher than those at low-malnutrition risk. Small sample size may limit these findings, warranting further evaluation in larger cohorts. Additionally, future research should investigate the impact of MST scores on 30-day hospital admissions across the cancer continuum, including during active treatment when the risk of developing malnutrition is highest. Screening for malnutrition risk in the outpatient setting may be important for early intervention to prevent poor outcomes, especially among at-risk groups.

Background/Objectives: Refeeding syndrome (RFS) is challenging to prevent and manage in hospitalized patients receiving enteral nutrition (EN). Nebraska Medicine implemented an Electronic Medical Record (EMR) Refeeding Risk Order Set (RROS) to standardize prevention measures, including structured electrolyte monitoring, thiamine supplementation, and conservative EN initiation. This study evaluated whether RROS implementation reduced RFS occurrence or severity and assessed its operational impact. Methods: In this retrospective cohort study, adults receiving EN before and after RROS implementation were compared. Primary outcomes were RFS occurrence and severity; secondary outcomes included EN initiation and advancement rates, electrolyte trends, lab frequency, and electrolyte repletion. Results: RFS occurrence did not differ significantly between groups (92.3% vs. 91.3%, p = 0.694), nor did severity (p = 0.535). The post-RROS group received more electrolyte boluses on EN Day 0 (p = 0.027) and had a lower EN starting rate (15.7 vs. 18.3 mL/h, p = 0.045). Conclusions: Although the RROS did not reduce RFS occurrence or severity, integrating American Society for Parenteral and Enteral Nutrition (ASPEN)-based guidance into the EMR was highly feasible and adopted immediately. Automating electrolyte monitoring, micronutrient supplementation, and conservative feeding initiation reduces the risk of errors and promotes consistent care. These benefits improve workflow efficiency and support providers during high census periods, limited staffing, or when experience varies. Future research should explore combining EMR tools with predictive analytics to optimize early risk identification and individualized management.

Background: Hyperglycemia and hypoglycemia are associated with undesirable clinical outcomes. Patients receiving parenteral nutrition (PN) are at increased risk due to the intravascular administration of dextrose. Lipid injectable emulsion (ILE) is also a component of PN, however, administration practices for ILE vary widely, with unknown implications for blood glucose control. Research Objective: This cross-sectional study explored the incidence of hyper- and hypoglycemia in hospitalized patients before and after a clinical practice change designed to base ILE on patients weight (i.e., 50 gm/day for< 75 kg, 100 gm/day for >/= 75 kg). Methods: Patients with weight >/= 75 kg with sole PN support at a goal rate for >/= 3 days were included based on the ILE dosing guideline in Nebraska Medicine. Baseline demographic, clinical, nutritional, and blood glucose-related data were collected and analyzed in the first 24 and 24-48 hours. Results: 112 patients were included (58 NWBD and 54 WBD). The adjusted ORs (aOR) from the multivariate logistic regression model showed hyperglycemia risk in the first 24 hours after PN at the goal rate decreased by 67% for the WBD compared to the NWBD (P = 0.022, aOR = 0.330 [95%CI: 0.127, 0.854]). Additionally, patients with type 1 or type 2 diabetes were more likely to have hyperglycemia events in the first 24 hours of PN initiation (P< 0.0001, aOR = 13.075 [95%CI: 4.297, 39.789]). The risk of hypoglycemia between the two groups was not significant. Discussion: The WBD ILE can improve hyperglycemia events in hospitalized patients with PN support, especially when they have been diagnosed with diabetes. We recommend dosing 100 g/d ILE for patients of weight >/= 75 kg to meet the daily lipid requirements and improve glycemic control.

Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term ‘human assumed central sensitisation’ (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.

We thank Dr. Jensen for his interest [...]

Background: X-linked Charcot-Marie-Tooth type 1 disease has been associated with 280 mutations in the GJB1 [gap junction protein, beta 1, 32kDa (connexin 32, Charcot-Marie-Tooth neuropathy, X-linked)] gene. High-resolution melting analysis with an automated instrument can be used to scan DNA for alterations, but its use in X-linked disorders has not been described. Methods: A 96-well LightScanner for high resolution melting analysis was used to scan amplicons of the GJB1 gene. All mutations reported in this study had been confirmed previously by sequence analysis. DNA samples were amplified with the double-stranded DNA-binding dye LC Green Plus. Melting curves were analyzed as fluorescence difference plots. The shift and curve shapes of melting profiles were used to distinguish controls from patient samples. Results: The method detected each of the 23 mutations used in this study. Eighteen known mutations provided validation of the high-resolution melting method and a further 5 mutations were identified in a blind study. Altered fluorescence difference curves for all the mutations were easily distinguished from the wild-type melting profile. Conclusion: High-resolution melting analysis is a simple, sensitive, and cost-efficient alternative method to scan for gene mutations in the GJB1 gene. The technology has the potential to reduce sequencing burden and would be suitable for mutation screening of exons of large multiexon genes that have been discovered to be associated with Charcot Marie Tooth neuropathy.

Multiplex imaging technologies have revolutionized our ability to study cellular behavior within the tissue microenvironment. Translating this complex data into meaningful biological insights requires a unified analytical framework. To address this, we developed SPACEMAP ( patial henotyping nd lassification with nhanced ultiplex nalysis ipeline), a comprehensive Python and Qupath-based platform for multiplex imaging analysis. SPACEMAP integrates image registration, segmentation, artifact removal, tissue and zone classification, spatial feature extraction, and a consolidated phenotyping approach into a single system. A core feature of SPACEMAP is its high-fidelity phenotyping. To evaluate classification performance, we benchmarked our method RESOLVE, against three established approaches, Leiden clustering, Self-Organizing Maps, and SCIMAP revealing substantial disagreement among them. SPACEMAP overcomes this through two complementary workflows: a machine learning model trained on expert-labeled cells, and a consensus classifier that integrates high-confidence cells across methods. Here, we validated SPACEMAP on in-house colorectal cancer samples and a public dataset, demonstrating its robustness.