Bioelectrical impedance vector analysis (BIVA) for the assessment of two-compartment body composition.

This review is directed to define the efficacy of bioelectrical impedance vector analysis (BIVA) for assessing two-compartment body composition. A systematic literature review using MEDLINE database up to 12 February 2014 was performed. The list of papers citing the first description of BIVA, obtained from SCOPUS, and the reference lists of included studies were also searched. Selection criteria included studies comparing the results of BIVA with those of other techniques, and studies analyzing bioelectrical vectors of obese, athletic, cachectic and lean individuals. Thirty articles met the inclusion criteria. The ability of classic BIVA for assessing two-compartment body composition has been mainly evaluated by means of indirect techniques, such as anthropometry and bioelectrical impedance analysis (BIA). Classic BIVA showed a high agreement with body mass index, that can be interpreted in relation to the greater body mass of obese and athletic individuals, whereas the comparison with BIA showed less consistent results, especially in diseased individuals. When a reference method was used, classic BIVA failed to accurately recognize FM% variations, whereas specific BIVA furnished good results. Specific BIVA is a promising alternative to classic BIVA for assessing two-compartment body composition, with potential application in nutritional, sport and geriatric medicine.

Lower lean mass and higher percent fat mass in patients with Alzheimer's disease.

In this study we analyzed body composition in relation to cognitive and functional status, in a cross-sectional sample of patients with Alzheimer's disease (AD). Seventy individuals (27 men, 78.1±6.5years; 43 women, 80.4±5.6years) with mild-moderate stages of AD (clinical dementia ratings 1 and 2) were selected from the Alzheimer Center, SS. Trinità Hospital, ASL 8 of Cagliari (Italy). Cognitive and psycho-functional status was evaluated using mini-mental state examination (MMSE), activities of daily living (ADL) scale, and geriatric depression scale (GDS). Mini-nutritional assessment (MNA) was applied. Anthropometric measurements were taken and body mass index (BMI) was calculated. Body composition was assessed by means of specific bioelectrical impedance vector analysis (BIVA), using the references for the elderly. In comparison with the reference group, patients with AD showed similar BMI and MNA, but peculiar bioelectrical characteristics: lower phase angles and longer vectors (p<0.05). According to specific BIVA, this bioelectrical pattern is indicative of a reduction of lean tissue mass and an increase of percent fat mass (FM%). A more accentuated lean mass reduction (p < 0.05) was observed in women with worse cognitive status and a FM% increase (p < 0.01) in women with worse functional status. In conclusion, patients with AD had lower lean tissue mass and higher percent fat mass than healthy elderly individuals. In women, this pattern was associated with cognitive and functional decline, as indicated by MMSE and ADL values. Specific BIVA showed to be a suitable technique in the elderly, that could enhance BMI and MNA information in the evaluation of nutritional status.

The nutrition transition in the Venezuelan Amazonia: increased overweight and obesity with transculturation.

OBJECTIVES: Amerindians have a particularly high propensity to overweight and obesity as they change lifestyle and experience a nutrition transition. The aim of this study was to evaluate the effects of transculturation on nutritional status in three Amazonian Amerindian villages. METHODS: Nutritional status was assessed in 232 volunteers: 65 Yanomami from an isolated village and 167 Guahibo subjects from villages with intermediate and high levels of transculturation. RESULTS: There was a significant pattern of decreasing stunting and increasing overweight and obesity across the gradient of transculturation. From the jungle Yanomami to the intermediate and transculturated Guahibo, stunting was respectively 72, 55, and 39%, and children /adult overweight was 0, 3/44, and 15/89%. These anthropometric-based patterns were confirmed by bioimpedance vector analysis. CONCLUSIONS: Transculturation in these Amerindian populations is associated with an increase in overweight and obesity coexisting with undernourished children.

Efficacy of specific bioelectrical impedance vector analysis (BIVA) for assessing body composition in the elderly.

OBJECTIVES: This study aimed to ascertain the efficacy of bioelectrical impedance vector analysis (BIVA) in assessing body composition in the elderly by comparing findings with the results of dual-energy X-ray absorptiometry (DXA), and to test an analytical variant of the method (specific BIVA). DESIGN: Cross-sectional study. PARTICIPANTS: The sample comprised 207 free-living elderly individuals (75 men and 132 women) aged 65 to 93 years. MEASUREMENTS: Anthropometric and bioelectrical measurements were taken according to standard criteria. BIVA was applied using the 'classic' procedure and correcting bioelectrical values for body geometry to obtain an estimate of the whole-body impedivity. DXA was used as a reference body composition assessment method. BIVA (classic and specific values) and DXA findings were compared using Student's t and Hotelling's T2 tests, and Pearson's correlation coefficient. RESULTS: In both sexes, BIVA distinguished between individuals with different amounts of fat and fat-free mass (lean mass including bone mineral content), according to DXA, but not between those with different proportions of fat mass (FM%). Specific bioelectrical values detected changes in body composition. CONCLUSION: BIVA should be used with caution for evaluating body composition in the elderly. Specific bioelectrical values proved effective, showing promise as a methodological variant of BIVA, suitable for identifying age-related changes in body fatness.

Nutritional and psycho-functional status in elderly patients with Alzheimer's disease.

OBJECTIVES: Analysis of variations of nutritional status in relation to psycho-functional conditions in elderly patients with mild to moderate Alzheimer's disease (AD) by means of bioelectrical impedance vector analysis (BIVA). DESIGN: Cross-sectional study. SETTING: Alzheimer Center, SS. Trinità Hospital, Cagliari (Italy). PARTICIPANTS: 83 free-living patients (29 men, 54 women) with mild-moderate Alzheimer's disease, aged 66 to 96 years, and 91 age-matched controls (37 men and 54 women). MEASUREMENTS: Nutritional status was evaluated by anthropometry (weight, height, waist and upper arm circumferences, triceps skinfold; body mass index, BMI; arm muscle area, AMA); Mini Nutritional Assessment, MNA®; bioelectrical impedance vector analysis, BIVA. Psycho-functional status was assessed by the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). RESULTS: Compared to the control groups, patients with Alzheimer's disease had a worse psycho-functional and nutritional status. BIVA detected lower body cell mass in Alzheimer's patients with respect to controls (men: T²= 23.4; women: T²=27.3; p<0.01), as well as in the female patients with lower levels of IADL and MMSE (respectively, T²= 8.0; T²=7.4; p<0.05). In patients with AD, a worse psycho-functional status was associated with obesity. CONCLUSION: The psycho-functional decline of patients with AD is related to body composition variations, with a relative increase of fat mass with respect to the muscle component. The BIVA technique distinguished patients from controls and patients with different levels of cognitive decline. Therefore, it is a suitable tool for the screening and monitoring of nutritional status in Alzheimer's disease.

Bioelectrical impedance vector analysis detects low body cell mass and dehydration in patients with Alzheimer's disease.

OBJECTIVES: This paper evaluates the nutritional status in patients with mild-moderate and severe Alzheimer's disease (AD) by bioelectrical impedance vector analysis (BIVA). DESIGN: Cross-sectional study. SETTING: Alzheimer Center, SS. Trinita Hospital, Cagliari, and "Monsignor Angioni" Nursing Home, Quartu Sant'Elena (Cagliari, Italy). PARTICIPANTS: 83 free-living patients with mild-moderate Alzheimer's disease (29 men, 54 women), 9 institutionalized women in the severe stage; 468 age-matched controls (202 men, 266 women). MEASUREMENTS: Mini Nutritional Assessment (MNA), anthropometric (height, weight, BMI), bioelectrical (R, Xc) and biochemical variables (serum albumin) were assessed. RESULTS: Bioelectrical characteristics were significantly different in the patients with mild-moderate AD with respect to controls, indicating low body cell mass (men, T2= 12.8; women, T2=34.9; p < 0.01). Women with severe AD showed low body cell mass and dehydration with respect to patients with mild-moderate AD (T2=17.1; p < 0.01). The phase angle, R/H and Z/H were significantly correlated (p < 0.05) with MNA (phase: r = 0.31; R/H: r =-0.37; Z/H: r =-0.37) and albumin (phase: r=0.47; R/H: r=-0.36; Z/H: r=-0.36). CONCLUSION: Alzheimer's disease is characterized by a tendency to malnutrition, present even in the mild-moderate stages, and a tendency to dehydration that appears in the severe stage. The BIVA technique is a promising tool for the screening and monitoring of nutrition and hydration status in Alzheimer's disease.

Preparation and the kinetic stability of hyaluronan radiolabeled with 111In, 125I and 14C.

Three different procedures for the labeling of hyaluronan (HA) with (111)In, (125)I and (14)C radionuclides were compared, and the kinetic stability of radiolabeled HA under different conditions (saline, artificial gastric juice and plasma) was established. Modification of HA structure with bifunctional chelating agents (DTPA) or with the prosthetic group (tyramine or tyrosine) was essential prior (111)In and (125)I labeling. These chemical labeling techniques were fast, simple and inexpensive, and labeled agents with a high specific activity were obtained. The only disadvantage of these methods was the occurrence of unknown functional groups in the HA molecule requiring further characterization of the compound. Conversely, HA labeling with (14)C by biotechnological synthesis was found to be rather expensive and time-consuming process. Although, the final product (14)C-HA was identical to natural HA its low specific activity presents certain limitation for its application in biological experiments. Stability studies showed that (14)C-HA and (125)I-Tm-HA were stable in all studied mediums. In the case of (125)I-Trs-HA, stability slightly decreased in rat plasma and in artificial gastric juice with increasing time. The least stable was (111)In-DTPA-HA, which degraded completely after 48h in artificial gastric juice. Kinetic stability studies may provide primary information concerning the properties of radiolabeled HA in vitro, which is essential for the use and explanation of its behavior in biological experiments.

Nutritional status in the healthy longeval population from Sardinia (Italy).

OBJECTIVES: The aim of this study was to evaluate sex- and age-related variations of the nutritional status in the aged population of central Sardinia, a geographical area with a high frequency of long-lived people, particularly men. DESIGN: The sample consisted of 200 subjects over 70 years of age (men: N= 100, age= 81.0 +/- 7.0 years; women: N= 100, age= 81.5 +/- 7.3 years). SETTING: Orroli (central Sardinia, Italy). MEASUREMENTS: Mini nutritional assessment (MNA) and bioelectrical impedance vector analysis (BIVA) were used to evaluate nutritional status and body composition. RESULTS: The indicators revealed a generally good nutritional status. The MNA results (men: 24.6 +/- 2.2; women: 23.4 +/- 2.5) showed that 64.1% of the subjects had a normal nutritional status and only a small proportion (1.2%) could be classified as malnourished. BIVA showed that most subjects (74.2%) were normal, while the prevalence of low body cell mass was 10.7% and that of dehydration 11.2%. According to the MNA, the nutritional status was significantly better in the men. Almost three-quarters of the men (73.1%) were well nourished vs. half of the women (50.6%). A worsening of the nutritional status with age was observed. The proportion of malnourished individuals, as assessed by MNA, increased from 0% to 9.1% from 70-79 to > 90 years. CONCLUSIONS: With respect to their contemporaries from other regions, the elderly of Orroli presented a better nutritional status, a similar worsening with age and generally higher sexual dimorphism.

A primary adrenal non-Hodgkin's lymphoma presenting as an incidental adrenal mass.

The primary adrenal localization of a non-Hodgkin's lymphoma (NHL) is a rare event. We report the case of a 70-yr-old woman, who was admitted at our Institute for a hormonal evaluation after the incidental discovery of a right adrenal mass during ultrasonography (US) performed for cardiovascular disease. At the physical examination, no sign of adrenal hyperfunction was present. She showed only an androgenetic alopecia and her blood pressure was 180/70 mm Hg, with an arrhythmic heart rate of 100 beats/min. No alterations in hormonal and biochemical data were observed. US studies showed a right adrenal mass (major diameter 16 mm), and an abdominal computed tomography (CT) scan confirmed this solid lesion (major diameter 15 mm) with a high density. [75Se] methylnorcholesterol adrenal scintigraphy exhibited a normal symmetrical radiotracer uptake. After 8 months of follow-up, an abdominal CT scan demonstrated a significant increase of the right adrenal mass (major diameter: 40 mm), with a solid tissue density and enhancement after i.v. contrast. [75Se] methylnorcholesterol adrenal scintigraphy showed an absent uptake on the right side versus the contralateral side. The hematological, hormonal and radiological evaluation did not reveal any sign of malignancy. Owing to the mass enlargement and the modification of scintigraphic pattern, the patient underwent unilateral adrenalectomy. Histological examination revealed a primary diffuse large B-cell NHL (REAL classification) of the adrenal gland. After surgery, she underwent a combined polychemotherapy (cyclophospamide, adriamycin, vincristine and prednisone) and subsequently one cycle of radiotherapy. At present, the patient is in good conditions and there are no signs or symptoms of recurrent disease.

Variations of somatotype in elderly Sardinians.

Somatotyping is an effective technique for the study of anthropometric variations and body composition in elderly subjects, even though it has not often been used in this field. The present study was conducted on a sample of 280 healthy Sardinians (134 men and 146 women) of age 60-89 years, subdivided into three age classes (60-69 years; 70-79 years; and 80-89 years). Somatotypes were computed according to Carter and Heath (Somatotyping-Development and Applications. Cambridge, England: Cambridge University Press; 1990). The results show a dominance of the endo- and mesomorphic components in the elderly subjects, with less development of ectomorphy than in younger individuals. In a comparison with other populations, our sample shows strong development of endomorphy and especially of mesomorphy, while ectomorphy values are generally low. Age-related variations are significant in both sexes and consist in a progressive reduction of the endomorphic component, particularly in the 80-89-year class (endomorphy in the three age classes: 6.4, 6.1, and 5.3 in men; 8.1, 7.8, and 6.8 in women). The mesomorphic component is characterized by stability (age variations: 6.4, 6.4, and 5.9 in men; 6.3, 6.4, and 6.3 in women) and the ectomorphic component by a slight increase (age variations: 0.5, 0.6, and 0.8 in men; 0.4, 0.3, and 0.5 in women). Sex differences are significant and especially large for the endomorphic component, with generally higher values in women. The sexual dimorphism tends to decrease with age. The results are discussed with regard to the biology of aging, with emphasis on the potential application of somatotype to studies of the elderly population.

Immunoreactivity for p27(KIP1) and cyclin E is an independent predictor of survival in primary gastric non-Hodgkin's lymphoma.

Our aim was to assess the prognostic implications of the expression of p27(KIP1) and cyclin E in gastric lymphoma. We investigated the prognostic value of the immunoreactivity of these molecules in 92 cases of primary gastric lymphoma: 34 LGMLs, 24 DLCLMLs and 34 DLCLs. p27 was positive in 88% of LGMLs, 71% of DLCLMLs and 32% of DLCLs (p = 0.004); cyclin E was positive in 9%, 33% and 59% of cases, respectively (p < 0.00001). p27/cyclin E immunoreactivity significantly correlated with histologic category, stage and LDH serum level. p27 immunoreactivity was significantly associated with better survival, whereas cyclin E reactivity was significantly related to worse outcome. Five-year CSS was 94% for patients with p27(+)/cyclin E(-) phenotype (n = 42), 79% for p27(+)/cyclin E(+) (n = 14) or p27(-)/cyclin E(-) (n = 16) phenotype and 60% for p27(-)/cyclin E(+) phenotype (n = 16) (p = 0.02). The prognostic role of p27/cyclin E expression was confirmed when analyzed separately within LGMLs and large-cell lymphomas. Immunoreactivity for p27 and cyclin E is an independent predictor of survival in PGLs that may be an adjunctive tool in identifying high-risk patients. It correlates with histologic category, stage and LDH serum level. p27(-)/cyclin E(+) phenotype is associated with worse survival, probably due to a synergistic effect of both cell-cycle defects. The predictive role of these molecules within each histologic group of PGLs deserves to be confirmed in larger series.

Variation in sexual dimorphism in relation to physical activity.

The aim of this study was to examine variations in sexual dimorphism in relation to physical activity. A sample of 542 males and females (20-30 years), born and resident in Cagliari (Sardinia, Italy), was divided into two groups: active and inactive. Twenty-five anthropometric dimensions were taken (weight, lengths, breadths, circumferences, and skinfolds). The circumferences and skinfolds were adjusted for the effects of overall body size (represented by skeletal variables). Body composition parameters--fat-free mass (FFM), fat mass (FM), and arm muscular area (AMA)--were derived from the adjusted values. The D index (Bennett, 1981; Chakraborty and Majumder, 1982) was used to assess the degree of sexual dimorphism. The difference between the D values of active and inactive individuals was analyzed with the technique of Bennett (1981). Principal components analysis (PCA) was performed on groups of homogeneous variables (circumferences and skinfolds) in order to simplify the description of the original anthropometric data. The univariate and multivariate analyses indicate a greater sex difference in the group of individuals who are regularly active. The results agree with theoretical expectations, and suggest greater stability of women to environmental pressures (i.e., physical activity).

Clinical relevance of microvessel density in laryngeal squamous cell carcinomas.

The clinical implications of microvessel density (MVD) in head and neck tumors have not been fully elucidated. We investigated the clinicopathologic correlates and prognostic relevance of MVD in a series of 122 consecutive patients with surgically treated laryngeal squamous cell carcinoma followed-up for a mean of 79 months. MVD was evaluated after CD34 immunostaining in 3 250x microscopic fields representative of the "hot spot" area, and expressed as the mean value of the vessel counts per millimeter squared. The overall median value of the intratumoral vessel count was 69.5/mm(2). In the 20 cases we analyzed, MVD increased significantly from normal to dysplastic mucosa and infiltrating carcinoma (p = 0.0001). Nineteen carcinomas (15.6%) had MVD values that were equal to or lower than the highest MVD value (52.7/mm(2)) observed in normal mucosa samples (in which the median MVD count was 34.5/mm(2), range 16.6-52.7/mm(2), mean 35.1 +/- 11.5/mm(2)) and were therefore considered poorly vascularized. Periodic acid-Schiff (PAS) staining revealed intratumoral PAS-positive connective tissue septa in 13 cases (10.7%). The patients with poorly vascularized tumors showed a tendency toward a better prognosis, but the anatomical site, tumor extension and clinical stage were the only variables significantly associated with disease-free and overall survival.

Transient sum-frequency mixing with temporally tailored laser pulses.

We discuss the possibility of using temporally tailored pump laser pulses to control the temporal width and shape of optical pulses generated in a process of transient sum-frequency mixing in crystals with second-order nonlinearity. Specific calculations performed in a model crystal in the case of fifth-harmonic generation are presented.

Gastric endocrine cells: types, function and growth.

The history of gastric endocrine cells identification and functional characterization is briefly outlined. An up to date classification of such cells is given. Present status of histopathological, histochemical, ultrastructural and molecular investigations on gastric endocrine hyperplasia and neoplasia is summarized and briefly discussed.

Melanoma antigen genes 1 and 2 are differentially expressed in human gastric and cardial carcinomas.

BACKGROUND: MAGE genes encode for tumor-rejection antigens and are expressed in tumors of different histologic types but not in normal tissues, with the exception of testis and placenta. The aim of this study was to evaluate the frequency of MAGE-1 and -2 expression in gastric and in cardial carcinomas; these conditions have been described as two distinct diseases, having different etiologies, epidemiologic patterns, and gene mutations. METHODS: Two groups of patients were studied: patients with distal gastric carcinoma and patients with carcinoma of the cardia. A group of patients with intestinal metaplasia in the gastric mucosa and controls were also included. All of them underwent upper GI endoscopy. Paired biopsy specimens were taken for routine histology and for RNA extraction, to study the expression of MAGE-1 and -2 genes. RESULTS: None of the intestinal metaplastic samples or controls expressed MAGE-1 and -2 at detectable levels. Whereas 40% of the gastric cancer patients expressed either MAGE-1 or -2, 26.6% transcribed both. In the cardial cancer group, 20% of the cases expressed at least one MAGE, and only 6.6% expressed both genes. These results might reinforce the concept that cancer of the cardia is a distinct neoplastic disease with regard to esophageal and gastric (distal) carcinomas. CONCLUSIONS: Here we show that MAGE gene expression occurs in advanced stages of gastric and cardial cancer and therefore appears to be a late event. This might point to a reconsideration of their potential role in cancer immunotherapy.

Immunohistochemical analysis of cyclin D1 shows deregulated expression in multiple myeloma with the t(11;14).

The t(11;14)(q13;q32) chromosomal translocation, the hallmark of mantle cell lymphoma (MCL), is recurrently found in multiple myelomas (MM) by means of conventional cytogenetics. Unlike MCL, recent molecular studies of MM-derived cell lines with t(11;14) have indicated that the breakpoints are highly dispersed over the 11q13 region; however, the fact that cyclin D1 is generally overexpressed in these cell lines suggests that this gene is the target of the translocation. To evaluate further the involvement of cyclin D1 in MM, we used immunohistochemistry and fluorescence in situ hybridization to investigate cyclin D1 expression and the presence of chromosome 11 abnormalities in a representative panel of 48 MM patients (40 at diagnosis and 8 at relapse). Cyclin D1 overexpression occurred in 12/48 (25%) of cases; combined immunohistochemistry and fluorescence in situ hybridization analyses in 39 patients showed cyclin D1 positivity in all of the cases (7/7) bearing the t(11;14), in two of the 13 cases with trisomy 11, and in one of the 19 cases with no apparent abnormalities of chromosome 11. Our data indicate that the t(11;14) translocation in MM leads to cyclin D1 overexpression and that immunohistochemical analysis may represent a reliable means of identifying this lesion in MM.