Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis.

PURPOSE: Persistent fatigue among colorectal cancer (CRC) patients might be associated with unfavorable body composition, but data are sparse and inconsistent. We studied how skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at diagnosis are associated with fatigue up to 24 months post-diagnosis in stage I-III CRC patients. METHODS: SMI, SMR, VAT, and SAT were assessed among 646 CRC patients using pre-treatment computed tomography images. Fatigue at diagnosis, at 6, and 24 months post-diagnosis was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. RESULTS: Prevalence of fatigue at diagnosis was 18%, at 6 months 25%, and at 24 months 12%. At diagnosis, a significant (p = 0.01) non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower levels of SMR were linearly associated with higher prevalence of fatigue at 6 months post-diagnosis (overall association p = 0.02). None of the body composition parameters were significantly associated with fatigue at 24 months. CONCLUSION: Having more SAT was associated with more fatigue at diagnosis, while low levels of SMR were associated with more fatigue at 6 months post-diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Our results suggest that it may be interesting to investigate whether interventions that aim to increase SMR around the time of diagnosis may help to lower fatigue. However, more knowledge is needed to understand the mechanisms behind the association of SMR with fatigue.

Mercury in the Black Sea: New Insights From Measurements and Numerical Modeling.

Redox conditions and organic matter control marine methylmercury (MeHg) production. The Black Sea is the world's largest and deepest anoxic basin and is thus ideal to study Hg species along the extended redox gradient. Here we present new dissolved Hg and MeHg data from the 2013 GEOTRACES MEDBlack cruise (GN04_leg2) that we integrated into a numerical 1-D model, to track the fate and dynamics of Hg and MeHg. Contrary to a previous study, our new data show highest MeHg concentrations in the permanently anoxic waters. Observed MeHg/Hg percentage (range 9-57%) in the anoxic waters is comparable to other subsurface maxima in oxic open-ocean waters. With the modeling we tested for various Hg methylation and demethylation scenarios along the redox gradient. The results show that Hg methylation must occur in the anoxic waters. The model was then used to simulate the time evolution (1850-2050) of Hg species in the Black Sea. Our findings quantify (1) inputs and outputs of HgT (~31 and ~28 kmol yr-1) and MeHgT (~5 and ~4 kmol yr-1) to the basin, (2) the extent of net demethylation occurring in oxic (~1 kmol yr-1) and suboxic water (~6 kmol yr-1), (3) and the net Hg methylation in the anoxic waters of the Black Sea (~11 kmol yr-1). The model was also used to estimate the amount of anthropogenic Hg (85-93%) in the Black Sea.

Bio-impedance analysis for appendicular skeletal muscle mass assessment in (pre-) frail elderly people.

BACKGROUND & AIMS: Screening populations for skeletal muscle mass (SMM) is important for early detection of sarcopenia. Our aim was to develop an age specific bio-impedance (BI) prediction equation for the assessment of appendicular skeletal muscle mass (ASMM) in (pre-) frail elderly people aged 65 and older. METHODS: Anthropometric, BI and dual-energy X-ray absorptiometry (DEXA) measurements from 106 (pre-) frail elderly subjects (61 females and 45 males, aged 65-96 years) were used to derive three ASMM prediction equations using multiple regression analysis: one for single frequency BI measurements at 50 kHz (ASMM50kHz), one for measurements at the characteristic frequency (ASMMFc) and one for bioelectrical impedance spectroscopy (ASMMBIS). The same data was used to evaluate an existing prediction equation. RESULTS: ASMM50kHz had the best fitting model (r2adj = 0.923, SEE = 1.19 and a PRESS value = 163.4), followed by ASMMFc (r2adj = 0.915, SEE = 1.25 and a PRESS value = 175.9) and ASMMBIS (r2adj = 0.915, SEE = 1.26 and a PRESS value = 177.1). Average ASMM measured by DEXA and both ASMM50kHz and ASMMFc were comparable. ASMMBIS tended to underestimate ASMM slightly. An existing prediction equation had a tendency to underestimate ASMM in people with a lower amount of ASMM and overestimate ASMM in people with a higher amount of ASMM. CONCLUSIONS: ASMM50kHz was able to measure average ASMM within our population of (pre-) frail elderly in a valid way. However, its predictive power on both individual and population level needs to be confirmed in an independent and larger (pre-) frail elderly population and across multiple institutions and ethnic groups.

Mesoscale iron enrichment experiments 1993-2005: synthesis and future directions.

Since the mid-1980s, our understanding of nutrient limitation of oceanic primary production has radically changed. Mesoscale iron addition experiments (FeAXs) have unequivocally shown that iron supply limits production in one-third of the world ocean, where surface macronutrient concentrations are perennially high. The findings of these 12 FeAXs also reveal that iron supply exerts controls on the dynamics of plankton blooms, which in turn affect the biogeochemical cycles of carbon, nitrogen, silicon, and sulfur and ultimately influence the Earth climate system. However, extrapolation of the key results of FeAXs to regional and seasonal scales in some cases is limited because of differing modes of iron supply in FeAXs and in the modern and paleo-oceans. New research directions include quantification of the coupling of oceanic iron and carbon biogeochemistry.

Shipboard techniques based on flow injection analysis for measuring dissolved Fe, Mn and Al in seawater.

An overview is presented of sampling techniques and flow injection analysis (FIA) methods for low concentrations of Fe, Mn and Al in filtered seawater. On the basis of sampling procedures, filtration techniques, accuracy, blanks, detection limits, intercalibration results and oceanographic consistency, the feasibility of these FIA methods was evaluated. It was found that these metals could be measured on board with a minimum risk of contamination and with good accuracy even at low subnanomolar levels (<0.5 nM). Results for reference seawater were in the case of Fe-FIA and Mn-FIA in excellent agreement with the certified values. Data from samples analyzed by Fe-FIA and by cathodic stripping voltametry (CSV) compared well, as did Mn-FIA and GFAAS. All three methods gave results that were mostly in good agreement with data from the same ocean regions published by other research groups. Two different types of surface water sampling were also tested and compared, namely conventional hand filling of a sample bottle from a rubber dinghy away from the ship, and underway pumping of seawater using a 'tow fish'. The latter method gave the best results. Also, conventional membrane filtration and cartridge filtration for large volume filtration were compared using Fe and Al data from water column samples. Good agreement was found for both filter types, although for defining dissolved metal species the latter filter type was preferred.

The determination and distribution of Zn in surface water samples collected in the northeast Atlantic Ocean.

Dissolved Zn concentrations were determined in surface water samples collected on-line along transects in the eastern North Atlantic in spring (March 1998). Two frontal zones could be identified in the research area by a change in salinity, temperature and nutrient concentrations. One zone was identified at 42 degrees N, separating the North Atlantic central water (NACW) and the Atlantic surface water (ASW) from each other, and another one crossing the continental slope at 12 degrees and 8 degrees E, respectively. Variability in Zn concentrations was observed near these zones, not only as a result of a change of water mass, but also due to external Zn sources. Surface Zn concentrations were 0.5-1 nM and 2 nM in the NACW and ASW, respectively, increasing to 4 nM over the continental shelf and finally 5-6 nM in the English Channel. Contributions of Zn derived from shelf sediments appear to be the major source for the enriched surface values in the continental zone.

Practicability and acceptance of subcutaneous self-administration of the selective serotonin agonist sumatriptan.

To cater to the special situation of much reduced oral bioavailability which occurs in severe migraine attacks with pronounced nausea and vomiting, sumatriptan can also be used in a subcutaneous form that can be self-administered. The aim of this study was to analyze the practicability and acceptance of a method of self-administration ("Glaxo-Pen") for treatment of severe migraine attacks by subcutaneous injection of sumatriptan. The Glaxo-Pen was compared with the conventional autoinjector for subcutaneous administration of sumatriptan. The multicenter study was conducted under practical conditions by 150 office-based physicians in Germany. Patients who commonly suffered from severe migraine attacks were given a careful explanation of how to use the device ("Glaxo-Pen") for self-administration of subcutaneous sumatriptan and were able to practice using it under guidance. They were given a Glaxo-Pen with two sumatriptan refills to take with them for treating their own migraine attacks. The patients used a headache diary to document administration outside the practice session. A total of 376 patients were included in the study. The major findings were that 80% of the patients rated the Glaxo-Pen "very easy" or "easy" to use, and only 6.4% rated it "difficult" or "very difficult." Compared with the conventional autoinjector, the Glaxo-Pen was rated "much better" or "better" by 77.9% of patients. Only 8.5% considered the Glaxo-Pen "worse" or "much worse" than the conventional autoinjector. The figures show that the great majority of patients found it easy to use sumatriptan for treating severe migraine attacks by self-administration under practical conditions. Thus, especially for patients who suffer from severe nausea, vomiting, or diarrhea during migraine attacks, this method of delivery is an easily used means of arresting migraine attacks.

The hair root pattern after calcipotriol treatment for scalp psoriasis.

Scalp psoriasis is associated with hair loss and an increased telogen/anagen ratio. Topical treatment of scalp psoriasis (with corticosteroids, dithranol or tar) results in decreased scaling, induration and erythema of the plaques. Calcipotriol is effective in the treatment of psoriasis vulgaris. However, the potent growth-inhibiting potential of this compound might theoretically induce hair loss. A study was designed to find out to what extent calcipotriol treatment modulates the percentage of anagen and telogen hair during treatment of scalp psoriasis. A group of 26 patients participated in a placebo-controlled dose-finding study on the efficacy of calcipotriol in scalp psoriasis. Hair plucks before and after treatment were taken. The telogen/anagen ratio remained unaffected during 6 weeks of calcipotriol treatment. No correlation was demonstrated between efficacy of treatment and quantification of telogen/anagen ratio. It can be concluded that the growth-inhibiting potential of calcipotriol is not reflected in the in vivo hair growth pattern during calcipotriol treatment.

Dapsone versus topical immunotherapy in alopecia areata.

Twenty-seven patients with severe alopecia areata were treated with dapsone. The results of a mean treatment duration of 10 +/- 0.5 months are reported, and compared with the results of long-term topical immunotherapy obtained previously at the same institute. The efficacy of dapsone proved to be markedly inferior to that of topical immunotherapy. The percentage of patients showing regrowth of hair during treatment with dapsone was comparable with the occurrence of spontaneous regrowth of hair reported in the literature.

[Neuromuscular blockade with atracurium in dermatomyositis]. / Neuromuskuläre Blockade mit Atracurium bei Dermatomyositis.

Dermatomyositis (DM) is a rare disease of unknown aetiology involving weakness of proximal muscles, myalgia and impairment of the integument. Due to its low incidence, only few reports exist on the anaesthesiologic management of neuromuscular blockade in patients with DM considered for surgical therapy. In this setting, special attention should be given to the administration of muscle relaxants since an increased sensitivity to these drugs in neuromuscular diseases may be expected. METHODS. This case report describes the neuromuscular monitoring of a female patient aged 53 years with DM undergoing strumectomy and treated with methotrexate and prednylidene. Muscle relaxation was induced with 0.35 mg/kg atracurium (1.5 x ED95). An additional bolus of 0.07 mg/kg was administered 50 min later. Control of sufficient relaxation was performed by tactile methods, and time of onset (TO), duration of action (DA) and recovery index (RI) were measured. RESULTS. Relaxation was obtained within TO of 3 min, DA of 50 min and RI of 11 min. These timer indicate slightly increased sensitivity to atracurium. The postoperative outcome demonstrated no muscular weakness and sufficient spontaneous ventilation. DISCUSSION. To date, few experiences of neuromuscular blockade with atracurium in DM have been presented, hence this report. In addition, no standard recommendations are given regarding the application of nondepolarizing muscle relaxants in this context. In our case, atracurium could be implemented as a safe drug under neuromuscular monitoring.

Co-occurrence of plasma cell orificial mucositis and plasmoacanthoma. Report of a case and review of the literature.

Plasma cell orificial mucositis is a relatively rare condition which may occur on mucous membrane. Plasmoacanthoma is a verrucous tumor with plasmacytic infiltration and has been described as a separate disease entity. Such a tumor is supposed to occur without lesions which could be compatible with plasma cell orificial mucositis. The present case report documents the coexistence of both conditions in one single patient. This observation suggests that both conditions are part of one single disease entity.

Cytokeratin expression in alopecia areata hair follicles.

Alopecia areata is a human hair disease of unknown etiology. Immunological mechanisms, alterations in the extracellular matrix and follicular growth abnormalities have been suggested as a possible cause. Here we compare the expression of cytokeratins in normal hair follicles to that of alopecia areata using immunohistology with monoclonal antibodies. A number of cytokeratins were specifically expressed in defined anatomical parts of the follicle; however, no gross qualitative or quantitative differences were found between normal and diseased scalp. Interestingly, the expression of cytokeratin 16, which is modulated by conditions that affect the rate of keratinocyte proliferation, was found to be unchanged in the outer root sheet of alopecia areata follicles. This is in contrast with earlier observations of a decrease in the expression of the proliferation-associated, Ki-67 nuclear antigen.

Epidermal proliferation and keratinization following standardized elicitation with diphenylcyclopropenone.

Diphenylcyclopropenone (DCP) was applied to the upper arms of five alopecia areata patients using 10% of the concentration that had been applied previously to the scalp during topical immunotherapy. DCP applied in this concentration evoked a mild eczematous reaction. Biopsies were taken before DCP application and after 24, 48 and 96 h. A large increase in T-lymphocytes and CD14-positive cells in the dermis was seen after 24 h. Migration of these cells into the epidermis was mainly observed during the first 48 h. This was followed by epidermal proliferation as assessed by the number of Ki-67-positive nuclei and the degree of Ks8.12-binding. Both showed their main increase after 48 h; but after 24 h the increase of Ki-67-positive nuclei was significant (P < 0.04). Involucrin and filaggrin showed a gradual increase which became substantial after 96 h (both P < 0.04). As the invasion of inflammatory cells into the epidermis preceded the main increase in epidermal proliferation, cytokines are suggested as possible mediators for the initial phase of the proliferative response after DCP application.

Sweet's syndrome as the presenting symptom of hairy cell leukemia with concomitant infection by Mycobacterium kansasii.

A patient with Sweet's syndrome and leukopenia is reported. Hematological evaluation revealed hairy cell leukemia (HCL). The clinical picture was dominated by persistent fever, which is a common feature of both Sweet's syndrome and HCL. Since fever frequently reflects concomitant infection in HCL, a thorough search for infectious disease was performed. Blood cultures grew Mycobacterium kansasii. The patient recovered after treatment with recombinant interferon-alpha (r-IFN-alpha) and tuberculostatic drugs. Remarkably, the skin lesions completely regressed within 1 week after the start of r-IFN-alpha. In the literature, Sweet's syndrome is rarely mentioned as a feature of HCL. Mycobacterial disease, especially atypical mycobacteria, is relatively often seen in HCL.

The hair root pattern in psoriasis of the scalp.

Several reports suggest that a localized effluvium of scalp hair may occur in patients with psoriasis. The percentages of telogen and catagen hair have been claimed to be normal or increased in isolated cases. In the present study the anagen/telogen ratio was quantified under standardized conditions in psoriatic plaques and uninvolved areas of the scalp in 22 patients and the scalp of 22 normal controls. This assessment was carried out by light microscopic analysis of hair roots, obtained by the hair pluck-method. A consistent increase in the percentages of telogen and catagen hair was shown in psoriatic plaques, compared with the uninvolved areas. Compared with the scalp of normal controls, this percentage was significantly increased in psoriatic plaques, but not in the uninvolved areas.

Abnormal expression of Ki-67 antigen in hair follicle of alopecia areata.

The monoclonal antibody Ki-67 was used to determine the numbers of cycling cells in hair follicles both in alopecia areata and in normal scalp skin. Pronounced nuclear staining was limited to the area below the critical line of Auber and the exterior part of the outer root sheath. In alopecia areata there is reduced nuclear Ki-67 binding in the bulb of anagen hair follicles. These findings indicate that inhibition of keratinocyte proliferation might be a pathogenetic mechanism in alopecia areata.

Prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone.

One hundred thirty-nine patients with alopecia areata were treated with diphenylcyclopropenone. Before treatment, 85 patients had subtotal or total hair loss (greater than 90% bald area) and in the remaining patients scalp involvement was between 40% and 90%. The following three factors were found to be of prognostic significance: type of alopecia areata as documented before treatment, duration of the disease before therapy, and presence of nail changes. Other factors such as age at onset, sex, presence of atopic features, the extent of variation in the range of diphenylcyclopropenone concentrations during treatment, and sleep disturbances caused by pruritus did not influence the prognosis significantly.