-
European Journal of Medical Research Apr 2021Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative...
BACKGROUND
Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative intervention targeting identified risk factors could improve postoperative outcome. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM).
METHODS
Data of patients diagnosed with CRLM who underwent liver resection between 2006 and 2016 were analysed. Muscle quantity (psoas muscle index [PMI]), and muscle quality, (average muscle radiation attenuation [AMA] of the psoas), were measured using computed tomography. Changes in PMI and AMA of psoas after surgery were assessed.
RESULTS
A total of 128 patients were analysed; 67 (52%) had surgery-related loss of muscle quantity and 83 (65%) muscle quality loss. Chronic obstructive pulmonary disease (COPD) (P = 0.045) and diabetes (P = 0.003) were risk factors for surgery-related loss of muscle quantity. A higher age (P = 0.002), open resection (P = 0.003) and longer operation time (P = 0.033) were associated with muscle quality loss. Overall survival was lower in patients with both muscle quantity and quality loss compared to other categories (P = 0.049). The rate of postoperative complications was significantly higher in the group with surgery-related loss of muscle quality.
CONCLUSIONS
Risk factors for surgery-related muscle loss were identified. Overall survival was lowest in patients with both muscle quantity and quality loss. Complication rate was higher in patients with surgery-related loss of muscle quality.
Topics: Aged; Colorectal Neoplasms; Colorectal Surgery; Female; Follow-Up Studies; Humans; Liver Neoplasms; Male; Postoperative Complications; Prognosis; Psoas Muscles; Retrospective Studies; Risk Factors; Sarcopenia; Survival Rate
PubMed: 33892809
DOI: 10.1186/s40001-021-00507-9 -
American Journal of Nephrology 2022Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and...
INTRODUCTION
Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and which are at high risk for post-transplant complications. Sarcopenia is associated with poor outcome in various conditions, including in chronic kidney disease patients. The gold standard for measuring sarcopenia is computed tomography (CT) imaging to estimate muscle mass and quality since it is objective, reproducible, and reflects the overall health condition. The data regarding those measurements among kidney transplant recipients are limited, therefore we aimed to describe it in patients before kidney transplantation, assess the parameters associated with sarcopenia, and evaluate the clinical significance of those markers on outcomes following transplantation.
METHODS
We retrospectively analyzed 183 kidney transplant recipients who had a CT scan 90 days prior to transplant. Sarcopenia was assessed by measuring the cross-sectional area (CSA) and mean muscle density of the psoas muscle at the third and fourth lumbar vertebrae levels and paravertebral muscles at the 12th thoracic vertebra level.
RESULTS
There was a strong linear correlation between muscle size measured as CSA of the psoas muscle at the L3 and L4 vertebral body level and the CSA of the paravertebral muscles at the D12 vertebra level, and a moderate correlation to muscle density at those levels. Age was independently associated with risk of sarcopenia, defined as psoas CSA in the lowest tertile, with every year of age increasing the risk by 5%. CSA at the L3 level had a significant independent association with post kidney transplantation mortality, with an adjusted hazard ratio of 0.86 per cm2. There was a significantly longer hospitalization period postoperation in kidney recipients in the lower tertile of psoas CSA and density.
CONCLUSIONS
Sarcopenia as measured by psoas CSA is associated with poor short- and long-term outcomes following kidney transplantation and should be included as part of the assessment of kidney transplantation candidates.
Topics: Humans; Kidney Transplantation; Proportional Hazards Models; Psoas Muscles; Retrospective Studies; Sarcopenia
PubMed: 35584614
DOI: 10.1159/000524774 -
PloS One 2021Little is known about the muscle condition in children with obesity.
BACKGROUND
Little is known about the muscle condition in children with obesity.
OBJECTIVES
To investigate the effect of obesity and fatty liver on muscle area and muscle fat in children and young adults.
MATERIALS AND METHODS
We evaluated consecutive liver fat quantification MRIs in children and young adults between June 2015 and April 2019. We obtained hepatic fat and paraspinal muscle fat at mid L2 from the fat map, psoas muscle area (PMA) at mid L3, and z-score of PMA. The patient's age, height and weight at the time of the MRI were recorded. Body mass index (BMI) z-score was also calculated. Spearman correlation and partial correlation analyses were performed. Univariate and multivariate regression analyses were also performed using significant variables.
RESULTS
A total of 132 patients (97 male) were included with a median age of 13.0 years (interquartile range 11-16 years). The median BMI was 23.7 kg/m2 (interquartile range 21.2-27.7 kg/m2). The weight, BMI, liver fat, and z-score of PMA were all higher in male patients than they were in female patients. The amount of liver fat had no correlation with muscle fat or PMA z-score after adjusting BMI. However, the BMI z-score was positively correlated with the PMA z-score (ρ = 0.432, p<0.001) even after adjusting for liver fat. On regression analyses, the BMI z-score had linear positive relationship with PMA z-score (β = 0.289, p<0.001) and muscle fat (β = 0.218, p = 0.016).
CONCLUSIONS
Male children and young adults have greater PMA than do female children and young adults. Obesity is associated with higher PMA and paraspinal muscle fat. However, liver fat is not related with the muscle condition in children and young adults.
Topics: Adolescent; Child; Fatty Liver; Female; Humans; Male; Obesity; Paraspinal Muscles; Psoas Muscles; Young Adult
PubMed: 34788336
DOI: 10.1371/journal.pone.0259948 -
Journal of Clinical Orthopaedics and... Dec 2022Conventional imaging studies of human spine are done in a supine posture in which the axial loading of the spine is not considered. Upright images better reveal the...
Conventional imaging studies of human spine are done in a supine posture in which the axial loading of the spine is not considered. Upright images better reveal the interrelationships between the various internal structures of the spine. The objective of the current study is to determine the cross-sectional areas, radii, and angulations of the psoas, erector spinae, and multifidus muscles of the lumbar spine in the sitting posture. Ten young (mean age 31 ± 4.8 years) asymptomatic female subjects were enrolled. They were seated in an erect posture and weight-bearing T1 and T2 MRIs were obtained. Cross-sectional areas, radii, and angulations of the muscles were measured from L1-L5. Two observers repeated all the measurements for all parameters, and reliability was determined using the inter- and intra-class coefficients. The Pearson product moment correlation was used for association between levels, while level differences were used using a linear regression model. The cross-sectional areas of the psoas and multifidus muscles increased from L1 to L5 (1.9 ± 1.1 to 12.1 ± 2.5 cm and 1.8 ± 0.3 to 5.7 ± 1.4 cm). The cross-sectional area of the erector spinae was greatest at the midlevel (13.9 ± 2.2 cm) and it decreased in both directions. For the angle, the range for psoas muscles was 75-105°, erector spinae were 39-46° and multifidus was 11-19°. Correlations magnitudes were inconsistent between levels and muscle types. These quantitated data improve our understanding of the geometrical properties in the sitting posture. The weight-bearing MRI-quantified morphometrics of human lumbar spine muscles from this study can be used in biomechanical models for predicting loads on spinal joints under physiological and traumatic situations.
PubMed: 36340960
DOI: 10.1016/j.jcot.2022.102051 -
Cureus Apr 2018Introduction The psoas muscle group is part of the posterior abdominal wall and is comprised of long muscles - major, minor, and tertius. Out of those, only the psoas...
Introduction The psoas muscle group is part of the posterior abdominal wall and is comprised of long muscles - major, minor, and tertius. Out of those, only the psoas major muscle is an obligatory muscle present in all individuals. The psoas minor muscle (PMM) originates as vertical fascicles inserted in the bodies of the last thoracic and first lumbar vertebrae and inserting into the iliopectineal eminence. The muscle provide flexion of the lumbar spine in a limited fashion. The aim of the study was to establish the frequency of the muscle in the Bulgarian population. Materials and methods This study was carried out in the Department of Anatomy and Cell Biology, Medical University, Varna, Bulgaria, by Dr. Paraskev Stoyanov in November 2017, on a total of 10 cadavers. The length, width, and circumference of the muscles were measured. The collected data were interpreted in a descriptive manner. Results The PMM was present in six out of ten cadavers (60%). Out of those six cadavers, the muscle was bilateral in three, unilateral on the left side in one, and unilateral on the right side in two cadavers. The average length of the muscle was 19.66 cm (range:14.4 cm - 21.7 cm), average width was 1.73 cm (range: 1.0 cm - 3.2 cm ) and average circumference was 3.48 cm (range: 1.7 cm - maximum 5.6 cm). The male to female ratio of cadavers with a PMM was 1:1. Conclusion The frequency of the muscle's variations considering its presence in the Bulgarian population (60%) is higher when compared to its presence in the Indian population (36.67%), virtually identical to the Brazilian population (59%), and lower than that reported in the US (65.6%). The morphometric analyses of the different populations showed a shorter psoas minor in the Bulgarian population.
PubMed: 29888151
DOI: 10.7759/cureus.2447 -
Journal of Orthopaedic Surgery and... Feb 2023This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal...
OBJECTIVE
This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal stenosis (SMLSS) and assess the correlations of these morphological characteristics with function and clinical symptoms.
METHODS
One hundred fourteen patients diagnosed with SMLSS (≥ 3 segments) were included. The patients' presenting symptoms were assessed with the Oswestry Disability Index (ODI), and visual analogue scale (VAS) scores were recorded. The morphology of the psoas major was evaluated at the L3/4 intervertebral disc level in three ways: by measuring (i) the psoas muscle mass index (PMI); (ii) the mean muscle attenuation (Hounsfield units, HU); and (iii) the morphologic change of the psoas major (mean ratios of the short axis to the long axis of the bilateral psoas major).
RESULTS
Men had a higher PMI than women (p = 0.001). Patients with severe disability had a significantly lower PMI (p = 0.002) and muscle attenuation (p = 0.001). The PMI and muscle attenuation were significantly higher in the patients with no or mild back pain (both p < 0.001). In the univariable and multivariable analyses, a greater HU value was associated with a higher functional status as assessed by the ODI (p = 0.002), and a higher PMI was associated with less severe back pain as measured by the VAS score (p < 0.001).
CONCLUSION
This study showed that muscle attenuation of psoas major positively correlated with the functional status and PMI negatively correlated with low back pain severity in patients diagnosed with SMLSS. Future prospective studies are needed to evaluate whether improvement in such muscle parameters through physiotherapy programs can alleviate the clinical symptoms and improve the functional status of patients with SMLSS.
Topics: Male; Humans; Female; Spinal Stenosis; Psoas Muscles; Back Pain; Intervertebral Disc Degeneration; Lumbar Vertebrae; Muscles; Retrospective Studies; Treatment Outcome
PubMed: 36793071
DOI: 10.1186/s13018-023-03596-w -
Investigative and Clinical Urology Jul 2022Two methods are used to identify sarcopenia by calculating skeletal muscle area on computed tomography: the skeletal muscle index (SMI) and the psoas muscle index (PMI)....
PURPOSE
Two methods are used to identify sarcopenia by calculating skeletal muscle area on computed tomography: the skeletal muscle index (SMI) and the psoas muscle index (PMI). Programmed death (PD)-1 inhibitors are helpful in treating metastatic renal cell carcinoma (mRCC). However, there remains insufficient information regarding a clear and easy-to-use biomarker for predicting the response to PD-1 inhibitors in patients with mRCC. Therefore, we investigated the influence of sarcopenia on clinical outcomes in patients with mRCC undergoing treatment with nivolumab.
MATERIALS AND METHODS
This study evaluated 96 patients with RCC who received nivolumab. The SMI and PMI were calculated for each patient and normalized for stature by use of the following formulas: SMI (cm²/m²)=([skeletal muscle cross-sectional area at the level of L3]/[height]²) and PMI (cm²/m²) = ([left-right sum of the psoas muscle areas at the level of L3]/[height]²). The relationship of the clinical variables with progression-free survival and overall survival (OS) was examined using a Cox proportional hazards model.
RESULTS
According to the SMI-based definition of sarcopenia, 74.0% of patients had sarcopenia. However, according to the PMI-based definition of sarcopenia, only 34.3% of patients were diagnosed with sarcopenia. Multivariate analysis identified sarcopenia based on PMI (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.04-7.26; p<0.001) and International Metastatic RCC Database Consortium poor risk status (HR, 1.90; 95% CI, 1.03-3.50; p=0.041) as significant and independent prognostic factors of OS.
CONCLUSIONS
PMI-based sarcopenia is a significant prognostic factor for OS in patients with RCC who receive nivolumab therapy.
Topics: Antineoplastic Agents, Immunological; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Nivolumab; Prognosis; Psoas Muscles; Retrospective Studies; Sarcopenia
PubMed: 35796138
DOI: 10.4111/icu.20220028 -
Pain Physician Oct 2022Handgrip strength (HGS) and psoas muscle index (PMI) are widely used protocols for screening or diagnosing sarcopenia by measuring muscle strength and mass. Epidural... (Observational Study)
Observational Study
BACKGROUND
Handgrip strength (HGS) and psoas muscle index (PMI) are widely used protocols for screening or diagnosing sarcopenia by measuring muscle strength and mass. Epidural steroid injection (ESI) is a common intervention for the treatment of spinal pain; however, the influence of pre-procedural sarcopenic status on therapeutic effects after ESI has not been investigated.
OBJECTIVES
In the present study, whether pre-procedural HGS or PMI predicts analgesic efficacy of ESI in elderly patients with degenerative lumbar spinal disease was investigated.
STUDY DESIGN
This was a retrospective observational study.
SETTING
The study included patients from the outpatient department for interventional pain management at a university hospital.
METHODS
Following institutional review board (IRB) approval, patients >= 65 years of age who underwent fluoroscopy-guided lumbar ESI from 2016 to 2017 in our clinic were enrolled in the present study. Good analgesia was defined as >= 50% reduction in pain score at 4 weeks after injection. Patient characteristics, pain-related factors, clinical factors, HGS, and PMI measurements were collected and analyzed using multivariate analysis to identify the predictors of good analgesia after lumbar ESI. In addition, a receiver operating characteristic curve (ROC) analysis was performed, and area under the curve (AUC) values with 95% confidence interval (CI) were calculated for the HGS.
RESULTS
A total of 259 patients satisfied the study protocol requirements. HGS was significantly higher in the good analgesia group (23.12 ± 7.54 vs 16.55 ± 6.66 kg, P < 0.001). However, the PMI did not differ between the 2 groups (5.25 ± 1.55 vs 5.08 ± 1.69 cm2/m2, P = 0.406). Multivariate analysis revealed higher HGS (odds ratio, OR = 1.142, 95% CI = 1.094-1.193, P < 0.001) and low-grade foraminal stenosis (OR = 0.403, 95% CI = 0.199-0.814, P = 0.011) were significantly associated with good analgesia after injection. The AUC values with 95% CI for HGS were 0.819 (0.718-0.920) in men and 0.800 (0.732-0.869) in women. In addition, HGS cutoff values for predicting good analgesic outcomes were 26.5 kg in men and 16.5 kg in women.
LIMITATIONS
This study was conducted in a single center, and sample size was relatively small. The lack of physical performance evaluation did not fully meet the current criteria for sarcopenia. In addition, post-procedural clinical data associated with disability or quality of life could not be collected.
CONCLUSION
In the present study, pre-procedural HGS was an independent predictor of analgesic efficacy after ESI in elderly patients with degenerative lumbar spinal disease. However, the PMI was not associated with pain relief after injection.
Topics: Male; Humans; Female; Aged; Spinal Stenosis; Injections, Epidural; Psoas Muscles; Hand Strength; Sarcopenia; Pain; Spinal Diseases; Steroids; Analgesics
PubMed: 36288597
DOI: No ID Found -
Cancer Medicine Feb 2023The body composition of patients has been associated with tolerability and effectiveness of anticancer therapy. This study aimed to assess the influence of the skeletal...
BACKGROUND
The body composition of patients has been associated with tolerability and effectiveness of anticancer therapy. This study aimed to assess the influence of the skeletal muscle index (SMI) on the pharmacokinetics and toxicity of fluorouracil.
METHODS
Patients treated in an oncological practice with fluorouracil-based chemotherapy and undergoing therapeutic drug monitoring were retrospectively investigated. Computed tomography images were analyzed to measure abdominal skeletal muscle areas in Hounsfield units for the psoas major muscle, back and total skeletal muscle to determine the SMI. For the latter, an automated segmentation method was used additionally. SMI measures were tested as covariates on fluorouracil clearance in a population pharmacokinetic model. Furthermore, regression analyses were performed to analyze the influence of SMI measures on the probability of clinically relevant adverse events (CTCAE grades ≥ 2).
RESULTS
Fluorouracil plasma concentrations of 111 patients were available. Covariate analyses showed significant improvements of the model fit by all SMI measures. However, interindividual variability of fluorouracil clearance was only slightly reduced, whereas the SMI of the back muscle showed the largest reduction (-1.1 percentage points). Lower SMI values of the back muscle increased the probability for polyneuropathy and lower SMI of the psoas increased the probability for fatigue.
CONCLUSIONS
Our results suggest that pharmacokinetics and toxicity of fluorouracil may be associated with specific SMI measures which deserve further investigation.
Topics: Humans; Retrospective Studies; Psoas Muscles; Tomography, X-Ray Computed; Fluorouracil; Prognosis
PubMed: 35941837
DOI: 10.1002/cam4.5118 -
PloS One 2021Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating...
BACKGROUND
Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating evidence suggest that low skeletal muscle mass has a negative impact on clinical outcome in elderly adult population. We sought to determine the significance of psoas muscle area as a novel index of low skeletal muscle mass in elderly patients with ADHF.
METHODS
In this single-center retrospective observational study, we reviewed consecutive 865 elderly participants (65 years or older) who were hospitalized for ADHF and 392 were available for analysis (79 years [74-85], 56% male). Cross-sectional areas of psoas muscle at the level of fourth lumbar vertebra were measured by computed tomography and normalized by the square of height to calculate psoas muscle index (PMI, cm2/m2).
RESULTS
Dividing the patients by the gender-specific quartile value (2.47 cm2/m2 for male and 1.68 cm2/m2 for female), we defined low PMI as the lowest gender-based quartile of PMI. Multiple linear regression analysis revealed female sex, body mass index (BMI), and E/e', but not left ventricular ejection fraction, were independently associated with PMI. Kaplan-Meier analysis showed low PMI was associated with higher rate of composite endpoint of all-cause death and ADHF re-hospitalization (P = 0.033). Cox proportional hazard model analysis identified low PMI, but not BMI, was an independent predictor of the composite endpoint (Hazard ratio: 1.52 [1.06-2.16], P = 0.024).
CONCLUSIONS
PMI predicted future clinical adverse events in elderly patients with ADHF. Further studies are needed to assess whether low skeletal muscle mass can be a potential therapeutic target to improve the outcome of ADHF.
Topics: Aged; Aged, 80 and over; Body Mass Index; Cross-Sectional Studies; Female; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Muscle, Skeletal; Prognosis; Proportional Hazards Models; Psoas Muscles; Retrospective Studies
PubMed: 33592068
DOI: 10.1371/journal.pone.0247140