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There are few longitudinal data on nutritional status and body composition of patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). We assessed nutritional status of 105 patients before alloHCT and its course during the early post-transplant period to day +30 and day +100 via weight history, body mass index (BMI) normalized for gender and age, Subjective Global Assessment, phase angle normalized for gender, age, and BMI, and fat-free and body fat masses. Furthermore, we present a multivariate regression model investigating the impact of factors on body weight. At admission, 23.8% reported significant weight losses (>5%) in the previous 6 months, and we noted 31.5% with abnormal age- and sex-adjusted BMI values (⩽10th, ⩾90th percentiles). BMI decreased significantly ( P <0.0001) in both periods by 11% in total, meaning a weight loss of 8.6±5.7 kg. Simultaneously, the patients experienced significant losses ( P <0.0001) of both fat-free and body fat masses. Multivariate regression model revealed clinically relevant acute GVHD (parameter estimate 1.43; P =0.02) and moderate/severe anorexia (parameter estimate 1.07; P =0.058) as independent factors influencing early weight loss. In conclusion, our results show a significant deterioration in nutritional status during the early post-transplant period. Predominant alloHCT-associated complications such as anorexia and acute GVHD became evident as significant factors influencing nutritional status.

Objectives The purpose was to create a time sequential three-dimensional virtual reality model, also referred to as a four-dimensional model, to explore its possible benefit and clinical applications. We hypothesized that this novel solution allows for the visuospatial benefits of the 3D model and the dynamic benefits of other existing imaging modalities. Background We have seen how 3D models hold great value in medical decision making by eliminating the variable visuospatial skills of practitioners. They have proved especially invaluable concerning the correction of congenital heart defects and have altered the course of many surgeries. There are, however, limitations to three-dimensional models. The static models only show what the heart looks like in one snapshot of its cycle and do not allow for an understanding of the physiological and dynamic processes. Methods This solution segments a 3D heart derived from a 2D image stack, times the 18 phases of a cardiac cycle and creates a 4D model that can be manipulated in space and time through the use of virtual reality. Results We believe the 4D heart provides a unique understanding of in situ cardiac anatomy not possible with other imaging techniques. Our expanding case series of clinician experiences and their immediate recognition of the potency of this technique is highly encouraging and reveals the future of functional and dynamic 4D representations of anatomy. Conclusions The 4D heart improved our understanding around complex 3D relationships over time. We propose time and effort dedicated to 4D cardiac imaging analysis of dynamic cardiac pathologies such as hypertrophic obstructive cardiomyopathy or a pre-op Rastelli repair with a narrow outflow tract could offer tremendous insight into the medical decision-making process.

Background This pilot trial aimed to investigate whether modified short-term fasting (mSTF) reduces the incidence of chemotherapy-induced toxicities and whether an initial ketogenic diet (KD) as fasting supportive diet reduces fasting-related discomfort and improves the compliance. Methods In this controlled cross-over trial, gynaecologic cancer patients undergoing chemotherapy with a minimum of 4 cycles fasted for 96 h during half of their chemotherapy cycles and consumed a normocaloric diet during the other chemotherapy cycles. The caloric intake during mSTF was restricted to 25% of each patient’s daily requirement. In addition, half of the patients should eat a 6-day normocaloric KD prior to each mSTF period to investigate a KD’s hunger-suppression effect. Chemotherapy-induced toxicities, fasting-related discomfort, body composition, quality of life, laboratory values, and compliance were assessed at each chemotherapy. Results Thirty patients aged 30–74 years (median 54 years) completed the study. During mSTF the frequency and severity score of stomatitis [− 0.16 ± 0.06; 95% CI -0.28 - (− 0.03); P  = 0.013], headaches [− 1.80 ± 0.55; 95% CI -2.89 – (− 0.71); P  = 0.002], weakness [− 1.99 ± 0.87; 95% CI -3.72 – (− 0.26); P  = 0.024] and the total toxicities’ score were significantly reduced [− 10.36 ± 4.44; 95% CI -19.22 - (− 1.50); P  = 0.023]. We also observed significantly fewer chemotherapy postponements post-mSTF, reflecting improved tolerance of chemotherapy [− 0.80 ± 0.37; 95% CI -1.53 – (− 0.06); P  = 0.034]. A significant reduction in mean body weight by − 0.79 ± 1.47 kg during mSTF was not compensated and remained until study’s conclusion ( P  < 0.005). On average, Insulin [− 169.4 ± 44.1; 95% CI -257.1 – (− 81.8); P  < 0.001] and Insulin-like growth factor 1 levels [− 33.3 ± 5.4; 95% CI -44.1 – (− 22.5); P  < 0.001] dropped significantly during fasting. The KD as a fasting supportive diet neither reduced fasting-related discomfort nor improved compliance of our fasting regimen. Conclusion MSTF is safe and feasible in gynaecologic cancer patients. Our results indicate that mSTF during chemotherapy can reduce chemotherapy-induced toxicities and enhance the tolerance of chemotherapy. Larger clinical trials are required to recommend mSTF for cancer patients. Trial registration germanctr.de: DRKS00011610 , registered 30 January, 2017.

Background The ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet that without limiting calories induces different metabolic adaptations, eg, increased levels of circulating ketone bodies and a shift to lipid metabolism. Our objective was to assess the impact of a 6-week non-energy-restricted KD in healthy adults beyond cohorts of athletes on physical performance, body composition, and blood parameters. Methods Our single arm, before-and-after comparison study consisted of a 6-week KD with a previous preparation period including detailed instructions during classes and individual counselling by a dietitian. Compliance with the dietary regimen was monitored by measuring urinary ketones daily, and 7-day food records. All tests were performed after an overnight fast: cardiopulmonary exercise testing via cycle sprioergometry, blood samples, body composition, indirect calorimetry, handgrip strength, and questionnaires addressing complaints and physical sensations. Results Forty-two subjects aged 37 ± 12 years with a BMI of 23.9 ± 3.1 kg/m 2 completed the study. Urinary ketosis was detectable on 97% of the days, revealing very good compliance with the KD. Mean energy intake during the study did not change from the habitual diet and 71.6, 20.9, and 7.7% of total energy intake were from fat, protein, and carbohydrates, respectively. Weight loss was −2.0 ± 1.9 kg ( P  < 0.001) with equal losses of fat-free and fat mass. VO 2 peak and peak power decreased from 2.55 ± 0.68 l/min to 2.49 ± 0.69 l/min by 2.4% ( P  = 0.023) and from 241 ± 57 W to 231 ± 57 W by 4.1% ( P  < 0.001), respectively, whereas, handgrip strength rose slightly from 40.1 ± 8.8 to 41.0 ± 9.1 kg by 2.5% ( P  = 0.047). The blood lipids TG and HDL-C remained unchanged, whereas total cholesterol and LDL-C increased significantly by 4.7 and 10.7%, respectively. Glucose, insulin, and IGF-1 dropped significantly by 3.0, 22.2 and 20.2%, respectively. Conclusions We detected a mildly negative impact from this 6-week non-energy-restricted KD on physical performance (endurance capacity, peak power and faster exhaustion). Our findings lead us to assume that a KD does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training. However, a KD may be a matter of concern in competitive athletes. Trial registration DRKS00009605 , registered 08 January 2016.

Subjects/Methods: Fresh mushrooms were irradiated with an UV-B dose of 1.5J/[cm.sup.2], increasing vitamin [D.sub.2] content from <1 to 491 µg/100g and made to an experimental soup. In this 5-week, single-blinded, randomized, placebo- controlled trial, 26 young subjects with serum 25-hydroxyvitamin D (25OHD) ≤ 50nmol/l were randomly assigned into three groups ((a) mushroom, (b) supplement and (c) placebo). They received during winter (a) 28 000IU (700 mg) vitamin [D.sub.2] via the experimental soup, or (b) 28 000IU vitamin [D.sub.2] via a supplement or (c) placebo, respectively. European Journal of Clinical Nutrition (2011) 65, 965-971; doi: 10.1038/ejcn.2011.53; published online 4 May 2011

Background /Objectives: Mushrooms contain very little or any vitamin D 2 but are abundant in ergosterol, which can be converted into vitamin D 2 by ultraviolet (UV) irradiation. Our objective was to investigate the bioavailability of vitamin D 2 from vitamin D 2 -enhanced mushrooms by UV-B in humans, and comparing it with a vitamin D 2 supplement. Subjects/Methods: Fresh mushrooms were irradiated with an UV-B dose of 1.5 J/cm 2 , increasing vitamin D 2 content from <1 to 491 μg/100 g and made to an experimental soup. In this 5-week, single-blinded, randomized, placebo-controlled trial, 26 young subjects with serum 25-hydroxyvitamin D (25OHD) ⩽50 nmol/l were randomly assigned into three groups ((a) mushroom, (b) supplement and (c) placebo). They received during winter (a) 28 000 IU (700 μg) vitamin D 2 via the experimental soup, or (b) 28 000 IU vitamin D 2 via a supplement or (c) placebo, respectively. Results: After 2 weeks, serum 25OHD was significantly higher in the mushroom than in the placebo group ( P =0.001). The serum 25OHD concentrations in the mushroom and supplement groups rose significantly and similarly over the study period by 3.9 nmol/l (95% confidence interval (95% CI): 2.9, 4.8) and by 4.7 nmol/l per week (95% CI: 3.8, 5.7), respectively. Conclusions: We are the first to demonstrate in humans that the bioavailability of vitamin D 2 from vitamin D 2 -enhanced button mushrooms via UV-B irradiation was effective in improving vitamin D status and not different to a vitamin D 2 supplement. This trial was registered at http://germanctr.de as DRKS00000195.

We have an 11-year experience with Silastic ring vertical gastroplasy (SRVG) by laparotomy (1991-1994), followed by SRVG by mini-laparotomy (1995-2002), giving a total of 1,286 patients up to May 31, 2002. Searching for optimal results, we have utilized a new device; the Silastic ring has been replaced by the Proring-Band. 174 mini-laparotomy SRVGs (mini-SRVG) were carried out with the Proring-Band from July 16, 2001 to May 31, 2002. The ring is more flexible, slightly elastic and white-colored. At the operation, handling, fixing to the stomach and extraction were easier. No immediate postoperative complications or overall morbidities were related to the new band. No side-effect has been noted. The Proring-Band appeared simpler in its use, during preparatory extra-body handling, placement and fixation. Considering its flexibility, its flat part and its smooth edges, the Proring-Band appears to present less risk of dysphagia, rupture and migration. This situation will be evaluated in a comparative blind study with a follow-up of more than 2 years. The Proring-Band ring is manufactured, sterilized and marketed by a pharmaceutical company. The use of this ring, provided as a medical device designed for restrictive surgery, assures to the surgeon a reproducibility of the material and of the sterilization conditions.

Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.