Introduction: Bariatric procedures lead to changes in body composition. Desired fat loss may be accompanied by decrease of muscle mass, thus raising the risk of sarcopenia. Aim: To detect the risk of sarcopenia in patients 24 months after different bariatric/metabolic (B/M) procedures by DEXA. Material and methods: Consecutive patients scheduled for a B/M procedure underwent DEXA scan and anthropometric assessment before and 24 months after surgery in a prospective manner. Obtained data were tested for significant differences (p < 0.05) to detect body composition changes and occurrence of sarcopenia. The International Physical Activity Questionnaire (IPAQ) was answered at 24 months to assess physical activity. Results: Nineteen patients were enrolled, with no drop-off at follow-up. Body mass index dropped from 42.4 ±6.3 to 30.3 ±4.9 kg/m 2 , with excess weight loss of 72 ±25% and substantial improvement of all relevant anthropometric measurements (p < 0.001). Significant changes in DEXA parameters were observed: fat mass index (19.5 ±4.7 vs. 12.1 ±3.7 kg/m 2), estimated visceral adipose area (235.8 ±70.0 vs. 126.5 ±50.4 cm 2), lean mass index (22.1 ±2.4 vs. 18.1 ±2.3 kg/m 2), appendage lean mass index (9.7 ±1.3 vs. 7.7 ±1.1 kg/m 2), bone mineral content (1.22 ±0.1 vs. 1.12 ±0.1 kg), Z score (2.32 vs. 0.96) and T score (0.58 vs.-0.58). A low level of physical activity was recorded at 24 months. Conclusions: B/M procedures lead to significant changes in body composition at 24 months after surgery. DEXA detects these changes effectively. Desired fat loss is associated with significant reduction of skeletal muscle and bone mineral mass. As such, patients after B/M surgery are at risk of sarcopenia. A low level of physical activity may also play a negative role.

Anthracyclines represent one of the important classes of anti-cancer drugs; however, their major disadvantage is their profound cardiovascular toxicity. This study aimed to evaluate influence of anthracyclines on cardiovascular stiffness parameters estimated from pulse wave (PW). PW was measured in 59 cancer survivors treated with anthracyclines in childhood and in 248 healthy age-matched controls. Both patients and controls were divided into three age groups (13 – 15, 16 – 18 and 19 – 24 years). Central PW augmentation index (C-AI75) and augmentation pressure (C-AP75), both normalized to heart rate 75 bpm, were calculated as parameters of arterial wall stiffness. Central Buckberg sub-endocardial viability ratio (SEVR) was calculated as a parameter of diastolic function. Patients and controls were compared in each age group. C-AI75 and C-AP75 were significantly increased in patients in age groups 16 – 18 and 19 – 24 years. SEVR was decreased in patients in the oldest age group. Our results suggest that although toxic influence of anthracyclines to arterial wall and heart are developing during childhood and puberty, they can be detected rather in the adulthood. These changes are yet subclinical; however, their presence indicates potentially increased cardiovascular risk in childhood cancer survivors treated with anthracyclines during childhood.

Introduction Sarcopaenia seems to be predictive factor for postoperative morbidity and mortality after colorectal resection for cancer. Nevertheless, an ideal sarcopaenic indicator is still to be identified. Aim To evaluate computed tomography (CT) measured total abdominal muscle area (TAMA), total psoas muscle area (TPA), and psoas density (PD) – previously described sarcopaenia indicators – as possible risk factors for postoperative complications in patients after curative colon and rectal resections for colorectal cancer. Material and methods Consecutive patients after elective curative colon or rectal resection for cancer at a single institution were divided into cohorts with uncomplicated postoperative course or complications Clavien-Dindo grade I-II (Cl-Di 0-II) and complications Clavien-Dindo grade III-V (Cl-Di III-V). Cohorts were statistically tested for significant differences in TAMA, TPA, and PD calculated from preoperative staging CT scans at the level of the third lumbar vertebra. Results Data of 112 patients were analysed from a prospectively run database; 65 underwent colon and 47 rectal resections. PD was significantly higher in the Cl-Di 0-II cohort compared to the Cl-Di III-V for both colon (42.67 ±6.52 vs. 40.11 ±7.57 HU, p = 0.002) and rectal resections (44.08 ±5.86 vs. 43.03 ±5.70HU, p = 0.016). TAMA and TPA failed to show significant differences. Conclusions Psoas density is significantly decreased in patients with Clavien-Dindo grade III-V complications after curative resection for colon and rectal cancer. Due to the simplicity and affordability of its assessment from preoperative staging CT scan, it might be considered an optimal sarcopaenic indicator to be utilised in everyday practice.

Sarcopenia is an independent risk factor for morbidity and mortality in patients suffering from small cell lung cancer (SCLC), however, a universal indicator of sarcopenia usable in clinical practice is still missing. A novel indicator for describing the severity of cancer could be helpful in tailoring the anti-tumor therapy. The aim of this study was to evaluate the computed tomography (CT) scans of total muscle area and radiation attenuation in patients suffering from small cell lung cancer. We used staging CT scans performed at the time of diagnosis to measure total muscle area (TMA) and average psoas density (PD) at level of the 3rd lumbar vertebra. TMA and PD were statistically evaluated in association with overall survival and disease staging. We used Mann-Whitney test and Spearman´s correlation coefficient for statistical testing and p-value under 0.05 was considered statistically significant. Retrospectively we examined 47 patients suffering from SCLC (mean age 65.05±7.3 years, BMI 23.97±4.4 kg/m2, BSA 1.77±0.2 m2, 30-day mortality was 4.3 % with 10 months median survival). As sarcopenia was pointed TMA under 55 and 39 cm2/m2 for men and women respectively. The sarcopenic patients had significantly shorter median survival (7 vs. 11 months, p=0.05). We observed a significant relationship between survival and performance status (Spearman´s correlation, R=-0.39, p=0.05). The patients were divided into two groups according to the extensive (ED, n=34) or limited (LD, n=13) form of the disease. We observed significant difference in PD (42.49±6.1 vs. 47.67±4.5 HU, p=0.006) between ED vs. LD groups.

Obezita je závažným onemocněním s mezioborovým medicínským přesahem a významnými socioekonomickými dopady na život pacientů a společnosti. Proto se nyní věnuje velká pozornost objasnění patofyziologických mechanismů podílejících se na vzniku tohoto onemocnění, možnosti jejich ovlivnění a následně i léčby již vzniklého stavu a navazujících komplikací. Sarkopenická obezita je typem obezity, při které dochází k infiltraci svalstva tukovou tkání, která nahrazuje jeho objem a zapříčiňuje ztrátu jeho síly. Klíčovým patofyziologickým mechanismem v etiologii tohoto problému je zánětlivá aktivita zmnožené tukové tkáně. K posouzení množství svalové hmoty v těle se používá denzitometrie, k posouzení morfologie počítačová tomografie nebo magnetická rezonance. Sarkopenická obezita zvyšuje zdravotní rizika, hlavně kardiovaskulární komplikace, zhoršuje inzulinovou rezistenci, je rizikovým prediktivním faktorem pro vznik kardiovaskulárních nemocí u pacientů s diabetes mellitus 2. typu, je ve vztahu se zvýšeným výskytem pooperačních komplikací, zhoršuje kognitivní funkce, oslabuje hojení akutních i chronických nemocí a snižuje fyzickou výkonnost. V léčbě sarkopenické obezity se ukazuje nejúčinnějším kombinované aerobní a silové cvičení. Termogeneze v hnědé tukové tkáni se zdá být nadějnou v boji proti obezitě, není ale známo, zda farmakologicky vyvolána nemůže zároveň navyšovat i riziko vzniku sarkopenie. Cílem této práce je přinést aktuální pohled na danou problematiku a nastínit možnosti dalšího výzkumu.Klíčová slova: hnědá tuková tkáň, obezita, patofyziologie, sarkopenická obezita, sarkopenie. Sarcopenic obesity -current viewObesity is a serious disease with interdisciplinary medical overlap and important socio-economic implications for patients and society. Therefore, a great deal of attention is paid to the clarification of the exact pathophysiological mechanisms involved in the disease, the possibility of their influence and, consequently, the treatment of the already existing conditions and related complications. Sarcopenic obesity is a type of obesity that is caused by fat infiltration of muscle tissue, that replaces its volume and causes its strength loss. A key pathophysiological mechanism in the aetiology of this problem is the inflammatory activity of the excessive fat tissue. To assess the amount of muscle mass in the body, densitometry is used. Computer tomography or magnetic resonance is used to assess its morphology. Sarcopenic obesity increases health risks, mainly cardiovascular complications, increases insulin resistance, is a predictive risk factor for the development of cardiovascular disease in patients with diabetes mellitus type 2, increases incidence of postoperative complications, impairs cognitive function, weakens healing of acute and chronic diseases, reduces physical performance. The combination of aerobic and power exercises appears to be the most efficient in the treatment of sarcopenic obesity. Thermogenesis in brown adipose tissue appears to be promising in fighting obesity, however it is unknown...