The anemia-independent impact of myelodysplastic syndromes on health-related quality of life

Myelodysplastic syndromes (MDS) are in the majority of cases characterized by anemia. Both anemia and MDS per se may directly contribute to impairments in health-related quality of life (HRQoL). In this study, we aimed to investigate the anemia-independent impact of MDS on HRQoL. We evaluated participants (≥ 50 years) from the large population-based Lifelines cohort (N = 44,694, mean age 59.0 ± 7.4 years, 43.6% male) and the European MDS Registry (EUMDS) (N = 1538, mean age 73.4 ± 9.0 years, 63.0% male), which comprises a cohort of lower-risk MDS patients. To enable comparison concerning HRQoL, SF-36 scores measured in Lifelines were converted to EQ-5D-3L index (range 0-1) and dimension scores. Lower-risk MDS patients had significantly lower HRQoL than those from the Lifelines cohort, as illustrated in both the index score and in the five different dimensions. Multivariable linear regression analysis demonstrated that MDS had an adjusted total impact on the EQ-5D index score (B =  - 0.12, p < 0.001) and an anemia-independent "direct" impact (B =  - 0.10, p < 0.001). Multivariable logistic regression analysis revealed an anemia-independent impact of MDS in the dimension mobility, self-care, usual activities, and anxiety/depression (all except pain/discomfort). This study demonstrates that the major part of the negative impact of lower-risk MDS on HRQoL is not mediated via anemia. Thus, the therapeutic focus should include treatment strategies directed at underlying pathogenic mechanisms to improve HRQoL, rather than aiming predominantly at increasing hemoglobin levels

The anemia-independent impact of myelodysplastic syndromes on health-related quality of life

Myelodysplastic syndromes (MDS) are in the majority of cases characterized by anemia. Both anemia and MDS per se may directly contribute to impairments in health-related quality of life (HRQoL). In this study, we aimed to investigate the anemia-independent impact of MDS on HRQoL. We evaluated participants (≥ 50 years) from the large population-based Lifelines cohort (N = 44,694, mean age 59.0 ± 7.4 years, 43.6% male) and the European MDS Registry (EUMDS) (N = 1538, mean age 73.4 ± 9.0 years, 63.0% male), which comprises a cohort of lower-risk MDS patients. To enable comparison concerning HRQoL, SF-36 scores measured in Lifelines were converted to EQ-5D-3L index (range 0-1) and dimension scores. Lower-risk MDS patients had significantly lower HRQoL than those from the Lifelines cohort, as illustrated in both the index score and in the five different dimensions. Multivariable linear regression analysis demonstrated that MDS had an adjusted total impact on the EQ-5D index score (B =  - 0.12, p < 0.001) and an anemia-independent "direct" impact (B =  - 0.10, p < 0.001). Multivariable logistic regression analysis revealed an anemia-independent impact of MDS in the dimension mobility, self-care, usual activities, and anxiety/depression (all except pain/discomfort). This study demonstrates that the major part of the negative impact of lower-risk MDS on HRQoL is not mediated via anemia. Thus, the therapeutic focus should include treatment strategies directed at underlying pathogenic mechanisms to improve HRQoL, rather than aiming predominantly at increasing hemoglobin levels

Malnutrition in Older Patients With Hematological Malignancies at Initial Diagnosis – Association With Impairments in Health Status, Systemic Inflammation and Adverse Outcome

Abstract. Poor nutritional status is a common problem in cancer patients at advanced age, but the prevalence and impact of malnutrition in hematological malignancies remains underinvestigated. To evaluate nutritional status in older adults over age 70 with newly diagnosed hematological malignancies, we enrolled 147 patients and assessed weight loss, food intake, Mini Nutritional Assessment (MNA), and BMI. We compared nutritional status with demographic data, inflammation markers, and restrictions in multidimensional geriatric assessment. MNA classified 43% of patients being at risk of, and 15% having manifest malnutrition. A moderate/severe decrease in food intake was reported by 24% or 16%, a recent weight loss of 1 to 3 kg or >3 kg by 19% or 31%, and a BMI 3 kg weight loss (HR: 2.3 (1.4–3.9), p = 0.001), impaired MNA (HR: 2.8 (1.3–6.2), p = 0.010), and low serum albumin (HR: 2.1 (1.1–4.0), p = 0.030) were significantly associated with shortened overall survival. Recent weight loss >3 kg (HR: 2.2 (1.1–4.3), p = 0.022), and low BMI (HR: 3.3 (1.8–6.0), p < 0.001) remained independent adverse parameters in multivariate Cox proportional hazard regression analyses. Malnourishment at initial diagnosis is frequent in older patients with hematological malignancies and represents an adverse prognosticator. Clustering of malnutrition with impairments and systemic inflammation suggests an underlying common pathway

The Little Ice Age signature in a 700-year high-resolution chironomid record of summer temperatures in the Central Eastern Alps

Despite the fact that the Little Ice Age (LIA) is well documented for the European Alps, substantial uncertainties concerning the regional spatio-temporal patterns of temperature changes associated with the LIA still exist, especially for their eastern sector. Here we present a high-resolution (4-10 years) 700-year long mean July air temperature reconstruction based on subfossil chironomid assemblages from a remote lake in the Austrian Eastern Alps to gain further insights into the LIA climatic deterioration in the region. The record provides evidence for a prolonged period of predominantly cooler conditions during AD 1530-1920, broadly equivalent to the climatically defined LIA in Europe. The main LIA phase appears to have consisted of two cold time intervals divided by slightly warmer episodes in the second half of the 1600s. The most severe cooling occurred during the eighteenth century. The LIA temperature minimum about 1.5 °C below the long-term mean recorded in the mid-1780 s coincides with the strongest volcanic signal found in the Greenland ice cores over the past 700 years and may be, at least in part, a manifestation of cooling that followed the long-lasting AD 1783-1784 Laki eruption. A continuous warming trend is evident since ca AD 1890 (1.1 °C in 120 years). The chironomid-inferred temperatures show a clear correlation with the instrumental data and reveal a close agreement with paleotemperature evidence from regional high-elevation tree-ring chronologies. A considerable amount of the variability in the temperature record may be linked to changes in the North Atlantic Oscillation

Copepods in Turbid Shallow Soda Lakes Accumulate Unexpected High Levels of Carotenoids

<div><p>Carotenoids are protective pigments present in many aquatic organisms that reduce the photooxidative stress induced by short-wavelenght solar radiation, yet increase their susceptibility to predators. <em>Arctodiaptomus spinosus</em>, a calanoid copepod typically found in many fishless shallow soda lakes, shows large between-lake differences in pigmentation. Here, we attribute these differences to the environmental state of these ecosystems, namely, ‘dark water’ lakes with submersed vegetation and turbid ‘white’ lakes lacking macrophytes. Copepod carotenoid concentration in the turbid ‘white’ lakes was significantly (about 20-fold) higher than in the ‘dark water’ ones, although the latter systems were characterized by higher transparency. In addition, males had on a dry weight basis around three times higher carotenoid concentrations than females. Mycosporine-like amino acids (direct UV screening substances) were found in all cases, but in low concentration. The environmental conditions in these ecosystems were largely shaped by the presence/absence of submersed macrophytes Thus, in the turbid lakes, the strong wind-driven mixis allows for copepods to be brought to the surface and being exposed to solar radiation, whereas in ‘dark water’ ones, macrophytes reduce water turbulence and additionally provide shelter. Our results explain the counter-intuitive notion of strong red pigmentation in copepods from a turbid ecosystem and suggest that factors other than high UV transparency favor carotenoid accumulation in zooplankton.</p> </div

Seasonality of carotenoid concentrations in <i>A. spinosus</i> and environmental parameters.

<p>(A) carotenoid concentration normalized to dry weight, (B) carotenoids per individual copepod, (C) water temperature, (D) total suspended solids and chlorophyll <i>a</i>, and (E) Z_1%(380) : Z_max as an estimate of UV exposure (inverse of depth refuge). The four studied lakes are indicated by different colors. Carotenoids, TSS and Chl <i>a</i> are displayed in log scale. In A and B, full downward triangles represent females’ values, open upward triangles males’ values. In D, the solid line and symbols represent TSS, the dotted line Chl <i>a</i>.</p

UV attenuation vs. environmental variables.

<p>Attenuation coefficient at 380 nm (<i>K_d</i>₃₈₀) plotted as a function of (A) total suspended solids, (B) chlorophyll <i>a</i>, (C) CDOM absorption at 440 nm, and (D) DOC concentration. The parameters in A–C were used to calculate the <i>K_d</i> values (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043063#s4" target="_blank">methods</a>).</p

PCA biplot of samples (i.e., observations of one lake on one date) and environmental variables.

<p>The two groups of lakes (‘dark water’ lakes RL and US vs. ‘white’ lakes OS and GN) are significantly separated on a diagonal gradient (compare <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043063#pone.0043063.s003" target="_blank">Table S3</a>). Selected observations are labeled indicating lake (RL, US, OS, GN) and sampling date (1–11). Secchi depth, TSS and Chl <i>a</i> have been log-transformed. Light green squares, RL; dark green diamonds, US; orange triangles, OS; red circles, GN. Chl-<i>a</i> = chlorophyll <i>a</i>, Cond = conductivity, Depth = water level, DOC = dissolved organic carbon, SUVA = DOC-specific UV absorptivity at 254 nm, Temp = temperature, TSS = total suspended solids, z1%(380) = 1% attenuation depth at 380 nm, DRef380 = depth-related UV exposure (Z_1%(380) : Z_max, inverse to the depth refuge at 380 nm).</p