Appropriate regulation of inflammation during the perioperative period is important for achieving a stable postoperative course and early recovery and for reducing the malignancy relapse rate. For these reasons, an immune-modulating diet that includes anti-inflammatory substances such as ω-3 fatty acids has been used widely in clinical settings. The amino acids cystine and theanine are both involved in the synthesis of glutathione (GSH), a strong antioxidant, and there have been several reports that oral cystine and theanine enhance immunoreactions. This study was a pilot study to assess the effect of perioperatively administering oral cystine and theanine in gastric surgery patients and suggested that oral administration of these amino acids may reduce inflammation and promote recovery after gastric surgery. IntroductionPreventing organ dysfunction and immune suppression by inhibiting excess inflammation is considered an important aspect of perioperative surgical management, and several studies have indicated that immunonutrition is effective for this purpose.1,2 Administering the amino acids cystine and theanine has been shown to significantly suppress increases in C-reactive protein (CRP) levels and neutrophil counts and decreases in the number of lymphocytes after excessive exercise, resulting in a reduction in excessive inflammation and immune dysfunction; similar effects are expected to result from immunonutrition. 3 Cystine is a sulfur-containing amino acid that consists of 2 cysteine molecules joined by a disulfide bond. 4 Transporters on cell membranes (including those of neutrophils, macrophages, and dendritic cells) mediate the uptake of cystine into cells, and then thioredoxin rapidly 798P ENXXX10.1177/0148607112458798Journal of Parenteral and Enteral Nutrition / Vol. AbstractBackground: It has been reported that cystine and theanine, amino acids related to glutathione synthesis, have immunomodulatory effects, such as suppressing inflammation after strenuous exercise. In this study, we examined the effects of oral administration of cystine and theanine during the perioperative period as a pilot study. Methods: Forty-three cases of distal gastrectomy for cancer conducted in our department were assigned to the cystine and theanine group (CT group) or to the placebo control group (P group), and a randomized, singleblind, parallel-group study was then performed. Cystine (700 mg) and theanine (280 mg) or a placebo was administered to participants for 10 continuous days (4 days before to 5 days after surgery). Changes in pre-and postoperative interleukin (IL)-6, C-reactive protein (CRP), albumin, white blood cell (WBC) count, neutrophil count, total lymphocyte count, resting energy expenditure (REE), and body temperature were compared and examined. Results: Ten patients were excluded, leaving 33 patients in the study. The CT group had significantly lower IL-6 values (postoperative day [POD] 4), CRP levels (POD 7), neutrophil counts (POD 4), and body temperatures (POD 5) than the P group (P < .05). In addi...

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In order to clarify the pathogenesis of hypercalcemia in multiple myeloma, we measured plasma levels of parathyroid hormone related peptide (PTHrP), tumor necrosis factor alpha (TNF-alpha), tumor necrosis factor beta (TNF-beta), intact PTH and, serum 1,25-dihydroxyvitamin D in fifteen patients of multiple myeloma. We also measured serum levels of inorganic phosphorus (iP) and alkalinephosphatase activity (ALP). No significant differences in iP (3.2 +/- 0.4 vs. 4.0 +/- 2.2 mg/dl), ALP (150 +/- 28 vs. 335 +/- 305 IU/l) 1,25(OH)2 D (31.5 +/- 17.0 vs. 23.3 +/- 11.2 pg/ml) or TNF-alpha (7.8 +/- 2.1 vs. 8.0 +/- 2.0 pg/ml) were observed between normocalcemic and hypercalcemic patients. Plasma iPTH levels in hypercalcemic patients were significantly lower than those in normocalcemic patients (28.5 +/- 9.4 vs. 16.3 +/- 5.6 pg/ml, p = 0.01). Plasma levels of TNF-beta were less than 15.6 pg/ml in all subjects. On the other hand, the frequency of patients with abnormally high plasma levels of PTHrP was significantly greater (2/9 for normocalcemia vs 5/6 for hypercalcemia, chi 2 = 5.20, p = 0.02) in patients with hypercalcemia than in normocalcemic patients. Furthermore, a significant positive relationship between plasma PTHrP levels and corrected serum calcium levels (cCa) was observed using Spearman's correlation analysis by rank in fifteen myeloma cases (rs = 0.66, p = 0.013). These results suggest that PTHrP might be involved in the elevation of serum calcium levels in hypercalcemic myeloma patients. However, a few cases exhibit normocalcemia despite elevated plasma PTHrP levels or hypercalcemia without high plasma PTHrP levels. Therefore, further studies are necessary to elucidate the pathogenesis of hypercalcemia in multiple myeloma.