Local and distant recurrences in rectal cancer patients are predicted by the nonspecific immune response; specific immune response has only a systemic effect - a histopathological and immunohistochemical study

BACKGROUND: Invasion and metastasis is a complex process governed by the interaction of genetically altered tumor cells and the immunological and inflammatory host reponse. Specific T-cells directed against tumor cells and the nonspecific inflammatory reaction due to tissue damage, cooperate against invasive tumor cells in order to prevent recurrences. Data concerning involvement of individual cell types are readily available but little is known about the coordinate interactions between both forms of immune response. PATIENTS AND METHODS: The presence of inflammatory infiltrate and eosinophils was determined in 1530 patients with rectal adenocarcinoma from a multicenter trial. We selected 160 patients to analyze this inflammatory infiltrate in more detail using immunohistochemistry. The association with the development of local and distant relapses was determined using univariate and multivariate log rank testing. RESULTS: Patients with an extensive inflammatory infiltrate around the tumor had lower recurrence rates (3.4% versus 6.9%, p = 0.03), showing the importance of host response against tumor cells. In particular, peritumoral mast cells prevent local and distant recurrence (44% versus 15%, p = 0.007 and 86% versus 21%, p < 0.0001, respectively), with improved survival as a consequence. The presence of intratumoral T-cells had independent prognostic value for the occurrence of distant metastases (32% versus 76%, p < 0.0001). CONCLUSIONS: We showed that next to properties of tumor cells, the amount and type of inflammation is also relevant in the control of rectal cancer. Knowledge of the factors involved may lead to new approaches in the management of rectal cancer

Impact of a program based in eating habits and physiotherapy on anthropometric parameters in patients with coronary artery disease: randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. On the one hand, physical training such as High intensity interval training (HIIT) and on the other, eating habits, it is often prescribed to patients with coronary artery disease (CAD). Nevertheless, the combination of HIIT and eating habits in CAD with percutaneous coronary intervention (PCI) there is no consensus on using a combined protocol of both. Purpose. The purpose of this study was to evaluate the impact of an HIIT program with eating habits, with a program based in HIIT, on anthropometric parameters in CAD patients with PCI. Methods. A randomized controlled trial was carried out in a hospital.  44 patients with CAD and PCI were recruited. All participants signed an informed consent. Patients were randomly allocated to a HIIT group (HIIT, n = 22, 81.8% men, 62.05 ± 4.9 years) or to a Dietary education and HIIT (DEHIIT) group (n = 22, 81.8% men, 60.2 ± 5.6 years). HIIT consisted of a 3-month physiotherapy program, twice a week for one hour, at 85-95% peak heart rate. DEHIIT consisted of a multidisciplinary program, including the same HIIT program explained, plus eating habits. Body composition (weight, BMI, % body fat, % visceral fat, muscle mass) and waist circumference, hip circumference and Waste-to-Hip Ratio (WHR) were evaluated at baseline and at week 12. Results. At the end of the program, DEHIIT significantly decreased all anthropometrics parameters except muscle mass. The following parameters decreased: weight (p ≤ 0.001), BMI (p ≤ 0.001), body fat (p ≤ 0.001), visceral fat (p ≤ 0.001), waist circumference (p ≤ 0.001), hip circumference (p = 0.043) and WHR (p ≤ 0.001). Instead, the muscle mass increased  significantly (p ≤ 0.001). When comparing between groups, DEHIIT did not show significant differences weight (p = 0.575), BMI (p = 0.404), % body fat (p = 0.217), muscle mass (p = 0.508), waist circumference (p = 0.165), hip circumference (p = 0.307), WHR (p = 0.379), except for presenting less visceral fat (p = 0.040) than HIIT. Conclusions HIIT programme with eating habits reducing visceral fat in CAD patients with PCI compared to a HIIT-only program. </jats:sec

Effectiveness of a physiotherapy and nutrition program in patients with coronary artery disease: randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Dietary and exercise interventions are effective strategies for improving physical and nutritional status of patients with coronary artery disease (CAD). However, few studies have applied a combined exercise protocol based on high intensity interval training (HIIT) and dietary education in patients with CAD with percutaneous coronary intervention (PCI). Purpose This study researches the effectiveness of a multidisciplinary program based in HIIT with dietary education (DEHIIT) in comparison with only HIIT, on adherence to Mediterranean diet in CAD patients with PCI. Methods. A prospective, assessor-blinded, parallel group, randomized trial was developed. The study was developed at a University research lab. Forty-four adults diagnosed with CAD (between 40 and 72 years), were randomized to receive either combined dietary intervention and HIIT (DEHIIT, n = 22) or only HIIT (HIIT, n = 22). The adherence to the Mediterranean diet was assessed with a 14-item tool of adherence to the Mediterranean diet (MEDAS-14) at baseline and after the intervention. DEHIIT performed a 3-month dietary intervention program combined with 24 HIIT sessions at 85-95% of peak heart rate, whilst HIIT performed a 3-month HIIT sessions at 85-95% of peak heart rate. This study did not receive any funding. No conflict of interest is declared. Results. After three months, regarding to MEDAS-14, DEHIIT increased the fish/seafood consumption significantly (p = 0.001) and decreased the fruit consumption (p = 0.032) and dry fruits (p = 0.006). And, when comparing between groups, DEHIIT obtained significantly more MEDAS-14 score (p = 0.01) and more adherence to dieta mediterránea (p = 0.001). No adverse events were reported. Conclusions. A combined protocol including dietary intervention and HIIT can bring benefits for CAD patients with PCI on adherence to Mediterranean diet in comparison to only HIIT. Consequently, our combined program could be used as a treatment option in the therapeutic approach for these patients. </jats:sec

Multidisciplinary program based in physiotherapy and nutrition in coronary artery disease patients: randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The interventions on eating habits and exercise in physiotherapy programs are usually recommended in coronary artery disease (CAD), since they are beneficial to improve physical and nutritional status of patient. Despite this, scarce studies are focused on combined protocols based on high intensity interval training (HIIT) and dietary education in CAD patients with percutaneous coronary intervention (PCI). Purpose The main goal of this study was to compare the effectiveness of a multidisciplinary program based in HIIT, with a program based in dietary education and HIIT (DEHIIT), on eating habits in CAD patients with PCI. Methods. A prospective, randomized controlled trial with blinded outcome assessment was developed. The study was developed at a University research laboratory. 44 participants diagnosed with CAD, aged between 40 and 72 years, were randomly allocated to two treatment groups: HIIT group (HIITG, n = 22) and dietary intervention and HIIT group (DEHIITG, n = 22). The assessment consisted of applying a Food Frequency Questionnaires (FFQ) at baseline and post-intervention. DEHIITG performed a 3-month dietary intervention program combined with 24 HIIT sessions at 85-95% of peak heart rate, whilst HIITG performed a 3-month HIIT sessions at 85-95% of peak heart rate. This study did not receive any funding. No conflict of interest is declared. Results. At the end of the program, when comparing between groups, statistically significant changes were noted. DEHIITG consumed more olive oil (p = 0.021), chicken or turkey (p = 0.039), stir-fried with vegetables (p = 0.033), vegetables (p = 0.003), fish and seafood (p = 0.039), and quantity of commercial juices (p = 0.042), sweets and snacks (p = 0.033). HIITG showed more improvements than DEHIITG in soups and creams consumption (p = 0.042). No adverse events were reported. Conclusions. A dietary intervention with HIIT protocol yields better benefits than only HIIT on eating habits in CAD patients with PCI. Thus, our combined program could be considered a suitable treatment option among these patients. </jats:sec

Combining surgery and immunotherapy: turning an immunosuppressive effect into a therapeutic opportunity

Abstract Background Cancer surgery is necessary and life-saving. However, the majority of patients develop postoperative recurrence and metastasis, which are the main causes of cancer-related deaths. The postoperative stress response encompasses a broad set of physiological changes that have evolved to safeguard the host following major tissue trauma. These stress responses, however, intersect with cellular mediators and signaling pathways that contribute to cancer proliferation. Main Previous descriptive and emerging mechanistic studies suggest that the surgery-induced prometastatic effect is linked to impairment of both innate and adaptive immunity. Existing studies that combine surgery and immunotherapies have revealed that this combination strategy is not straightforward and patients have experienced both therapeutic benefit and drawbacks. This review will specifically assess the immunological pathways that are disrupted by oncologic surgical stress and provide suggestions for rationally combining cancer surgery with immunotherapies to improve immune and treatment outcomes. Short conclusion Given the prevalence of surgery as frontline therapy for solid cancers, the emerging data on postoperative immunosuppression and the rapid development of immunotherapy for oncologic treatment, we believe that future targeted studies of perioperative immunotherapy are warranted