The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Abstract Background Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. Methods This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross‐sectional areas (cm2) using CT scan data through the Picture archiving and communication system (PACS) image system. Results In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2/m2. Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2. Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow‐up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression‐free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23–3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30–4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil–lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06–1.61, P = 0.010). Conclusions Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data

Influence of body mass index on extent of coronary atherosclerosis and cardiac events in a cohort of patients at risk of coronary artery disease

BACKGROUND AND AIM: To estimate if a meaningful relationship exists between body mass index (BMI) and the entity of coronary atherosclerosis, coronary events and mortality in a cohort of consecutive patients with suspected coronary artery disease (CAD).METHODS AND RESULTS: In this prospective study, we enrolled 1299 consecutive patients (905 [69.7%] males) who had undergone coronary angiography. Our sample consisted of 477 patients (36.8%) of normal weight; 567 (43.6%) overweight and 255 (19.6%) obese, according to the WHO classification. Conventional cardiovascular risk factors, BMI, endothelial function and subclinical inflammation were studied. Different angiographic CAD scores were used to quantify coronary atherosclerotic burden. In overweight and obese patients, respect to normal weight population, there is a higher prevalence of hypertension, hypercholesterolemia and diabetes mellitus, but BMI was not significantly associated with greater extent of coronary atherosclerosis. At follow-up (mean: 40; range: 24-82 months) obese and overweight patients showed a higher incidence of coronary events compared to the normal weight population (74.9% [obese] versus 62.7% [overweight] versus 53.2% [normal weight]; adjusted relative risk [obese versus overweight]: 1.08 [95% confidence interval: 1.02-1.23]; P<0.05; and adjusted RR [obese versus normal weight]: 1.17 [95% CI: 1.10-1.42], P<0.01). Mortality from cardiac events was not significant within the categories. The Cox regression model showed flow mediated dilation (P<0.0001), high-sensitive C reactive protein (P=0.022) and BMI (P=0.045) as independent predictors of acute coronary events.CONCLUSION: BMI is not associated with the extent of coronary atherosclerosis and mortality. The higher incidence of coronary events in obese subjects is only partly explained by conventional associated risk factors. Impaired endothelial function and sub-clinical inflammation could be involved in this association but BMI itself is related to cardiovascular events suggesting that other unknown (or not considered) pathways are involved

Confronto delle caratteristiche del MMPI-A tra minorenni autori di reato e adolescenti che hanno subito maltrattamenti

The Minnesota Multiphasic Personality Inventory–Adolescent (MMPI–A) is the self-report test most commonly applied to assess personality charatceristics, behavior difficulties, and psychopathology among adolescents. However, the literature on the use of the MMPI-A in different forensic populations remains limited. The current investigation was designed to identify differences in the MMPI–A scales between adolescents with a history of child maltreatment (CM), juvenile convicted of different type of&nbsp;offenses (JOs) or adolescents who never had contact with the Juvenile Justice and with no history childhood maltreatment. We found that adolescents in CM group had higher ANX, BIZ, LSE, and SOD scores compared with adolescents in JOs group; while they had higher BIZ, TRT and MAC scores compared with adolescents in control group. Adolescents in JOs group had higher LSE and MAC scores compared with adolescents in control group. Finding differences in personality profiles between differentforensic populations could lead to the creation of more appropriate treatments as well as a better understanding of the possible responses to outcomes of treatments.Il Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) è il test di autovalutazione più comunemente applicato per valutare i tratti della personalità, le difficoltà comportamentali e la psicopatologia tra gli adolescenti. Tuttavia, la letteratura sull'uso dell'MMPI-A in diverse popolazioni forensi rimane limitata. L'attuale indagine è stata progettata per identificare le differenze nelle scale MMPI-A tra adolescenti con una storia di maltrattamenti subiti (CM), minori condannati per diversitipi di reati (JO) o adolescenti che non hanno mai avuto contatti con la Giustizia Minorile e senza storia maltrattamenti infantili. Abbiamo scoperto che gli adolescenti nel gruppo CM avevano punteggi ANX, BIZ, LSE e SOD più alti rispetto agli adolescenti nel gruppo JOs; mentre avevano punteggi BIZ, TRT e MAC più alti rispetto agli adolescenti nel gruppo di controllo. Gli adolescenti nel gruppo JOs avevano punteggi MAC più alti rispetto agli adolescenti nel gruppo di controllo. Trovare differenze nei profili di personalità tra diverse popolazioni forensi potrebbe portare alla creazione di trattamenti più appropriati, nonché a una migliore comprensione delle possibili risposte agli esiti dei trattamenti.&nbsp