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Annals of Vascular Surgery Nov 2022Low psoas muscle area (PMA) is associated with worse post-operative outcomes. Our objective was to evaluate the association of PMA and postoperative outcomes in patients...
BACKGROUND
Low psoas muscle area (PMA) is associated with worse post-operative outcomes. Our objective was to evaluate the association of PMA and postoperative outcomes in patients undergoing fenestrated/branched endovascular aneurysm repair (F/BEVAR).
METHODS
Patient characteristics, anatomical and clinical information, and post-operative outcomes were collected from patients undergoing F/BEVAR between 2005-February 2019 who were deemed too high-risk for open repair. PMA was measured using a validated web-based software (coreslicer.com). Post-operative outcomes were compared between patients with low PMA (lowest quartiles) and high PMA (highest quartiles).
RESULTS
We included 129 patients with a mean age of 74.6 ± 8.1, 81.4% male, and a mean follow-up of 29.4 ± 32.2 months. Patients in the low PMA group were more likely to be female (33.8% vs. 3.1%, P < 0.0001), less likely to have hypertension (72.3% vs. 87.5%, P = 0.03), dyslipidemia (63.1% vs. 78.1%, P = 0.06), and a trend towards a greater history of endovascular aneurysm repair (4.6% vs. 0%, P = 0.08). There were no significant differences in aneurysm or device characteristics between groups. In a multivariate model including age, sex, aneurysm type, and presence of prophylactic spinal drain, the low PMA group had a significantly increased risk of spinal cord injury (odds ratio 12.7, 95% CI 1.1-143.6). There were no significant differences in other 30-day outcomes. When compared to the highest quartile, the lowest PMA quartile patients had a hazard ratio of 4.6 (95% CI 1.2-17.6) for mortality during follow-up in a model with age, sex, and aneurysm type. For each 1 cm increase in PMA, the HR was 0.90 (95% CI 0.82-0.99) for mortality during follow-up.
CONCLUSIONS
In high-risk patients undergoing F/BEVAR low PMA is associated with spinal cord injury and mortality during follow-up. We found no association between PMA and 30-day mortality. PMA measurement is a simple method to assess for sarcopenia and frailty and may be useful for risk stratification pre-operatively.
Topics: Humans; Male; Female; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Psoas Muscles; Retrospective Studies; Risk Factors; Treatment Outcome; Spinal Cord Injuries; Aortic Aneurysm, Thoracic
PubMed: 35772667
DOI: 10.1016/j.avsg.2022.05.037 -
Urology Dec 2021To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and...
OBJECTIVE
To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and operative outcome after radical cystectomy (RC) for bladder cancer.
METHODS
In a retrospective single-center study, bladder cancer patients who underwent RC and urinary diversion between 2007 and 2012 were enrolled. TPA was evaluated in the cross-sectional imaging. The psoas muscles were normalized with the height. Male patients with a psoas mass index ≤7.4 cm/m and female patients with a psoas mass index ≤5.2 cm/m were classified as sarcopenic. Outcome measures were 30- and 90-day readmission and complications, and survival. Multivariable logistic and Cox proportional-hazards regression models were used to determine relevant predictors.
RESULTS
The median age of the 441 participants and follow up time was 68 years (IQR 59-75) and 1.2 years (IQR 0.5-1.9), respectively. One hundred forty-three patients (32.4%) were sarcopenic. The 30-day readmission and the complication rates were 13.8% and 44.7%, respectively. The 90-day readmission and complication rates were 23.9% and 53.1%, respectively. The 1-year mortality rate was 11.6% (95%CI 8.7-15.4). Multivariable logistic regression analysis revealed an association between increased TPA and lower odds of 30-day complications after RC (OR 0.95, 95%CI 0.92-0.99, P = .02); similarly, an increase in TPA was of prognostic value, although not statistically significant in the multivariable model (P = .05) once adjusting for other patient factors.
CONCLUSION
Sarcopenia predicted early complications and showed an informative trend for overall survival after RC, and thus may inform models predicting postsurgical outcomes.
Topics: Aged; Cystectomy; Female; Humans; Male; Middle Aged; Patient Readmission; Postoperative Complications; Psoas Muscles; Retrospective Studies; Sarcopenia; Tomography, X-Ray Computed; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 34437899
DOI: 10.1016/j.urology.2021.08.013 -
The American Surgeon Jun 2023Sarcopenia and frailty have both emerged as risk factors for elderly falls. We investigated whether radiologic sarcopenia or frailty are associated with falls in a... (Review)
Review
Sarcopenia and frailty have both emerged as risk factors for elderly falls. We investigated whether radiologic sarcopenia or frailty are associated with falls in a high-risk geriatric outpatient population. We reviewed 114 patients followed at the Center for Healthy Senior Living who had undergone a computerized tomography (CT) of the abdomen and pelvis for any reason from 2013 to 2019. Sarcopenia was determined by psoas muscle cross-sectional area at L3 on CT scan. Their individual frailty score was calculated. The primary outcome was admission to hospital for falls. There were no statistical differences in frailty score or sarcopenia between the 2 groups (left/right psoas muscle: no hospital admission = 6.8 ± 2.4/6.4 ± 2.5 vs falls requiring hospital admission 6.5 ± 2.3/6.5 ± 2.3 cm). We concluded that neither frailty score nor sarcopenia predicted the occurrence of falls in our high-risk geriatric outpatient population.
Topics: Humans; Aged; Frailty; Sarcopenia; Risk Factors; Hospitalization; Tomography, X-Ray Computed; Psoas Muscles; Retrospective Studies
PubMed: 35142564
DOI: 10.1177/00031348221075593 -
Acta Gastro-enterologica Belgica 2022To establish a new psoas muscle depletion index (PDI) from healthy young donors and to explore the correlation between the PDI and the severity of cirrhosis in patients...
OBJECTIVE
To establish a new psoas muscle depletion index (PDI) from healthy young donors and to explore the correlation between the PDI and the severity of cirrhosis in patients with endstage liver disease (ESLD).
METHODS
Clinical data of 461 healthy donors were collected during the period 2014-2019, and clinical data of 331 patients with ESLD were collected during the period 2014-2018. The patients were divided into four groups by PDI severity: PDI ≥ 0.90, PDI = 0.75-0.90, PDI = 0.50-0.75 and PDI ≤ 0.50 (Gsev). Differences in international normalised ratio (INR), total bilirubin and serum creatinine levels, and Child-Pugh (CP) and model for end-stage liver disease (MELD) scores were compared. The sarcopenia incidence according to the PDI and the psoas muscle index (PMI) in different weight groups were also compared.
RESULTS
Gsev had the highest CP (10.2 ± 2.1) and MELD (20.1 ± 7.4) scores and total bilirubin (166.3 ± 192.0 umol/L) and blood creatinine (92.9 ± 90.2 umol/L) levels and the lowest haemoglobin (93.8 ± 21.7 g/L) and blood albumin (30.9 ± 5.8 g/L) levels. Gsev showed significant changes in INR (1.74 ± 0.65) and blood sodium (135.3 ± 5.65 mmol/L). If PDI <0.75 was used as the diagnostic criterion for sarcopenia, the incidence was 53.3% in patients weighing >90 kg and 53.6% in those weighing <60 kg. This differed from the PMI, with an incidence of 3.3% in patients weighing >90 kg.
CONCLUSIONS
The PDI had no significant correlation with body height, body weight or body mass index (BMI) in healthy individuals and patients with ESLD. The PDI was significantly correlated with the severity of cirrhosis and loss of skeletal muscle.
Topics: Albumins; Bilirubin; Creatinine; End Stage Liver Disease; Hemoglobins; Humans; Liver Cirrhosis; Psoas Muscles; Retrospective Studies; Sarcopenia; Severity of Illness Index; Sodium
PubMed: 35770283
DOI: 10.51821/85.3.10110 -
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 -
Clinical Anatomy (New York, N.Y.) Apr 2021To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles.
INTRODUCTION
To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles.
METHOD
A modified Sihler's method was performed on the psoas major and iliacus muscles (16 specimens each). Intramuscular nerve arborization was recorded according to the most prominent point of the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the lesser trochanter (LT), and the transverse process of the 12th thoracic vertebra.
RESULTS
Intramuscular nerve arborization of the psoas major muscle was the largest from 1/5 to 3/5 the distance from the transverse process of the 12th thoracic vertebra to the PSIS, and the tendinous portion of the muscle occupied from 3/5 to 5/5 this distance. In terms of the plane of the ASIS, the PSIS, and the LT, the arborization of the iliacus muscle was the largest from 1/5 to 3/5 the horizontal distance and 0 to 1/3, the distance longitudinally, and from 1/5 to 2/5, the horizontal distance and 1/3 to 2/3, the longitudinal distance.
DISCUSSION
These results suggest that an injection of BoNT to the psoas major and iliacus muscle should be applied in specific areas. Additionally, the posterior approach is an ideal method for targeting only the psoas major because the injection point is above the PSIS. However, when treating both the psoas major and iliacus muscles, the proximal anterior approach is an ideal method according to the arborization patterns.
Topics: Aged; Aged, 80 and over; Botulinum Toxins, Type A; Cadaver; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Muscle Spasticity; Neuromuscular Agents; Psoas Muscles
PubMed: 32805076
DOI: 10.1002/ca.23670 -
Magnetic Resonance in Medicine Jan 2020To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting...
PURPOSE
To develop and test in animal studies ex vivo and in vivo, an intravascular (IV) MRI-guided high-intensity focused ultrasound (HIFU) ablation method for targeting perivascular pathology with minimal injury to the vessel wall.
METHODS
IV-MRI antennas were combined with 2- to 4-mm diameter water-cooled IV-ultrasound ablation catheters for IV-MRI on a 3T clinical MRI scanner. A software interface was developed for monitoring thermal dose with real-time MRI thermometry, and an MRI-guided ablation protocol developed by repeat testing on muscle and liver tissue ex vivo. MRI thermal dose was measured as cumulative equivalent minutes at 43°C (CEM ). The IV-MRI IV-HIFU protocol was then tested by targeting perivascular ablations from the inferior vena cava of 2 pigs in vivo. Thermal dose and lesions were compared by gross and histological examination.
RESULTS
Ex vivo experiments yielded a 6-min ablation protocol with the IV-ultrasound catheter coolant at 3-4°C, a 30 mL/min flow rate, and 7 W ablation power. In 8 experiments, 5- to 10-mm thick thermal lesions of area 0.5-2 cm were produced that spared 1- to 2-mm margins of tissue abutting the catheters. The radial depths, areas, and preserved margins of ablation lesions measured from gross histology were highly correlated (r ≥ 0.79) with those measured from the CEM = 340 necrosis threshold determined by MRI thermometry. The psoas muscle was successfully targeted in the 2 live pigs, with the resulting ablations controlled under IV-MRI guidance.
CONCLUSION
IV-MRI-guided, IV-HIFU has potential as a precision treatment option that could preserve critical blood vessel wall during ablation of nonresectable perivascular tumors or other pathologies.
Topics: Animals; Blood Vessels; Chickens; High-Intensity Focused Ultrasound Ablation; In Vitro Techniques; Liver; Magnetic Resonance Imaging; Muscle, Skeletal; Psoas Muscles; Swine; Temperature; Thermometry; Vena Cava, Inferior
PubMed: 31402512
DOI: 10.1002/mrm.27932 -
Clinical Spine Surgery Jun 2023This article is a research methodology study.
STUDY DESIGN
This article is a research methodology study.
OBJECTIVE
We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers.
SUMMARY OF BACKGROUND DATA
Lumbar interbody fusion techniques have seen an impressive degree of refinement over recent years. This innovation has ushered in a plethora of naming conventions for these new surgical approaches. Many of the current trends in naming lumbar fusion techniques are, however, redundant and contradictory, creating unnecessary confusion in the field.
METHODS
Following an extensive literature review, we developed a 4-part naming convention that highlights the crucial features of lumbar fusion surgical procedures.
RESULTS
Current literature regarding lumbar fusions is rife with inconsistent usage and privatization of terminology that can inadvertently result in ambiguous operative vocabulary, potentially compromising the accuracy of future research. We propose a 4-part naming system that highlights crucial features of lumbar interbody fusions, including (1) intra-operative repositioning, (2) patient position, (3) surgical technique, and (4) orientation of the surgical corridor to the psoas muscle.
CONCLUSIONS
This study raises awareness of current inconsistencies in naming conventions and proposes a standardized system for improving the clarity of lumber interbody fusion terminology for the broader spine community.
LEVEL OF EVIDENCE
Level V.
Topics: Humans; Lumbar Vertebrae; Spinal Fusion; Psoas Muscles; Lumbosacral Region
PubMed: 36728215
DOI: 10.1097/BSD.0000000000001425 -
Journal of the Formosan Medical... Jul 2022Although nutrition and sarcopenia have impacts on the surgery outcome of patients who have received living donor liver transplant (LDLT), the use of the prognostic...
BACKGROUND/PURPOSE
Although nutrition and sarcopenia have impacts on the surgery outcome of patients who have received living donor liver transplant (LDLT), the use of the prognostic nutritional index (PNI) or psoas muscle mass index (PMI) as an indicator for five-year survival in those patients is still unclear.
METHODS
A total of 138 patients receiving LDLT were followed at a medical center in Taiwan. As well as analysis of clinical factors using Cox regression, time-varying PNI and PMI values as before surgery (0) and at 3-, 6-, and 12- months after LDLT were analyzed by time-dependent Cox analysis. For those 124 patients who survived after 3 months of LDLT, the values of PNI-3m, PMI-3m and their combination were further analyzed.
RESULTS
PNI and PMI were noted to be highly associated with mortality at three months post-LDLT (PNI-3m hazard ratio [HR] = 0.89, 95% confidence interval [CI]: 0.85-0.94, p < 0.001; PMI-3m HR = 0.58, 95% CI: 0.41-0.82, p = 0.002). Per the Youden index, the cut-off point of PNI-3m was 42.35, and that of PMI-3m was 1.94. Compared to the subjects with higher levels of PNI-3m and PMI-3m (N-high/M-high), the HRs for subjects with N-high/M-low, N-low/M-high, and N-low/M-low were 5.27 (p = 0.004), 4.46 (p = 0.010) and 12.97 (p < 0.001) respectively.
CONCLUSION
PNI and PMI at the third month post-LDLT serve as excellent predictors for 5-year survival. For patients with lower levels of PNI-3m or PMI-3m, combination use of these indexes is suggested to provide better prognostic information.
Topics: Humans; Liver Transplantation; Living Donors; Muscular Diseases; Nutritional Status; Prognosis; Psoas Muscles; Retrospective Studies
PubMed: 34666924
DOI: 10.1016/j.jfma.2021.09.020 -
International Journal of Computer... Feb 2022The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual...
PURPOSE
The psoas major muscle (PMM) volume serves as an opportunistic imaging marker in cross-sectional imaging datasets for various clinical applications. Since manual segmentation is time consuming, two different automated segmentation methods, a generative adversarial network architecture (GAN) and a multi-atlas segmentation (MAS), as well as a combined approach of both, were investigated in terms of accuracy of automated volumetrics in given CT datasets.
MATERIALS AND METHODS
The bilateral PMM was manually segmented by a radiologist in 34 abdominal CT scans, resulting in 68 single 3D muscle segmentations as training data. Three different methods were tested for their ability to generate automated image segmentations: a GAN- and MAS-based approach and a combined approach of both methods (COM). Bilateral PMM volume (PMMV) was calculated in cm by each algorithm for every CT. Results were compared to the corresponding ground truth using the Dice similarity coefficient (DSC), Spearman's correlation coefficient and Wilcoxon signed-rank test.
RESULTS
Mean PMMV was 239 ± 7.0 cm and 308 ± 9.6 cm, 306 ± 9.5 cm and 243 ± 7.3 cm for the CNN, MAS and COM, respectively. Compared to the ground truth the CNN and MAS overestimated the PMMV significantly (+ 28.9% and + 28.0%, p < 0.001), while results of the COM were quite accurate (+ 0.7%, p = 0.33). Spearman's correlation coefficients were 0.38, 0.62 and 0.73, and the DSCs were 0.75 [95%CI: 0.56-0.88], 0.73 [95%CI: 0.54-0.85] and 0.82 [95%CI: 0.65-0.90] for the CNN, MAS and COM, respectively.
CONCLUSION
The combined approach was able to efficiently exploit the advantages of both methods (GAN and MAS), resulting in a significantly higher accuracy in PMMV predictions compared to the isolated implementations of both methods. Even with the relatively small set of training data, the segmentation accuracy of this hybrid approach was relatively close to that of the radiologist.
Topics: Algorithms; Humans; Image Processing, Computer-Assisted; Machine Learning; Psoas Muscles; Tomography, X-Ray Computed
PubMed: 34928445
DOI: 10.1007/s11548-021-02539-2