[Skull base meningioma: Clinical and radiological efficacy based on a quantitative volumetric analysis]. / Méningiomes de la base du crâne : efficacité clinique et radiologique basée sur une analyse volumétrique quantitative.

PURPOSE: To date, no correlation has been found between clinical and radiological efficacy after irradiation of skull base meningiomas. However, the evaluation of the radiological response was most often made by questionable methods that may have underestimated the radiological effectiveness of radiotherapy. The objective of this work is to verify this hypothesis by quantitative volumetric analysis. MATERIAL AND METHODS: Data from 35 patients treated with either helical tomotherapy (45.7%) or fractionated stereotactic radiotherapy (54.3%) were retrospectively analysed. These were mainly women (94%) aged 59 (43-81) with lesions mainly of the cavernous sinus (60%). There was a median of 2 (1-4) symptoms and the main symptoms were visual impairment (39%), cranial nerve deficits (23.4%) and headaches (17.2%). RESULTS: Median tumour volume decreased significantly (P<0.05) from 9.6mL (0.3-36.6) to 6.8mL (0.1-26.5) after median follow-up of 44 months (24-77). Sixty-three percent of patients had an improvement of at least one symptom. In univariate analysis, clinical efficacy (P<0.05), radiotherapy technique (P<0.05), tumor topography (P<0.05) and initial tumor volume (P<0.05) were predictive factors for radiological response. In multivariate analysis, only the inverse correlation between radiological response and initial tumor volume remained significant (ρ: -0.47 95% CI -3.2 to 5.7; P<0.05). CONCLUSION: The quantitative volumetric monitoring demonstrates a major radiological efficiency of radiotherapy. However, no clear correlation between clinical and radiological efficacy was found.

Unexpected malignant uterine pathology: Incidence, characteristics and outcome in a large single-center series of hysterectomies for presumed benign uterine disease.

OBJECTIVE: Hysterectomy is a frequently used therapeutic option for benign gynecological conditions. The purpose of this study was to investigate the incidence and characteristics of unforeseen malignant pathologies of the uterine corpus in a large population-based, single center cohort. METHODS: Patients who underwent hysterectomy for presumed benign conditions between 2003 and 2016 were identified. In cases of unexpected malignancies of the uterine corpus (UUM), available tissue samples were collected and a specialized gynecopathological review was performed. RESULTS: A total of 10,756 patients underwent hysterectomy for benign indications. After chart and gynecopathological review, 45/10,756 (0.42%) cases of unexpected uterine malignancies were confirmed. 33/45 (73.3%) were endometrial carcinomas (UEC) and 12/45 (26.7%) were uterine sarcomas (UUS). 27/33 (81.8%) UEC were FIGO IA, 5/33 (15.2%) FIGO IB and 1/33 (3%) FIGO stage II disease. Endometrioid and serous histotype were present in 31/33 (93.9%) and in 2/33 (6.1%) cases, respectively. 8/12 (66.7%) USS were early stage (FIGO IA or IB); only 3/12 (25.0%) were diagnosed at an advanced stage (≥FIGO II). Fatal outcome was observed in 1 patient diagnosed with UEC and 3 patients diagnosed with UUS. CONCLUSION: Our study shows that diagnosis of UUM is rare (0.42%). The majority of UUM tend to be early stage, making preoperative diagnosis difficult. In case of UEC, patient outcome is generally favorable. Nevertheless, the appropriate surgical approach for hysterectomy for a benign indication should be chosen carefully, taking all preoperative findings into account. Patients should always be informed about the residual risk of UUM.

A cost-benefit analysis and the potential trade effects of the bovine viral diarrhoea eradication programme in Styria, Austria.

This study evaluated the voluntary and compulsory implementation of a bovine viral diarrhoea virus (BVDV) eradication programme in the Austrian Federal State of Styria, Austria, from an economic point of view using ex-post assessment of costs and benefits (disease losses avoided). An economic net benefit (benefit:cost ratio, BCR=1.18) of the programme was demonstrated during the voluntary programme phase (January 1998-July 2004). The break-even point was reached in 2003. If investments in the compulsory programme (August 2004-December 2016) were taken into account, a net economic loss (BCR=0.16) was demonstrated. In contrast to on-going annual testing of all cattle herds, annual testing in accordance with a revised sampling scheme could reduce total surveillance costs by more than 77%. A Bayesian structural time series model was applied to analyse a hypothesised positive impact of the compulsory BVDV programme on the Styrian cattle export market. The average number of exported cows and bulls increased significantly by 42% (P=0.03) and 47% (P=0.01), respectively, and the producer price increased by 14% (P=0.00) and 5% (P=0.16), respectively, during the compulsory programme period compared with the period prior to intervention. This equates to an average revenue increase of €29,754 for cows and €137,563 for bulls per month. These results justify the implementation of eradication programmes, which initially may not appear to be economically viable, particularly if trade effects are not included in the calculations.

First-trimester risk assessment based on ultrasound and cell-free DNA vs combined screening: a randomized controlled trial.

OBJECTIVE: This was a randomized controlled trial to compare risk assessment by first-trimester combined screening (FTCS) with an approach that combines a detailed ultrasound examination at 11-13 weeks' gestation and cell-free DNA (cfDNA) analysis. METHODS: Pregnant women with a normal first-trimester ultrasound examination at 11-13 weeks' gestation (fetal nuchal translucency (NT) ≤ 3.5 mm and no fetal defects) were randomized into one of two groups. In the first group, risk of aneuploidy was assessed using FTCS based on the most recent UK Fetal Medicine Foundation algorithm. In the second group, risk assessment was based on ultrasound findings and cfDNA analysis. An additional tube of blood was collected for FTCS in case the cfDNA analysis was uninformative. Primary outcome was false-positive rate in screening for trisomy 21. A case was considered false positive if the karyotype was not trisomy 21 and if the risk for trisomy 21 was >1:100, irrespective of the method of risk calculation. Results were compared using 95% CIs using the Clopper-Pearson method. RESULTS: Between October 2015 and December 2016, 1518 women with singleton pregnancy underwent first-trimester screening. Thirty-one (2.0%) pregnancies were not eligible for randomization due to increased NT (> 3.5 mm) and/or fetal defect. After exclusion of women who declined randomization (n = 87) and cases of fetal death and loss to follow-up (n = 24), 688 pregnancies were randomized into the FTCS arm and 688 into the ultrasound + cfDNA analysis arm. There were no differences in maternal and gestational age, maternal weight and BMI, ethnicity, use of assisted reproduction and cigarette smoking between the two arms. In the ultrasound + cfDNA analysis arm, median risk for trisomy 21 was 1 in 10 000. None of the cases had a risk above 1: 100 (95% CI, 0.0-0.5%). In the FTCS arm, the median risk for trisomy 21 was 1 in 3787 and in 17 cases, the risk was higher than 1:100, which corresponds to 2.5% (95% CI, 1.5-3.9%) of the FTCS study-arm population. CONCLUSION: Our study has shown that first-trimester risk assessment for trisomy 21 that includes a detailed ultrasound examination as well as NT measurement and is followed by cfDNA testing is associated with a significant reduction in the false-positive rate compared with FTCS. This approach obviates the need for maternal serum free ß-human chorionic gonadotropin and pregnancy-associated plasma protein-A in screening for fetal aneuploidy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

[Inpatient multimodal pain therapy : Additive value of neuromuscular core stability exercises for chronic back pain]. / Die stationäre multimodale Schmerztherapie : Additiver Wert eines sensomotorischen Stabilisationstrainings bei chronischem Rückenschmerz.

INTRODUCTION: The medical and healthcare economic burden caused by chronic lumbar back pain (CLBP) requires the use of interdisciplinary treatment approaches. The present study aimed to evaluate whether the effectiveness of inpatient multimodal pain therapy (MPT, operations and procedures (OPS) coding 8-918.02), can be increased by implementing additional neuromuscular core stability exercises (NCSE). MATERIAL AND METHODS: As part of a prospective controlled study, subjects with CLBP (n = 48, 17 males, 58.2 ± 11.7 years) were allocated to one of two groups. One group received standard care (SC, n =23) encompassing manual, pharmacological and psychological therapy in addition to passive physiotherapeutic applications. The intervention group (IG, n =25) additionally completed NCSE. On the day of admission and on discharge as well as 1 and 6 weeks after inpatient care, pain intensity (numeric rating scale), pain-related routine daily functions (Oswestry disability index), well-being (SF-12 Health Survey) and motor function parameters (trunk strength, endurance and postural control) were assessed. Data analysis was performed using statistical inference methods. In addition, effect sizes (Cohen's d) of intergroup differences were calculated. RESULTS: Both groups showed significant reductions in pain intensity (p < 0.05, d > 0.6) at all measurement points (MP). Physical well-being and disability (p < 0.05, d > 0.6) were improved 1 week after discharge in the intervention group only. Overall, no systematic differences between groups were detected (p > 0.05). In relation to the motor outcomes, no significant changes over time nor between groups were verified (p > 0.05). DISCUSSION: Despite the use of an additional NCSE, no significant added value in individuals with CLBP could be detected, although a systematic pre-post effect in daily functions and physical well-being (one week after discharge) was observed for the IG only. Therefore, on the basis of the study results, the implementation of additional NCSE into the inpatient MPT cannot be clearly recommended. To further delineate the therapeutic relevance, studies with larger sample sizes are needed.

Enhanced immune response to MMP3 stimulation in microglia expressing mutant huntingtin.

Huntington's Disease (HD) is an inherited neurodegenerative disease caused by a polyglutamine expansion in the huntingtin protein. The YAC128 mouse model of HD expresses the full-length human huntingtin protein with 128 CAG repeats and replicates the phenotype and neurodegeneration that occur in HD. Several studies have implicated a role for neuroinflammation in HD pathogenesis. Studies on presymptomatic HD patients have illustrated microgliosis (activated microglia) in brain regions affected in HD. Mutant huntingtin expressing isolated primary monocytes (human HD patients) and primary macrophages (YAC128) are overactive in response to lipopolysaccharide (LPS) stimulation. In this study we demonstrate that cultured primary microglia (the resident immune cells of the brain cells) from YAC128 mice differentially express a wide number of cytokines compared to wildtype microglia cultures in response to LPS. Furthermore, this study outlines a direct interaction between mutant huntingtin and cytokine secretion in HD microglia. Increased cytokine release in YAC128 microglia can be blocked by cannabinoid activation or by mutant huntingtin knockdown with anti-sense oligonucleotide treatment. Matrix metalloprotease 3 (MMP3), an endogenous neuronal activator of microglia, also induces increased cytokine release from YAC128 microglia compared to wildtype microglia. We found elevated MMP levels in HD CSF, and MMP levels correlate with disease severity in HD. These data support a novel role for MMPs and microglial activation in HD pathogenesis. With an improved understanding of the specific cellular processes involved in HD neuroinflammation, novel therapeutic agents targeting these processes can be developed and hold great promise in the treatment of HD.

Prediction of hip displacement in children with cerebral palsy: development of the CPUP hip score.

Hip displacement, defined in this study as a migration percentage (MP) of more than 40%, is a common, debilitating complication of cerebral palsy (CP). In this prospective study we analysed the risk of developing hip displacement within five years of the first pelvic radiograph. All children with CP in southern and western Sweden are invited to register in the hip surveillance programme CPUP. Inclusion criteria for the two groups in this study were children from the CPUP database born between 1994 and 2009 with Gross Motor Function Classification System (GMFCS) III to V. Group 1 included children who developed hip displacement, group 2 included children who did not develop hip displacement over a minimum follow-up of five years. A total of 145 children were included with a mean age at their initial pelvic radiograph of 3.5 years (0.6 to 9.7). The odds ratio for hip displacement was calculated for GMFCS-level, age and initial MP and head-shaft angle. A risk score was constructed with these variables using multiple logistic regression analysis. The predictive ability of the risk score was evaluated using the area under the receiver operating characteristics curve (AUC). All variables had a significant effect on the risk of a MP > 40%. The discriminatory accuracy of the CPUP hip score is high (AUC = 0.87), indicating a high ability to differentiate between high- and low-risk individuals for hip displacement. The CPUP hip score may be useful in deciding on further follow-up and treatment in children with CP.

Alargamiento de extremidades: actualización y revisión del tema / Limb lengthening: review and update

El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...

[Diffuse pulmonary meningotheliomatosis]. / Diffuse pulmonale Meningotheliomatose.

In two patients with bilateral micronodular pulmonary changes a diffuse pulmonary meningotheliomatosis was found. A 73-year-old woman presented with bilateral disseminated miliary pulmonary nodules as a radiological incidental finding. The surgical lung biopsy showed multiple tiny nodular proliferations meningothelial-like cells, corresponding "minute pulmonary meningothelial-like nodules", MPMN. A 60-year-old lady with similar radiological findings showed also proliferations of meningothelial-like cells in a transbronchial cryo-biopsy. These lesions are well known to pathologists as curious isolated incidental findings on histological examination of lung specimens. The here described diffuse form of these changes is very rare; its knowledge is important for the differential diagnosis with neoplastic proliferations and other diffuse parenchymal diseases of the lung. This rare diagnosis is made on histological grounds and is also possible in transbronchial biopsies when careful correlation with clinical and radiological data, knowledge of the entity and adequate specimens are provided.

Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme.

In 1994 a cerebral palsy (CP) register and healthcare programme was established in southern Sweden with the primary aim of preventing dislocation of the hip in these children. The results from the first ten years were published in 2005 and showed a decrease in the incidence of dislocation of the hip, from 8% in a historical control group of 103 children born between 1990 and 1991 to 0.5% in a group of 258 children born between 1992 and 1997. These two cohorts have now been re-evaluated and an additional group of 431 children born between 1998 and 2007 has been added. By 1 January 2014, nine children in the control group, two in the first study group and none in the second study group had developed a dislocated hip (p < 0.001). The two children in the first study group who developed a dislocated hip were too unwell to undergo preventive surgery. Every child with a dislocated hip reported severe pain, at least periodically, and four underwent salvage surgery. Of the 689 children in the study groups, 91 (13%) underwent preventive surgery. A population-based hip surveillance programme enables the early identification and preventive treatment, which can result in a significantly lower incidence of dislocation of the hip in children with CP.

Evaluation of photodynamic therapy using a diode laser and different photosensitizers against Enterococcus faecalis

Photodynamic therapy (PDT) has been proven to be effectivein disinfecting root canals. The aim of this present study wasto evaluate the effects of PDT on the viability of Enterococcusfaecalis using methylene blue (MB) and malachite green(MG) as photosensitizers. Solutions containing E. faecalis(ATCC 29212) were prepared and harvested by centrifugationto obtain cell suspensions, which were mixed with MBand MG. Samples were individually irradiated by the diodelaser at a distance of 1mm for 30, 60, or 120 seconds. Colonyformingunits (CFU) were determined for each treatment.PDT for 60 and 120 seconds with MG reduced E. faecalis viabilitysignificantly. Similar results were obtained when MBwas used as photosensitizer. PDT using MB and MG haveantibacterial effect against E. faecalis, showing potential tobe used as an adjunctive antimicrobial procedure in endodontictherapy...

Molecularly imprinted polymers as synthetic receptors for the QCM-D-based detection of L-nicotine in diluted saliva and urine samples.

Molecularly imprinted polymers (MIPs) are synthetic receptors that are able to specifically bind their target molecules in complex samples, making them a versatile tool in biosensor technology. The combination of MIPs as a recognition element with quartz crystal microbalances (QCM-D with dissipation monitoring) gives a straightforward and sensitive device, which can simultaneously measure frequency and dissipation changes. In this work, bulk-polymerized L-nicotine MIPs were used to test the feasibility of L-nicotine detection in saliva and urine samples. First, L-nicotine-spiked saliva and urine were measured after dilution in demineralized water and 0.1× phosphate-buffered saline solution for proof-of-concept purposes. L-nicotine could indeed be detected specifically in the biologically relevant micromolar concentration range. After successfully testing on spiked samples, saliva was analyzed, which was collected during chewing of either nicotine tablets with different concentrations or of smokeless tobacco. The MIPs in combination with QCM-D were able to distinguish clearly between these samples: This proves the functioning of the concept with saliva, which mediates the oral uptake of nicotine as an alternative to the consumption of cigarettes.

Heat-transfer-based detection of L-nicotine, histamine, and serotonin using molecularly imprinted polymers as biomimetic receptors.

In this work, we will present a novel approach for the detection of small molecules with molecularly imprinted polymer (MIP)-type receptors. This heat-transfer method (HTM) is based on the change in heat-transfer resistance imposed upon binding of target molecules to the MIP nanocavities. Simultaneously with that technique, the impedance is measured to validate the results. For proof-of-principle purposes, aluminum electrodes are functionalized with MIP particles, and L-nicotine measurements are performed in phosphate-buffered saline solutions. To determine if this could be extended to other templates, histamine and serotonin samples in buffer solutions are also studied. The developed sensor platform is proven to be specific for a variety of target molecules, which is in agreement with impedance spectroscopy reference tests. In addition, detection limits in the nanomolar range could be achieved, which is well within the physiologically relevant concentration regime. These limits are comparable to impedance spectroscopy, which is considered one of the state-of-the-art techniques for the analysis of small molecules with MIPs. As a first demonstration of the applicability in biological samples, measurements are performed on saliva samples spiked with L-nicotine. In summary, the combination of MIPs with HTM as a novel readout technique enables fast and low-cost measurements in buffer solutions with the possibility of extending to biological samples.

[Current approaches to smoking cessation]. / Aktuelle Strategien der Raucherentwöhnung.

Smoking causes about 5 Million deaths worldwide every year. Prevention and cessation of smoking should therefore be one of the most important public health priorities. The family doctor as a trusted contact and representative of the health care system plays an important role in this case. Smoking cessation can be achieved by a gradual cognitive-behavioral therapy which may be supported by pharmacotherapy. The continuous empathic support and motivation by the family doctor is however the most important factor. Even a small advance within this step-by-step strategy can be considered as a success which will be followed by further progress.

The importance of adequate stem anteversion for rotational stability in cemented total hip replacement: a radiostereometric study with ten-year follow-up.

Progressive retroversion of a cemented stem is predictive of early loosening and failure. We assessed the relationship between direct post-operative stem anteversion, measured with CT, and the resulting rotational stability, measured with repeated radiostereometric analysis over ten years. The study comprised 60 cemented total hip replacements using one of two types of matt collared stem with a rounded cross-section. The patients were divided into three groups depending on their measured post-operative anteversion (< 10°, 10° to 25°, > 25°). There was a strong correlation between direct post-operative anteversion and later posterior rotation. At one year the < 10° group showed significantly more progressive retroversion together with distal migration, and this persisted to the ten-year follow-up. In the < 10° group four of ten stems (40%) had been revised at ten years, and an additional two stems (20%) were radiologically loose. In the 'normal' (10° to 25°) anteversion group there was one revised (3%) and one loose stem (3%) of a total of 30 stems, and in the > 25° group one stem (5%) was revised and another loose (5%) out of 20 stems. This poor outcome is partly dependent on the design of this prosthesis, but the results strongly suggest that the initial rotational position of cemented stems during surgery affects the subsequent progressive retroversion, subsidence and eventual loosening. The degree of retroversion may be sensitive to prosthetic design and stem size, but < 10° of anteversion appears deleterious to the long-term outcome for cemented hip prosthetic stems.

MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy.

PURPOSE: To investigate the positive biopsy rate of MRI-guided biopsy (MR-GB) in a routine clinical setting, identify factors predictive for positive biopsy findings and to report about the clinical significance of the diagnosed tumors. METHODS: Patients with at least one negative trans-rectal-ultrasound-guided biopsy (TRUS-GB), persistently elevated or rising serum prostate specific antigen (PSA) and at least one lesion suspicious for PCa on diagnostic 1.5 Tesla endorectal coil MRI (eMR) were included. Biopsies were carried out using a 1.5 Tesla MRI and an 18 G biopsy gun. Clinical information and biopsy results were collected; logistic regression analysis was carried out. Definite pathology reports of patients with diagnosis of PCa and subsequent radical prostatectomy (RP) were analyzed for criteria of clinical significance. RESULTS: One hundred patients were included, mean number of previous biopsies was 2 (range 1-9), mean PSA at time of biopsy was 11.7 ng/ml (1.0-65.0), and mean prostate volume was 46.7 ccm (range 13-183). In 52/100 (52.0%) patients, PCa was detected. Out of 52 patients, 27 patients with a positive biopsy underwent RP, 20 patients radiation therapy, and 5 patients active surveillance. In total, 80.8% of the patients revealed a clinically significant PCa. In univariate regression analysis, only serum PSA levels were predictive for a positive biopsy result. Number of preceding negative biopsies was not associated with the likelihood of a positive biopsy result. CONCLUSIONS: MR-GB shows a high detection rate of clinically significant PCa in patients with previous negative TRUS-GB and persisting suspicion for PCa.

Body composition and plasma levels of inflammatory biomarkers in COPD.

Previous studies suggest a relationship between systemic inflammation and body composition in chronic obstructive pulmonary disease (COPD). We examined the relationships between body composition (fat free mass index (FFMI) kg·m(-2) and fat mass index (FMI) kg·m(-2)) and three plasma inflammatory markers C-reactive Protein (CRP), soluble tumour necrosis factor receptor 1 (sTNF-R1) and osteoprotegerin (OPG) in 409 stable COPD patients (aged 40-75 yrs, Global Initiative for Obstructive Chronic Lung Disease (GOLD) categories II-IV, 249 male) from the Bergen COPD Cohort Study in Norway. FFMI and FMI were measured by bioelectrical impedance. Plasma CRP (µg·mL(-1)), sTNF-R1 (pg·mL(-1)) and OPG (ng·mL(-1)) were determined by enzyme immunoassays. Correlations and Kruskal-Wallis tests were used for bivariate analyses. Linear regression models were fitted for each of the three markers, CRP, sTNF-R1 and OPG, with FFMI and FMI as explanatory variables including sex, age, smoking habits, GOLD category, hypoxaemia, Charlson Comorbidity Index and inhaled steroid use as potential confounders. CRP and sTNF-R1 levels correlated positively with both FFMI and FMI. The adjusted regression coefficients for an increase in logCRP per unit increase in FFMI was 1.23 (1.14-1.33) kg·m(-2) and 24.9 (11.8-38.1) kg·m(-2) for sTNF-R1. Higher FMI was associated with a lower OPG, with adjusted regression coefficient -0.14 (-0.23- -0.04), whereas FFMI was unrelated to OPG. In conclusion, COPD patients with low FFMI had lower not higher plasma levels of CRP and sTNF-R1, whereas higher fat mass was associated with higher CRP and sTNF-R1 and lower OPG.