Irrespective of method, 1 year of weight loss leads to partial regression of cardiac hypertrophy and to reversal of both diastolic dysfunction and aortic distensibility impairment. These findings provide a potential mechanism for the reduction in mortality seen with weight loss.

Despite careful selection of patients with non-functioning pituitary adenomas, tumour regrowth occurs in a significant proportion. These results show that continued follow-up in these patients is essential as significantly more patients showed evidence of tumour regrowth at this second assessment compared with the 1994 data. Until we are able to predict which tumours are likely to regrow postoperatively, radiotherapy should be considered for all patients with non-functioning pituitary adenomas as even in carefully selected cases, the regrowth rate is approaching 50% at 10 years.

IntroductIonObesity is a growing global public health problem and is associated with both an increased risk of death (1) and an increased risk of cardiovascular events (2-4). The mechanisms by which obesity increases mortality are unclear, but may be related to changes in the cardiovascular system that occur as a result of increased fat mass. One of the potential mechanisms by which obesity changes cardiovascular risk is via its effect of increasing aortic stiffness, a change known to be predictive of increased cardiovascular mortality.Aortic pulse wave velocity (PWV) is a useful, well-validated, clinical measure of central arterial stiffness. Increased aortic PWV, a reflection of vascular stiffening, has been shown to be predictive of increased mortality, coronary heart disease, and stroke in multiple patient groups (5-7).Traditionally, PWV has been measured using Doppler ultrasound or pulse tonometry to assess the pulse wave at two points of the vasculature. The distance estimated between these two points is divided by the time taken for the waveform to travel between these points to calculate the PWV (m/s) (7,8). However, this method is limited by both body habitus and vessel tortuosity that hinders the measurement of the distance over which the pulse wave has traveled, making this technique limi ted in the setting of obesity (9). More recently, however, vascular magnetic resonance imaging (MRI) has provided a reliable, reproducible and accurate method of measuring PWV (10,11) that does not rely on geometric assumptions needed for ultrasound methods and, due to direct visualization of the vasculature, is not affected by either body size or vessel tortuosity.Although obesity, with associated comorbidities, has been linked to increased PWV (12,13), the effects of obesity alone, in the absence of additional cardiovascular risk factors, on PWV remains unknown. In view of the growing obesity epidemic and the links between obesity, mortality, and aortic stiffness, understanding the effects of excess fat on aortic elastic function is of increasing importance.

Blood-borne markers of the systemic inflammatory response are predictors of AL and major complications after oesophageal resection. When combined they may categorise a patient's risk of developing a serious complication with higher sensitivity and specificity.

Background Oesophageal adenocarcinoma (OAC) is increasingly common in the west, and survival remains poor at 10–15 % at 5 years. Immune responses are increasingly implicated as a determining factor of tumour progression. The ability of lymphocytes to recognise tumour antigens provides a mechanism for a host immune attack against cancer providing a potential treatment strategy.Materials and MethodsTumour infiltrating lymphocytes (TILs: CD3+, CD4+, CD8+ and FOXp3+) were assessed by immunohistochemistry using tissue microarrays in a contemporary and homogeneous cohort of OAC patients (n = 128) undergoing curative treatment.Results Multivariate analysis identified three independent prognostic factors for improved cancer-specific survival (CSS): increased CD8+ TILs (p = 0.003), completeness of resection (p < 0.0001) and lower pathological N stage (p < 0.0001). Independent prognostic factors for favourable disease-free survival included surgery-only treatment (p = 0.015), completeness of resection (p = 0.001), increased CD8+ TILs (p < 0.0001) and reduced pathological N stage (p < 0.0001). Higher levels of TILs in the pathological specimen were associated with significant pathological response to neoadjuvant chemotherapy (NAC). On multivariate analysis increased levels of CD4+ (p = 0.017) and CD8+ TILs (p = 0.005) were associated with significant local tumour regression and lymph node downstaging, respectively.DiscussionOur results establish an association of TILs and survival in OAC, as seen in other solid tumours, and identify particular TIL subsets that are present at higher levels in patients who responded to NAC compared to non-responders. These findings highlight potential therapeutic strategies in EAC based on utilising the host immunological response and highlight the immune responses biomarker potential.Electronic supplementary materialThe online version of this article (doi:10.1007/s00262-016-1826-5) contains supplementary material, which is available to authorized users.