Fully-automated CT derived body composition analysis reveals sarcopenia in functioning adrenocortical carcinomas.

Determination of body composition (the relative distribution of fat, muscle, and bone) has been used effectively to assess the risk of progression and overall clinical outcomes in different malignancies. Sarcopenia (loss of muscle mass) is especially associated with poor clinical outcomes in cancer. However, estimation of muscle mass through CT scan has been a cumbersome, manually intensive process requiring accurate contouring through dedicated personnel hours. Recently, fully automated technologies that can determine body composition in minutes have been developed and shown to be highly accurate in determining muscle, bone, and fat mass. We employed a fully automated technology, and analyzed images from a publicly available cancer imaging archive dataset (TCIA) and a tertiary academic center. The results show that adrenocortical carcinomas (ACC) have relatively sarcopenia compared to benign adrenal lesions. In addition, functional ACCs have accelerated sarcopenia compared to non-functional ACCs. Further longitudinal research might shed further light on the relationship between body component distribution and ACC prognosis, which will help us incorporate more nutritional strategies in cancer therapy.

Role of anti-tumor necrosis factor-alpha agents in treatment of sarcoidosis: A meta-analysis.

IMPORTANCE: Anti-tumor necrosis factor-alpha agent (anti-TNF-α) is considered an effective third-line therapy for refractory sarcoidosis,studies observing the efficacy of anti-TNF-α agents show conflicting results. OBJECTIVE: We performed an up-to-date systemic meta-analysis to determine effectiveness and further elucidate the role of anti-TNF-α in the treatment of sarcoidosis. DATA SOURCES: A systematic search was carried out in PubMed/Medline, EMBASE, and Cochrane Library for studies reporting the therapeutic effects of anti-TNF drugs on patients with pulmonary and extra-pulmonary sarcoidosis, published up to April 10, 2022. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42022364614. STUDY SELECTION: Clinical trials written reporting the therapeutic effects of anti-TNF drugs on patients with pulmonary and extra-pulmonary sarcoidosis were included. DATA EXTRACTION AND SYNTHESIS: Statistical analyses were performed with Comprehensive Meta-Analysis software, and the random-effects model was used. The combined overall treatment success was determined for patients with pulmonary and extrapulmonary sarcoidosis. MAIN OUTCOMES AND MEASURES: Overall treatment success rate wasdefined as no disease progression or improvement in symptoms. RESULTS: Eight clinical trial articles were included in the meta-analysis; four used Infliximab, two Etanercept, one Adalimumab, and one Ustekinumab and Golimumab. The mean age of participants was 48.5 years. The duration of drug therapy ranged from 14 to 45 weeks. We found a combined overall treatment success rate, defined as no disease progression or improvement in symptoms, of 69.9% (95% CI 35.0-90.9, I2: 70%) in the pulmonary sarcoidosis group and 74.5% (95% CI 36.3-93.7, I2: 90%) in the extrapulmonary sarcoidosis group. There was no evidence of publication bias in either group. CONCLUSION AND RELEVANCE: Treatment of refractory sarcoidosis with anti-TNF-α agents was effective in both pulmonary and extrapulmonary sarcoidosis, with a slightly higher efficacy seen in extrapulmonary sarcoidosis. Further randomized controlled trials should be conducted to determine the effects of anti-TNF-α agents as a part of the management strategy of sarcoidosis. Patients with pulmonary sarcoidosis should be studied separately from patients with extrapulmonary sarcoidosis to adjust for confounding results.

Inflammatory Serum Biomarker Pattern in Emphysema and Chronic Bronchitis Phenotypes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Background: COPD exacerbation is characterized by both airway and systemic inflammation. The present study aimed to investigate the relationship between serum levels of some inflammatory biomarkers and the phenotypes of COPD exacerbation. Materials and Methods: This study includes known COPD patients, presenting to a hospital with acute exacerbation of COPD. Serum levels of CRP, ESR, CBC, TNF-α, IL-8, and IL-6 were measured at the time of admission. According to the previously done HRCT, the patients were divided into two groups including emphysema and chronic bronchitis. Levels of serum biomarkers were compared in the two groups. The relationships between biomarkers and duration of hospitalization were assessed too. Results: Comparison of quantitative CRP levels, WBC, and platelet counts did not show a statistically significant difference between emphysema and chronic bronchitis but it was significantly higher than control subjects. Although not statistically significant, ESR level was higher in emphysema. TNF-alpha was 6.0±1.5 ng / ml and 1.5 ng / ml in the emphysema and chronic bronchitis groups, respectively. TNF-α had no significant difference compared to the groups. Although higher than the control group, IL-6 and IL-8 did not show significant differences between emphysema and chronic bronchitis. The two groups did not statistically differ in terms of hospital stay but patients with higher serum TNF-α tended to have longer hospitalization and ICU admission. Conclusion: The present study showed predictably higher inflammatory biomarkers in COPD exacerbation but no significant difference between the two phenotypes of COPD and these two entities could not be discriminated based on inflammatory bio-factors.

Incidence, Time Trends and Geographical Distribution of Leukemia and Multiple Myeloma in Golestan Province, Northern Iran, 2004-2017.

BACKGROUND: Leukemia and multiple myeloma (MM) are the most common hematologic malignancies in Iran. This paper describes the geographic and temporal changes in their incidence in Golestan, northern Iran. METHODS: Data on cases of leukemia and MM during 2004-2017 were obtained from the Golestan Population-based Cancer Registry (GPCR). The GPCR is a dynamic database of Golestan residents diagnosed with primary cancers. Age-standardized incidence rates (ASRs) (per 100000) of leukemia and MM were calculated using direct standardization method considering the world standard population. We used Joinpoint regression to assess incidence trends using the average annual percent change (AAPC). RESULTS: In total, 2119 new cases of leukemia and MM were registered by the GPCR during 2004-2017. The ASRs of leukemia were 9.71 and 6.70 in males and females, respectively, while the rates were lower for MM: 2.66 and 1.97 in males and females, respectively. The incidence rates of leukemia suggested an increasing trend in urban population (AAPC=2.73; P value=0.154), while in rural area, the incidence rates were slightly decreasing (AAPC=- 0.73; P value=0.658). There were high incidence areas of leukemia in the central and western regions of Golestan. CONCLUSION: Our results suggested high incidence rates of leukemia and MM in the Golestan province. We also found geographical diversities and increasing trends in the incidence of leukemia in the urban population. Exposure to occupational and environmental carcinogens including pesticides may partly explain high rates and the observed trends. Further investigations should be considered to clarify these points in our population.