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Nephron 2023Computed tomography (CT) can accurately measure muscle mass, which is necessary for diagnosing sarcopenia, even in dialysis patients. However, CT-based screening for...
INTRODUCTION
Computed tomography (CT) can accurately measure muscle mass, which is necessary for diagnosing sarcopenia, even in dialysis patients. However, CT-based screening for such patients is challenging, especially considering the availability of equipment within dialysis facilities. We therefore aimed to develop a bedside prediction model for low muscle mass, defined by the psoas muscle mass index (PMI) from CT measurement.
METHODS
Hemodialysis patients (n = 619) who had undergone abdominal CT screening were divided into the development (n = 441) and validation (n = 178) groups. PMI was manually measured using abdominal CT images to diagnose low muscle mass by two independent investigators. The development group's data were used to create a logistic regression model using 42 items extracted from clinical information as predictive variables; variables were selected using the stepwise method. External validity was examined using the validation group's data, and the area under the curve (AUC), sensitivity, and specificity were calculated.
RESULTS
Of all subjects, 226 (37%) were diagnosed with low muscle mass using PMI. A predictive model for low muscle mass was calculated using ten variables: each grip strength, sex, height, dry weight, primary cause of end-stage renal disease, diastolic blood pressure at start of session, pre-dialysis potassium and albumin level, and dialysis water removal in a session. The development group's adjusted AUC, sensitivity, and specificity were 0.81, 60%, and 87%, respectively. The validation group's adjusted AUC, sensitivity, and specificity were 0.73, 64%, and 82%, respectively.
DISCUSSION/CONCLUSION
Our results facilitate skeletal muscle screening in hemodialysis patients, assisting in sarcopenia prophylaxis and intervention decisions.
Topics: Humans; Sarcopenia; Muscle, Skeletal; Psoas Muscles; Renal Dialysis; Kidney Failure, Chronic; Mass Screening; Retrospective Studies
PubMed: 36273447
DOI: 10.1159/000526866 -
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 -
Clinical Anatomy (New York, N.Y.) Mar 2022To evaluate the operating range and morphology of the surgical safe zone for oblique lumbar interbody fusion (OLIF). Twenty embalmed full-torso cadaveric specimens were...
To evaluate the operating range and morphology of the surgical safe zone for oblique lumbar interbody fusion (OLIF). Twenty embalmed full-torso cadaveric specimens were dissected. The oblique corridor and the distance between adjacent lumbar arteries were measured in a static state and with psoas major retraction. The morphology and size of the safe zone for OLIF and the location of the lumbar sympathetic trunk were also recorded. The oblique corridor of the L1-L5 segments was significantly greater in the retracted state than in the static state (p < 0.05). With psoas major retraction, the distances between adjacent lumbar arteries at L1-4 were significantly greater (p < 0.05) than those in the static state. The lumbar sympathetic trunk is just located in the safe zone and travels downward adjacent to the psoas major. The shape of the safe zone for OLIF was approximately an oblique upward parallelogram at L1/2 and L2/3, an isosceles trapezoid at L3/4, and an irregular quadrangle or triangle at L4/5. The safe zone for OLIF at L1/2, L2/3, and L3/4 was significantly larger during retraction than in the static state (p < 0.05). On the lateral side of the lumbar spine there is a natural surgical safe zone for OLIF, which can provide a sufficient operating space. The safe zone has a certain morphological pattern in L1-5 segments and psoas major retraction can significantly enlarge it.
Topics: Cadaver; Humans; Lumbar Vertebrae; Lumbosacral Region; Psoas Muscles; Spinal Fusion
PubMed: 34704286
DOI: 10.1002/ca.23804 -
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 -
Anticancer Research Sep 2023Sarcopenia is a progressive and generalized muscle disorder correlated with an increased risk of adverse outcomes, including falls, fractures, physical disability and...
BACKGROUND/AIM
Sarcopenia is a progressive and generalized muscle disorder correlated with an increased risk of adverse outcomes, including falls, fractures, physical disability and mortality. Moreover, sarcopenia is associated with short- and long-term outcomes after surgery in patients with gastrointestinal malignancies. Additionally, severe skeletal muscle loss after surgery reduces quality of life. In this study, we analyzed the perioperative risk factors for skeletal muscle loss after gastrectomy in elderly patients undergoing radical gastrectomy for gastric cancer.
PATIENTS AND METHODS
In this case-control study, we enrolled patients aged ≥75 years who underwent radical gastrectomy for gastric cancer between January 2014 and December 2020 at our Institution. The psoas muscle index was used to assess skeletal muscle mass. They were divided into two groups-muscle depletion (D group) and no depletion (ND group)-depending on the ratio of skeletal muscle loss before and after gastrectomy.
RESULTS
The D and ND groups comprised 34 and 41 patients, respectively. Univariate analysis showed that open gastrectomy was a potential risk factor for postoperative skeletal muscle loss in elderly gastric cancer patients (p=0.017). In multiple logistic regression analysis using the following variables: sex, operation and approach, the D group had a significantly higher proportion of patients who underwent open surgery than the ND group (p=0.032).
CONCLUSION
Open gastrectomy is an independent risk factor for the progression of sarcopenia after gastrectomy in elderly patients with gastric cancer. Laparoscopic surgery is an eligible method for preserving skeletal muscle mass in elderly patients with gastric cancer.
Topics: Aged; Humans; Stomach Neoplasms; Sarcopenia; Case-Control Studies; Quality of Life; Gastrectomy; Psoas Muscles
PubMed: 37648324
DOI: 10.21873/anticanres.16612 -
Journal of Vascular and Interventional... Apr 2023To evaluate the effect of peritoneonvenous shunt placement on metrics of sarcopenia in patients with refractory ascites.
PURPOSE
To evaluate the effect of peritoneonvenous shunt placement on metrics of sarcopenia in patients with refractory ascites.
MATERIALS AND METHODS
An institutional review board-approved single-institution retrospective analysis of all patients who underwent peritoneovenous shunt (Denver Shunt; BD, Franklin Lakes, New Jersey) placement (N = 29) and a comparator cohort of patients with cirrhosis who underwent serial paracentesis (N = 42) from 2009 to 2019 with baseline and follow-up cross-sectional imaging of at least 3 months was performed. Axial muscle area measurements (psoas, paraspinal, and total abdominal wall) were performed using free-hand region-of-interest technique. Patient records were reviewed for demographic characteristics, referring indication, laboratory studies, and performance status. Statistical analyses were performed with Student t test, Welch unequal variances, Fisher exact test, and Wilcoxon signed rank test.
RESULTS
The most common indications for peritoneovenous shunt placement were metastatic disease or cirrhosis. In the shunt cohort, there were no significant differences in the aggregate psoas muscle area (13.4 vs 14.0 cm; P = .223) or paraspinal muscle area (43.0 vs 42.2 cm; P = .471). In the paracentesis cohort, there were significant decreases in aggregate psoas (18.1 vs 15.7 cm; P < .0001) and erector spinae (43.4 vs 39.9 cm; P < .0001) muscle area. In addition, there was a significant decrease in serum albumin level (3.2 vs 3.0 g/dL; P = .015) and Eastern Cooperative Oncology Group performance status score (1.0 vs 1.3; P < .0001) in the paracentesis group, compared with no significant changes in the shunt cohort.
CONCLUSIONS
In patients with refractory ascites who are not candidates for transjugular intrahepatic portosystemic shunt placement, peritoneovenous shunt mitigates loss of truncal muscle and, in some instances, promotes muscle growth.
Topics: Humans; Ascites; Retrospective Studies; Sarcopenia; Peritoneovenous Shunt; Liver Cirrhosis; Psoas Muscles; Portasystemic Shunt, Transjugular Intrahepatic
PubMed: 36563934
DOI: 10.1016/j.jvir.2022.12.037 -
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