Cancer cachexia is a syndrome characterized by weight and muscle loss and functional impairment, strongly influencing survival in cancer patients. In this study, we aimed to establish the role of saliva cytokine measurement in cancer cachexia investigation and define two potential independent salivary biomarkers of the condition. Methods: serum and saliva specimens were obtained from 78 patients. Forty-six patients were non-cachectic, and 32 patients were cachectic (per SCRINIO group criteria), all with metastatic solid tumors. Commercial ELISA kits were used to determine the salivary and serum concentrations of interleukin 13 (IL-13) and transforming growth factor beta (TGF-β) in two patient groups and healthy controls. Laboratory values were obtained from the hospital information system, and weight and height were measured at the time of sampling. Results: A statistically significant difference was observed between the groups in saliva IL-13 concentrations but no difference in serum concentrations. Statistically significant differences were also observed between the groups in saliva and serum concentrations of TGF-β. Logistic regression analysis has identified salivary IL-13 and TGF-β as independent factors for cancer cachexia. Conclusions: We demonstrated saliva as a valuable specimen for cachexia investigation and established IL-13 and TGF-β as potential cancer cachexia biomarkers. Further research is needed to evaluate these findings.

Background: Balkan nephropathy (BEN), caused by chronic dietary exposure to aristolochic acid (AA), is a tubulointerstitial kidney disease strongly associated with upper-tract urothelial carcinoma (UTUC). Patient and graft survival, the cumulative incidence and timing of post-transplant UTUC, and the burden of non-urothelial malignancy after kidney transplantation remain poorly defined. Methods: We retrospectively analyzed all patients with BEN as the primary cause of end-stage kidney disease transplanted at University Hospital Center Zagreb between October 1973 and December 2023. Outcomes included patient and graft survival, the incidence and timing of post-transplant UTUC, and burden of non-urothelial malignancies. Results: Of 2282 kidney transplants performed in the study period, 44 (2%) were in patients with BEN. The median age at transplantation was 56 years, and the median dialysis vintage was 3.7 years. After 10 years (median) of follow up, among 34 patients with adequate follow-up, 16 (47%) developed a de novo malignancy: eight (24%) UTUC, one renal cell carcinoma, four other solid tumors, and three hematological. UTUC was diagnosed between 6 months and 15 years post-transplant (median 7 years); five of eight patients died within one year of diagnosis. Five- and ten-year patient survival rates were 82% and 54.5%. Conclusions: Kidney transplantation in patients with BEN carries a lifelong cancer risk dominated by UTUC. Prophylactic bilateral nephroureterectomy should be the default management strategy when feasible, with lifelong surveillance extending beyond the urothelium.

Background and Objectives: High-speed digital imaging (HSDI) is the most advanced method of phonation process analysis. Hoarseness is the most common indication for HSDI, and laryngopharyngeal reflux (LPR) is an etiological cofactor of hoarseness in 50% of cases. Clinical practice in HSDI includes the elective use of topical anesthesia (TA), but without defined recommendations and indications for use, and a potential altering effect of TA on the phonation process has not been unequivocally proven. The aim of this prospective, randomized, double-blind, placebo-controlled study was to examine the effect of TA application on the phonation process by analyzing Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form parameters in subjects with LPR. Materials and Methods: A total of 70 volunteer subjects were included in the study; 50 subjects who completed both recording sessions were included in the final analysis. All subjects were recorded in two modalities, with TA application (lidocaine spray 100 mg/mL) and without it, on two consecutive days. Results: By evaluating phonation process parameters according to the VALI form, we determined that TA application during HSDI in subjects with LPR was not associated with statistically significant changes in the evaluated phonation process parameters. Conclusions: TA application during HSDI in subjects with LPR was not associated with significant changes in the analyzed phonation process parameters. Further research is needed to determine the benefit of TA in reducing pain and discomfort during examination, weighed against the risk of potentially life-threatening side effects, in order to individualize the approach to each patient.