Distribution and density of tertiary lymphoid structures predict clinical outcome in intrahepatic cholangiocarcinoma.

BACKGROUND & AIMS: The prognostic value and clinical relevance of tertiary lymphoid structures (TLSs) in intrahepatic cholangiocarcinoma (iCCA) remain unclear. Thus, we aimed to investigate the prognostic value and functional involvement of TLSs in iCCA. METHODS: We retrospectively included 962 patients from 3 cancer centers across China. The TLSs at different anatomic subregions were quantified and correlated with overall survival (OS) by Cox regression and Kaplan-Meier analyses. Multiplex immunohistochemistry (mIHC) was applied to characterize the composition of TLSs in 39 iCCA samples. RESULTS: A quaternary TLS scoring system was established for the intra-tumor region (T score) and peri-tumor region (P score) respectively. T scores positively correlated with favorable prognosis (p <0.001), whereas a high P score signified worse survival (p <0.001). mIHC demonstrated that both T follicular helper and regulatory T cells were significantly increased in intra-tumoral TLSs compared to peri-tumoral counterparts (p <0.05), and regulatory T cell frequencies within intra-tumoral TLSs were positively associated with P score (p <0.05) rather than T score. Collectively, the combination of T and P scores stratified iCCAs into 4 immune classes with distinct prognoses (p <0.001) that differed in the abundance and distribution pattern of TLSs. Patients displaying an immune-active pattern had the lowest risk, with 5-year OS rates of 68.8%, whereas only 3.4% of patients with an immune-excluded pattern survived at 5 years (p <0.001). The C-index of the immune class was statistically higher than the TNM staging system (0.73 vs. 0.63, p <0.001). These results were validated in an internal and 2 external cohorts. CONCLUSIONS: The spatial distribution and abundance of TLSs significantly correlated with prognosis and provided a useful immune classification for iCCA. T follicular helper and regulatory T cells may play a critical role in determining the functional orientation of spatially different TLSs. LAY SUMMARY: Tertiary lymphoid structures (TLSs) are associated with favorable prognosis in a number of cancers. However, their role in intrahepatic cholangiocarcinoma (iCCA) remains unclear. Herein, we comprehensively evaluated the spatial distribution, abundance, and cellular composition of TLSs in iCCA, and revealed the opposite prognostic impacts of TLSs located within or outside the tumor. This difference could be mediated by the different immune cell subsets present within the spatially distinct TLSs. Based on our analysis, we were able to stratify iCCAs into 4 immune subclasses associated with varying prognoses.

Decreased body-fat accumulation and increased vasorelaxation to glyceryl trinitrate in middle-aged male rats following six-weeks consumption of coconut milk protein

Abstract We investigated whether coconut milk protein (CMP) contributes to the beneficial effects of coconut milk consumption on cardiovascular health markers previously found in middle-aged rats. CMP was isolated and precipitated from dried fresh coconut milk, then gavaged (1 g/kg) to middle-aged male rats for six weeks; control rats received distilled water. Compared to controls, CMP caused decreased body fat and lipid accumulation in liver cells and the platelet count. CMP did not affect basal blood pressure or heart rate in anesthetized rats. Vascular responsiveness to phenylephrine, DL-propargylglycine (PAG), acetylcholine or sodium nitroprusside was unaffected, but vasorelaxation to glyceryl trinitrate (GTN) increased. Effects of ODQ on vasorelaxation to GTN were similar in both groups. Expression of blood vessel eNOS, CSE and sGC was normal. The cyclic guanosine monophosphate (cGMP) level of CMP-treated rats was normal but addition of GTN increased cGMP and NO concentration more in CMP-treated rats than in controls, an effect unaltered by addition of diadzin. Taken together, CMP appears partially responsible for the improvement in cardiovascular health markers caused by coconut milk in middle-aged male rats

História da obesidade na classificação internacional de doenças (CID): de 1900 a 2018 / History of obesity in the international classification of diseases (ICD): 1900 to 2018

O presente artigo teve como objetivo descrever o histórico da inserção da condição clínica denominada atualmente de "obesidade" nas onze revisões da Classificação Internacional de Doenças (CID), publicadas pela Organização Mundial da Saúde (OMS), entre os anos 1900 e 2018. Para tanto, buscou-se pela palavra-chave "obesity" nos documentos, realizando, posteriormente, uma descrição e uma análise da presença, modo de inserção e as mudanças ocorridas ao longo do tempo. Os resultados demonstraram que a condição já foi e continua sendo inserida como sintoma, morbidade, coREVSmorbidade, causa de mortalidade e/ou doença. Concluiu-se que há uma grande inconsistência lógica nos princípios que regem a classificação.

This article aimed at describing the history of insertion of the clinical condition currently referred to as "obesity" in the eleven revisions of the International Classification of Diseases (ICD) published by the World Health Organization (WHO) between 1900 and 2018. For this purpose, a search for the keyword obesity was performed in the documents, with subsequent description and analysis of the presence, mode of insertion, and changes occurring over time. The results demonstrated that the condition has been and continues to be inserted as symptom, morbidity, comorbidity, cause of mortality and/or disease. It can be concluded that there is a massive logical inconsistency in the principles that govern the classification.

Estimación de la masa grasa por medio de indicadores antropométricos en jóvenes con síndrome de Down / Estimation of fat mass by anthropometric indicators in young people with Down syndrome

Introducción: la evaluación de la composición corporal es relevante y útil para diseñar intervenciones de estilos de vida saludables y estrategias nutricionales.Objetivos: verificar las relaciones existentes entre los indicadores de adiposidad y la masa grasa (MG), y validar ecuaciones que permitan predecir la MG en jóvenes con síndrome de Down (SD).Métodos: se efectuó un estudio transversal en 48 jóvenes con SD (24 hombres y 24 mujeres). Se evaluaron el peso, la estatura, la circunferencia de la cintura (CC) y la circunferencia de la cadera (CCa). Se calcularon el índice de masa corporal (IMC), el índice de adiposidad corporal (IAC), el índice cintura-cadera (ICC) y el índice cintura-estatura (ICE). Se evaluó la MG mediante absorciometría de rayos X de doble energía (DXA). Resultados: la edad de los hombres era de 19,3 ± 3,0 años y la de las mujeres de 18,9 ± 1,9 años; el peso era de 73,6 ± 14,3 kg en los hombres y de 75,8 ± 20,3 kg en las mujeres; finalmente, la estatura de los hombres era de 168,9 ± 6,5 cm y la de las mujeres de 156,3 ± 6,2 cm. En los hombres, las correlaciones entre la MG (DXA) y los parámetros IMC, CC, CCa, ICE, IAC e ICE oscilaron entre r = 0,01 y r = 0,89; en las mujeres, entre r = 0,10 y r = 0,97. Las correlaciones más altas se observaron con el IMC y la CC en ambos sexos (hombres, r = 0,78 a 0,92 y mujeres, r = 0,83 a 0,97). Se generaron ecuaciones de regresión para estimar la MG en los hombres (R2 = 84 %) y en las mujeres (R2 = 96 %). Se calcularon los percentiles de MG según la DXA y con cada ecuación. Conclusiones:hubo correlaciones positivas significativas del IMC y la CC con la MG. Estos indicadores fueron determinantes para desarrollar ecuaciones que estiman la MG de los jóvenes con SD. Los resultados sugieren su uso y aplicación para evaluar, clasificar y monitorizar los niveles de adiposidad corporal en contextos clínicos y epidemiológicos. (AU)

Introduction: the assessment of body composition is relevant and useful for designing interventions for healthy lifestyles and nutritional strategies. Objective: our goal was to verify the relationships between adiposity indicators with fat mass (FM), and to validate equations that allow predicting FM in young people with Down syndrome (SD). Methods: a cross-sectional study was carried out in 48 young people with DS (24 men and 24 women). Weight, height, waist circumference (WC), and hip circumference (HC) were evaluated. Body mass index (BMI), body adiposity index (BAI), waist-to-hip index (WHI), and waist-to-height index (WHtR) were calculated. FM was evaluated by dual energy X-ray absorptiometry (DXA). Results: age in men was 19.3 ± 3.0 years, and in women it was 18.9 ± 1.9 years; weight was 73.6 ± 14.3 kg in men and 75.8 ± 20.3 kg in women, and height in men was 168.9 ± 6.5 cm, and in women it was 156.3 ± 6.2 cm. In males the correlations between FM (DXA) with BMI, WC, HC, WHtR, BAI and WHtR ranged from r = 0.01 to r = 0.89, and in females from r = 0.10 to r = 0.97. The highest correlations were observed with BMI and WC in both sexes (males r = 0.78 to 0.92, and females r = 0.83 to 0.97). Regression equations were generated to estimate FM in males (R2 = 84 %) and in females (R2 = 96 %). Percentiles were calculated for MG per DXA and for each equation. Conclusions: there were significant positive correlations between BMI and WC with FM. These indicators were decisive for developing equations that estimate FM in young people with DS. The results suggest its potential use and application to evaluate, classify and monitor body fat levels in clinical and epidemiological contexts. (AU)

[Estimation of fat mass by anthropometric indicators in young people with Down syndrome]. / Estimación de la masa grasa por medio de indicadores antropométricos en jóvenes con síndrome de Down.

INTRODUCTION: Introduction: the assessment of body composition is relevant and useful for designing interventions for healthy lifestyles and nutritional strategies. Objective: our goal was to verify the relationships between adiposity indicators with fat mass (FM), and to validate equations that allow predicting FM in young people with Down syndrome (SD). Methods: a cross-sectional study was carried out in 48 young people with DS (24 men and 24 women). Weight, height, waist circumference (WC), and hip circumference (HC) were evaluated. Body mass index (BMI), body adiposity index (BAI), waist-to-hip index (WHI), and waist-to-height index (WHtR) were calculated. FM was evaluated by dual energy X-ray absorptiometry (DXA). Results: age in men was 19.3 ± 3.0 years, and in women it was 18.9 ± 1.9 years; weight was 73.6 ± 14.3 kg in men and 75.8 ± 20.3 kg in women, and height in men was 168.9 ± 6.5 cm, and in women it was 156.3 ± 6.2 cm. In males the correlations between FM (DXA) with BMI, WC, HC, WHtR, BAI and WHtR ranged from r = 0.01 to r = 0.89, and in females from r = 0.10 to r = 0.97. The highest correlations were observed with BMI and WC in both sexes (males r = 0.78 to 0.92, and females r = 0.83 to 0.97). Regression equations were generated to estimate FM in males (R2 = 84 %) and in females (R2 = 96 %). Percentiles were calculated for MG per DXA and for each equation. Conclusions: there were significant positive correlations between BMI and WC with FM. These indicators were decisive for developing equations that estimate FM in young people with DS. The results suggest its potential use and application to evaluate, classify and monitor body fat levels in clinical and epidemiological contexts.

INTRODUCCIÓN: Introducción: la evaluación de la composición corporal es relevante y útil para diseñar intervenciones de estilos de vida saludables y estrategias nutricionales. Objetivos: verificar las relaciones existentes entre los indicadores de adiposidad y la masa grasa (MG), y validar ecuaciones que permitan predecir la MG en jóvenes con síndrome de Down (SD). Métodos: se efectuó un estudio transversal en 48 jóvenes con SD (24 hombres y 24 mujeres). Se evaluaron el peso, la estatura, la circunferencia de la cintura (CC) y la circunferencia de la cadera (CCa). Se calcularon el índice de masa corporal (IMC), el índice de adiposidad corporal (IAC), el índice cintura-cadera (ICC) y el índice cintura-estatura (ICE). Se evaluó la MG mediante absorciometría de rayos X de doble energía (DXA). Resultados: la edad de los hombres era de 19,3 ± 3,0 años y la de las mujeres de 18,9 ± 1,9 años; el peso era de 73,6 ± 14,3 kg en los hombres y de 75,8 ± 20,3 kg en las mujeres; finalmente, la estatura de los hombres era de 168,9 ± 6,5 cm y la de las mujeres de 156,3 ± 6,2 cm. En los hombres, las correlaciones entre la MG (DXA) y los parámetros IMC, CC, CCa, ICE, IAC e ICE oscilaron entre r = 0,01 y r = 0,89; en las mujeres, entre r = 0,10 y r = 0,97. Las correlaciones más altas se observaron con el IMC y la CC en ambos sexos (hombres, r = 0,78 a 0,92 y mujeres, r = 0,83 a 0,97). Se generaron ecuaciones de regresión para estimar la MG en los hombres (R2 = 84 %) y en las mujeres (R2 = 96 %). Se calcularon los percentiles de MG según la DXA y con cada ecuación. Conclusiones: hubo correlaciones positivas significativas del IMC y la CC con la MG. Estos indicadores fueron determinantes para desarrollar ecuaciones que estiman la MG de los jóvenes con SD. Los resultados sugieren su uso y aplicación para evaluar, clasificar y monitorizar los niveles de adiposidad corporal en contextos clínicos y epidemiológicos.

Body fat indices and biomarkers of inflammation: a cross-sectional study with implications for obesity and peri-implant oral health.

PURPOSE: To examine the relationships between three measures of body fat-body mass index (BMI), waist circumference (WC), and total body fat percent-and markers of inflammation around dental implants in stable periodontal maintenance patients. MATERIALS AND METHODS: Seventy-three subjects were enrolled in this cross-sectional assessment. The study visit consisted of a physical examination that included anthropologic measurements of body composition (BMI, WC, body fat %); intraoral assessments were performed (full-mouth plaque index, periodontal and peri-implant comprehensive examinations) and peri-implant sulcular fluid (PISF) was collected on the study implants. Levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17, tumor necrosis factor-α, C-reactive protein, osteoprotegerin, leptin, and adiponectin in the PISF were measured using multiplex proteomic immunoassays. Correlation analysis with body fat measures was then performed using appropriate statistical methods. RESULTS: After adjustments for covariates, regression analyses revealed statistically significant correlation between IL-1ß in PISF and WC (R = 0.33; P = .0047). CONCLUSION: In this study in stable periodontal maintenance patients, a modest but statistically significant positive correlation was observed between the levels of IL-1ß, a major proinflammatory cytokine in PISF, and WC, a reliable measure of central obesity.

A comparison of fat mass and skeletal muscle mass estimation in maleultra-endurance athletes using bioelectrical impedance analysis anddifferent anthropometric methods / Comparación de la masa grasa y muscular estimada en atletas varones de ultra-resistencia utilizando la bioimpedancia eléctrica y diferentes métodos antropométricos

Two hundred and fifty seven male Caucasian ultraendurance athletes were recruited, pre-race, before different swimming, cycling, running and triathlon races. Fat mass and skeletal muscle mass were estimated using bioelectrical impedance analysis (BIA) and anthropometric methods in order to investigate whether the use of BIA or anthropometry would be useful under field conditions. Total body fat estimated using BIA was significantly high (P < 0.001) compared with anthropometry. When the results between BIA and anthropometry were compared, moderate to low levels of agreement were found. These results were in accordance with the differences found in the Bland-Altman analysis, indicating that the anthropometric equation of Ball et al. had the highest level of agreement (Bias = -3.0 ± 5.8 kg) with BIA, using Stewart et al. (Bias = -6.4 ± 6.3 kg), Faulkner (Bias = -4.7 ± 5.8 kg) and Wilmore-Siri (Bias = -4.8 ± 6.2 kg). The estimation of skeletal muscle mass using BIA was significantly (P < 0.001) above compared with anthropometry. The results of the ICC and Bland-Altman method showed that the anthropometric equation from Lee et al. (Bias = -5.4 ± 5.3 kg) produced the highest level of agreement. The combined method of Janssen et al. between anthropometry and BIA showed a lower level of agreement (Bias = -12.5 ± 5.7 kg). There was a statistically significant difference between the results derived from the equation of Lee et al. and Janssen et al. (P < 0.001). To summarise, the determination of body composition in ultra-endurance athletes using BIA reported significantly high values of fat and skeletal muscle mass when compared with anthropometric equations (AU)

Se reclutaron a 257 hombres caucasianos que eran atletas de alto rendimiento, antes de competir en diferentes pruebas triatlón de natación, ciclismo y carrera. Se estimaron la masa grasa y la masa de músculo esquelético utilizando un análisis de impedancia bioeléctrica (BIA) y métodos antropométricos con el fin de investigar si el uso de BIA o de la antropometría sería útil en tales condiciones de campo. La grasa corporal total estimada por BIA fue significativamente mayor en comparación con la antropometría (P < 0,001). Cuando se compararon los resultados entre BIA y antropometría, se encontraron niveles de concordancia bajos a moderados. Estos resultados concuerdan con las diferencias halladas con el análisis Bland-Altman, lo que indica que la ecuación antropométrica de Ball et al. posee el mayor grado de concordancia (desviación = -3,0 ± 5,8 kg) con BIA, con Stewart et al. (desviación = -6,4 ± 6,3 kg), Faulkner (desviación = -4,7 ± 5,8 kg) y Wilmore-Siri (desviación = -4,8 ± 6,2 kg). La estimación de la masa de músculo esquelético fue significativamente superior con BIAS que con antropometría (P < 0,001). Los resultados de la ICC y del método Bland-Altman muestran que la ecuación antropométrica de Lee et al. (desviación = -5,4 ± 5,3 kg) produjo el mayor grado de concordancia. El método combinado de Janssen et al. entre antropometría y BIA mostró el menor grado de concordancia (desviación = -12,5 ± 5,7 kg). Hubo una diferencia estadísticamente significativa entre los resultados derivados de la ecuación de Lee et al. y de la de Janssen et al. (P < 0,001). En resumen, la determinación de la composición corporal en atletas de alto rendimiento utilizando BIA produjo valores significativamente mayores de masa grasa y músculo esquelético en comparación con las ecuaciones antropométricas (AU)

Obese oral and maxillofacial surgical patient.

The incidence of obesity is rising in many countries around the world. With obesity exerting a direct impact on oral health, more obese patients are likely to report for oral and maxillofacial surgical procedures. The obese patient population presents with unique anatomic and physiologic challenges that can significantly influence treatment strategies. The implications of obesity must be understood by the maxillofacial surgeon to avoid potential pitfalls. This study focuses on the relevant issues concerning obesity with regard to oral and maxillofacial surgery.

Association between physical and echographic fat thickness assessments and a lipodystrophy grading scale in lipodystrophic HIV patients: practical implications.

A simple diagnostic method for detecting in clinical routine HAART-associated lipodystrophy in HIV-infected patients is lacking. We studied the relationships between the scores obtained with a subjective lipodystrophy severity grading scale (LSGS) and standard anthropometric and echographic measurements of the subcutaneous and visceral fat thickness of 74 HIV-infected patients. Patients were divided into four groups according to their LSGS score (0, 1-7, 8-14, 15-21). Significant correlations between the LSGS and the anthropometric and echographic measurements of fat thickness, mainly the limb circumferences (brachial: r= -0.43, p < 0.001; thigh: r= -0.41, p < 0.001), and, especially, the echographically assessed perirenal fat diameters either adjusted (r= 0.46, p < 0.001) or nonadjusted to the body mass index (r= 0.35, p < 0.001) were observed. Significant differences in most of these anthropometric parameters between either the lowest (score 0) and the highest (score 15-21) score groups and the remaining groups were found, but not between the two intermediate groups (scores 1-7 vs. 8-14). This suggests that lipodystrophy should be clinically categorized as absent, mild, or marked, and that even minor changes in physical aspect should be considered as indicative of this disorder. The combination of these subjective and objective parameters could be helpful in the early detection of lipodystrophy in clinical practice.