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BACKGROUND: While much cancer research focuses on tumours and their microenvironment, malignancies cause widespread physiologic changes. Cancer and treatment-related sarcopenia, measured with quantitative imaging or as a decrease in overall body mass, are indicative of poor prognosis in elderly diffuse large B-cell lymphoma (DLBCL) patients, skeletal muscle radiodensity (SMD) may be a better prognostic marker. SMD, a measure of muscle radiation attenuation on CT imaging, is more prognostic than sarcopenia or International Prognostic Index (IPI) scores in follicular lymphoma and multiple solid organ malignancies. Low SMD appears to correlate with fat accumulation in muscle and is associated with inflammation. This study set out to examine SMD's prognostic ability in DLBCL. METHODS: All DLBCL patients treated with rituximab-containing therapy between 2004 and 2009 were compared to determine SMD's prognostic ability in this single centre, retrospective study. Pre-treatment CT scans were used to measure SMD and muscle cross-sectional area. Primary endpoints included progression free (PFS) and overall survival (OS) while objective response rates (ORR) were secondary. RESULTS: Of 224 evaluable patients, 116 were identified as having low SMD. Low SMD predicted poorer 5 year PFS, 60 vs. 81% (p = 0.001) and OS, 58 vs. 86% (p < 0.0001). SMD's prognostic ability retained significance in multivariate analysis taking into consideration the Revised International Prognostic Index (R-IPI) and sex. Although high SMD was not predictive of ORR (95.4 vs. 91.4%, p = 0.17), it was strongly associated with radiographic complete response (85 vs. 66%, p = 0.0007). Contrary to previous findings, sarcopenia did not predict for poorer OS but suggested improved OS in elderly DLBCL patients (HR 0.38, p = 0.01). CONCLUSIONS: SMD is a novel prognostic (and potentially treatment predictive) marker independent of R-IPI in DLBCL. It presents an inexpensive yet complementary assessment to R-IPI for prognosticating DLBCL outcomes.

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Aunque se ha investigado extensamente el significado clinico de los anticuerpos antinuecleares (ANA) y se han reconocido algunas correlaciones, no esta establecido el valor diagnostico del patron mixto de ANA y anticitoplasmaticos (ANA + ACA). Nosotros observamos dicho patron mixto en el suero de 43 pacientes de un total de 7.121 examinados (0.6%). La combinacion mas comun fue con el patron homogeneo de ANA. Las entidades asociadas al patron mixto son basicamente las mismas que se asocian con los diferentes ANA; el Lupus Eritematoso Sistemico (LES) es la mas frecuente. Concluimos que la informacion obtenida del hallazgo de un patron combinado ANA + ACA es la misma que se obtiene con los ANA positivos y que su presencia en pacientes con LES no caracteriza a ningun subgrupo de la enfermedad en particular

To date, the clinical significance of combined antinuclear (ANA) and anti-cytoplasmic (ACA) indirect immunofluorescent staining has not been comprehensively studied. ANA + ACA staining was observed in 43 (0.6%) out of 7.121 consecutive sera during ANA screening for immunologic disorders in a referral hospital; both inpatient and outpatient population were included. Homogeneous ANA + cytoplasmic was by far the most common staining pattern among 6 different fluorescent combinations detected. Disease distribution was similar in groups of patients with ANA + ACA and in those with only ANA +. We conclude that information provided by mixed antibody pattern is similar to the one obtained with the sole presence of ANA; also that the presence of the mixed pattern does not characterize any particular subgroup of LES patiens.

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El metabolismo del acido araquinodico (AA) y la actividad de la fosfolipasa A2 (FLA2), fueron estudiados en neutrofilos segmentados (NS) pertenecientes a diez pacientes con artritis reumatoidea (AR), que recibian distintos antinflamatorios no esteroides (AINE), diez pacientes con AR sin tratamiento con AINE y diez voluntarios sanos. El porcentaje de AA que se metabolizo a leuctorieno B4 (LTB4) fue significativamente mayor en los pacientes sin tratamiento que en el grupo control; en los pacientes en tratamiento con AINE se observo una disminucion en LTB4, que no fue estadisticamente diferente del grupo de control. La actividad de la enfermedad, medida por parametros clinicos, mostro correlacion con la generacion del LTB4, y la actividad de la FLA2. Estos resultados preliminares sugieren que un aumento en la actividad de la FLA2, es al menos en parte, responsable del aumento en la generacion de LTB4 y que el tratamiento con AINE puede, eventualmente, modificar esta anormalidad

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This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. The psychological variables examined did not predict independently RA pain behavior. The rheumatoid activity index explained a significant proportion of the variance in functional status ratings and MHAQ daily function scores. Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.

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Four studies examined the reliability and validity of a behavioral observation method for the assessment of pain associated with rheumatoid arthritis (RA). The major purpose of experiment 1 was to evaluate the interobserver reliability of the observation method. Two observers recorded the frequencies of pain behaviors displayed by 20 RA patients. Each of 3 types of reliability estimates indicated that the pain behavior could be reliably observed. The purpose of experiment 2 was to examine the concurrent validity of the observation system by correlating 53 patients' self-reports of pain with the frequencies of their pain behaviors. Significant and positive correlations were found between patients' total pain behavior and 3 self-report measures of pain and functional disability. Furthermore, unlike the self-reports of pain, total pain behavior was only minimally related to self-report of depression. Experiment 3 was performed in order to assess the observation method's construct validity. Naive observers viewed video recordings of 25 RA patients and made global estimates of patients' pain severity and unpleasantness. Highly significant and positive correlations were found between these global estimates and total pain behavior. In experiment 4, the pain behaviors of 11 RA patients were recorded prior to and immediately following cognitive-behavioral treatment for the reduction of RA pain. There was a significant decrease in total pain behavior from pretreatment to posttreatment. The data indicate that the observation method provides a reliable, valid, and relatively objective measure of RA patient pain behavior. Future validation studies of the observation method are discussed.

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