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Journal of Cardiovascular Medicine... Jan 2022The aim of this study was to determine if computed tomography (CT) psoas muscular attenuation measurements may predict all-cause mortality in patients undergoing TAVI.
AIMS
The aim of this study was to determine if computed tomography (CT) psoas muscular attenuation measurements may predict all-cause mortality in patients undergoing TAVI.
METHODS
Ninety-four consecutive patients undergoing TAVI were analysed. The CT axial slice at the level of the fourth lumbar vertebra was selected. The psoas muscle areas were manually contoured. The circumferential surface area (CSA) of both psoas muscles was determined by selecting the voxels with attenuation values, ranging from 0 to 100 Hounsfield Units (HU). The mean CT attenuation coefficient of the psoas muscle (Psoas mean HU) was measured. The muscle was subdivided into a low-density muscle (LDM) (0-29 HU) and high-density muscle (HDM) (30-100 HU) portion. The HDM/LDM ratio was calculated. We searched for a correlation between HDM/LDM, CSA LDM (%), Psoas mean HU and all-cause mortality.
RESULTS
The mean age was 81.2 ± 7.5 years. Thirty patients had adverse outcome (all-cause mortality). Compared with patients with the lowest CSA LDM (%), patients in the third and second tertiles had an increased hazard ratio for mortality (2.871; 95% confidence interval 0.880-9.371 and 5.044; 95% confidence interval 1.641-15.795, respectively) in a multivariable model with EuroSCORE II, Barthel frailty index and CSA LDM (%) (P = 0.231, 0.097 and 0.019, respectively). HDM/LDM and Psoas mean HU (as continuous variable) were also independent predictors of all-cause mortality (P = 0.019, P = 0.013, respectively).
CONCLUSION
CSA LDM (%), Psoas mean HU and HDM/LDM are independent and incremental predictors of all-cause mortality in patients undergoing TAVI.
Topics: Aged, 80 and over; Female; Humans; Male; Mortality; Psoas Muscles; Sarcopenia; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement
PubMed: 34387273
DOI: 10.2459/JCM.0000000000001234 -
The Journal of Surgical Research Apr 2019Sarcopenia is a syndrome that is defined by the loss of skeletal muscle mass, quality, and strength. In adult patients with malignancies, the presence of sarcopenia is...
PURPOSE
Sarcopenia is a syndrome that is defined by the loss of skeletal muscle mass, quality, and strength. In adult patients with malignancies, the presence of sarcopenia is known to be correlated with a poor prognosis; however, there have been no reports on the influence of sarcopenia on malignant tumors in pediatric patients. In the present study, we investigated whether or not sarcopenia affects the prognosis of high-risk neuroblastoma.
MATERIALS AND METHODS
Thirteen patients with high-risk neuroblastoma who were treated according to the standard protocol at our hospital from 2007 to 2016 were divided into a progression-free survival group (n = 8) and a relapse/death group (n = 5). The rate of change in sarcopenia was calculated by comparing the psoas muscle area (PMA) of the L3-level lumbar spine on computed tomography before and after treatment with the standard protocol. The rate of change in the PMA, Kaup index, and serum albumin level were compared. Furthermore, we determined the cutoff rate of change in the PMA and compared the overall and progression-free survival.
RESULTS
The rates of change in the PMA were 1.24 and 0.84 in the progression-free survival and relapse/death groups, respectively (P = 0.0472). There were no significant differences in the rates of change in the Kaup index or the serum albumin level of the two groups. The patients whose rate of change in the PMA was >1.00 showed a prolonged overall (P = 0.0078) and progression-free survival (P = 0.006).
CONCLUSIONS
A decrease in the skeletal muscle mass was suggested to be a significant prognostic factor for high-risk neuroblastoma.
Topics: Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Neoplasm Recurrence, Local; Neuroblastoma; Prognosis; Progression-Free Survival; Psoas Muscles; Retrospective Studies; Risk Factors; Sarcopenia; Survival Analysis; Tomography, X-Ray Computed
PubMed: 30694741
DOI: 10.1016/j.jss.2018.10.048 -
American Journal of Obstetrics and... Nov 2014The objective of the study was to examine the anatomic relationship of the genitofemoral and femoral nerves to the psoas major muscle.
OBJECTIVE
The objective of the study was to examine the anatomic relationship of the genitofemoral and femoral nerves to the psoas major muscle.
STUDY DESIGN
Dissections were performed in 17 unembalmed female cadavers. Point A was used as the approximate location for placement of psoas hitch sutures and as the reference point from which all measurements were taken. Measurements included the width of the psoas major muscle, psoas minor tendon, genitofemoral nerve branches, and femoral nerve. The relative location of the genitofemoral and femoral nerves to point A and the presence or absence of a psoas minor tendon were documented.
RESULTS
The psoas minor tendon was absent on at least 1 side in 11 specimens (64.7%). The median width of the psoas minor tendon was 7 mm (range, 3-11.5 mm). The median width and depth of the psoas major muscle was 21.5 mm (range, 10-35 mm) and 20.0 mm (range, 11.5-32 mm), respectively. The median width of the genitofemoral nerve was 2 mm (range, 1-4.5 mm) and that of the femoral nerve was 6.3 mm (range, 5-10.5 mm). Overall, 54 genitofemoral nerve branches were identified in 17 cadavers, 30 medial (55.5%), 22 lateral (40.7%), and 2 directly overlying point A (3.7%).
CONCLUSION
The exact location for the placement of the psoas hitch sutures will vary, depending on the location of the ureteral injury and the anatomy of the psoas muscle and surrounding structures. A thorough understanding of this regional anatomy should optimize the placement of psoas hitch sutures during ureteral reimplantation procedures and help avoid nerve and vessel injury.
Topics: Aged; Aged, 80 and over; Cadaver; Dissection; Female; Femoral Nerve; Humans; Lumbosacral Plexus; Middle Aged; Psoas Muscles; Replantation; Suture Techniques; Ureter
PubMed: 25019482
DOI: 10.1016/j.ajog.2014.07.008 -
International Journal of Molecular... Apr 2022Duchenne muscular dystrophy (DMD) is a muscle disease characterized by the absence of the protein dystrophin, which causes a loss of sarcolemma integrity, determining...
Duchenne muscular dystrophy (DMD) is a muscle disease characterized by the absence of the protein dystrophin, which causes a loss of sarcolemma integrity, determining recurrent muscle injuries, decrease in muscle function, and progressive degeneration. Currently, there is a need for therapeutic treatments to improve the quality of life of DMD patients. Here, we investigated the effects of a low-intensity aerobic training (37 sessions) on satellite cells, peroxisome proliferator-activated receptor-gamma coactivator (PGC)-1α protein (PGC-1α), and different types of fibers of the psoas muscle from mice (DMD experimental model). Wildtype and mice were randomly divided into sedentary and trained groups ( = 24). Trained animals were subjected to 37 sessions of low-intensity running on a motorized treadmill. Subsequently, the psoas muscle was excised and analyzed by immunofluorescence for dystrophin, satellite cells, myosin heavy chain (MHC), and PGC-1α content. The minimal Feret's diameters of the fibers were measured, and light microscopy was applied to observe general morphological features of the muscles. The training (37 sessions) improved morphological features in muscles from mice and caused an increase in the number of quiescent/activated satellite cells. It also increased the content of PGC-1α in the group. We concluded that low-intensity aerobic exercise (37 sessions) was able to reverse deleterious changes determined by DMD.
Topics: Animals; Disease Models, Animal; Dystrophin; Humans; Mice; Mice, Inbred mdx; Muscle, Skeletal; Muscular Dystrophy, Duchenne; Psoas Muscles; Quality of Life
PubMed: 35562874
DOI: 10.3390/ijms23094483 -
Injury May 2022Recent studies have suggested that skeletal muscle area (SMA) and psoas muscle area (PMA), markers for sarcopenia, are associated with the prognosis of many diseases....
BACKGROUND
Recent studies have suggested that skeletal muscle area (SMA) and psoas muscle area (PMA), markers for sarcopenia, are associated with the prognosis of many diseases. However, it remains unclear which of the two is a superior prognostic marker. Thus, the objective of this study was to analyse these markers in patients with traumatic brain injury (TBI).
METHODS
Patients with TBI [abbreviated injury scale (AIS) score of 4 or 5] were selected. Those with an AIS score of 4 or 5 for chest, abdomen, or extremity lesion were excluded. Clinical data, including Glasgow Outcome Scale (GOS), mortality, and anthropometric data, were collected. SMA and PMA were measured. Skeletal muscle index (SMI) and psoas muscle index (PMI) were calculated for each muscle area divided by height squared. The good prognosis group was defined as patients with a GOS score of 4 to 5. The poor prognosis group was defined as those with a GOS score of 1-3. Data of both groups were analysed for the overall prognosis. After excluding patients with a hospital stay of 1 or 2 days, the modified prognosis and mortality of patients were analysed.
RESULTS
A total of 212 patients were enrolled in the statistical analysis. Patients with good prognosis showed a larger PMA (17.4 cm vs. 15.0 cm, P = 0.002) and PMI (6.1 cm m vs. 5.3 cm m, P = 0.001). After modification, patients with good prognosis showed a larger PMA (17.4 cm vs. 14.9 cm, P = 0.002) and PMI (6.1 cm m vs. 5.3 cm m, P = 0.01). On binary logistic regression analysis, PMI was found to be a significant risk factor for the modified prognosis (Odds ratio (OR) (95% confidence interval (CI)): 0.763 (0.633 - 0.921), P = 0.005) and modified mortality (OR (95% CI): 0.740 (0.573 - 0.957), P = 0.022).
CONCLUSION
Less amount of psoas muscle (PM) was found to be a significant risk factor for the prognosis of patients with TBI. PM was a better prognostic marker than skeletal muscle (SM) in patients with TBI. Further studies are needed to increase our understanding of sarcopenia and TBI.
Topics: Biomarkers; Brain Injuries, Traumatic; Humans; Muscle, Skeletal; Prognosis; Psoas Muscles; Retrospective Studies; Sarcopenia; Tomography, X-Ray Computed
PubMed: 35241285
DOI: 10.1016/j.injury.2022.02.043 -
The Journal of Bone and Joint Surgery.... Jun 2024Sarcopenia is associated with falls, fractures, postoperative complications such as periprosthetic joint infections and dislocations, and early mortality. Although...
BACKGROUND
Sarcopenia is associated with falls, fractures, postoperative complications such as periprosthetic joint infections and dislocations, and early mortality. Although cross-sectional imaging is currently used to diagnose sarcopenia, inexpensive and widely available screening tests are needed. The goal of this study was to investigate whether measurements of thigh muscles made on radiographs can predict psoas muscle area and the presence of sarcopenia as determined on computed tomography (CT) scans.
METHODS
A retrospective radiographic review was performed to measure thigh muscle area in the coronal and sagittal planes using the differential in soft-tissue attenuation. Psoas muscle area on CT at L3 and L4 served as the gold standard for the diagnosis of sarcopenia. The correlation between thigh muscle and psoas muscle areas was determined, and multivariable models were developed to identify predictors of psoas muscle area and sarcopenia.
RESULTS
Four hundred and fourteen patients (252 male, 162 female) were identified. Seventy-six (18.4%) of the patients had an L4 psoas muscle area below the sex-specific cutoff value for sarcopenia. Patients with sarcopenia on abdominal CT had significantly smaller thigh muscle measurements on all radiographic views. The mean and standard deviation of the thigh muscle measurements were determined for the entire cohort and for patients with sarcopenia, as well as for adults aged 18 to 40 years without sarcopenia to provide normative reference values. The intraclass correlation coefficients were >0.8 for all radiographic measurements. The anteroposterior-view measurement of thigh muscle width and lateral-view measurement of quadriceps height were identified as independent predictors of both psoas muscle area and sarcopenia.
CONCLUSIONS
Measurements of thigh muscle size made on radiographs can predict both psoas muscle area and sarcopenia. These measurements are a reliable and readily available screening tool to aid in the diagnosis and treatment of sarcopenia in the orthopaedic population.
LEVEL OF EVIDENCE
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Sarcopenia; Male; Female; Psoas Muscles; Retrospective Studies; Tomography, X-Ray Computed; Aged; Middle Aged; Adult; Thigh; Aged, 80 and over; Young Adult; Adolescent; Predictive Value of Tests
PubMed: 38598605
DOI: 10.2106/JBJS.23.01177 -
Orthopaedic Surgery Feb 2022To describe the anatomical feature positioned beneath the psoas muscle at the lateral aspect of the lower lumbar, and to create a new location system to identify the...
OBJECTIVE
To describe the anatomical feature positioned beneath the psoas muscle at the lateral aspect of the lower lumbar, and to create a new location system to identify the risk factors of lateral lumbar interbody fusion.
METHODS
Six cadavers were dissected and analyzed. The anatomy and neurovascular distribution beneath the psoas major from L to S was observed and recorded, with particular focus on the L disc and below. The psoas major surface was divided homogeneously into four parts, from the anterior border of psoas major to the transverse process. The cranial-to-caudal division was from the lower edge of the psoas muscle attachment on the L vertebrae to the upper part of the S vertebrae, and was divided into five segments. Then a grid system was used to create 20 grids on the psoas major surface, from the anterior border of the muscle to the transverse process and from L to superior S , which was used to determine the anatomical structures' distribution and relationship beneath the psoas major.
RESULTS
A cleft was identified beneath the psoas major, from the level of L downwards. It was filled with loose connective tissue and neurovascular structures. We termed it the cleft of psoas major (CPM). The sympathetic trunk, ascending lumbar vein, iliolumbar vessels, obturator nerve, femoral nerve and occasionally the great vessels are contained within the CPM, although there is significant interpersonal variation. The grid system on the psoas major surface helped to identify the anatomical structures in CPM. There was a considerably lower frequency of occurrence of neurovascular structures in the grids of I/II at the L level where can be considered the "safe zones" for the lateral lumbar interbody fusion. In contrast, the distribution of neurovascular structures at the L S level is dense, where the operation risk is high.
CONCLUSION
The CPM exists lateral to the vertebral surface from L and below. Although the occurrence and distribution of neurovascular structures within the CPM is complex and varies greatly, it can provide a potential cavity for visualization during lateral lumbar interbody fusion. Using psoas major as a reference, this novel grid system can be used to identify the risk factors in CPM and thus identify a safe entry point for surgery.
Topics: Femoral Nerve; Humans; Lumbar Vertebrae; Lumbosacral Region; Psoas Muscles; Spinal Fusion
PubMed: 34939336
DOI: 10.1111/os.13180 -
Journal of Pediatric Gastroenterology... Feb 2021Adults with decreased muscle mass experience worse outcomes and more frequent complications. The effects of sarcopenia on pediatric outcomes are unknown. Our objective...
OBJECTIVES
Adults with decreased muscle mass experience worse outcomes and more frequent complications. The effects of sarcopenia on pediatric outcomes are unknown. Our objective was to define reference values for lean muscle mass in a healthy pediatric population to facilitate future studies on the impact of lean muscle mass on pediatric outcomes.
PATIENTS AND METHODS
Bilateral psoas muscle surface area was measured by computed tomography in a healthy pediatric population undergoing evaluation after trauma. Pearson correlation coefficients (PCCs) were calculated for age, weight, height, body mass index (BMI), total psoas muscle area, and psoas muscle index (PMI; defined as psoas muscle area divided by height squared). Quantile regression was used to determine age- and sex-specific percentiles of psoas muscle area and PMI.
RESULTS
Analysis of 494 male and 288 female patients with available imaging (median age: 9.3 years, interquartile range: 5.4-13.4; 63.1% male) was performed. For males, age correlated strongly with total psoas volume (PCC = 0.87), height (0.95), and weight (0.88) and poorly with BMI (0.45). In females, age correlated strongly with total psoas volume (0.88), height (0.92), weight (0.88) and poorly with BMI (0.19). Gender-specific curves and charts were created using output from the quantile regression from reference values of the total psoas muscle area corresponding to the 25th, 50th, and 75th percentiles across all ages.
CONCLUSIONS
We created gender-specific reference charts for total and height-normalized psoas muscle area in healthy children based on age. These results can be used in future studies to establish the effects of sarcopenia in pediatric patients.
Topics: Adult; Child; Female; Humans; Male; Psoas Muscles; Reference Values; Retrospective Studies; Sarcopenia; Tomography, X-Ray Computed
PubMed: 33003166
DOI: 10.1097/MPG.0000000000002958 -
BMC Musculoskeletal Disorders Oct 2022With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely...
BACKGROUND
With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely related to osteoporosis by dual-energy x-ray absorptiometry (DXA) measurement. However, few studies have explored whether the skeletal muscle and adipose tissue index measured at the lumbar spine 3 (L3) level are closely related to bone mineral density (BMD) and can even predict osteoporosis. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are closely related to BMD.
METHODS
A total of 180 participants were enrolled in this study to obtain skeletal muscle index (SMI), psoas muscle index (PMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at L3 levels and divide them into osteoporotic and normal groups based on the T-score of DXA. Spearman rank correlation was used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and BMD. Similarly, spearman rank correlation was also used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and the fracture risk assessment tool (FRAX). Receiver operating characteristic (ROC) was used to analyze the efficacy of SMI, PMI, SFI, VFI, and VSR in predicting osteoporosis.
RESULTS
BMD of L1-4 was closely correlated with SMI, PMI, VFI and VSR (r = 0.199 p = 0.008, r = 0.422 p < 0.001, r = 0.253 p = 0.001, r = 0.310 p < 0.001). BMD of the femoral neck was only correlated with PMI and SFI (r = 0.268 p < 0.001, r = - 0.164 p-0.028). FRAX (major osteoporotic fracture) was only closely related to PMI (r = - 0.397 p < 0.001). FRAX (hip fracture) was closely related to SMI and PMI (r = - 0.183 p = 0.014, r = - 0.353 p < 0.001). Besides, FRAX (major osteoporotic fracture and hip fracture) did not correlate with VFI, SFI, and VSR. SMI and PMI were statistically significant, with the area under the curve (AUC) of 0.400 (95% confidence interval 0.312-0.488 p = 0.024) and 0.327 (95% confidence interval 0.244-0.410 p < 0.001), respectively. VFI, SFI, and VSR were not statistically significant in predicting osteoporosis.
CONCLUSIONS
This study demonstrated that L3-based muscle index could assist clinicians in the diagnosis of osteoporosis to a certain extent, and PMI is superior to SMI in the diagnosis of osteoporosis. In addition, VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well.
Topics: Humans; Osteoporotic Fractures; Psoas Muscles; Risk Factors; Risk Assessment; Osteoporosis; Absorptiometry, Photon; Bone Density; Hip Fractures; Lumbar Vertebrae; Tomography, X-Ray Computed
PubMed: 36280811
DOI: 10.1186/s12891-022-05887-5 -
International Journal of Clinical... Jan 2023Higher relative dose intensity (RDI) of chemotherapy improves the clinical outcomes of various cancers. The psoas muscle index (PMI) is related to sarcopenia, and...
BACKGROUND
Higher relative dose intensity (RDI) of chemotherapy improves the clinical outcomes of various cancers. The psoas muscle index (PMI) is related to sarcopenia, and patients with low PMI have worse prognoses. However, few studies have demonstrated its clinical relevance in gastric cancer.
METHODS
This retrospective study included 188 stage II/III gastric cancer patients who had undergone curative gastrectomy between January 2013 and March 2017, 124 of whom had received postoperative S-1 adjuvant chemotherapy.
RESULTS
Per receiver operating characteristic analysis, patients were divided into high and low RDI groups, between which relapse-free survival differed marginally significantly and disease-specific survival differed significantly. In patients who received adjuvant chemotherapy, multivariate analysis found that high RDI and low PMI reduction rate 1 year after surgery were significantly associated with better relapse-free survival. Low RDI can be predicted by a combination of low preoperative PMI and non-distal gastrectomy, whereas high PMI reduction rate at 1 year can be affected by non-distal gastrectomy.
CONCLUSION
High RDI with preserved psoas muscle up to 1 year after gastrectomy may be associated with prognoses in gastric cancer requiring postoperative adjuvant chemotherapy. Since RDI and PMI reduction rate can be predicted preoperatively, respectively, interventional consideration is possible for optimal adjuvant therapy in gastric cancer.
Topics: Humans; Stomach Neoplasms; Prognosis; Psoas Muscles; Retrospective Studies; Neoplasm Recurrence, Local; Chemotherapy, Adjuvant; Gastrectomy
PubMed: 36326962
DOI: 10.1007/s10147-022-02260-3