Malnutrition in patients with head and neck cancer is frequent, multifactorial and widely associated with clinical evolution and prognosis. Accurate nutritional assessments allow for early identification of patients at risk of malnutrition in order to start nutritional support and prevent sarcopenia. We aimed to perform a novel morphofunctional nutritional evaluation and explore changes in inflammasome-machinery components in 45 patients with head and neck cancer who are undergoing systemic treatment. To this aim, an epidemiological/clinical/anthropometric/biochemical evaluation was performed. Serum RCP, IL6 and molecular expression of inflammasome-components and inflammatory-associated factors (NOD-like-receptors, inflammasome-activation-components, cytokines and inflammation/apoptosis-related components, cell-cycle and DNA-damage regulators) were evaluated in peripheral-blood mononuclear-cells (PBMCs). Clinical-molecular correlations/associations were analyzed. Coherent and complementary information was obtained in the morphofunctional nutritional assessment of the patients when bioimpedance, anthropometric and ultrasound data were analyzed. These factors were also correlated with different biochemical and molecular parameters, revealing the complementary aspect of the whole evaluation. Serum reactive C protein (RCP) and IL6 were the most reliable parameters for determining patients with decreased standardized phase angle, which is associated with increased mortality in patients with solid malignancies. Several inflammasome-components were dysregulated in patients with malnutrition, decreased phase angle and dependency grade or increased circulating inflammation markers. A molecular fingerprint based on gene-expression of certain inflammasome factors (p27/CCL2/ASC) in PBMCs accurately differentiated patients with and without malnutrition. In conclusion, malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components in PBMCs. A comprehensive nutritional assessment including novel morphofunctional techniques and molecular markers allows a broad characterization of the nutritional status in cancer patients. Profile of certain inflammasome-components should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients.

patients who receive ENS keep their nutritional condition instead of associated effects due to RT. ENS represents an efficient treatment and could prevent malnutrition associated comorbidities in oncologic patients.

BackgroundFingolimod (Gilenya) is an immunomodulator which alters the immune system to reduce inflammation. It has been shown to benefit patients with relapsing forms of multiple sclerosis (MS). Progressive multifocal leukoencephalopathy (PML) is a serious brain infection caused by the John Cunningham (JC) virus.In August 2015, the US Food and Drug Administration (FDA) announced that a case of definite PML and a case of probable PML had been reported in MS patients taking fingolimod. One of these two cases is described here. It was reported to our reference pharmacovigilance centre and then to the US FDA.PurposeTo report a case of PML associated with fingolimod use.Material and methodsThe patient was a 54-year-old man diagnosed with MS in 2002 and treated with interferon beta-1b. In 2012, after neurological evaluation, he began a secondline of treatment with fingolimod 0.5 mg/24 h. He was also taking mesalazine and pitavastatine for ulcerative colitis; none of these drugs are linked to PML. In 2015, the patient was hospitalised with suspected PML after developing new symptoms, including gait instability, clumsiness, inattention, somnolence and mental sluggishness. Fingolimod was discontinued.ResultsHe was diagnosed with PML based on symptoms, MRI findings and positive JC virus test in CSF. Mefloquine, mirtazapine and cidofovir/probenecib were prescribed to treat PML.ConclusionThis is one of very few cases of PML reported worldwide in patients taking fingolimod with no prior exposure to an immunosuppressant drug for MS or any other medical condition. However, no definitive causal relation between  fingolimod and PML has been established. It was classified as conditional using the Karsch-Lasagna algorithm.No conflict of interest.

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