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Journal of Hepatology Aug 2021Studies exploring the relationship between muscle fat content and non-alcoholic fatty liver disease (NAFLD) are scarce. Herein, we aimed to evaluate the association of...
BACKGROUND & AIMS
Studies exploring the relationship between muscle fat content and non-alcoholic fatty liver disease (NAFLD) are scarce. Herein, we aimed to evaluate the association of muscle mass and fatty infiltration with biopsy-assessed NAFLD in patients with obesity.
METHODS
At inclusion (n = 184) and 12 months after a dietary intervention (n = 15) or bariatric surgery (n = 24), we evaluated NAFLD by liver biopsy, and skeletal muscle mass index (SMI) by CT (CT-SMI) or bioelectrical impedance analysis (BIA-SMI). We developed an index to evaluate absolute fat content in muscle (skeletal muscle fat index [SMFI]) from CT-based psoas muscle density (SMFI).
RESULTS
Muscle mass was higher in patients with NAFLD than in those without (CT-SMI 56.8 ± 9.9 vs. 47.4 ± 6.5 cm/m, p <0.0001). There was no association between sarcopenia and non-alcoholic steatohepatitis (NASH). SMFI was higher in NASH ≥F2 and early NASH F0-1 than in NAFL (78.5 ± 23.6 and 73.1 ± 15.6 vs. 61.2 ± 12.6, p <0.001). A 1-point change in the score for any of the individual cardinal NASH features (i.e. steatosis, inflammation or ballooning) was associated with an increase in SMFI (all p <0.05). The association between SMFI and NASH was highly significant even after adjustment for multiple confounders (all p <0.025). After intervention (n = 39), NASH improvement, defined by NAFLD activity score <3 or a 2-point score reduction, was achieved in more than 75% of patients (n = 25 or n = 27, respectively) that had pre-established NASH at inclusion (n = 32) and was associated with a significant decrease in SMFI (p <0.001). Strikingly, all patients who had ≥11% reduction in SMFI achieved NASH improvement (14/14, p <0.05).
CONCLUSIONS
Muscle fat content, but not muscle mass, is strongly and independently associated with NASH. All individuals who achieved a ≥11% decrease in SMFI after intervention improved their NASH. These data indicate that muscle fatty infiltration could be a potential marker for (and perhaps a pathophysiological contributor to) NASH.
LAY SUMMARY
The fat content in skeletal muscles is highly reflective of the severity of non-alcoholic fatty liver disease (NAFLD) in patients with morbid obesity. In particular, muscle fat content is strongly associated with non-alcoholic steatohepatitis (NASH) and decreases upon NASH improvement. These data indicate that muscle fatty infiltration could be a marker and possible pathophysiological contributor to NASH.
Topics: Adipose Tissue; Adult; Analysis of Variance; Cohort Studies; Female; Humans; Logistic Models; Male; Middle Aged; Muscles; Non-alcoholic Fatty Liver Disease; Odds Ratio
PubMed: 33865909
DOI: 10.1016/j.jhep.2021.02.037 -
IDCases 2022
PubMed: 35308779
DOI: 10.1016/j.idcr.2022.e01470 -
Journal of Spine Surgery (Hong Kong) Jun 2020In recent years, full-endoscopic debridement and drainage (FEDD) is gaining popularity treating spondylodiscitis. Comparing to tradition open surgery, FEDD possess many...
BACKGROUND
In recent years, full-endoscopic debridement and drainage (FEDD) is gaining popularity treating spondylodiscitis. Comparing to tradition open surgery, FEDD possess many advantages including lower anesthesia risk and minimally invasiveness. In this study, we report our surgical technique of FEDD and preliminary clinical outcome in 34 consecutive patients with minimum 12 months follow-up.
METHODS
In our institute, "early intervention and minimally invasive surgery" is our primary strategy to treat spine infection. Surgical approaches of FEDD include transforaminal and interlaminar technique. Selection of surgical approach depends on the location of spine infection. "Trocar-rotating technique" is a novel method to treat psoas muscle abscess. Additional instrumentation is suggested in complicated patients with unstable spinal segment.
RESULTS
Since June 2016 to June 2018, 34 patients including 22 males and 12 females with average aged 62.3 years (21 to 82 years old) sustained spine infection were treated by FEDD. Twenty-eight patients belong to primary spondylodiscitis and 15 patients among them sustained concomitant psoas abscess. Five patients was post-operative infection and one patient was mixed infection including lumbar spondylodiscitis, psoas abscess and multi-level posterior epidural abscess. Positive culture was obtained in 27 patients (27/34=79%) while gram-positive cocci (Staphyloccocci and Streptoccoi) are the most frequent pathogen (67%). Infection was controlled in 28 patients (28/34=82%). Six patients were defined as treatment failure with infection recurrence, they underwent repeat FEDD surgery or open revision surgeries. There was no major intra-operative complications expect two patients sustained transient paresthesia and one instrument broken. Superficial wound infection was encountered in 2 patients and healed after local debridement.
CONCLUSIONS
FEDD is a safe and effective procedure. We hope that, FEDD surgery will be the first-line surgery method to treat lumbar spine infection globally in the near future.
PubMed: 32656379
DOI: 10.21037/jss.2020.01.04 -
Journal of Clinical Medicine May 2024Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific... (Review)
Review
Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized by diagnostic and therapeutic challenges due to its varied etiology and nonspecific symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging techniques used in the image-guided percutaneous drainage (PD) of PMA. A systematic review was conducted following the PRISMA guidelines. We searched PubMed, Google Scholar, and Science Direct for studies published in English from 1998 onwards that reported on the use of PD in treating PMA, detailing outcomes and complications. Imaging modalities guiding PD were also examined. We identified 1570 articles, selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results. Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using both CT and US was reported in two articles. Most studies using CT-guided PD showed complete success, while outcomes varied among those using US-guided PD. No studies employed MRI-guided PD. This review supports a multimodal approach for psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to enhance treatment precision and outcomes, particularly in complex cases with challenging abscess characteristics.
PubMed: 38892910
DOI: 10.3390/jcm13113199 -
Scientific Reports Jun 2022This study aimed to investigate the associations of computed tomography (CT)-measured psoas muscle index (PMI: psoas muscle area normalized by height) and psoas muscle...
This study aimed to investigate the associations of computed tomography (CT)-measured psoas muscle index (PMI: psoas muscle area normalized by height) and psoas muscle density (PMD: average of bilateral psoas muscle CT values [Hounsfield unit (HU)]) with mortality in patients undergoing hemodialysis. We included 188 hemodialysis patients who underwent abdominal CT. PMI and PMD were measured at the third lumbar vertebral level. We found that PMI and PMD were independently associated with the geriatric nutritional risk index and log C-reactive protein, respectively. The optimal cut-off values of PMI and PMD for men and women were 3.39 cm/m and 41.6 HU, and 2.13 cm/m and 37.5 HU, respectively. During follow-up (median 3.5 years), 69 patients died. Lower PMI and lower PMD were independently associated with an increased risk of all-cause mortality [adjusted hazard ratio (aHR) 2.05, 95% confidence interval (CI) 1.14-3.68; aHR 3.67, 95% CI 2.04-6.60), respectively]. The aHR for lower PMI and lower PMD vs. higher PMI and higher PMD was 5.34 (95% CI 2.38-11.97). The addition of PMI and PMD to the risk model significantly improved C-index from 0.775 to 0.893 (p < 0.00001). The combination of PMI and PMD may improve mortality prediction in patients undergoing hemodialysis.
Topics: Aged; Female; Humans; Male; Prognosis; Psoas Muscles; Renal Dialysis; Retrospective Studies; Sarcopenia; Tomography, X-Ray Computed
PubMed: 35729286
DOI: 10.1038/s41598-022-14927-y -
Nutrition (Burbank, Los Angeles County,... Jan 2022Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass...
OBJECTIVES
Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX).
METHODS
Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX.
RESULTS
PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%.
CONCLUSIONS
PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk.
Topics: Absorptiometry, Photon; Bone Density; Humans; Osteoporosis; Osteoporotic Fractures; Psoas Muscles; Risk Assessment; Risk Factors; Spinal Diseases
PubMed: 34474186
DOI: 10.1016/j.nut.2021.111428 -
Asian Spine Journal Oct 2022A retrospective study.
STUDY DESIGN
A retrospective study.
PURPOSE
This study aimed to evaluate the relationship between age and trunk muscle composition and between trunk muscle composition and overall survival in patients with spinal metastasis.
OVERVIEW OF LITERATURE
A low skeletal muscle mass is associated with a poor overall survival in patients with cancer. However, no previous studies have evaluated the relative effects of age and disease on muscle mass and muscle quality in patients with advanced cancer.
METHODS
This study included 539 patients diagnosed with spinal metastasis from February 2009 to July 2018. The patients were categorized into four groups based on age: <59, 60-69, 70-79, and ≥80 years. Differences in trunk muscle composition among age groups and among groups were classified on the basis of survival (< or >3 months after spinal metastasis diagnosis) were evaluated.
RESULTS
In total, 515 patients (273 men, 242 women; mean age, 67.8 years) with complete medical records were included in the analysis. No significant differences were observed in the area of the psoas and paravertebral muscles among age groups in either sex. A significant trend toward a low muscle density with the increase in age was found for both sexes. Patients who survived less than 3 months had significantly smaller trunk muscle area than those who survived for more than 3 months in both sexes.
CONCLUSIONS
The results suggest that the reduction in muscle density is associated with advanced age, whereas a decreased muscle area is associated with pathology. Additionally, a small trunk muscle area was associated with a short overall survival. Further studies are needed to elucidate the underlying mechanisms of age- versus cancer-related changes in the muscle area and their influence on overall survival.
PubMed: 35654110
DOI: 10.31616/asj.2021.0192 -
BMC Musculoskeletal Disorders May 2024It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the...
BACKGROUND
It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the relationship between preoperative and postoperative change of psoas major muscle (PS) and S1 pedicle screw loosening in degenerative lumbar spinal stenosis (DLSS) patients has not been reported. This study investigated the effects of preoperative and follow-up variations in the psoas major muscle (PS) on the first sacral vertebra (S1) screw loosening in patients with DLSS.
METHODS
212 patients with DLSS who underwent lumbar surgery were included. The patients were divided into the S1 screw loosening group and the S1 screw non-loosening group. Muscle parameters were measured preoperatively and at last follow-up magnetic resonance imaging. A logistic regression analysis was performed to investigate the risk factors for S1 screw loosening.
RESULTS
The S1 screw loosening rate was 36.32% (77/212). The relative total cross-sectional areas and relative functional cross-sectional areas (rfCSAs) of the PS at L2-S1 were significantly higher after surgery. The increased rfCSA values of the PS at L3-S1 in the S1 screw non-loosening group were significantly higher than those in the S1 screw loosening group. The regression analysis showed male, lower CT value of L1 and longer segment fusion were independent risk factors for S1 screw loosening, and postoperative hypertrophy of the PS was a protective factor for S1 screw loosening.
CONCLUSIONS
Compared to the preoperative muscle, the PS size increased and fatty infiltration decreased after surgery from L2-3 to L5-S1 in patients with DLSS after short-segment lumbar fusion surgery. Postoperative hypertrophy of the PS might be considered as a protective factor for S1 screw loosening. MRI morphometric parameters and postoperative selected exercise of PS for DLSS patients after posterior lumbar fusion surgery might contribute to improvement of surgical outcome.
Topics: Humans; Male; Spinal Stenosis; Female; Lumbar Vertebrae; Aged; Psoas Muscles; Middle Aged; Follow-Up Studies; Spinal Fusion; Pedicle Screws; Magnetic Resonance Imaging; Sacrum; Retrospective Studies; Risk Factors; Aged, 80 and over; Preoperative Period
PubMed: 38807200
DOI: 10.1186/s12891-024-07298-0 -
Medicine Sep 2022Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease... (Observational Study)
Observational Study
Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), or Child-Turcotte-Pugh (CTP) do not contain sarcopenia as a variable. For this study, we utilized psoas muscle index (PMI) to objectively determine sarcopenia in hospitalized LC patients, and evaluated it as a predictor of time between discharge and readmission in LC. Abdominal computed tomography and magnetic resonance imaging scans of 65 consecutive LC patients were retrospectively examined to determine PMI. MELD, MELD-Na, and CTP were calculated from clinical data. PMI was then combined with CTP to form an experimental score: CTP sarcopenia (CTPS). For PMI alone and for each score, correlation with time between discharge and readmission for liver-related complications was calculated. PMI was also tested for correlation with sex, body mass index (BMI), MELD, MELD-Na, and CTP. CTPS was most closely correlated with time to readmission (R = 0.730; P < .001), followed by CTP (R = 0.696; P < .001), MELD-Na (R = 0.405; P = .009), and PMI alone (R = 0.388; P = .01). Correlation with MELD (R = 0.354; P = .05) was lowest. Additionally, there were significant differences in PMI between male and female individuals (5.16 vs 4.54 cm2/m2; P = .04) and in BMI between sarcopenic and nonsarcopenic individuals (29.63 vs 25.88 kg/m2; P = .009). Sarcopenia is an independent short-term prognostic factor in LC. By combining data on sarcopenia with CTP, we created an experimental score that predicts time to readmission better than MELD, MELD-Na, or CTP.
Topics: Female; Humans; Male; End Stage Liver Disease; Liver Cirrhosis; Prognosis; Psoas Muscles; Retrospective Studies; ROC Curve; Sarcopenia; Severity of Illness Index; Sodium
PubMed: 36086704
DOI: 10.1097/MD.0000000000030259 -
Hepatology Communications Oct 2023Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT)...
BACKGROUND
Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT) measurement in patients with HCC undergoing immunotherapy.
METHODS
HCC patients treated with programmed death ligand 1-based therapies between June 2016 and October 2022 at the Vienna General Hospital (n = 80) and the Hôpital Beaujon Clichy (n = 96) were included and followed until April 2023. TPMT at the level of the third lumbar vertebra was measured independently by 2 radiologists to evaluate interreader reliability. TPMT <12 mm/m in men and <8 mm/m in women indicated sarcopenia.
RESULTS
Overall, 176 patients (age: 66.3±11.7 y; male: n=143, 81%, Barcelona-Clinic Liver Cancer C: n=121, 69%) were included, of which 131 (74%) exhibited cirrhosis. Interreader agreement for the diagnosis of sarcopenia based on TPMT was 92.6%, and Cohen κ showed a "strong agreement" [κ = 0.84 (95% CI: 0.75-0.92)]. Sarcopenia, present in 58 patients (33%), was associated with shorter median overall survival [7.2 (95% CI: 5.0-9.5) vs. 22.6 (95% CI: 16.4-28.8 months); p < 0.001] and median progression-free survival [3.4 (95% CI: 0.2-6.8) vs. 7.9 (95% CI: 5.8-9.9 months), p = 0.001], and an independent predictor of overall [adjusted HR: 1.63 (95% CI: 1.07-2.48)] and progression-free mortality [adjusted HR: 1.54 (95% CI: 1.06-2.23)] in multivariable analyses. The objective response rate [evaluable in 162 subjects (92.0%)] per modified Response Evaluation Criteria In Solid Tumors (mRECIST) in patients with and without sarcopenia was 22% and 39%, respectively (p = 0.029). Survival and radiological responses were worse in patients with sarcopenia and systemic inflammation [median overall survival: 6.1 (95% CI: 3.6-8.6) mo; median progression-free survival: 2.8 (95% CI: 2.1-3.4) mo; objective response rate=16%; disease control rate=39%].
CONCLUSIONS
Evaluation of sarcopenia using TPMT measurement is reliable and identifies HCC patients with a dismal prognosis and response to immunotherapy.
Topics: Humans; Female; Male; Middle Aged; Aged; Carcinoma, Hepatocellular; Psoas Muscles; Reproducibility of Results; Sarcopenia; Liver Neoplasms; Immunotherapy
PubMed: 37708441
DOI: 10.1097/HC9.0000000000000261