Anthropometric Variables Accurately Predict Dual Energy X-Ray Absorptiometric-Derived Body Composition and Can Be Used to Screen for Diabetes

The current world-wide epidemic of obesity has stimulated interest in developing simple screening methods to identify individuals with undiagnosed diabetes mellitus type 2 (DM2) or metabolic syndrome (MS). Prior work utilizing body composition obtained by sophisticated technology has shown that the ratio of abdominal fat to total fat is a good predictor for DM2 or MS. The goals of this study were to determine how well simple anthropometric variables predict the fat mass distribution as determined by dual energy x-ray absorptometry (DXA), and whether these are useful to screen for DM2 or MS within a population. To accomplish this, the body composition of 341 females spanning a wide range of body mass indices and with a 23% prevalence of DM2 and MS was determined using DXA. Stepwise linear regression models incorporating age, weight, height, waistline, and hipline predicted DXA body composition (i.e., fat mass, trunk fat, fat free mass, and total mass) with good accuracy. Using body composition as independent variables, nominal logistic regression was then performed to estimate the probability of DM2. The results show good discrimination with the receiver operating characteristic (ROC) having an area under the curve (AUC) of 0.78. The anthropometrically-derived body composition equations derived from the full DXA study group were then applied to a group of 1153 female patients selected from a general endocrinology practice. Similar to the smaller study group, the ROC from logistical regression using body composition had an AUC of 0.81 for the detection of DM2. These results are superior to screening based on questionnaires and compare favorably with published data derived from invasive testing, e.g., hemoglobin A1c. This anthropometric approach offers promise for the development of simple, inexpensive, non-invasive screening to identify individuals with metabolic dysfunction within large populations

Prognostic scores in brain metastases from breast cancer

<p>Abstract</p> <p>Background</p> <p>Prognostic scores might be useful tools both in clinical practice and clinical trials, where they can be used as stratification parameter. The available scores for patients with brain metastases have never been tested specifically in patients with primary breast cancer. It is therefore unknown which score is most appropriate for these patients.</p> <p>Methods</p> <p>Five previously published prognostic scores were evaluated in a group of 83 patients with brain metastases from breast cancer. All patients had been treated with whole-brain radiotherapy with or without radiosurgery or surgical resection. In addition, it was tested whether the parameters that form the basis of these scores actually have a prognostic impact in this biologically distinct group of brain metastases patients.</p> <p>Results</p> <p>The scores that performed best were the recursive partitioning analysis (RPA) classes and the score index for radiosurgery (SIR). However, disagreement between the parameters that form the basis of these scores and those that determine survival in the present group of patients and many reported data from the literature on brain metastases from breast cancer was found. With the four statistically significant prognostic factors identified here, a 3-tiered score can be created that performs slightly better than RPA and SIR. In addition, a 4-tiered score is also possible, which performs better than the three previous 4-tiered scores, incl. graded prognostic assessment (GPA) score and basic score for brain metastases (BSBM).</p> <p>Conclusion</p> <p>A variety of prognostic models describe the survival of patients with brain metastases from breast cancer to a more or less satisfactory degree. However, the standard brain metastases scores might not fully appreciate the unique biology and time course of this disease, e.g., compared to lung cancer. It appears possible that inclusion of emerging prognostic factors will improve the results and allow for development and validation of a consensus score for broad clinical application. The model that is based on the authors own patient group, which is not large enough to fully evaluate a large number of potential prognostic factors, is meant to illustrate this point rather than to provide the definitive score.</p

Prognostic indices for brain metastases – usefulness and challenges

<p>Abstract</p> <p>Background</p> <p>This review addresses the strengths and weaknesses of 6 different prognostic indices, published since the Radiation Therapy Oncology Group (RTOG) developed and validated the widely used 3-tiered prognostic index known as recursive partitioning analysis (RPA) classes, i.e. between 1997 and 2008. In addition, other analyses of prognostic factors in groups of patients, which typically are underrepresented in large trials or databases, published in the same time period are reviewed.</p> <p>Methods</p> <p>Based on a systematic literature search, studies with more than 20 patients were included. The methods and results of prognostic factor analyses were extracted and compared. The authors discuss why current data suggest a need for a more refined index than RPA.</p> <p>Results</p> <p>So far, none of the indices has been derived from analyses of all potential prognostic factors. The 3 most recently published indices, including the RTOG's graded prognostic assessment (GPA), all expanded from the primary 3-tiered RPA system to a 4-tiered system. The authors' own data confirm the results of the RTOG GPA analysis and support further evaluation of this tool.</p> <p>Conclusion</p> <p>This review provides a basis for further refinement of the current prognostic indices by identifying open questions regarding, e.g., performance of the ideal index, evaluation of new candidate parameters, and separate analyses for different cancer types. Unusual primary tumors and their potential differences in biology or unique treatment approaches are not well represented in large pooled analyses.</p

Neutrinos

229 pages229 pages229 pagesThe Proceedings of the 2011 workshop on Fundamental Physics at the Intensity Frontier. Science opportunities at the intensity frontier are identified and described in the areas of heavy quarks, charged leptons, neutrinos, proton decay, new light weakly-coupled particles, and nucleons, nuclei, and atoms

Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy

Anthropometric data from three groups of adolescent girls - preoperative adolescent idiopathic scoliosis (AIS), screened for scoliosis and normals were analysed by comparing skeletal data between higher and lower body mass index subsets. Unexpected findings for each of skeletal maturation, asymmetries and overgrowth are not explained by prevailing theories of AIS pathogenesis. A speculative pathogenetic theory for girls is formulated after surveying evidence including: (1) the thoracospinal concept for right thoracic AIS in girls; (2) the new neuroskeletal biology relating the sympathetic nervous system to bone formation/resorption and bone growth; (3) white adipose tissue storing triglycerides and the adiposity hormone leptin which functions as satiety hormone and sentinel of energy balance to the hypothalamus for long-term adiposity; and (4) central leptin resistance in obesity and possibly in healthy females. The new theory states that AIS in girls results from developmental disharmony expressed in spine and trunk between autonomic and somatic nervous systems. The autonomic component of this double neuro-osseous theory for AIS pathogenesis in girls involves selectively increased sensitivity of the hypothalamus to circulating leptin (genetically-determined up-regulation possibly involving inhibitory or sensitizing intracellular molecules, such as SOC3, PTP-1B and SH2B1 respectively), with asymmetry as an adverse response (hormesis); this asymmetry is routed bilaterally via the sympathetic nervous system to the growing axial skeleton where it may initiate the scoliosis deformity (leptin-hypothalamic-sympathetic nervous system concept = LHS concept). In some younger preoperative AIS girls, the hypothalamic up-regulation to circulating leptin also involves the somatotropic (growth hormone/IGF) axis which exaggerates the sympathetically-induced asymmetric skeletal effects and contributes to curve progression, a concept with therapeutic implications. In the somatic nervous system, dysfunction of a postural mechanism involving the CNS body schema fails to control, or may induce, the spinal deformity of AIS in girls (escalator concept). Biomechanical factors affecting ribs and/or vertebrae and spinal cord during growth may localize AIS to the thoracic spine and contribute to sagittal spinal shape alterations. The developmental disharmony in spine and trunk is compounded by any osteopenia, biomechanical spinal growth modulation, disc degeneration and platelet calmodulin dysfunction. Methods for testing the theory are outlined. Implications are discussed for neuroendocrine dysfunctions, osteopontin, sympathoactivation, medical therapy, Rett and Prader-Willi syndromes, infantile idiopathic scoliosis, and human evolution. AIS pathogenesis in girls is predicated on two putative normal mechanisms involved in trunk growth, each acquired in evolution and unique to humans

Análise do consumo de oxigênio, freqüência cardíaca e dispêndio energético, durante as aulas do Jump Fit Análisis del consumo de oxígeno, frecuencia cardiaca y dispendio energético en las clases de Jump Fit Analysis of the oxygen intake, cardiac frequency and energetic expenditure during Jump Fit lessons

As aulas de Jump Fit promovem a melhora da aptidão física geral, através de coreografias executadas sobre uma superfície elástica com variação de ritmo e movimentos, de forma intervalada, com baixo impacto. Contudo, pouco se sabe sobre o real dispêndio energético e o comportamento das variáveis metabólicas relacionadas às aulas do Jump Fit. O objetivo deste estudo foi identificar e avaliar o comportamento das variáveis funcionais, tais como: freqüência cardíaca (FC), consumo de oxigênio (VO2), produção de dióxido de carbono (VCO2), quociente respiratório (QR), equivalente metabólico (MET) e dispêndio energético, através da mensuração por espirometria da rotina de uma aula de Jump Fit. Os testes foram realizados em quatro visitas, por 10 mulheres praticantes do Jump Fit, com idade de 26,8 anos (± 7,2), massa corporal de 57,6kg (± 6,8), estatura de 162,2cm (± 3,9). A avaliação espirométrica das diversas etapas da aula revelou os seguintes resultados médios: FC de 160,3bpm (± 8,9), VO2 de 1,59L.min-1 (± 0,45), QR 0,87 (± 0,10) e dispêndio energético total 386,4kcal (± 13,8). A intensidade média da aula de Jump Fit correspondeu a 75% (± 7,7) do VO2pico. Para a análise do comportamento das variáveis metabólicas nas diferentes etapas das aulas recorreu-se à ANOVA para medidas repetidas, com verificação de Bonferroni. O teste t foi utilizado para identificar se houve diferença entre as respostas funcionais nas fases de repouso e do EPOC. Foi adotado nível de significância de p < 0,05. Conclui-se que, a partir da magnitude das respostas funcionais, a aula do Jump Fit proporciona aumento da resistência cardiorrespiratória, contribuindo de forma efetiva para a manutenção e melhora da aptidão física e saúde na qualidade de vida.<br>Las clases de Jump Fit producen mejora en la capacidad física general mediante coreografías que se ejecutan sobre una superficie elástica, con variación de ritmo y movimientos, en forma intermitente, con bajo impacto. Sin embargo, es escaso el conocimiento que se tiene acerca del dispendio real energético y del comportamiento de las variables metabólicas relacionadas a las clases de Jump Fit. El objetivo de este estudio fue el de identificar y evaluar el comportamiento de las variables funcionales, como: frecuencia cardiaca (FC), consumo de oxígeno (VO2), producción de dióxido de carbono (VCO2), cuociente respiratorio (QR), equivalente metabólico (MET) y dispendio energético a través de la medición por espirometría de la rutina de una clase de Jump Fit. Las pruebas se realizaron en cuatro visitas por 10 mujeres que practican Jump Fit, con edad de 26,8 años (± 7,2), masa corporal de 57,6kg (± 6,8), altura de 162,2cm (± 3,9). La evaluación espirométrica de las diversas etapas de la clase reveló los siguientes resultados promedios: FC de 160,3bpm (± 8,9), VO2 de 1,59L.min-1 (± 0,45), QR 0,87 (± 0,10) y dispendio energético total 386,4kcal (± 13,8). El promedio de intensidad de la clase de Jump Fit correspondió al 75% (± 7,7) del VO2máximo. Para el análisis del comportamiento de las variables metabólicas en las distintas etapas de las clases se utilizó la ANOVA para medidas repetidas, con verificación de Bonferroni. Se empleó la prueba t para determinar se hubo diferencia entre las respuestas funcionales en las fases de reposo y del EPOC. Se adoptó el nivel de significancia de p < 0,05. Se concluye que, a partir de la magnitud de las respuestas funcionales, la clase de Jump Fit proporciona aumento de la resistencia cardiorespiratoria, lo que contribuye en forma efectiva para el mantenimiento y la mejora de la capacidad física, salud y calidad de vida.<br>Jump Fit lessons further the improvement of the general physical fitness through choreographies performed on an elastic surface with rhythm and movements variation with intervals and low impact. However, not much is known about the actual energetic expenditure and the behavior of the metabolic variables related to Jump Fit lessons. The objective of this study was to identify and to evaluate the behavior of the functional variables such as: heart rate (HR), oxygen intake (VO2), metabolic equivalent (MET) and energetic expenditure through routine spirometry measurement of a Jump Fit lesson. The tests were performed in four visits by 10 women who practice Jump Fit with age of 26.8 (± 7.2), body mass of 57.6 kg (± 6.8) and height of 162.2 cm (± 3.9). The spirometric evaluation of the several stages of the lesson revealed the following average results: HR of 160.3 bpm (± 8.9), VO2 of 1.59 L.min-1 (± 0.45), RQ 0.87 (± 0.10) and total energetic expenditure of 386.4 kcal (± 13.8). The Jump Fit lesson average intensity corresponded to 75% (± 7.7) of the VO2peak. For the analysis of the metabolic variables behavior in the different stages of the lessons, the results were treated through ANOVA for repeated measures with Bonferroni verification. The t-test was used to identify if differences between the functional responses in rest and EPOC phases occurred. The level of significance of p < 0.05 was adopted. It was concluded that from the magnitude of the functional responses, the Jump Fit lesson provides increase on the cardiorespiratory resistance, thus contributing effectively for the maintenance and improvement of the physical fitness and health in quality of life