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Abstract
BACKGROUND Cancer-associated cachexia is a multi-organ disorder associated with progressive weight loss due to a variable combination of anorexia, systemic inflammation and excessive energy wasting. Considering the importance of immunoregulation in cachexia, it still lacks a complete understanding of the immunological mechanisms in cachectic progression. AIM OF REVIEW Our aim here is to describe the complex immunoregulatory system in cachexia. We summarize the effects and translational potential of the immune system on the development of cancer-associated cachexia and we attempt to conclude with thoughts on precise and integrated therapeutic strategies under the complex immunological context of cachexia. KEY SCIENTIFIC CONCEPTS OF REVIEW This review is focused on three main key concepts. First, we highlight the inflammatory factors and additional mediators that have been identified to modulate this syndrome. Second, we decipher the potential role of immune checkpoints in tissue wasting. Third, we discuss the multilayered insights in cachexia through the immunometabolic axis, immune-gut axis and immune-nerve axis.
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Affiliation(s)
- Qi Wu
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University.
| | - Zhou Liu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Bei Li
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Yu-E Liu
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University
| | - Ping Wang
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University.
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2
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Shimizu S, Hara H, Muto Y, Kido T, Miyata R. Gastritis cystica profunda in an unoperated stomach mimicking a pyloric submucosal tumor and causing anorexia: A case report and literature review. Medicine (Baltimore) 2024; 103:e37652. [PMID: 38552036 PMCID: PMC10977580 DOI: 10.1097/md.0000000000037652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/28/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Gastritis cystica profunda (GCP), commonly observed in remnant gastric anastomosis, is associated with developing gastric cancer. CASE This case report describes a patient with GCP in a previously unoperated stomach that mimicked a pyloric submucosal tumor and caused anorexia, which is rare in clinical practice. PATIENT CONCERNS A 72-year-old woman presented with loss of appetite and weight. DIAGNOSES Gastroscopy detected a 20 mm diameter submucosal tumor near the pylorus. Computed tomography and magnetic resonance imaging identified a cystic lesion, unlike a usual submucosal tumor in the stomach. The diagnosis was difficult, even with endoscopic ultrasound-guided fine-needle aspiration. INTERVENTIONS Surgery was performed for diagnosis and treatment. The lesion was resected using a submucosal dissection technique after an incision of the gastric wall during open laparotomy. Histopathological examination confirmed the diagnosis of GCP and revealed no dysplasia or cancer. OUTCOMES Anorexia resolved after the surgery. Residual or recurrent lesions were not detected during follow-up examinations performed 1 year after surgery. LESSONS GCP occurring in a previously unoperated stomach as a macroscopic lesion like a submucosal tumor causing some symptoms is rare. GCP is associated with a risk of developing cancer. Therefore, careful evaluation and management during treatment are required.
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Affiliation(s)
- Seito Shimizu
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan
| | - Hitoshi Hara
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan
| | - Yasuhide Muto
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan
| | - Tomoki Kido
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan
| | - Ryohei Miyata
- Department of Surgery, Social Welfare Organization Saiseikai Imperial Gift Foundation Inc., Saiseikai Kazo Hospital, Kazo, Japan
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Cox NJ. Consequences of Anorexia of Aging in Hospital Settings: An Updated Review. Clin Interv Aging 2024; 19:451-457. [PMID: 38496748 PMCID: PMC10941985 DOI: 10.2147/cia.s431547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.
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Affiliation(s)
- Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
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4
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Arenare L, Di Liello R, De Placido P, Gridelli C, Morabito A, Pignata S, Nuzzo F, Avallone A, Maiello E, Gargiulo P, Schettino C, Gravina A, Gallo C, Chiodini P, Di Maio M, Perrone F, Piccirillo MC. Under-reporting of subjective symptoms and its prognostic value: a pooled analysis of 12 cancer clinical trials. ESMO Open 2024; 9:102941. [PMID: 38452437 PMCID: PMC10937229 DOI: 10.1016/j.esmoop.2024.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Oncologists tend to under-report subjective symptoms during cancer treatment. This study describes the under-reporting rate of selected symptoms and explores its association with overall survival (OS). A secondary aim is to test the association of patient-reported symptoms with OS. PATIENTS AND METHODS This is a post hoc analysis on data pooled from 12 randomized trials, promoted by the National Cancer Institute of Naples (Italy), enrolling patients between 2002 and 2019, with published primary analyses. Occurrence and grade of six side-effects (anorexia, nausea, vomiting, constipation, diarrhea and fatigue) reported by physicians were compared with corresponding symptoms reported by patients in quality-of-life (QoL) questionnaires. Under-reporting was defined as the rate of cases reported grade 0 by the physician while grade ≥1 by the patient. Prognostic value was tested in a multivariable model stratified by trial, including age, sex and performance status as confounders. A landmark threshold was defined for OS analyses. RESULTS 3792 patients with advanced lung, ovarian, pancreatic, breast or colorectal cancer were pooled; 2603 (68.6%) were eligible having at least one toxicity assessment and one QoL questionnaire, before the first planned disease restaging. Concordance between physicians' and patients' reporting was low with Cohen's k coefficients ranging from 0.03 (fatigue) to 0.33 (vomiting). Under-reporting ranged from 52.7% (nausea) to 80.5% (anorexia), and was not associated with OS. Patient-reported anorexia, vomiting and fatigue ('a little' or more) were significantly associated with shorter OS. CONCLUSIONS Under-reporting of treatment side-effects is frequent, but it does not affect OS. Patients' reported symptoms should be used for prognostic evaluation.
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Affiliation(s)
- L Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - R Di Liello
- Oncologia Medica, P.O. Ospedale del Mare-ASL Napoli 1 Centro, Naples
| | - P De Placido
- Department of Clinical Medicine and Surgery, Università Federico II, Naples
| | - C Gridelli
- Divisione di Oncologia Medica, A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino
| | - A Morabito
- Oncologia Clinica Sperimentale Toraco-Polmonare, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - S Pignata
- Oncologia Clinica Sperimentale Uroginecologica Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - F Nuzzo
- Oncologia Clinica Sperimentale Di Senologia, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - A Avallone
- Oncologia Clinica Sperimentale Addominale, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - E Maiello
- Oncologia, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - P Gargiulo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - C Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - A Gravina
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - C Gallo
- Statistica Medica, Università della Campania 'Luigi Vanvitelli', Naples
| | - P Chiodini
- Statistica Medica, Università della Campania 'Luigi Vanvitelli', Naples
| | - M Di Maio
- Department of Oncology, Università di Torino, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - F Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - M C Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples.
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Ishimoto T, Fujimoto T, Matsudaira N, Yamamoto N, Hayashi H, Hisamatsu K, Toyota Y, Akazawa N. Association between anorexia as assessed by simplified nutritional appetite questionnaire and sarcopenia in community-dwelling older adults using outpatient rehabilitation: A cross-sectional study. Clin Nutr ESPEN 2024; 59:176-180. [PMID: 38220373 DOI: 10.1016/j.clnesp.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE A previous study reported an association between sarcopenia and anorexia determined by the simplified nutritional appetite questionnaire (SNAQ) in community-dwelling older adults. However, it is unclear in the community-dwelling older adults who are using outpatient rehabilitation. The purpose of this study was to investigate the relationship between anorexia and sarcopenia as judged by SNAQ in community-dwelling older adults using outpatient rehabilitation. METHODS This study included 120 older adults (72.5% female). Subjects were provided outpatient rehabilitation one to three times a week. The main outcome was sarcopenia as determined using the Asian working group for sarcopenia 2019. The simplified nutritional appetite questionnaire (SNAQ) was used to assess anorexia. The SNAQ total score range from 4 (worst) to 20 (best), with 13 score and lower considered to indicate anorexia. Statistical analysis was performed by forced-entry logistic regression analysis with sarcopenia as the dependent variable, body mass index (BMI), food intake level scale, anorexia, and propensity score calculated using age, sex, number of medications, updated Charlson comorbidity index as the independent variable. RESULTS Sarcopenia was observed in 79 of 120 subjects (65.8%). Anorexia was observed in 28 subjects (23.3%). Logistic regression analysis revealed BMI (odds ratio: 0.71 [95% CI: 0.61-0.84]), anorexia (odds ratio: 5.35 [95% CI: 1.24-23.2]) were extracted as a significant variable. CONCLUSIONS The results of this study show that anorexia as determined by the SNAQ is associated with sarcopenia in community-dwelling older adults using outpatient rehabilitation. This indicates the importance of understanding anorexia in assessing sarcopenia in community-dwelling older adults who are using outpatient rehabilitation.
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Affiliation(s)
- Taisei Ishimoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Takehiro Fujimoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Nozomi Matsudaira
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Natsuki Yamamoto
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Hikaru Hayashi
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Ken Hisamatsu
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Yoshio Toyota
- Department of Rehabilitation, Akahige Clinic, Kinokawa, Wakayama, Japan.
| | - Naoki Akazawa
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan.
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Ishida M, Sato S, Sato I, Yoshioka A, Uchida N, Mizunuma N, Hasegawa K, Onishi H. What can cause cancer patients to attempt suicide? Thiamine deficiency mimicking the symptoms of major depressive disorder. Palliat Support Care 2024; 22:205-208. [PMID: 37496388 DOI: 10.1017/s1478951523001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Thiamine deficiency (TD) presents with various physical and psychiatric symptoms, but no cases with depression-like symptoms have been reported. METHODS We report a patient with cancer who appeared to attempt suicide as a consequence of depressive mood likely related to TD. RESULTS The patient was a 58-year-old woman diagnosed with recurrent endometrial cancer, with lung metastasis and pelvic dissemination. The patient apparently attempted suicide was referred to the psycho-oncology department. At the time of the examination, major depressive disorder was suspected based on her mental symptoms, but when thiamine was administered intravenously in response to her poor dietary intake, her palpitations, dyspnea, anorexia, and insomnia improved, and her suicidal ideation disappeared at her reexamination 1 hour later after thiamine administration. SIGNIFICANCE OF RESULTS It is likely that the observed palpitations, dyspnea, anorexia, and insomnia, as well as the severe depression and the attempted suicide, which were thought to be physical symptoms associated with depression, were actually related to TD. Suicidal ideation and attempted suicide are conspicuous as psychiatric symptoms. However, in such cases, rather than simply starting treatment for depression, it is necessary to consider reversible TD as a cause of these symptoms and perform differential diagnosis to confirm the physical illness.
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Affiliation(s)
- Mayumi Ishida
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Sho Sato
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Izumi Sato
- Department of Clinical Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akira Yoshioka
- Department of Medical Oncology and Palliative Care, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Nozomu Uchida
- Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
| | | | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideki Onishi
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Sakaguchi T, Maeda K, Takeuchi T, Mizuno A, Kato R, Ishida Y, Ueshima J, Shimizu A, Amano K, Mori N. Validity of the diagnostic criteria from the Asian Working Group for Cachexia in advanced cancer. J Cachexia Sarcopenia Muscle 2024; 15:370-379. [PMID: 38115133 PMCID: PMC10834352 DOI: 10.1002/jcsm.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Recently, the Asian Working Group for Cachexia (AWGC) published a consensus statement on diagnostic criteria for cachexia in Asians. We aimed to validate the criteria in adult patients in Japan with advanced cancer. METHODS We conducted a single-institution retrospective cohort study between April 2021 and October 2022. The AWGC criteria include chronic comorbidities and either a weight loss of >2% over 3-6 months or a body mass index (BMI) of <21 kg/m2 . In addition, any of the following items were required: anorexia as a subjective symptom, decreased grip strength as an objective measurement and an elevated C-reactive protein (CRP) level as a biomarker. We used the cut-off value of grip strength of 28/18 kg for male/female individuals and CRP level of 5 mg/L. RESULTS Of the 449 consecutive patients, 85 of those who could not be evaluated because of end-of-life or refractory symptoms (n = 41) or missing data (n = 44) were excluded from the primary analysis. The prevalence of the AWGC-defined cachexia was 76% (n = 277), and the median survival time (MST) for all patients was 215 (95% confidence interval [CI] 145-270) days. The prevalence of the following criteria was significantly higher in patients with cachexia than in those without cachexia: a BMI of <21 kg/m2 (65% vs. 15%, P < 0.001), a weight loss of >2% in 6 months (87% vs. 14%, P < 0.001), anorexia (75% vs. 47%, P < 0.001), a grip strength of <28 kg in male individuals (63% vs. 28%, P < 0.001) and CRP level of >5 mg/L (85% vs. 56%, P < 0.001). Overall survival was significantly shorter in patients with cachexia than in those without cachexia (MST 157 days, 95% CI 108-226 days vs. MST 423 days, 95% CI 245 days to not available, P = 0.0023). The Cox proportional hazards analysis showed that best supportive care (hazard ratio [HR] 2.91, P ≤ 0.001), lung cancer (HR 1.67, P = 0.0046), an Eastern Cooperative Oncology Group Performance Status score of ≥3 (HR 1.58, P = 0.016), AWGC-defined cachexia (HR 1.56, P = 0.015), an age of ≥70 years (HR 1.53, P = 0.0070), oedema (HR 1.31, P = 0.022) and head/neck cancer (HR 0.44, P = 0.023) were found to be the significant predictors for mortality. CONCLUSIONS We demonstrated that AWGC-defined cachexia has a significant prognostic value in advanced cancer.
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Affiliation(s)
- Tatsuma Sakaguchi
- Palliative Care Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology University, Obu, Aichi, Japan
| | - Tomoko Takeuchi
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ai Mizuno
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ryoko Kato
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nutritional Service, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Health Science, Faculty of Health and Human Development, University of Nagano, Nagano-shi, Nagano, Japan
| | - Koji Amano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Palliative and Supportive Care Center, Osaka University Hospital, Suita, Osaka, Japan
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
- Department of Palliative Medicine, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Naoharu Mori
- Palliative Care Center, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
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Baenas I, Etxandi M, Fernández-Aranda F. [Medical complications in anorexia and bulimia nervosa]. Med Clin (Barc) 2024; 162:67-72. [PMID: 37598049 DOI: 10.1016/j.medcli.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
Anorexia nervosa and bulimia nervosa are eating disorders associated with life-threatening multisystemic medical complications. This narrative review aimed to present the medical complications most related to these disorders. In anorexia nervosa, many of them are linked to malnutrition and underweight, usually reversible with renutrition and weight restoration, although refeeding can also be linked to some medical complications. Purging behaviors observed in the anorexia nervosa binge-purging subtype and bulimia nervosa have been mainly related to hydrolectrolyte and acid-base disturbances, in addition to local complications. Thus, an early identification and therapeutic intervention of these disorders is considered crucial. Integral medical monitoring should be ensured to prevent potential serious complications from the early stages, with the involvement of physicians, psychologists, nutritionists, and other specialists in a multidisciplinary approach according to the patient's needs.
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Affiliation(s)
- Isabel Baenas
- Unidad de Psicología Clínica, Hospital Universitario de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; Grupo de Investigación de Psiconeurobiología de los Trastornos de la Conducta Alimentaria y Adicciones Comportamentales, Programa de Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España; Programa de Doctorado en Medicina e Investigación Traslacional, Universidad de Barcelona (UB), Barcelona, España
| | - Mikel Etxandi
- Unidad de Psicología Clínica, Hospital Universitario de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; Programa de Doctorado en Medicina e Investigación Traslacional, Universidad de Barcelona (UB), Barcelona, España; Servicio de Psiquiatría, Hospital Universitario Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, España
| | - Fernando Fernández-Aranda
- Unidad de Psicología Clínica, Hospital Universitario de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; Grupo de Investigación de Psiconeurobiología de los Trastornos de la Conducta Alimentaria y Adicciones Comportamentales, Programa de Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, España.
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Ali AA, Stemboroski L, Ravi M. Acute HIV presenting as rhabdomyolysis. BMJ Case Rep 2023; 16:e255621. [PMID: 37793847 PMCID: PMC10551877 DOI: 10.1136/bcr-2023-255621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
A man, in his early 30s, with no significant medical history presented with a 2-week history of fatigue, chest and abdominal pain, associated with anorexia and vomiting. Initial laboratory testing was suggestive of rhabdomyolysis with acute renal failure and transaminitis. The aetiology of his rhabdomyolysis initially remained unexplained as there were no clear risk factors or inciting events. An extensive workup revealed acute HIV as the precipitant of rhabdomyolysis.
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Affiliation(s)
- Aleem Azal Ali
- Gastroenterology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Lauren Stemboroski
- Gastroenterology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Malleswari Ravi
- Infectious Disease, University of Florida College of Medicine, Jacksonville, Florida, USA
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10
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Cazzuli G, Suárez G, Busconi S, Damián JP, Pessina P. Clinical signs associated with prostatic disorders in canines: Retrospective study in Uruguay (2011-2019). Open Vet J 2023; 13:1308-1317. [PMID: 38027403 PMCID: PMC10658021 DOI: 10.5455/ovj.2023.v13.i10.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Prostate disease represents about 0.7% of diseases in canines. The main diagnosed pathology is benign prostatic hyperplasia (BPH). However, the reports that study the association of a certain clinical sign with a specific prostate disease are scarce. Aim The main objective of this study was to evaluate the clinical relevance of the most commonly observed clinical signs associated with the different prostatic disorders in canines admitted to the hospital of the Facultad de Veterinaria-Universidad de la República between 2011 and 2019. Methods This retrospective study included 7,729 male canines treated at the hospital de la Facultad de Veterinaria-Universidad de la República (Montevideo, Uruguay) between 2011 and 2019. 289 canines with a presumptive/definitive diagnosis of prostate diseases were selected, recording the presence/absence of associated clinical signs. Results were reported in terms of odds ratios (ORs) using logistic regression (p < 0.05). Results The five most frequently reported clinical signs were tenesmus (34%), anorexia (32%), lethargy (27%), prostatomegaly or pain during rectal examination (25%), and abdominal pain from palpation (22%). Diarrhea (3.39 vs. 0.33 OR), anorexia (2.07 vs. 0.39 OR), weight loss (2.27 vs. 0.27 OR), hematuria (3.25 vs. 0.44 OR), and urinary incontinence (2.96 vs. 0.33 OR) indicated a highest predictive value (p < 0.05) with prostatitis versus BPH, respectively. Being weight loss, the clinical sign is more frequently associated with neoplasia (20.2 OR, p = 0.002). Conclusion This study shows that there are clinical signs with a higher degree of association for certain canine prostatic disorders than others.
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Affiliation(s)
- Guillermo Cazzuli
- Departamento de Clínicas y Hospital Veterinario, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Gonzalo Suárez
- Departamento de Clínicas y Hospital Veterinario, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Stefania Busconi
- Departamento de Clínicas y Hospital Veterinario, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Juan Pablo Damián
- Departamento de Biociencias Veterinarias, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Paula Pessina
- Departamento de Clínicas y Hospital Veterinario, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
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11
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Wynn J, Chan S, Yeung JM, Pellegrino SA. Gastrointestinal histoplasmosis presenting as a small bowel obstruction in an immunocompetent patient. BMJ Case Rep 2023; 16:e255349. [PMID: 37562860 PMCID: PMC10423768 DOI: 10.1136/bcr-2023-255349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
The clinical presentation of gastrointestinal histoplasmosis (GIH) is often non-specific, mimicking several other gastrointestinal diseases, making diagnosis difficult. We present a case of GIH, causing bowel obstruction in an immunocompetent patient. A woman in her 80s presented with anorexia and a distended abdomen. A CT scan of the abdomen and pelvis (CTAP) showed ileal thickening. Endoscopy was performed and ileal biopsies were taken. A diagnosis of histoplasmosis was made by histopathology, and she began treatment with liposomal amphotericin and itraconazole. Despite presenting well at her routine follow-up appointments, she presented 4 months after diagnosis with worsening symptoms of anorexia and abdominal distention. CTAP showed the ileal stricture causing bowel obstruction. She underwent itraconazole and steroid treatment while having nasogastric tube decompression. Subsequent gastrografin follow through showing partial obstruction and surgical resection was planned. Unfortunately, her condition deteriorated, her kidney function worsened and she suffered from aspiration pneumonia with eventual demise.
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Affiliation(s)
- Jessica Wynn
- Department of General Surgery, Western Health, Footscray, Victoria, Australia
| | - Stephen Chan
- Department of Pathology, Western Health, Footscray, Victoria, Australia
| | - Justin Mc Yeung
- Department of Colorectal Surgery, Western Health, Footscray, Victoria, Australia
- Department of Surgery, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
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Padmaprakash KV, Thareja S, Raman N, Muthukrishnan J, Miglani A, Summi P, Reddy SN. Gastrointestinal manifestations in symptomatic Coronavirus disease - 19 patients and its relevance in predicting severity and outcome. Indian J Gastroenterol 2023; 42:485-495. [PMID: 37329490 DOI: 10.1007/s12664-023-01370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/10/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Recent developments characterizing the pathophysiological basis of infection in the Coronavirus disease - 19 (COVID-19) have stirred great interest in studying this disease outside the purview of respiratory involvement and especially focusing on the gastrointestinal (GI) system. The present study involving a large cohort of COVID-19-infected patients reports on the characteristics of GI manifestations in patients infected with COVID-19 as well as the predictive role in their association with disease severity and adverse outcomes. METHODS A retrospective cohort study was carried out in a tertiary care hospital in northern India. Descriptive analysis of GI symptoms was carried out followed by predictive analysis assessing COVID-19 severity and with the primary endpoint of 28-day in-hospital all-cause mortality. RESULTS Of 3842 hospitalized COVID-19 patients, 2113 (55%) were symptomatic. GI symptoms were present in 163 (7.1%) patients. Common GI symptoms were diarrhea 65 (3.1%), anorexia 61 (2.9%) and vomiting 37 (1.8%). Mild and moderate-to-severe disease was seen in 1725 (81.6%) and 388 (18.4%) patients, respectively. Logistic regression showed greater odds of moderate-to-severe disease in patients with any GI symptoms (odds ratio [OR] 1.849, 95% CI 1.289-2.651 [p = 0.001]) and anorexia in particular (OR 2.797, 95% CI 1.647-4.753 [p = 0.001]); however, on multivariable-analysis, this association lost its significance. A total of 172 patients succumbed to illness. In the Cox proportional hazards model for mortality, patients with any GI symptom (HR 2.184, 95 CI 1.439-3.317 [p < 0.001]) and anorexia (HR 3.556, 95% CI 2.155-5.870 [p < 0.001]) had higher risk. In multi-variable analysis after adjustment to age, sex, oxygen saturation and comorbidities, the presence of any GI symptom was a significant predictor of mortality (hazard ratio adjusted [HRadj] 1.758, 95% CI 1.147-2.694 [p = 0.010]). CONCLUSION GI symptoms were common among patients infected with COVID-19. The presence of any GI symptom was a significant predictor of the risk of mortality after adjustment to respiratory failure, age, sex and pre-existing comorbidities. The clinical and pathophysiological basis of these associations has been explored.
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Affiliation(s)
| | | | - Nishant Raman
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
| | | | - Aman Miglani
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
| | - Pankaj Summi
- Base Hospital, Delhi Cantt, New Delhi, 110 010, India
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13
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Sandhya L, Devi Sreenivasan N, Goenka L, Dubashi B, Kayal S, Solaiappan M, Govindarajalou R, Kt H, Ganesan P. Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer. J Clin Oncol 2023; 41:2617-2627. [PMID: 36977285 DOI: 10.1200/jco.22.01997] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Anorexia occurs in 30%-80% of patients with advanced malignancies, which may be worsened with chemotherapy. This trial assessed the efficacy of olanzapine in stimulating appetite and improving weight gain in patients receiving chemotherapy. METHODS Adults (≥18 years) with untreated, locally advanced, or metastatic gastric, hepatopancreaticobiliary (HPB), and lung cancers were randomly assigned (double-blind) to receive olanzapine (2.5 mg once a day for 12 weeks) or placebo along with chemotherapy. Both groups received standard nutritional assessment and dietary advice. The primary outcomes were the proportion of patients with weight gain > 5% and the improvement in appetite (assessed by the visual analog scale [VAS] and the Functional Assessment of Chronic Illness Therapy system of Quality-of-Life questionnaires Anorexia Cachexia subscale [FAACT ACS]). Secondary end points were change in nutritional status, quality of life (QOL), and chemotherapy toxicity. RESULTS We enrolled 124 patients (olanzapine, 63 and placebo, 61) with a median age of 55 years (18-78 years), of whom 112 (olanzapine, 58 and placebo, 54) were analyzable. The majority (n = 99, 80%) had metastatic cancer (gastric [n = 68, 55%] > lung [n = 43, 35%] > HPB [n = 13, 10%]). The olanzapine arm had a greater proportion of patients with a weight gain of > 5% (35 of 58 [60%] v 5 of 54 [9%], P < .001) and improvement in appetite by VAS (25 of 58 [43%] v 7 of 54 [13%], P < .001) and by FAACT ACS (scores ≥37:13 of 58 [22%] v 2 of 54 [4%], P = .004). Patients on olanzapine had better QOL, nutritional status, and lesser chemotoxicity. Side effects attributable to olanzapine were minimal. CONCLUSION Low-dose, daily olanzapine is a simple, inexpensive, well-tolerated intervention that significantly improves appetite and weight gain in newly diagnosed patients on chemotherapy.
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Affiliation(s)
- Lakshmi Sandhya
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nirmala Devi Sreenivasan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Luxitaa Goenka
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Manikandan Solaiappan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ramkumar Govindarajalou
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Harichandrakumar Kt
- Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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14
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Mitsunaga S. [Development of Therapy for Cancer Cachexia in Pancreatic Cancer]. Gan To Kagaku Ryoho 2022; 49:728-731. [PMID: 35851339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cancer cachexia is a metabolic disorder syndrome that causes skeletal muscle loss and progressive physical dysfunction, which is observed in more than half of patients with advanced pancreatic cancer. Cancer cachexia is considered to be associated with poor prognosis, worsening adverse events, decreased treatment compliance, and decreased treatment efficacy. The ghrelin receptor agonist leads skeletal muscle gain, weight gain, and the improvement of anorexia in patients with cancer cachexia, and has been approved as an anti-cachexia treatment in Japan. Cancer cachexia patients who present with cachexia symptoms such as appetite loss as well as weight loss are able to receive the treatment of the ghrelin receptor agonist, but the evidence for patients with advanced pancreatic cancer is limited. Further research is needed to evaluate the efficacy of the ghrelin receptor agonist for cancer cachexia in pancreatic cancer patients. Inhibition of inflammatory cytokine such as interleukin-1α and nutrition and exercise therapy are under development for anti-cachexia therapy.
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Affiliation(s)
- Shuichi Mitsunaga
- Dept. of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East
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15
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Edell AS, Vella DG, Sheen JC, Carotenuto SE, McKee T, Bergman PJ. Retrospective analysis of risk factors, clinical features, and prognostic indicators for urolithiasis in guinea pigs: 158 cases (2009-2019). J Am Vet Med Assoc 2022; 260:S95-S100. [PMID: 35333752 DOI: 10.2460/javma.21.09.0421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate risk factors, clinical features, and prognostic indicators in guinea pigs with urolithiasis. ANIMALS 158 guinea pigs with urolithiasis. PROCEDURES Medical records of an exotics animal specialty service were searched, identifying guinea pigs with urolithiasis. Signalment, clinical data, and outcomes were recorded. Variables of interest were analyzed for statistical associations with outcome. RESULTS Overall, 54.4% (86/158) of animals survived to discharge. Median survival time was 177 days. Females (53.2%; 84/158) were more common than males (46.8%; 74/158). Males were presented younger (mean age, 3.64 years) than females (4.41 years). In 81 of 154 (52.5%) cases, animals were presented with primary urinary concerns, while 73 (47.5%) presented for nonurinary primary concerns. Females more commonly presented with distal urinary tract urolithiasis (63/84; 75%) but fared better overall with a longer median survival time (1,149 days) than males (59 days). Surgical intervention was not a risk factor for nonsurvival; however, increased age (> 4.1 years), male sex, anorexia, weight loss, and lower rectal temperature (< 37.2 °C) on presentation were associated with nonsurvival. Reoccurrence was noted in 13.9% (22/158) of cases, at an average of 284 days. CLINICAL RELEVANCE Urolithiasis should always be considered a differential diagnosis for any unwell guinea pig. In particular, distal urinary tract urolithiasis should be considered in females. A poorer prognosis was associated with older, male guinea pigs, and those displaying anorexia, weight loss, and hypothermia. The need for surgical intervention should not confer a poorer outcome. Further studies are needed to determine specific risk factors and identify possible preventative measures.
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Affiliation(s)
- Analisa S Edell
- VCA Valley Animal Hospital and Emergency Center, Tucson, AZ
- Wildlife Safari, Winston, OR
| | - David G Vella
- Sydney Exotics and Rabbits Vets, Artarmon, NSW, Australia
| | - Joanne C Sheen
- Sydney Exotics and Rabbits Vets, Artarmon, NSW, Australia
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Albuquerque B, Chen X, Hirenallur-Shanthappa D, Zhao Y, Stansfield JC, Zhang BB, Sheikh A, Wu Z. Neutralization of GDF15 Prevents Anorexia and Weight Loss in the Monocrotaline-Induced Cardiac Cachexia Rat Model. Cells 2022; 11:cells11071073. [PMID: 35406637 PMCID: PMC8997866 DOI: 10.3390/cells11071073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
Growth and differentiation factor 15 (GDF15) is a cytokine reported to cause anorexia and weight loss in animal models. Neutralization of GDF15 was efficacious in mitigating cachexia and improving survival in cachectic tumor models. Interestingly, elevated circulating GDF15 was reported in patients with pulmonary arterial hypertension and heart failure, but it is unclear whether GDF15 contributes to cachexia in these disease conditions. In this study, rats treated with monocrotaline (MCT) manifested a progressive decrease in body weight, food intake, and lean and fat mass concomitant with elevated circulating GDF15, as well as development of right-ventricular dysfunction. Cotreatment of GDF15 antibody mAb2 with MCT prevented MCT-induced anorexia and weight loss, as well as preserved lean and fat mass. These results indicate that elevated GDF15 by MCT is causal to anorexia and weight loss. GDF15 mAb2 is efficacious in mitigating MCT-induced cachexia in vivo. Furthermore, the results suggest GDF15 inhibition is a potential therapeutic approach to alleviate cardiac cachexia in patients.
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Affiliation(s)
- Bina Albuquerque
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (B.A.); (Y.Z.); (B.B.Z.); (A.S.)
| | - Xian Chen
- Comparative Medicine, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (X.C.); (D.H.-S.)
| | - Dinesh Hirenallur-Shanthappa
- Comparative Medicine, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (X.C.); (D.H.-S.)
| | - Yang Zhao
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (B.A.); (Y.Z.); (B.B.Z.); (A.S.)
| | - John C. Stansfield
- Biostatistics, Early Clinical Development, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA;
| | - Bei B. Zhang
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (B.A.); (Y.Z.); (B.B.Z.); (A.S.)
| | - Abdul Sheikh
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (B.A.); (Y.Z.); (B.B.Z.); (A.S.)
| | - Zhidan Wu
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development & Medical, Cambridge, MA 02139, USA; (B.A.); (Y.Z.); (B.B.Z.); (A.S.)
- Correspondence:
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17
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Lee B, Park HJ, Jung SY, Kwon OJ, Ko MM, Jeong HA, Jung J. Effects of Bojungikgi-tang on anorexic patients with atopic dermatitis: A protocol for a randomized, usual care-controlled, assessor-blinded, parallel, pilot clinical trial. Medicine (Baltimore) 2022; 101:e28965. [PMID: 35244061 PMCID: PMC8896432 DOI: 10.1097/md.0000000000028965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Anorexia and atopic dermatitis (AD) are highly prevalent diseases, and the herbal medicine Bojungikgi-tang (BJT) has been frequently used for the treatment of both anorexia and AD. However, no study has simultaneously evaluated the effects of BJT for both anorexia and AD. METHODS A prospective, randomized, usual care-controlled, assessor-blinded. parallel, pilot clinical trial has been designed to explore the feasibility, preliminary effectiveness, and safety of BJT for the treatment of anorexic patients with AD. Forty anorexic patients with AD will be randomly assigned (1:1) to BJT or the usual care group. The BJT group will be administered BJT granules twice a day for 8 weeks and followed up for 4 weeks whereas the usual care group will not receive BJT granules. All participants in both groups will be provided with over-the-counter topical corticosteroids as a relief drug. Data will be collected at baseline and at 4, 8, and 12 weeks after randomization. The primary outcome is the score on the anorexia visual analog scale at 8 weeks post-treatment. The secondary outcomes include body weight, body fat percentage, body fat mass, skeletal muscle mass, SCORing of Atopic Dermatitis index, Validated Investigator Global Assessment scale for Atopic Dermatitis, Dermatology Life Quality Index, EuroQoL 5 Dimension 5 Level, deficiency and excess pattern identification questionnaire, total immunoglobulin E, eosinophil count, and frequency and amount of use of topical corticosteroids. Adverse events and laboratory test results will be monitored to assess safety. Fecal samples to check for gut microbiome changes and blood samples to check immune and metabolic markers will be collected before and after taking BJT. DISCUSSION This is the first trial that explores the preliminary effectiveness and safety of BJT for the treatment of anorexic patients with AD. The results of this pilot study will provide the basic evidence for large-scale, confirmatory, multicenter, high-quality clinical trials. TRIAL REGISTRATION Clinical Research Information Service, KCT0006784 (registered on November 26, 2021).
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Affiliation(s)
- Boram Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyunghee-daero 26, Dongdaemun-gu, Seoul, Republic of Korea
| | - Hyo-Ju Park
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Yuseong-daero 1672, Yuseong-gu, Daejeon, Republic of Korea
| | - So Young Jung
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Yuseong-daero 1672, Yuseong-gu, Daejeon, Republic of Korea
| | - O-Jin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Yuseong-daero 1672, Yuseong-gu, Daejeon, Republic of Korea
| | - Mi Mi Ko
- KM Science Research Division, Korea Institute of Oriental Medicine, Yuseong-daero 1672, Yuseong-gu, Daejeon, Republic of Korea
| | - Hyun Ah Jeong
- Department of Korean Medicine Ophthalmology & Otolaryngology & Dermatology, Daejeon Korean Medicine Hospital of Daejeon University, Daedeok-daero 176 beon-gil 75, Seo-gu, Daejeon, Republic of Korea
| | - Jeeyoun Jung
- KM Science Research Division, Korea Institute of Oriental Medicine, Yuseong-daero 1672, Yuseong-gu, Daejeon, Republic of Korea
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18
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Huen SC. Metabolism as Disease Tolerance: Implications for Sepsis-Associated Acute Kidney Injury. Nephron Clin Pract 2022; 146:291-294. [PMID: 34161955 PMCID: PMC8695642 DOI: 10.1159/000516877] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/24/2021] [Indexed: 01/03/2023] Open
Abstract
Sepsis is a significant cause for mortality among critically ill patients. Metabolic derangements that develop in sepsis are often considered to be pathologic, contributing to sepsis morbidity and mortality. However, alterations in metabolism during sepsis are multifaceted and are incompletely understood. Acute anorexia during infection is an evolutionarily conserved response, suggesting a potential protective role of anorexia in the host response to infection. In animal models of bacterial inflammation, fasting metabolic programs associated with acute anorexia such as those regulated by fibroblast growth factor 21 and ketogenesis are associated with improved survival. Other fasting metabolic pathways such as fatty acid oxidation and autophagy are also implicated in preventing acute kidney injury (AKI). Global metabolic changes during sepsis and current clinical interventions can potentially affect disease tolerance mechanisms and modify the risk of AKI.
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Affiliation(s)
- Sarah C Huen
- Departments of Internal Medicine-Nephrology and Pharmacology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Westwater ML, Mancini F, Shapleske J, Serfontein J, Ernst M, Ziauddeen H, Fletcher PC. Dissociable hormonal profiles for psychopathology and stress in anorexia and bulimia nervosa. Psychol Med 2021; 51:2814-2824. [PMID: 32460904 PMCID: PMC8640366 DOI: 10.1017/s0033291720001440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/13/2020] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and bulimia nervosa (BN) are complex psychiatric conditions, in which both psychological and metabolic factors have been implicated. Critically, the experience of stress can precipitate loss-of-control eating in both conditions, suggesting an interplay between mental state and metabolic signaling. However, associations between psychological states, symptoms and metabolic processes in AN and BN have not been examined. METHODS Eighty-five women (n = 22 AN binge/purge subtype, n = 33 BN, n = 30 controls) underwent remote salivary cortisol sampling and a 2-day, inpatient study session to examine the effect of stress on cortisol, gut hormones [acyl-ghrelin, peptide tyrosine tyrosine (PYY) and glucagon-like peptide-1] and food consumption. Participants were randomized to either an acute stress induction or control task on each day, and plasma hormones were serially measured before a naturalistic, ad libitum meal. RESULTS Cortisol-awakening response was augmented in AN but not in BN relative to controls, with body mass index explaining the most variance in post-awakening cortisol (36%). Acute stress increased acyl-ghrelin and PYY in AN compared to controls; however, stress did not alter gut hormone profiles in BN. Instead, a group-by-stress interaction showed nominally reduced cortisol reactivity in BN, but not in AN, compared to controls. Ad libitum consumption was lower in both patient groups and unaffected by stress. CONCLUSIONS Findings extend previous reports of metabolic dysfunction in binge-eating disorders, identifying unique associations across disorders and under stress. Moreover, we observed disrupted homeostatic signaling in AN following psychological stress, which may explain, in part, the maintenance of dysregulated eating in this serious illness.
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Affiliation(s)
- Margaret L. Westwater
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
| | - Flavia Mancini
- Department of Engineering, Computational and Biological Learning Laboratory, University of Cambridge, CambridgeCB2 1PZ, UK
| | - Jane Shapleske
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Jaco Serfontein
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Monique Ernst
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Paul C. Fletcher
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
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Olson B, Zhu X, Norgard MA, Levasseur PR, Butler JT, Buenafe A, Burfeind KG, Michaelis KA, Pelz KR, Mendez H, Edwards J, Krasnow SM, Grossberg AJ, Marks DL. Lipocalin 2 mediates appetite suppression during pancreatic cancer cachexia. Nat Commun 2021; 12:2057. [PMID: 33824339 PMCID: PMC8024334 DOI: 10.1038/s41467-021-22361-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
Lipocalin 2 (LCN2) was recently identified as an endogenous ligand of the type 4 melanocortin receptor (MC4R), a critical regulator of appetite. However, it remains unknown if this molecule influences appetite during cancer cachexia, a devastating clinical entity characterized by decreased nutrition and progressive wasting. We demonstrate that LCN2 is robustly upregulated in murine models of pancreatic cancer, its expression is associated with reduced food consumption, and Lcn2 deletion is protective from cachexia-anorexia. Consistent with LCN2's proposed MC4R-dependent role in cancer-induced anorexia, pharmacologic MC4R antagonism mitigates cachexia-anorexia, while restoration of Lcn2 expression in the bone marrow is sufficient in restoring the anorexia feature of cachexia. Finally, we observe that LCN2 levels correlate with fat and lean mass wasting and is associated with increased mortality in patients with pancreatic cancer. Taken together, these findings implicate LCN2 as a pathologic mediator of appetite suppression during pancreatic cancer cachexia.
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Affiliation(s)
- Brennan Olson
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - Xinxia Zhu
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Mason A Norgard
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Peter R Levasseur
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - John T Butler
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - Abigail Buenafe
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kevin G Burfeind
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - Katherine A Michaelis
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - Katherine R Pelz
- Brenden-Colson Center for Pancreatic Care, Oregon Health and & Science University, Portland, OR, USA
| | - Heike Mendez
- Brenden-Colson Center for Pancreatic Care, Oregon Health and & Science University, Portland, OR, USA
| | - Jared Edwards
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Stephanie M Krasnow
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Aaron J Grossberg
- Brenden-Colson Center for Pancreatic Care, Oregon Health and & Science University, Portland, OR, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Daniel L Marks
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, OR, USA.
- Brenden-Colson Center for Pancreatic Care, Oregon Health and & Science University, Portland, OR, USA.
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
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Abstract
Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.
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Affiliation(s)
- Rhona Williams
- Faculty of Health and Social Work, Midwifery and Child Health, University of Hull, Hull, England
| | - Matthew Smith
- Children's and Adolescent Services, Hull University Teaching Hospitals NHS Trust, Hull, England
| | - David Wright
- Midwifery and Child Health, University of Hull, Hull, England
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Al-Obeidi RA, Al-Numan AH. Study of low vitamin D among children with anorexia in Sulaymaniyah, Kurdistan region, Iraq during summer months. Saudi Med J 2019; 40:1129-1133. [PMID: 31707410 PMCID: PMC6901778 DOI: 10.15537/smj.2019.11.24598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the impact of vitamin D deficiency and insufficiency on the development of anorexia in children with mild malnutrition without an obvious cause. Methods: This cross-sectional study was conducted in Faruk Medical City, Sulaymaniyah, Kurdistan Region, Iraq, between May and September 2018. It included 39 mildly malnourished children with a poor appetite for over 3 months and 156 children who were healthy except for minor illnesses as the control group. All the children were regular attendees at the outpatient clinic and were tested for serum levels of 25-hydroxy vitamin D. We used binary logistic regression statistical analysis to measure the significance of the association between vitamin D deficiency/insufficiency and anorexia with mild malnutrition in young children. Results: Of the 39 children in the anorexia group, 20 had vitamin D deficiency, and the remaining 6 had vitamin D insufficiency. On the other hand, 16 of the remaining children with normal appetites, showed a vitamin D deficiency, and 38 of them displayed insufficiency. Statistically significant association between vitamin D deficiency and anorexia with malnutrition was noted (odd ratio: 9.808; 95% confidence interval: 4.089 - 23.523; p=0.0001), while it was insignificant with vitamin D insufficiency. Conclusion: This study displayed a noteworthy relationship between vitamin D deficiency and anorexia with mild malnutrition in young children.
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Affiliation(s)
- Riyadh A Al-Obeidi
- Department of Pediatric, College of Medicine, University of Mosul, Mosul, Iraq. E-mail.
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23
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Mortazaei S, Sahraei H, Bahari Z, Meftahi GH, Pirzad Jahromi G, Hatef B. Ventral tegmental area inactivation alters hormonal, metabolic, and locomotor responses to inescapable stress. Arch Physiol Biochem 2019; 125:293-301. [PMID: 29580092 DOI: 10.1080/13813455.2018.1455711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Context: The involvement of unilateral and bilateral inhibition of the ventral tegmental area (VTA) in response to stress is not well understood. Objective: In the present study, the effect of unilateral and bilateral inhibition of the VTA on hormonal, metabolic, and locomotor responses to stress was assessed. Material and methods: Male rats seven days after cannulation into the VTA received electro foot-shock stress for seven consecutive days. Twenty minutes before induction of stress, 2% lidocaine hydrochloride or sterile saline (control) was injected either uni- or bi-laterally into the VTA. Results: Results showed that stress significantly increased serum corticosterone level, adrenal gland weight and anorexia, reduced weight gain, food-intake, and locomotor activity. However, bilateral inactivation of VTA prevented stress-induced these parameters changes. Conclusion: The present study demonstrated that the bilateral VTA blockade effectively relieves the symptoms of stress, while the unilateral VTA blockade does not significantly improve the changes caused by stress.
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Affiliation(s)
| | - Hedayat Sahraei
- b Neuroscience Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Zahra Bahari
- c Department of Physiology and Biophysics, Faculty of Medicine, Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Gholam Hossein Meftahi
- b Neuroscience Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Gila Pirzad Jahromi
- b Neuroscience Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
| | - Boshra Hatef
- b Neuroscience Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
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24
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Abstract
PURPOSE OF REVIEW Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment. RECENT FINDINGS Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice. SUMMARY Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Sivero L, Telesca DA, Gentile M, Aprea G, Massa G, Cestaro G, Danzi M, Sivero S, Formisano C. Percutaneous endoscopic gastrostomy (PEG), in elderly patients with dementia and anorexia. Medical and ethical issues regarding placement. Ann Ital Chir 2018; 89:305-308. [PMID: 30337506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Ethical and medico-legal issues reviews of Percutaneous Endoscopic Gastrostomy (PEG) placement in elderly patients is an important topic of international medical literature. PEG is often inappropriately placed in patients with not spontaneous oral feeding intake, cause of unrealistic expectations. We performed a critical review of the literature for placement of PEG in geriatric patients. METHODS A literature review was performed about the positioning of the PEG in geriatric patients with dementia and severe anorexia. This assessment has served to develop an algorithm that would be able to provide adequate indications for PEG placement in this patient population. RESULTS We obtained appropriate indications about PEG placement, below: 1) Esophageal obstructions (like esophageal or neck cancer) 2) neurological deficits correlated dysphagia (like ictus sequelae) 3) refusal to swallow without concomitant terminal illness (like protracted pseudo dementia caused by severe depression) 4) chronic gastric decompression in patients with benign/malignant obstruction who do not wish or can't have a nasogastric tube placed. CONCLUSIONS When compared with controls matched for age, elderly patients with cognitive impairment who have feeding gastrostomy do not demonstrate improved survival. KEY WORDS Anorexia, Dementia, Elderly, Percutaneous Endoscopic Gastrostomy.
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26
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Iacobucci G. Student who died from anorexia was failed by NHS, review finds. BMJ 2017; 359:j5731. [PMID: 29229629 DOI: 10.1136/bmj.j5731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Bassiouny MA, Tweddale E. Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care. Gen Dent 2017; 65:24-31. [PMID: 28862585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.
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28
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome. RECENT FINDINGS Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition. SUMMARY Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.
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Affiliation(s)
- Angela M Sanford
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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29
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Suzuki MH. [Endocrine and Metabolic Emergencies; Points of Initial Management. Topics: VI. Emergency treatment for eating disorders and refeeding syndrome]. Nihon Naika Gakkai Zasshi 2016; 105:676-682. [PMID: 27491261 DOI: 10.2169/naika.105.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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30
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Wang FF, Xu L, Chen BX, Cui M, Zhang Y. [Anorexia with sinus bradycardia: a case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:180-182. [PMID: 26885932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus bradycardia and hypothyroidism have good prognosis. And asymptomatic sinus bradycardia with reversible causes, because of the great prognosis, they do not need special treatment. Multiple medical and psychiatric disciplines were consulted, and then, family care, nutritional support and psychiatric therapy were given, and she did not need thyroid hormone replacement therapy. The patient's overall clinical status improved gradually during her hospital stay and her heart rate was recovered to 55 beats per minute.
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Affiliation(s)
- Fang-fang Wang
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China
| | - Ling Xu
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China
| | - Bao-xia Chen
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China
| | - Ming Cui
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China
| | - Yuan Zhang
- Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China
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Yennurajalingam S, Williams JL, Chisholm G, Bruera E. Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report. Oncologist 2016; 21:384-90. [PMID: 26888692 DOI: 10.1634/theoncologist.2014-0260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/11/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters in patients with advanced cancer. METHODS We reviewed the data from a previous randomized clinical trial to determine the effects of dexamethasone on cancer symptoms. Symptom clusters were identified according to baseline symptoms by using principal component analysis. Correlations and change in the severity of symptom clusters were analyzed after study treatment. RESULTS A total of 114 participants were included in this study. Three clusters were identified: fatigue/anorexia-cachexia/depression (FAD), sleep/anxiety/drowsiness (SAD), and pain/dyspnea (PD). Changes in severity of FAD and PD significantly correlated over time (at baseline, day 8, and day 15). The FAD cluster was associated with significant improvement in severity at day 8 and day 15, whereas no significant change was observed with the SAD cluster or PD cluster after dexamethasone treatment. CONCLUSION The results of this preliminary study suggest significant correlation over time and improvement in the FAD cluster at day 8 and day 15 after treatment with dexamethasone. These findings suggest that fatigue, anorexia-cachexia, and depression may share a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Mohabeer Hart M, Boffito M, Pozniak A. Unexpected rapid weight gain in a patient with HIV and anorexia. BMJ 2015; 351:h5551. [PMID: 26514997 DOI: 10.1136/bmj.h5551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Malika Mohabeer Hart
- Department of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation, London SW10 9NH, UK
| | - Marta Boffito
- Department of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation, London SW10 9NH, UK
| | - Anton Pozniak
- Department of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation, London SW10 9NH, UK
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Lindfors C, Katz A, Selander L, Johansen JE, Marconi G, Schalling M, Hökfelt T, Berggren PO, Zaitsev S, Nilsson IAK. Glucose intolerance and pancreatic β-cell dysfunction in the anorectic anx/anx mouse. Am J Physiol Endocrinol Metab 2015; 309:E418-27. [PMID: 26126683 DOI: 10.1152/ajpendo.00081.2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 12/21/2022]
Abstract
Inflammation and impaired mitochondrial oxidative phosphorylation are considered key players in the development of several metabolic disorders, including diabetes. We have previously shown inflammation and mitochondrial dysfunction in the hypothalamus of an animal model for anorexia, the anx/anx mouse. Moreover, increased incidence of eating disorders, e.g., anorexia nervosa, has been observed in diabetic individuals. In the present investigation we evaluated whether impaired mitochondrial phosphorylation and inflammation also occur in endocrine pancreas of anorectic mice, and if glucose homeostasis is disturbed. We show that anx/anx mice exhibit marked glucose intolerance associated with reduced insulin release following an intraperitoneal injection of glucose. In contrast, insulin release from isolated anx/anx islets is increased after stimulation with glucose or KCl. In isolated anx/anx islets there is a strong downregulation of the mitochondrial complex I (CI) assembly factor, NADH dehydrogenase (ubiquinone) 1α subcomplex, assembly factor 1 (Ndufaf1), and a reduced CI activity. In addition, we show elevated concentrations of free fatty acids (FFAs) in anx/anx serum and increased macrophage infiltration (indicative of inflammation) in anx/anx islets. However, isolated islets from anx/anx mice cultured in the absence of FFAs do not exhibit increased inflammation. We conclude that the phenotype of the endocrine pancreas of the anx/anx mouse is characterized by increased levels of circulating FFAs, as well as inflammation, which can inhibit insulin secretion in vivo. The anx/anx mouse may represent a useful tool for studying molecular mechanisms underlying the association between diabetes and eating disorders.
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Affiliation(s)
- Charlotte Lindfors
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Abram Katz
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden; Ariel University, Department of Physical Therapy, Ariel, Israel
| | - Lars Selander
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette E Johansen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Giulia Marconi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Hökfelt
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; and
| | - Per-Olof Berggren
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sergei Zaitsev
- The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Belozersky Institute of Physico-Chemical Biology and Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden;
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Pasalar M, Mehrabani D, Afrasiabi A, Mehravar Z, Reyhani I, Hamidi R, Karimi M. Prevalence of thalassaemia, iron-deficiency anaemia and glucose-6-phosphate dehydrogenase deficiency among Arab migrating nomad children, southern Islamic Republic of Iran. East Mediterr Health J 2014; 20:726-731. [PMID: 25601811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/18/2014] [Indexed: 06/04/2023]
Abstract
This study investigated the prevalence of iron-deficiency anaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency and β-thalassaemia trait among Arab migrating nomad children in southern Islamic Republic of Iran. Blood samples were analysed from 134 schoolchildren aged < 18 years (51 males, 83 females). Low serum ferritin (< 12 ng/dL) was present in 17.9% of children (21.7% in females and 11.8% in males). Low haemoglobin (Hb) correlated significantly with a low serum ferritin. Only 1 child had G6PD deficiency. A total of 9.7% of children had HbA2 ≥ 3.5 g/dL, indicating β-thalassaemia trait (10.8% in females and 7.8% in males). Mean serum iron, serum ferritin and total iron binding capacity were similar in males and females. Serum ferritin index was as accurate as Hb index in the diagnosis of iron-deficiency anaemia. A high prevalence of β-thalassaemia trait was the major potential risk factor in this population.
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Affiliation(s)
- M Pasalar
- Haematology Research Centre, Nemazee Hospital, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - D Mehrabani
- Stem Cell and Transgenic Technology Research Centre, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - A Afrasiabi
- Haematology Research Centre, Nemazee Hospital, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Z Mehravar
- Haematology Research Centre, Nemazee Hospital, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - I Reyhani
- Stem Cell and Transgenic Technology Research Centre, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - R Hamidi
- Haematology Research Centre, Nemazee Hospital, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - M Karimi
- Haematology Research Centre, Nemazee Hospital, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Bachmann KN, Fazeli PK, Lawson EA, Russell BM, Riccio AD, Meenaghan E, Gerweck AV, Eddy K, Holmes T, Goldstein M, Weigel T, Ebrahimi S, Mickley D, Gleysteen S, Bredella MA, Klibanski A, Miller KK. Comparison of hip geometry, strength, and estimated fracture risk in women with anorexia nervosa and overweight/obese women. J Clin Endocrinol Metab 2014; 99:4664-73. [PMID: 25062461 PMCID: PMC4255123 DOI: 10.1210/jc.2014-2104] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Data suggest that anorexia nervosa (AN) and obesity are complicated by elevated fracture risk, but skeletal site-specific data are lacking. Traditional bone mineral density (BMD) measurements are unsatisfactory at both weight extremes. Hip structural analysis (HSA) uses dual-energy X-ray absorptiometry data to estimate hip geometry and femoral strength. Factor of risk (φ) is the ratio of force applied to the hip from a fall with respect to femoral strength; higher values indicate higher hip fracture risk. OBJECTIVE The objective of the study was to investigate hip fracture risk in AN and overweight/obese women. DESIGN This was a cross-sectional study. SETTING The study was conducted at a Clinical Research Center. PATIENTS PATIENTS included 368 women (aged 19-45 y): 246 AN, 53 overweight/obese, and 69 lean controls. MAIN OUTCOME MEASURES HSA-derived femoral geometry, peak factor of risk for hip fracture, and factor of risk for hip fracture attenuated by trochanteric soft tissue (φ(attenuated)) were measured. RESULTS Most HSA-derived parameters were impaired in AN and superior in obese/overweight women vs controls at the narrow neck, intertrochanteric, and femoral shaft (P ≤ .03). The φ(attenuated) was highest in AN and lowest in overweight/obese women (P < .0001). Lean mass was associated with superior, and duration of amenorrhea with inferior, HSA-derived parameters and φ(attenuated) (P < .05). Mean φ(attenuated) (P = .036), but not femoral neck BMD or HSA-estimated geometry, was impaired in women who had experienced fragility fractures. CONCLUSIONS Femoral geometry by HSA, hip BMD, and factor of risk for hip fracture attenuated by soft tissue are impaired in AN and superior in obesity, suggesting higher and lower hip fracture risk, respectively. Only attenuated factor of risk was associated with fragility fracture prevalence, suggesting that variability in soft tissue padding may help explain site-specific fracture risk not captured by BMD.
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Affiliation(s)
- Katherine Neubecker Bachmann
- Neuroendocrine Unit (K.N.B., P.K.F., E.A.L., A.K., K.K.M.), Departments of Psychiatry (K.E.) and Radiology (M.A.B.), Massachusetts General Hospital and Harvard Medical School, and Neuroendocrine Unit (B.M.R., A.D.R., E.M., A.V.G.), Clinical Research Center (T.H.), Massachusetts General Hospital, and Division of Adolescent Medicine (M.G.), Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts 02114; Klarman Center (T.W.), McLean Hospital and Harvard Medical School, Belmont, Massachusetts 02478; Cambridge Eating Disorders Center (S.E.), Cambridge, Massachusetts 02138; Wilkins Center for Eating Disorders (D.M.), Greenwich, Connecticut 06831; and Beth Israel Deaconess Medical Center (S.G.) and Harvard Medical School, Boston, Massachusetts 02446
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Pimentel GD, Ganeshan K, Carvalheira JBC. Hypothalamic inflammation and the central nervous system control of energy homeostasis. Mol Cell Endocrinol 2014; 397:15-22. [PMID: 24952114 DOI: 10.1016/j.mce.2014.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/07/2014] [Accepted: 06/08/2014] [Indexed: 02/07/2023]
Abstract
The control of energy homeostasis relies on robust neuronal circuits that regulate food intake and energy expenditure. Although the physiology of these circuits is well understood, the molecular and cellular response of this program to chronic diseases is still largely unclear. Hypothalamic inflammation has emerged as a major driver of energy homeostasis dysfunction in both obesity and anorexia. Importantly, this inflammation disrupts the action of metabolic signals promoting anabolism or supporting catabolism. In this review, we address the evidence that favors hypothalamic inflammation as a factor that resets energy homeostasis in pathological states.
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Affiliation(s)
- Gustavo D Pimentel
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Kirthana Ganeshan
- Cardiovascular Research Institute, University of California, San Francisco, CA 94158-9001, United States
| | - José B C Carvalheira
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
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Pickard JM, Maurice CF, Kinnebrew MA, Abt MC, Schenten D, Golovkina TV, Bogatyrev SR, Ismagilov RF, Pamer EG, Turnbaugh PJ, Chervonsky AV. Rapid fucosylation of intestinal epithelium sustains host-commensal symbiosis in sickness. Nature 2014; 514:638-41. [PMID: 25274297 PMCID: PMC4214913 DOI: 10.1038/nature13823] [Citation(s) in RCA: 373] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 09/03/2014] [Indexed: 02/06/2023]
Abstract
Systemic infection induces conserved physiological responses that include both resistance and 'tolerance of infection' mechanisms. Temporary anorexia associated with an infection is often beneficial, reallocating energy from food foraging towards resistance to infection or depriving pathogens of nutrients. However, it imposes a stress on intestinal commensals, as they also experience reduced substrate availability; this affects host fitness owing to the loss of caloric intake and colonization resistance (protection from additional infections). We hypothesized that the host might utilize internal resources to support the gut microbiota during the acute phase of the disease. Here we show that systemic exposure to Toll-like receptor (TLR) ligands causes rapid α(1,2)-fucosylation of small intestine epithelial cells (IECs) in mice, which requires the sensing of TLR agonists, as well as the production of interleukin (IL)-23 by dendritic cells, activation of innate lymphoid cells and expression of fucosyltransferase 2 (Fut2) by IL-22-stimulated IECs. Fucosylated proteins are shed into the lumen and fucose is liberated and metabolized by the gut microbiota, as shown by reporter bacteria and community-wide analysis of microbial gene expression. Fucose affects the expression of microbial metabolic pathways and reduces the expression of bacterial virulence genes. It also improves host tolerance of the mild pathogen Citrobacter rodentium. Thus, rapid IEC fucosylation appears to be a protective mechanism that utilizes the host's resources to maintain host-microbial interactions during pathogen-induced stress.
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Affiliation(s)
- Joseph M Pickard
- Department of Pathology and Committee on Immunology, The University of Chicago, Chicago, Illinois 60637, USA
| | - Corinne F Maurice
- FAS Center for Systems Biology, Harvard University, Cambridge, Massachusetts 02138, USA
| | | | - Michael C Abt
- Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
| | | | - Tatyana V Golovkina
- Department of Microbiology, The University of Chicago, Chicago, Illinois 60637, USA
| | - Said R Bogatyrev
- California Institute of Technology, Pasadena, California 91125, USA
| | | | - Eric G Pamer
- Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
| | - Peter J Turnbaugh
- FAS Center for Systems Biology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - Alexander V Chervonsky
- Department of Pathology and Committee on Immunology, The University of Chicago, Chicago, Illinois 60637, USA
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Bischoff M. [Anorexia - sarcopenia -cachexia. Life threatening loss of appetite]. MMW Fortschr Med 2014; 156:25. [PMID: 24934040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Milos G, Häuselmann HJ, Krieg MA, Rüegsegger P, Gallo LM. Are patterns of bone loss in anorexic and postmenopausal women similar? Preliminary results using high resolution peripheral computed tomography. Bone 2014; 58:146-50. [PMID: 24084384 DOI: 10.1016/j.bone.2013.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 12/27/2022]
Abstract
This study intended to compare bone density and architecture in three groups of women: young women with anorexia nervosa (AN), an age-matched control group of young women, and healthy late postmenopausal women. Three-dimensional peripheral quantitative high resolution computed-tomography (HR-pQCT) at the ultradistal radius, a technology providing measures of cortical and trabecular bone density and microarchitecture, was performed in the three cohorts. Thirty-six women with AN aged 18-30 years (mean duration of AN: 5.8 years), 83 healthy late postmenopausal women aged 70-81 as well as 30 age-matched healthy young women were assessed. The overall cortical and trabecular bone density (D100), the absolute thickness of the cortical bone (CTh), and the absolute number of trabecules per area (TbN) were significantly lower in AN patients compared with healthy young women. The absolute number of trabecules per area (TbN) in AN and postmenopausal women was similar, but significantly lower than in healthy young women. The comparison between AN patients and post-menopausal women is of interest because the latter reach bone peak mass around the middle of the fertile age span whereas the former usually lose bone before reaching optimal bone density and structure. This study shows that bone mineral density and bone compacta thickness in AN are lower than those in controls but still higher than those in postmenopause. Bone compacta density in AN is similar as in controls. However, bone inner structure in AN is degraded to a similar extent as in postmenopause. This last finding is particularly troubling.
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Affiliation(s)
- Gabriella Milos
- Clinic for Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland.
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Hong S, Jeong IG, You D, Lee JL, Hong JH, Ahn H, Kim CS. Safety of megestrol acetate in palliating anorexia-cachexia syndrome in patients with castration-resistant prostate cancer. J Korean Med Sci 2013; 28:687-92. [PMID: 23678259 PMCID: PMC3653080 DOI: 10.3346/jkms.2013.28.5.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 03/12/2013] [Indexed: 12/01/2022] Open
Abstract
There are concerns whether megestrol acetate (MA) stimulates the growth of prostate cancer in castration-resistant prostate cancer (CRPC). We evaluated the effect of cumulative doses of MA on the disease-specific survival (DSS) in patients with CRPC who were receiving Docetaxel-based chemotherapy. From July 2003 through June 2009, we identified 109 consecutive patients with CRPC and who had received docetaxel-based chemotherapy. Of these patients, 68 (62.4%) have not received MA, whereas 21 patients (19.3%) and 20 patients (18.3%) had received low dose MA (total ≤ 18,400 mg) and high dose MA (total > 18,400 mg), respectively. We assessed the effect of several variables on DSS. None of the clinicopathological variables differed among the three groups. When comparing DSS using Kaplan-Meier analysis, there was no statistically significant survival differences among the three groups (P = 0.546). Using multivariate Cox proportional analyses with backward elimination, the number of docetaxel cycles was only significant factor predicting DSS (HR: 0.578, 95% CI: 0.318-0.923, P = 0.016). Cumulative doses of MA as adjuvant treatment for patients with CRPC and who are receiving docetaxel-based chemotherapy, did not affect their DSS. Therefore, MA can be safely administered in cachexic patients with CRPC.
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Affiliation(s)
- Sungwoo Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Lyun Lee
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Urso C, Brucculeri S, Caimi G. Marked elevation of transaminases and pancreatic enzymes in severe malnourished male with eating disorder. Clin Ter 2013; 164:e387-e391. [PMID: 24217841 DOI: 10.7417/ct.2013.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of a 45 year old Caucasian malnourished male with an history of eating disorder who developed severe liver and pancreatic damage and multiorgan disfunction. At admission to our department, his body mass index (BMI) was 11.1. Biochemical evaluation showed elevated serum levels of transaminases (AST= 2291 U/L, ALT= 1792 U/L), amylase (3620 U/L), lipase (4102 U/L), CPK= 1370 U/L, LDH= 2082 U/L. No other cause of acute liver and pancreatic damage was evidenced. Haematological disorders (anemia, thrombocytopenia, leukopenia) found on admission seem related to bone marrow hypoplasia and to gelatinous marrow transformation described in severe state of malnutrition. Although a moderate increase in liver and pancreatic enzymes are a common finding in malnourished patients, only a small number of reports describes severe liver injury and multiorgan dysfunction. After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. The association of chronic malnutrition and a decrease in systemic perfusion may be responsible for multiorgan dysfunction. In our patient the high levels of transaminases and pancreatic enzymes were the most important biochemical abnormalities normalized after refeeding.
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Affiliation(s)
- C Urso
- Department of Internal Medicine, University of Palermo, Palermo, Italy
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Adan RAH, Hillebrand JJG, Danner UN, Cardona Cano S, Kas MJH, Verhagen LAW. Neurobiology driving hyperactivity in activity-based anorexia. Curr Top Behav Neurosci 2012; 6:229-50. [PMID: 21243479 DOI: 10.1007/7854_2010_77] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hyperactivity in anorexia nervosa is difficult to control and negatively impacts outcome. Hyperactivity is a key driving force to starvation in an animal model named activity-based anorexia (ABA). Recent research has started unraveling what mechanisms underlie this hyperactivity. Besides a general increase in locomotor activity that may be an expression of foraging behavior and involves frontal brain regions, the increased locomotor activity expressed before food is presented (food anticipatory behavior or FAA) involves hypothalamic neural circuits. Ghrelin plays a role in FAA, whereas decreased leptin signaling is involved in both aspects of increased locomotor activity. We hypothesize that increased ghrelin and decreased leptin signaling drive the activity of dopamine neurons in the ventral tegmental area. In anorexia nervosa patients, this altered activity of the dopamine system may be involved not only in hyperactivity but also in aberrant cognitive processing related to food.
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Affiliation(s)
- R A H Adan
- Department of Neuroscience and Pharmacology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands.
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Mitchell S, Welch-Burke T, Dumitrescu L, Lomenick JP, Murdock DG, Crawford DC, Summar M. Peptide tyrosine tyrosine levels are increased in patients with urea cycle disorders. Mol Genet Metab 2012; 106:39-42. [PMID: 22459207 PMCID: PMC3336020 DOI: 10.1016/j.ymgme.2012.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
Abstract
Nutritional management is essential for patients with inborn errors of metabolism, such as urea cycle disorders (UCDs). Lack of appetite is common in these patients and can lead to underconsumption of calories, catabolism, and subsequently loss of metabolic control. The etiology of anorexia in these patients is largely unexplored. The neuroendocrine hormone peptide tyrosine tyrosine (PYY), secreted postprandially from endocrine cells of the ileum and colon, induces feelings of satiety and decreases food intake. While plasma PYY levels have been characterized in a number of populations, they have not been examined in UCD patients. In a retrospective study, plasma PYY concentrations were measured in UCD (n=42) patients and controls (n=28) via an ELISA to determine if levels of this anorexigenic hormone are altered in this patient population. Median PYY levels were significantly higher in UCD patients compared to controls (p=3.5×10(-5)). Body mass index was significantly associated with increased PYY levels in controls (p=0.02), while UCD diagnosis subtype was associated with PYY levels (p=1×10(-3)) in cases. Median PYY levels were significantly lower in ornithine carbamoyltransferase deficient patients compared with all other UCD subtypes (p=9×10(-3)), but significantly higher compared to controls (p=1.6×10(-3)). Overall, this study demonstrates that UCD cases have increased PYY levels compared to controls, suggesting that regulation of PYY may be altered in these patients. These observations may lead to a better understanding of the development of anorexia in UCD patients.
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Affiliation(s)
- Sabrina Mitchell
- Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Donini LM, Dominguez LJ, Barbagallo M, Savina C, Castellaneta E, Cucinotta D, Fiorito A, Inelmen EM, Sergi G, Enzi G, Cannella C. Senile anorexia in different geriatric settings in Italy. J Nutr Health Aging 2011; 15:775-81. [PMID: 22089227 DOI: 10.1007/s12603-011-0048-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status. DESIGN AND SETTING Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto). PARTICIPANTS 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile"). MEASUREMENTS Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication. RESULTS The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet. CONCLUSION Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.
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Affiliation(s)
- L M Donini
- University of Rome La Sapienza, Department of Medical Physiopathology, Rome, Italy.
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Enomoto T, Furuya Y, Tomimori Y, Mori K, Miyazaki JI, Yasuda H. Establishment of a new murine model of hypercalcemia with anorexia by overexpression of soluble receptor activator of NF-κB ligand using an adenovirus vector. J Bone Miner Metab 2011; 29:414-21. [PMID: 21063739 DOI: 10.1007/s00774-010-0235-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 09/21/2010] [Indexed: 12/15/2022]
Abstract
Hypercalcemia is a significant complication of certain human malignancies that is primarily caused by the release of calcium from bone due to marked bone resorption by osteoclast activation. Osteoclast differentiation and activation is mediated by receptor activator of NF-κB ligand (RANKL). Transgenic mice overexpressing murine soluble RANKL (sRANKL) that we generated previously exhibited severe osteoporosis accompanied with enhanced osteoclastogenesis, but never exhibited hypercalcemia. To analyze the relationship between serum concentration of sRANKL and hypercalcemia and generate a simple and quick hypercalcemia model, an adenovirus vector harboring murine sRANKL cDNA (Ad-sRANKL) was injected i.p. into male C57BL/6 mice. Sera were collected to measure the levels of sRANKL, calcium and biochemical markers of bone turnover. Food intake and body weight were measured every 3 or 4 days. All the mice were killed 2 weeks after the injection, and femurs were collected to measure bone structure and bone mineral density (BMD). Serum sRANKL and calcium increased, peaking on day 7. Food intake and body weight significantly declined on day 7. These results indicated that the mice had anorexia as a symptom of hypercalcemia. Increases in bone resorption and formation markers with a marked decrease in BMD were observed on day 14. These results reflect accelerated bone formation following activation of osteoclasts, indicating coupling between bone formation and resorption. In conclusion, a new murine model of hypercalcemia with anorexia was established by overexpressing sRANKL. This model would be useful for studies of hypercalcemia and coupling between bone formation and resorption.
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Affiliation(s)
- Tetsuro Enomoto
- Nagahama Institute for Biochemical Science, Oriental Yeast Co., Ltd, 50 Kano-cho, Nagahama, Shiga 526-0804, Japan
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Abstract
Weight loss is common in older people. It is associated with increased morbidity and mortality, particularly when unintentional, excessive (>5% body weight), or associated with low body weight (body mass index <22 kg/m(2)). It is often unrecognized, the associated adverse effects not appreciated, and underlying causes not addressed. Intentional weight loss by overweight older people is probably appropriate only when functional problems have resulted from the excess weight. It is important to include, wherever possible, exercise in weight-loss measures to preserve skeletal muscle mass.
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Affiliation(s)
- Ian M Chapman
- Division of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, North Terrace, Adelaide 5000, Australia.
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Yokoi Y, Hirayama K. [Gastric emphysema, a critical condition accompanied by eating disorders: a case report]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:1635-1640. [PMID: 20938114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Gastric emphysema encompasses a broad spectrum of diseases. A 31-year-old woman presented with severe vomiting and epigastric pain. She had lost body weight for several months, and was later diagnosed as having anorexia nervosa. A radiological study demonstrated intramural gas with huge gastric dilatation and portal venous gas. She underwent total gastrectomy and was rescued from extensive gastric necrosis. Her clinical findings suggest that extraordinary dilation of the stomach increased the intraluminal pressure, thereby resulting in perfusion disturbance and extensive gastric necrosis. There are five other case reports of gastric emphysema associated with eating disorders in the literature. All but one were young women, and one of 4 patients with massive gastric necrosis died due to septic shock. Eating disorders cause gastric emphysema through several unique mechanisms, including gastric muscular atrophy, occlusion of the gastroesophageal junction, and delayed gastric emptying. Gastric emphysema in relation to eating disorders carries a risk of life-threatening complications and requires urgent diagnosis and treatment.
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Peterson SJ, Tsai AA, Scala CM, Sowa DC, Sheean PM, Braunschweig CL. Adequacy of oral intake in critically ill patients 1 week after extubation. ACTA ACUST UNITED AC 2010; 110:427-33. [PMID: 20184993 DOI: 10.1016/j.jada.2009.11.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 09/04/2009] [Indexed: 01/08/2023]
Abstract
Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to intensive care units (ICUs). The purpose of this observational study (August to November 2007) was to examine the adequacy of oral intake and to identify predictors of oral intake after ICU patients were removed from invasive mechanical ventilation. Patients aged > or = 18 years who required mechanical ventilation for at least 24 hours, advanced to an oral diet postextubation, and did not require supplemental enteral or parenteral nutrition were included. The first 7 days of oral intake after extubation were assessed via modified multiple-pass 24-hour recall and the numbers of days on therapeutic diets and reasons for decreased intake were collected. Oral intake <75% of daily requirements was considered inadequate. Descriptive statistics, chi2, Student t tests, and logistic regression analyses were conducted. Of the 64 patients who met eligibility criteria, 50 were included. Of these 50 patients, 54% were women and intubated for 5.2 days, with a mean age of 59.1 years, body mass index of 28.7, and Acute Physiology and Chronic Health Evaluation II score of 21.9. Subjective Global Assessment determined 44% were malnourished upon admission to the ICU. The average daily energy and protein intake failed to exceed 50% of daily requirements on all 7 days for the entire population. The majority of patients who consumed <75% of daily requirements were prescribed a therapeutic diet and/or identified "no appetite" and nausea/vomiting as the barriers to eating. Although more research is needed, these data call into question the use of restrictive oral diets and suggest that alternative medical nutrition therapies are needed to optimize nutrient intake in this unique patient population.
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