Análisis comparativo de los métodos de bioimpedancia en la evaluación nutricional de pacientes con enfermedades respiratorias / Comparative analysis of bioimpedance methods in the nutritional evaluation of patients with respiratory disease

ANTECEDENTES: las guías clínicas actuales consideran la monitorización nutricional una parte importante en la evaluación de pacientes respiratorios. Gracias a la bioimpedancia, es posible obtener una medida de la composición corporal. OBJETIVO: comparar los dos métodos más comunes de análisis de la composición corporal mediante bioimpedancia sobre una población de pacientes respiratorios: una única frecuencia (SFBIA) y espectroscopía de bioimpedancia (BIS). MÉTODO: grupo I (pacientes en Rehabilitación Respiratoria, 6 personas); Grupo II (pacientes hospitalizados, 10 personas); Grupo III (sujetos sanos, 5 personas). Medidas: dispositivo SFBIA y dispositivo BIS. Análisis comparativo con índices normalizados: porcentaje de grasa e índice de masa libre de grasa (FFMI). RESULTADOS: análisis Bland-Altman del porcentaje de grasa: valor medio de -3,5%, límites de concordancia del 95% desde -18,8% a 11,7%. Análisis Bland-Altman de FFMI: valor medio de 0,8 kg/m2, límites de concordancia del 95% desde -3,5 kg/m2 a 5,1 kg/m2. Correlación en el porcentaje de grasa: r = 0,73 (p = 0,0009). Correlación en FFMI: r = 0,86 (p = 0,00001). CONCLUSIONES: en la muestra analizada, los métodos SFBIA y BIS han mostrado una buena correlación y una concordancia moderada a la hora de estimar la composición corporal. En la mayoría de los casos, el método SFBIA subestimó el porcentaje de grasa y sobreestimó la masa magra comparado con el método BIS. Las mayores discrepancias entre ambos métodos fueron observadas en los casos extremos de composición corporal

BACKGROUND: Current clinical guides consider nutritional monitoring to be an important part of the evaluation of respiratory patients. Thanks to bioimpedance, it is possible to obtain a body composition measurement. OBJECTIVE: to compare the two most common methods for analyzing body composition using bioimpedance in a population of respiratory patients: single frequency (SFBIA) and bioimpedance spectroscopy (BIS). METHODS: group I (respiratory rehabilitation patients: 6 people); group II (hospitalized patients: 10 people); group III (healthy subjects: 5 people). Measurements: SFBIA device and BIS device. Analysis: comparison with normal indexes: percent fat and fat free mass index (FFMI). RESULTS: Bland-Altman analysis of percent fat: mean value of -3.5%, 95% limits of agreement from -18.8% to 11.7%. Bland-Altman FFMI analysis: mean value of 0.8 kg/m2, 95% limits of agreement from -3.5 kg/m2 to 5.1 kg/m2. Correlation in percent fat: r = 0.73 (p = 0.0009). Correlation in FFMI: r = 0.86 (p = 0.00001). CONCLUSIONS: in the sample analyzed, the SFBIA and BIS methods have shown good correlation and moderate agreement when estimating body composition. In most cases, SFBIA underestimated the percent fat and overestimated the lean mass compared to the BIS method. The largest discrepancies between the two methods were seen in the cases of extreme body composition

Food preferences and Hg distribution in Chelonia mydas assessed by stable isotopes.

Mercury (Hg) is a highly toxic pollutant that poses in risk several marine animals, including green turtles (Chelonia mydas). Green turtles are globally endangered sea turtle species that occurs in Brazilian coastal waters as a number of life stage classes (i.e., foraging juveniles and nesting adults). We assessed total Hg concentrations and isotopic signatures ((13)C and (15)N) in muscle, kidney, liver and scute of juvenile green turtles and their food items from two foraging grounds with different urban and industrial development. We found similar food preferences in specimens from both areas but variable Hg levels in tissues reflecting the influence of local Hg backgrounds in food items. Some juvenile green turtles from the highly industrialized foraging ground presented liver Hg levels among the highest ever reported for this species. Our results suggest that juvenile foraging green turtles are exposed to Hg burdens from locally anthropogenic activities in coastal areas.

CD97 amplifies LPA receptor signaling and promotes thyroid cancer progression in a mouse model.

CD97, a member of the adhesion family of G-protein-coupled receptors (GPCRs), complexes with and potentiates lysophosphatidic acid (LPA) receptor signaling to the downstream effector RHOA. We show here that CD97 was expressed in a majority of thyroid cancers but not normal thyroid epithelium and that the level of CD97 expression was further elevated with progression to poorly differentiated and undifferentiated carcinoma. Intratumoral progression also showed that CD97 expression correlates with invasiveness and dedifferentiation. To determine the functional role of CD97, we produced a transgenic model of thyroglobulin promoter-driven CD97 expression. Transgenic CD97 in combination with Thrb(PV), an established mouse model of thyroid follicular cell carcinogenesis, significantly increased the occurrence of vascular invasion and lung metastasis. Expression of transgenic CD97 in thyroid epithelium led to elevated ERK phosphorylation and increased numbers of Ki67+ cells in developing tumors. In addition, tumor cell cultures derived from CD97 transgenic as compared with non-transgenic mice demonstrated enhanced, constitutive and LPA-stimulated ERK activation. In human thyroid cancer cell lines, CD97 depletion reduced RHO-GTP and decreased LPA-stimulated invasion but not EGF-stimulated invasion, further suggesting that CD97 influences an LPA-associated mechanism of progression. Consistent with the above, CD97 expression in human thyroid cancers correlated with LPA receptor and markers of aggressiveness including Ki67 and pAKT. This study shows an autonomous effect of CD97 on thyroid cancer progression and supports the investigation of this GPCR as a therapeutic target for these cancers.

Beta-catenin dysregulation in thyroid neoplasms: down-regulation, aberrant nuclear expression, and CTNNB1 exon 3 mutations are markers for aggressive tumor phenotypes and poor prognosis.

beta-catenin has a role in cell adhesion and Wnt signaling. It is mutated or otherwise dysregulated in a variety of human cancers. In this study we assess beta-catenin alteration in 145 thyroid tumors samples from 127 patients. beta-catenin was localized using immunofluorescence and mutational analysis was performed by single-strand conformational polymorphism. Membrane beta-catenin expression was decreased in eight of 12 (66%) adenomas and in all 115 carcinomas (P: < 0.0001). Among carcinomas, reduced membrane beta-catenin was associated with progressive loss of tumor differentiation (P: < 0.0001). CTNNB1 exon 3 mutations and nuclear beta-catenin localization were restricted to poorly differentiated [7 of 28 (25%) and 6 of 28 cases (21.4%), respectively] or undifferentiated carcinomas [19 of 29 (65.5%) and 14 of 29 (48.3%) cases, respectively]. Poorly differentiated tumors always featured mutations involving Ser and Thr residues and were characterized by Thr to Ile amino acid substitutions (P: = 0.0283). The association between CTNNB1 exon 3 mutations and aberrant nuclear immunoreactivity (P: = 0.0020) is consistent with Wnt activation because of stabilizing beta-catenin mutations. Low membrane beta-catenin expression as well as its nuclear localization or CTNNB1 exon 3 mutations are significantly associated with poor prognosis, independent of conventional prognostic indicators for thyroid cancer but not of tumor differentiation. Analysis of beta-catenin dysregulation may be useful to objectively subtype thyroid neoplasms and more accurately predict outcomes.

Downregulation of p27KIP1 and Ki67/Mib1 labeling index support the classification of thyroid carcinoma into prognostically relevant categories.

The cyclin-dependent kinase inhibitor p27KIP1 has been proposed as a valuable prognostic indicator for a variety of human neoplasms. Immunohistochemical reactivity for p27KIP1 and the proliferation marker Ki67/Mib1 were investigated in 90 thyroid carcinomas of follicular cell origin. The neoplasms were divided into three prognostic groups on the basis of their morphologic features: group 1, well-differentiated papillary or follicular carcinomas with favorable pathologic features (43 papillary carcinomas and 4 minimally invasive follicular carcinomas); group 2, papillary or follicular carcinomas with unfavorable pathologic features (21 poorly differentiated carcinomas and 2 papillary carcinomas, tall cell variant); and group 3, undifferentiated, or anaplastic, carcinomas. p27KIP1 expression (p = 0.007) and Ki67/Mib1 labeling index (p = 0.02) showed a strong correlation with the subdivision of the thyroid carcinomas in the three prognostic groups with a significant linear trend for tumors with low p27KIP1 (p = 0.002) and high Ki67/Mib1 labeling index (p = 0.005) to segregate into the unfavorable categories (groups 2 and 3). Low p27KIP1 expression, but not cellular proliferation, was related to adverse prognostic factors, such as large tumor size (p = 0.03) and extrathyroidal extension (p = 0.01), but the correlation was not independent of the subdivision in the three groups. Low p27KIP1 expression (p = 0.03) and high proliferative rate (p = 0.02) were associated with poor survival, reflecting the close association between patient morbidity and mortality rates and tumor differentiation. No significant association could be seen between p27KIP1 or cellular proliferation and clinicopathologic parameters (e.g., age, sex, tumor size, extrathyroidal extension, vascular invasion, lymph node metastases, distant metastases, tumor stage, and survival rate) within any of the groups, or the histologic diagnosis of papillary versus follicular carcinoma irrespective of their degree of differentiation. Modulation of p27KIP1 and cellular proliferation patterns in thyroid carcinoma correlate with tumor differentiation and support the morphologic classification of thyroid carcinoma into prognostically relevant categories.

Frequent chromosomal DNA unbalance in thyroid oncocytic (Hürthle cell) neoplasms detected by comparative genomic hybridization.

Thyroid oncocytic (Hürthle cell) neoplasms represent a distinct subset of follicular thyroid tumors characterized by abnormal accumulation of mitochondria, whose chromosomal abnormalities have never been systematically analyzed. We have used comparative genomic hybridization to investigate chromosomal DNA alterations in 11 thyroid oncocytic tumors (7 adenomas and 4 carcinomas). Unbalanced chromosomal DNA profiles were detected in 6 of 7 adenomas and 3 of 4 carcinomas, numerical chromosomal aberrations being the dominant feature. Comparative genomic hybridization findings are compatible with two separate groups of tumors with karyotypic abnormalities, one characterized by multiple chromosomal gains with polysomy of chromosomes 5 and 7, the other by loss of chromosome 2. Pathologic and clinical features were similar in the two groups with no difference observed between adenomas and carcinomas. Activating H-, K-, or N-Ras mutations are commonly detected in follicular adenomas and carcinomas of the thyroid gland. However, Ras mutational analysis demonstrated that only one of the tumors in this series, an oncocytic carcinoma with a balanced karyotype, had activating Ras mutations (at codon 13 of K-Ras). The lack of Ras mutations in the 9 oncocytic neoplasms exhibiting chromosomal aneuploidy indicates that numerical chromosomal abnormalities are independent of activating Ras mutations in oncocytic tumors.

Frequent mutation and nuclear localization of beta-catenin in anaplastic thyroid carcinoma.

Beta-catenin is an ubiquitously expressed cytoplasmic protein that has a crucial role in both E-cadherin-mediated cell-cell adhesion and as a downstream signaling molecule in the wingless pathway. Stabilization of beta-catenin followed by nuclear translocation and subsequent T-cell factor/lymphoid-enhancing factor-mediated transcriptional activation has been proposed as an important step in oncogenesis. Stabilization may occur through activating mutations in exon-3 at the phosphorylation sites for ubiquitination and degradation of beta-catenin. Immunohistochemical subcellular localization of beta-catenin and mutational analysis of exon-3 of the beta-catenin gene by single-strand conformational polymorphism followed by DNA sequencing was performed on 37 samples from 31 patients with anaplastic thyroid carcinoma. Immunofluorescent staining showed nuclear localization in 15 (42%) of the 36 samples examined. Nucleotide sequencing of mobility shifts detected by single-strand conformational polymorphism revealed somatic alterations in 19 (61%) of the 31 patients analyzed. We conclude that mutations in beta-catenin are common in anaplastic thyroid cancer and that they may activate transcription, as illustrated by frequent nuclear localization of the protein. These findings support the idea that beta-catenin acts as an oncogene and contributes to the highly aggressive behavior of this tumor.