Influence of Body Composition Assessed by Computed Tomography on Mortality Risk in Young Women with Breast Cancer.

Background/Objectives: Increasing evidence indicates that body composition can significantly influence prognosis in women with breast cancer. However, alterations in body composition, particularly among young women (<40 years), remain largely unknown and underexplored. This study aimed to investigate the relationship of computed tomography (CT)-derived body composition with mortality rates among young women recently diagnosed with breast cancer, identifying the best-correlated cutoff value. Methods: This is a bi-set cohort study with retrospective data collection. Women newly diagnosed with ductal invasive breast cancer, aged 20 to 40 years, treated in reference oncology units were included. Body composition was assessed using CT scans at the third lumbar vertebra (L3) level, including muscle and adipose compartments. The outcome of interest was the incidence of overall mortality. A maximally selected log-rank Cox-derived analysis was employed to assess the cutoffs associated with mortality. Results: A total of 192 women were included before any form of treatment (median age of 35 years, IQ range: 31-37). Overall mortality occurred in 12% of the females. Stages III-IV were the most frequent (69.5%). Patients who died had a significantly lower muscle area index. CT-derived muscle area was inversely associated with mortality. Each 1 cm2/m2 decrease in skeletal muscle index increased the mortality hazard by 9%. Higher values of adiposity compartments were independently associated with higher mortality. Conclusions: Our study highlights the predictive significance of skeletal muscle area and adipose tissue in predicting survival among young women recently diagnosed with breast cancer.

Thigh muscle by CT images as a predictor of mortality in patients with newly diagnosed colorectal cancer.

This study aimed to evaluate the prognostic value of thigh muscle assessed by CT images to predict overall mortality in patients with colorectal cancer (CRC). This was a multicenter cohort study including adults (≥ 18 years old) newly diagnosed with CRC, who performed a diagnostic computed tomography (CT) exam including thigh regions. CT images were analyzed to evaluate skeletal muscle (SM in cm2), skeletal muscle index (SMI in cm2/m2), and skeletal muscle density (SMD in HU). Muscle abnormalities (low SM, SMI, and SMD) were defined as the values below the median by sex. Kaplan-Meyer curves and hazard ratios (HRs) for low SM, SMI and SMD were evaluated for overall mortality, stratified by sex. A total of 257 patients were included in the final analysis. Patients' mean age was 62.6 ± 12.1 years, and 50.2% (n = 129) were females. In males, low thigh SMI was associated with shorter survival (log-rank P = .02). Furthermore, this low thigh SMI (cm2/m2) was independently associated with higher mortality rates (HR adjusted 2.08, 95% CI 1.03-4.18). Our additional findings demonstrated that low SMD was independently associated with overall mortality among early-stage patients (I-III) (HR adjusted 2.78, 95% CI 1.26-6.15).

Age-adjusted Charlson comorbidity index and its association with body composition and overall survival in patients with colorectal cancer.

OBJECTIVE: To examine the relationship between the age-adjusted Charlson comorbidity index (A-CCI) with body composition and overall survival in patients newly diagnosed with colorectal cancer (CRC). RESEARCH METHODS AND PROCEDURES: In this cohort study, patients (≥ 18 years old) with CRC were followed for 36 months. Computed tomography images of the third lumbar were analyzed to determine body composition, including skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Phenotypes based on comorbidity burden assessed by A-CCI and body composition parameters were established. RESULTS: A total of 436 participants were included, 50% male, with a mean age of 61 ± 13.2 years. Approximately half of the patients (50.4%) had no comorbidity, and the A-CCI median score was 4 (interquartile range: 3-6). A higher A-CCI score was a risk factor for 36-month mortality (HR = 3.59, 95% CI = 2.17-5.95). Low SMA and low SMD were associated with a higher A-CCI. All abnormal phenotypes (high A-CCI and low SMA; high A-CCI and low SMD; high A-CCI and high VAT) were independently associated with higher 36-month mortality hazard (adjusted HR 5.12, 95% CI 2.73-9.57; adjusted HR 4.58, 95% CI 2.37-8.85; and adjusted HR 2.36, 95% CI 1.07-5.22, respectively). CONCLUSION: The coexistence of comorbidity burden and abnormal body composition phenotypes, such as alterations in muscle or fat compartments, may pose an additional risk of mortality in patients newly diagnosed with CRC. Early assessment and management of these phenotypes could be crucial in optimizing outcomes in such patients.

Strength-to-muscle radiodensity: A potential new index for muscle quality.

BACKGROUND & AIMS: Although it is widely recognized that muscle quality significantly influences adverse outcomes in patients with cancer, the precise definition of muscle quality remains elusive. The muscle quality index (MQI), also known as muscle-specific strength, is a relatively recent functional concept of muscle quality. It is obtained through the ratio of muscle strength to muscle mass, but its predictive value in patients with cancer remains unknown. In this study, we explored the prognostic significance of MQI in patients with cancer. Furthermore, we introduce and assess the prognostic potential of a novel muscle quality metric: the strength-to-muscle-radiodensity index (SMRi). METHODS: A secondary analysis was conducted on a prospective cohort study. CT scans were opportunistically used to assess body composition parameters, including skeletal muscle mass (SM in cm2) and muscle radiodensity (SMD in HU) at the third lumbar vertebra (L3). Handgrip strength (HGS) was measured. MQICT was calculated using the ratio of HGS to SM (cm2). SMRi was calculated as the ratio of HGS to SMD (HU). For analysis purposes, low MQICT and SMRi were defined using two approaches: statistical cutoffs associated with survival, and median-based distribution data. RESULTS: A total of 250 patients were included (52.8% females, 52% adults, 20-90 years). Gastrointestinal tumors and stage III-IV were the most frequent diagnosis and stages. SMRi and MQICT were strongly positively correlated (ρ = 0.71 P < 0.001). Individual components of MQICT and SMRi were also positively correlated. Patients with both low MQICT and SMRi had shorter survival (log-rank P = 0.023 and P = 0.003, respectively). When applying median distribution cutoffs, SMRi emerged as the most accurate predictor of mortality (HR adjusted 3.18, 95% CI 1.50 to 6.75, C-index: 0.71), when compared to MQICT (HR adjusted 1.49, 95% CI 0.77 to 2.87, C-index: 0.68). CONCLUSION: This study introduces the concept and potential prognostic significance of the SMRi. The physiological and clinical implications of this new index warrant further investigation across a spectrum of diseases, including cancer.

Examining variations in body composition among patients with colorectal cancer according to site and disease stage.

Patients with colorectal cancer (CRC) often exhibit changes in body composition (BC) which are associated with poorer clinical outcomes. Many studies group colon and rectal cancers together, irrespective of staging, potentially affecting assessment and treatment strategies. Our study aimed to compare BC in patients with CRC focusing on tumor location and metastasis presence. A total of 635 individuals were evaluated, with a mean age of 61.8 ± 12.4 years and 50.2% female. The majority had rectal cancer as the primary cancer site (51.0%), and 23.6% had metastatic disease. The first regression model showed tumor site and metastasis as independent factors influencing skeletal muscle (SM), skeletal muscle index (SMI), and visceral adipose tissue variability (all p values < 0.05). The second model, adjusted for BMI, indicated tumor site as the primary factor affecting SMI variations (adjusted R2 = 0.50 p < 0.001), with colon tumors inversely associated with SM (standardized ß - 2.15(- 3.3; - 0.9) p < 0.001). A third model, considering all the confounders from the directed acyclic graphs, was constructed and the found association remained independent. Our findings highlight significant BC variations in patients with CRC, influenced by tumor location and metastases presence, underscoring the need for location-specific assessment in CRC management.

Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

Muscle Quality in Older Adults: A Scoping Review.

OBJECTIVE: This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults. DESIGN: Scoping review. SETTING AND PARTICIPANTS: All available studies. METHODS: Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years. RESULTS: A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%). CONCLUSIONS AND IMPLICATIONS: There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults.

Plataformas de financiamiento colectivo como instrumento de incentivo de innovaciones sociales en el contexto brasileño / Crowdfunding as an instrument for social innovation incentive in the brazilian context / Plataformas de financiamento coletivo como instrumento de incentivo à inovação social no contexto brasileiro

Resumen Introducción: Las plataformas de financiamiento colectivo y las innovaciones sociales son aspectos simbólicos fundamentales para el surgimiento y consolidación de una nueva economía. De esta forma, el presente artículo busca comprensión de las plataformas de financiamiento colectivo, también conocidas como crowdfunding en Brasil, y su relación con proyectos que son compatibles con las definiciones de innovación social. Objetivo: Esta investigación busca comprender la influencia y las posibles relaciones entre las plataformas de crowdfunding y los procesos de innovación social, a partir de la revisión de las principales líneas teóricas relacionadas con el crowdfunding y las matrices de innovación social. Materiales y métodos: El método utilizado fue un estudio de caso exploratorio. Para ello, se realizó un estudio en dos de las plataformas de crowdfunding más representativas de Brasil (Kickante y Vakinha) con entrevistas a sus representantes y acceso a datos secundarios. Resultados: Fue posible una percepción más clara de cómo la herramienta de crowdfunding actúan en el país y cómo pueden constituirse mecanismos fomentadores de innovación social, generando impactos positivos en la sociedad brasileña. Conclusiones: La evaluación realizada llevó a la comprensión de que las plataformas de crowdfunding, aliadas a proyectos que apuntan al bienestar social, resultan a menudo en prácticas compatibles con los conceptos de innovación social al resultar en mejoras significativas para la sociedad. Se observó que las plataformas de financiamiento colectivo, analizadas poseen el aspecto del bienestar social bastante destacado en gran parte de los proyectos vehiculados.

Abstract Introduction: The birth of a new economy, collaborative call has been subject increasingly explored in various spheres of society. The possibility of raising a revolution in the economic and social environment in which we live is a matter of interest to researchers and scholars around the world. Both crowdfunding platforms as said social innovations are key symbolic aspects for the emergence and consolidation of this new economy. Objective: This research seeks to understand the influence and possible relationships of crowdfunding platforms and social innovation processes, based on a review of the main theoretical lines related to crowdfunding and social innovation matrices. Materials and methods: The method used was an exploratory case study. For this, a study was carried out on two of the most representative crowdfunding platforms in Brazil (Kickante and Vakinha) with interviews with their representatives and access to secondary data. Results: As a result, you can get a clearer perception of how crowdfunding tool operate in the country and how they can be promoters mechanisms of social innovation, and generating positive impacts in Brazilian society. Conclusions: The evaluation has led to the understanding that crowdfunding platforms, combined with social welfare projects, often result in practices compatible with the concepts of social innovation, resulting in significant improvements for society. It was observed that crowdfunding analyzed have the aspect of social well-being that is highlighted in a large part of the projects conveyed.

Resumo Introdução: Plataformas de financiamento colectivo e inovações sociais são aspectos simbólicos fundamentais para o surgimento e consolidação de uma nova economia. Assim, este artigo procura compreender as plataformas de financiamento colectivo, também conhecido como crowdfunding no Brasil, e sua relação com projectos que são consistentes com definições de inovação social. Objetivo: Esta pesquisa procura entender a influência e possíveis relações das plataformas de crowdfunding com processos de inovação social, tomando por base a revisão das principais linhas teóricas relacionadas com crowdfunding e as matrizes de inovação social. Materiais e Métodos: O método utilizado foi o estudo de caso, de caracter exploratório. Para isso, foi realizado um estudo em duas das plataformas de financiamento colectivo mais representativos do Brasil (Kickante e Vakinha) com entrevistas com seus representantes e acesso a dados secundários. Resultados: Como resultado, foi possível observar uma percepção mais clara da ferramenta de crowdfunding que opera no país e como pode tornar-se promotora de mecanismos de inovação social, gerando impactos positivos na sociedade brasileira. Conclusão: A avaliação levou à constatação de que as plataformas de crowdfunding, aliados a projetos voltados para assistência social, muitas vezes são compatíveis com os conceitos de inovação social para resultar em melhorias significativas para as práticas da sociedade. Observou-se que plataformas de financimaneto coletivo, têm analisado o aspecto bem-estar social bastante proeminente na maior parte dos projectos veiculados.

Risco coronariano em adolescentes estimado pelo índice de conicidade / Coronary risk in adolescents as estimated by the conicity index

The objective of this study was to estimate the prevalence of coronary risk using the conicity index and to compare this index with other indicators of body adiposity in adolescents. This was a cross-sectional study with 185 adolescent students from public schools in Natal, Brazil, selected by random samplingin two stages, considering the two health districts of the city. The corporal adiposity was assessed using conicity index, abdominal circumferences,waist-height ratio and body mass index. Sexual maturity was clinically assessed according to Tanner. Measures of central tendency and dispersion (mean, median and standard deviation) and percentiles distribution of the corporal adiposity are compared according to sex. The correlation between conicity index and other variables of the corporal adiposity was performed using Pearson's partial correlation, considering age, sex and sexual maturation. These findings verified that 27.6% of adolescents have high coronary risk, regardless of sex (p=0,764). The low/medium and high categories of coronary risks were respectively 1.16 and 1.20, for the median values of conicity index concerning both sexes. Strong correlations were found between conicity index and the waist-height ratio (0.732), followed by moderate correlations with abdominal circumferences and the bodymass index. All correlations were significant (p < 0.0001). Therefore, the prevalence of high coronary risk rates was considerable. The conicity indexis strongly correlated with the waist-height ratio. This index can be used inadolescent coronary disease screening.

El objetivo de este estudio fue estimar la prevalencia de riesgo coronario en adolescentes mediante el índice de conicidad y evaluar su relación con otros indicadores antropométricos de grasa corporal. Es un estudio transversal con 185 adolescentes de escuelas pública sen dos distritos de salud de la ciudad de Natal, RN, Brasil, seleccionados mediante muestre o estratificado en dos etapas. La adiposidad corporal fue evaluada por el índice de conicidad, las circunferencias dela cintura, relación cintura / talla e índice de masa corporal. La madurez sexual fue clínicamente evaluada de acuerdo a Tanner. Todas las variables relacionadas con la adiposidad se analizaron mediante medidas de tendencia central y de dispersión, según el sexo. El coeficiente de correlación parcial de Pearson fue utilizado para verificar la relación entre el índice de conicidad y otras variables antropométricas, ajustado por edad, sexo y madurez sexual. Los resultados mostraron que 27,6% de los adolescentes presentan alto riesgo coronario, independientemente del sexo (p = 0,764). Los valores promedio de este índice, por categoría de riesgo: bajo/medio y alto fueron1,16 y 1,20, respectivamente para ambos sexos. Se observó una elevada correlación entre el índice de conicidad y el de cintura-altura(0, 732) y correlaciones moderadas con la circunferencia de la cintura y el IMC, todas estadísticamente significativas (p <0,0001). Porlo tanto, el alto riesgo coronario estimado por el índice de conicidad mostró elevada correlación, positiva y significativa, con el de cintura-altura. Este índice puede ser utilizado en adolescentes para detección de enfermedades coronarias.

Objetivou-se estimar a prevalência de risco coronariano em adolescentes, utilizando o índice de conicidade e avaliar sua relação com outros indicadores antropométricos de excesso de a diposidade corporal. Trata-se de um estudo transversal, realizado com 185 adolescentesde escolas públicas municipais de dois distritos sanitários de Natal, selecionados por amostra estratificada, em dois estágios. A adiposidade corporal foi avaliada pelo índice de conicidade, circunferências abdominais, razão cintura altura e índice de massa corporal. A maturação sexual foi avaliada conforme classificação de Tanner. Todas as variáveis relacionadas à adiposidade corporal foram analisadas por medidas de tendência central e de dispersão, segundo o sexo. A correlação parcial de Pearson foi utilizada para verificar a relação entre o índice de conicidade e as demais variáveis antropométricas, ajustadas por idade, sexo e maturação sexual. Os resultados indicaram que 27,6% dos adolescentes apresentaram risco coronariano elevado, sem associação com o sexo (p = 0,764). Os valores médios deste índice, segundo as categorias de risco baixo/médio e elevado foram 1,16 e 1,20, respectivamente para ambos os sexos. Constatou-se uma forte correlação entre o índice de conicidade e a razão cintura-altura (0,732) e correlações moderadas com as circunferências abdominais e o índice de massa corporal, todas significantes estatisticamente (p<0,0001). Dessa forma, o risco coronariano avaliado pelo índice de conicidade apresentou alta magnitude e mostrou correlação positiva e significante com a razão cintura-altura. Destaca-se, portanto, que este índice pode ser utilizado na triagem para a detecção precoce de eventos cardiovasculares em adolescentes.

Evidence for a role of the NOS1AP (CAPON) gene in schizophrenia and its clinical dimensions: an association study in a South American population isolate.

BACKGROUND/AIMS: Recent studies have implicated a region on chromosome 1q21-23, including the NOS1AP gene, in susceptibility to schizophrenia. However, replication studies have been inconsistent, a fact that could partly relate to the marked psychopathological heterogeneity of schizophrenia. The aim of this study is to evaluate association of polymorphisms in the NOS1AP gene region to schizophrenia, in patients from a South American population isolate, and to assess if these variants are associated with specific clinical dimensions of the disorder. METHODS: We genotyped 24 densely spaced SNPs in the NOS1AP gene region in a schizophrenia trio sample. The transmission disequilibrium test (TDT) was applied to single marker and haplotype data. Association to clinical dimensions (identified by factor analysis) was evaluated using a quantitative transmission disequilibrium test (QTDT). RESULTS: We found significant association between eight SNPs in the NOS1AP gene region to schizophrenia (minimum p value = 0.004). The QTDT analysis of clinical dimensions revealed an association to a dimension consisting mainly of negative symptoms (minimum p value 0.001). CONCLUSIONS: Our findings are consistent with a role for NOS1AP in susceptibility to schizophrenia, especially for the 'negative syndrome' of the disorder.

Esquizofrenia y Neurodesarrollo / Schizophrenia and neurodevelopment

La hipótesis del neurodesarrollo con respecto al origen de la esquizofrenia postula que ésta es producto de una alteración cerebral primaria, resultante de un defecto estructural que ocurre temprano en la vida. Este defecto interactúa con eventos del desarrollo del sistema nervioso central y produce deficiencias que, junto con precipitantes ambientales, llevan a las manifestaciones clínicas de la esquizofrenia. Esta hipótesis ha tenido gran aceptación y ha sido la base de múltiples estudios de genética molecular en los últimos años. En este artículo se revisan los estudios médicos que apoyan dicha hipótesis y aquellos que la controvierten, al mostrar hallazgos de procesos neurodegenerativos dentro del trastorno...

[Utilization of community mental health services in the city of Santos, São Paulo, Brazil]. / Utilização dos Centros de Atenção Psicossocial (CAPS) na cidade de Santos, São Paulo, Brasil.

To report on the clientele treated at community mental health services (CAPS) in the city of Santos, São Paulo, Brazil, a census was conducted of the patients examined at the services from June 1, 2001, to June 30, 2001. The patient's initial contact with the service was registered, and data were recorded on a standardized form, using the medical case history as a source of information. Among the 1,673 patients, average age was 46 years, 59.0% were female, 58.0% lived with their families, and mean duration of treatment was three years. Some 38.0% were schizophrenic, schizotypical, or in acute delusional states, 31.0% presented mood disorders, and 17.0% were neurotic. Treatment modalities included out-patient psychiatric (81.0%), individual (23.0%), group (13.0%), and psychosocial rehabilitation (4.3%). In Santos, CAPS treat all categories of mental disorders (and frequently those considered the most severe cases) expected at this type of service. The treatment model is that of an out-patient psychiatric clinic.

Utilização dos Centros de Atenção Psicossocial (CAPS) na cidade de Santos, São Paulo, Brasil / Utilization of community mental health services in the city of Santos, São Paulo, Brazil

A fim de descrever a clientela atendida nos Centros de Atenção Psicossocial (CAPS) da Cidade de Santos foi realizado um censo de pacientes atendidos nos CAPS no período 1º de junho de 2001 a 30 de junho de 2001. O primeiro contato do paciente com o serviço foi registrado e seus dados foram preenchidos em ficha padronizada utilizando o prontuário médico como fonte de informação. Foram atendidos 1.673 usuários, com idade média de 46 anos, mulheres (59,0 por cento), morando com a família (78,0 por cento) e tempo médio de três anos em tratamento no serviço. Atenderam 38,0 por cento de esquizofrênicos, esquizotípicos e delirantes, 31,0 por cento com transtorno de humor e 17,0 por cento de neuróticos, nas modalidades de ambulatório médico-psiquiátrico (81,0 por cento), individual (23,0 por cento), grupal (13,0 por cento) e reabilitação psicossocial (4,3 por cento). Os CAPS de Santos atendem todas as categorias de transtornos mentais, sendo os mais freqüentes aqueles considerados mais graves, o que é esperado para este tipo de serviço. O modelo de tratamento oferecido tem características ambulatorial e médico-psiquiátrica.