As one would expect patients with fatigue had higher hopelessness scores and less fighting spirit, and their positive adjustment to cancer was worse. MAC scores were not correlated with immune activation or tryptophan catabolism, and were also not predictive for the survival of patients. Patients’ attitude towards their disease might influence both, their fatigue feeling and also their immune activation status, however, from our data we cannot draw conclusions regarding this relationship in fact, it could also be the other way round. Patients with higher fatalism score were those with more progressed tumor stage, physical performance according to their ECOG score was better in patients with higher fighting spirit and with low hopelessness scores. It would be interesting to know whether inflammation-induced noradrenergic disturbances are associated to this spectrum of symptoms. Also the question, whether psychological intervention might be effective to interfere with immune-mediated tryptophan degradation, appears to be worth further examination as psychological intervention was shown to alleviate depressive symptoms. There are several limitations of this study: The cohort studied is quite heterogeneous with different types of lung cancer, different stages and different treatment regimes including antidepressants and chemotherapy. However, the analysis of the various subgroups would be underpowered because of the still small size of the study population. As highlighted in the introduction section, sleep disturbances might relate to the development of fatigue and depression in patients, but no validated sleep quality questionnaire such as the Pittsburgh Sleep Quality Index has been performed. Thus, the relationship between the metabolic SCH772984 changes found could not be analyzed. Also no direct measure of the enzyme pathways of tryptophan metabolism has been performed to further support the potential roles of IDO vs. and TDO. Finally this cross-sectional study can only provide correlational evidence but cannot prove any causeeffect relationship. In conclusion, this study confirms that fatigue is frequently encountered in patients with lung cancer and indicates that tryptophan breakdown might play a role in the development of fatigue and probably also depression in these patients. Still, it has to be kept in mind that our population of lung cancer patients was quite small, and that results are therefore rather preliminary. Further longitudinal studies with more patients with cancer are therefore needed to enable a better understanding of underlying biochemical processes. They may also be able to provide new information, as to whether therapeutic modulation of tryptophan availability may affect fatigue and depression in patients with cancer. Uterine leiomyomas, the most common pelvic tumor in women, are benign smooth muscle tumors originating from the myometrium. Uterine leiomyomas occur in 60% of women by the age of 45 years and cause symptoms in approximately 30% of the cases. These symptoms include pelvic pain, discomfort, and abnormal bleeding. Uterine leiomyomas are also an important cause of infertility and they are the most common medical reason for hysterectomy. Somatic stem cells are a subset of cells residing in normal adult tissues that, through asymmetric division, retain their ability to self-renew while producing daughter cells.