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Liu C, Li Y, Xu Y, Hou H. The impact of preoperative skeletal muscle mass index-defined sarcopenia on postoperative complications and survival in gastric cancer: An updated meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109569. [PMID: 39794171 DOI: 10.1016/j.ejso.2024.109569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/05/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND The impact of preoperative sarcopenia on postoperative outcomes in gastric cancer remains debated. This study aims to perform an in-depth meta-analysis and comprehensive review of the relationship between preoperative sarcopenia, as assessed by the Skeletal Muscle Mass Index (SMI), and postoperative complications and survival metrics in gastric cancer patients, to offer new insights into this issue. METHODS We conducted a systematic search of primary studies in databases such as Embase, PubMed, and Web of Science, up to July 2024. Our analysis focused on comparing postoperative readmission and mortality rates, overall and severe complication rates, incidence of specific complications, as well as overall survival (OS) and disease-free survival (DFS) between groups with and without preoperative sarcopenia. RESULTS Our review included 42 studies with a total of 11,981 patients. Findings revealed that patients with sarcopenia had significantly higher rates of overall postoperative complications, severe complications, mortality, and readmissions compared to those without sarcopenia (all P < 0.001). A detailed examination showed that sarcopenic patients had notably higher incidences of pulmonary complications, bowel obstruction, and pancreatic fistulas. Additionally, the OS (P < 0.001) and DFS (P = 0.003) rates were considerably lower in the sarcopenia group. CONCLUSIONS Preoperative sarcopenia is associated with an increased risk of postoperative complications and poorer survival outcomes in gastric cancer patients. Given these associations, it is recommended to incorporate routine screening for sarcopenia using SMI before surgery, where feasible, to enhance patient risk assessment and customize treatment approaches.
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Affiliation(s)
- Chengcong Liu
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Yueping Li
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Yongjing Xu
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Hong Hou
- Department of Breast Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China.
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Zou H, Zheng L, Zeng C. Polyunsaturated Fatty Acids and Reduced Risk of Low Muscle Mass in Adults. Nutrients 2025; 17:858. [PMID: 40077720 PMCID: PMC11902165 DOI: 10.3390/nu17050858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 02/22/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Background: We aimed to evaluate the effects of both joint and individual types of fatty acids on low muscle mass in adults. Methods: We enrolled 8842 adults selected from the National Health and Nutrition Examination Survey (NHANES). Multivariate adjusted weighted logistic regression models were employed to evaluate the connection between fatty acids and low muscle mass. We used restricted cubic splines (RCSs) to determine whether the relationship is linear or non-linear, while stratified analyses and interaction effects were also assessed. Weighted quantile sum (WQS) analysis assessed the impact of joint and individual types of fatty acids on low muscle mass. Additionally, mediation analysis determined the direct and indirect implications of polyunsaturated fatty acids on low muscle mass. Results: A total of 8842 participants were included in this study, of which 705 were identified as having low muscle mass. The logistic regression analyses identified a significant linear correlation between all three types of fatty acids and low-muscle-mass risk. Additionally, the WQS analysis demonstrated that a fatty acid mixture was inversely associated with low-muscle-mass risk, with polyunsaturated fatty acids being recognized as the principal component. Moreover, inflammation may mediate the relationship between polyunsaturated fatty acids and low muscle mass, accounting for 3.75% of the effect size (p < 0.001) through white blood cell count. We further examined linoleic acid (LA) and alpha-linolenic acid (ALA), and each unit increase in LA and ALA intake was linked to a decrease in low-muscle-mass risk by 0.29 (95% CI: 0.64-0.79, p < 0.001) and 0.27 (95% CI: 0.66-0.81, p < 0.001), respectively. Conclusions: These findings indicate that polyunsaturated fatty acids (especially LA and ALA) may effectively mitigate low-muscle-mass risk.
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Affiliation(s)
| | - Liangrong Zheng
- School of Medicine, Zhejiang University, Hangzhou 310000, China;
| | - Chunlai Zeng
- School of Medicine, Zhejiang University, Hangzhou 310000, China;
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Kim JH, Jang I, Jeong S, Shin J, Yoon S, Lee H, Lee S. Examining the Relationship Between Sarcopenia and Rotator Cuff Tears: A Retrospective Comparative Study. J Clin Med 2025; 14:220. [PMID: 39797302 PMCID: PMC11721911 DOI: 10.3390/jcm14010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 12/27/2024] [Accepted: 12/28/2024] [Indexed: 01/13/2025] Open
Abstract
Background: With the rapid increase in the aging population, the number of patients complaining of shoulder pain is also increasing. Among shoulder ailments, rotator cuff tears (RCTs) are most frequently observed in middle-aged and elderly individuals. Sarcopenia refers to the decline in muscle mass (lean body mass) and the subsequent decrease in muscle function that is linked to the natural aging process. To the best of our knowledge, there is currently limited information available regarding the association between RCTs and sarcopenia. Methods: The study included only individuals who had undergone dual-energy X-ray absorptiometry and body composition assessments. After applying the exclusion criteria, the participants were divided into sarcopenia and non-sarcopenia groups by the body composition tests. Next, those diagnosed with RCTs were assigned to the experimental group, and those without RCTs were assigned to the control group. The matching was performed using propensity score matching. Sarcopenia was defined as a skeletal muscle index lower than 7.0 kg/m2 in males and 5.4 kg/m2 in females. Multivariable logistic regression with backward elimination was performed. Results: After propensity score matching, there were no significant differences in age, sex, and bone mineral density between the RCT and control groups. In the univariate analysis, it was observed that most of the baseline data and demographic factors did not exhibit significant differences, except for calcium levels and the presence of chronic kidney injury. According to the multivariable logistic regression analysis of factors related to RCTs, sarcopenia was unrelated to RCTs, but chronic kidney injury and Ca levels were significantly associated. Also, there was also no significant association between sarcopenia and RCT size and severity. Conclusions: In conclusion, we cannot find a significant relationship between sarcopenia and RCTs.
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Affiliation(s)
- Jae-Hwa Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
| | - Inseok Jang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
| | - Simho Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
| | - Jeeseop Shin
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
| | - Hyunil Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170, Juhwa-ro, Ilsangeo-gu, Goyang-si 10380, Gyeonggi-do, Republic of Korea;
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (J.-H.K.); (I.J.); (J.S.); (S.Y.)
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Alikhani R, Horbal SR, Rothberg AE, Pai MP. Radiomic-based biomarkers: Transforming age and body composition metrics into personalized age-informed indices. Clin Transl Sci 2024; 17:e70062. [PMID: 39644153 PMCID: PMC11624483 DOI: 10.1111/cts.70062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/03/2024] [Accepted: 10/16/2024] [Indexed: 12/09/2024] Open
Abstract
Chronological age has been the standard for quantifying the aging process. While it is simple to quantify it cannot fully discern the biological variability of aging between individuals. The growing body of interest in this variability of human aging has led to the introduction of new biomarkers to operationalize biological age. The inclusion of body composition may provide additional value to biological aging as a prediction and estimation factor of individual health outcomes. Diagnostic images based on radiomic techniques such as Computed Tomography contain an untapped wealth of patient-specific data that remain inaccessible to healthcare providers. These images are beneficial for collecting information from body composition that adds precision and granularity when compared to traditional measures. This information can subsequently be aggregated to construct models for changes in the human body associated with aging. In addition, aging leads to a natural decline in the best parameter of drug dosing in older adults, glomerular filtration rate. Since the conventional models of kidney function are correlated with age and body composition, the radiomic biomarkers representing age-related changes in body composition may also serve as potential new imaging biomarkers of kidney function for personalized dosing. Our review introduces potential radiomic biomarkers as measures of body composition change targeting the aging processes. As a functional example, we have hypothesized an age-related model of radiomics as a covariate of kidney function to improve personalized dosing. Future research focusing on evaluating this hypothesis in human subject studies is acknowledged.
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Affiliation(s)
- Radin Alikhani
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Amy E. Rothberg
- Department of Internal Medicine – Metabolism, Endocrinology, and DiabetesUniversity of MichiganAnn ArborMichiganUSA
| | - Manjunath P. Pai
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMichiganUSA
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Druckmann I, Schwartz D, Rotem N, Khawaja J, Graziani T, Saban M, Kastner J, Sher R, Goykhman Y, Raz MA, Shashar M, Cohen-Hagai K, Nacasch N, Schwartz IF, Grupper A. Skeletal muscle size and quality in healthy kidney donors, normal range and clinical associations. Sci Rep 2024; 14:25257. [PMID: 39448639 PMCID: PMC11502878 DOI: 10.1038/s41598-024-76188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 10/11/2024] [Indexed: 10/26/2024] Open
Abstract
The gold standard to estimate muscle mass and quality is computed tomography (CT) scan. Lower mass and density (intramuscular fat infiltration) of skeletal muscles are markers of sarcopenia, associated with increased mortality risk, impaired physical function, and poorer prognosis across various populations and medical conditions. We aimed to describe standard reference values in healthy population, prospective kidney donors, and correlate clinical parameters to muscle mass and density. Included in the cohort 384 consecutive kidney donors. Mean age was 44.6 ± 11.5 (range 18.4-74.2), 46% were female and mean BMI was 25.6 ± 3.8 kg/m2. Our quantified reference values for psoas cross -sectional area (CSA) index at L3 level (males/females respectively) were 6.3 ± 1.8 and 4.8 ± 1.9 cm2 /m2, and density was 46.1 ± 5 and 41 ± 5 HU at that level. Older age (standardized beta coefficient - 0.12, p = 0.04), sex (- 0.32, p < 0.001) and BMI (0.17, p = 0.002) were significantly associated with CSA index of psoas at L3. Density, however, was associated with triglycerides level (- 0.21, p < 0.001), in addition to age (- 0.22, p < 0.0001), sex (- 0.27, p < 0.001) and BMI (- 0.1, p = 0.05). Our study validates the normative values of psoas muscle mass and density in healthy individuals and suggests correlations with clinical parameters. We demonstrate the significance of measuring not only the mass of the muscle, but also its density, as it has a valid association with metabolic parameters, including BMI and lipid level, even in healthy individuals and in the normal range of the tests.
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Affiliation(s)
- Ido Druckmann
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Radiology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Doron Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nirit Rotem
- Physiotherapy Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jayan Khawaja
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Radiology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Tamir Graziani
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Radiology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Mor Saban
- Nursing Department, The Stanley Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - James Kastner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Raz Sher
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Internal Medicine Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaacov Goykhman
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Michal Ariela Raz
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Naomi Nacasch
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Idit F Schwartz
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayelet Grupper
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
- Nephrology Department, Tel Aviv Medical Center, Tel Aviv, Israel.
- Organ Transplantation Unit, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Gunchick V, Brown E, Liu J, Locasale JW, Philip PA, Wang SC, Su GL, Sahai V. Morphomics, Survival, and Metabolites in Patients With Metastatic Pancreatic Cancer. JAMA Netw Open 2024; 7:e2440047. [PMID: 39418020 PMCID: PMC11581562 DOI: 10.1001/jamanetworkopen.2024.40047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 08/26/2024] [Indexed: 10/19/2024] Open
Abstract
Importance Associations of body mass index (BMI) with survival in pancreatic ductal adenocarcinoma (PDA) have substantial variability in literature, potentially due to heterogeneous patient populations and retrospective analyses. Additionally, BMI may inadequately describe body composition (ie, morphomics; including subcutaneous and visceral fats, muscle, and fascia), which might have independent biological roles and associations with survival. Objective To study the associations of BMI and morphomics with survival and metabolomics in metastatic PDA. Design, Setting, and Participants This cohort study prospectively collected patient data, imaging, and serum on the phase 3 trial (Avenger500), which investigated the efficacy and safety of 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) versus modified FOLFIRINOX plus devimistat. The randomized trial accrued 528 patients with chemotherapy-naive, metastatic PDA from Europe, Israel, Korea, and the US between 2018 and 2020. In the present study, per-protocol patients with L1 to L4, T10 to T12 vertebral levels were evaluated. Data analysis occurred from January 2023 to April 2024. Exposure Patient data were collected by clinical staff. Morphomics were analyzed from baseline imaging. Metabolites were extracted from baseline serum. Main Outcome and Measures A multifaceted statistical approach evaluated associations of BMI and morphomics with progression-free survival (PFS) and overall survival (OS). Associations of morphomics with metabolites were also studied. Results Of the 528 initial patients, 476 (median [IQR] age, 63 [56-68] years; 280 male [58.8%]; median [IQR] BMI, 25.0 [22.1-25.9]) were evaluable for the present study. BMI (obese [≥30] compared with normal [18.5-24.9]) was not associated with OS (hazard ratio [HR], 0.90; 95% CI, 0.67-1.22; P for trend = .33). More subcutaneous fat was associated with longer OS (HR, 0.62; 95% CI, 0.41-0.94; P for trend = .02). Higher visceral fat density was associated with shorter PFS (HR, 1.74; 95% CI, 1.23-2.48; P for trend = .002) and OS (HR, 1.50; 95% CI, 1.12-2.00; P for trend = .008). A higher muscle-to-fascia ratio was associated with longer PFS (HR, 0.58; 95% CI, 0.40-0.84; P for trend = .005) and OS (HR, 0.56; 95% CI, 0.41-0.75; P for trend = 1.7 × 10-4). Subcutaneous fat was positively associated with long-chain fatty acid metabolism including pristanic acid, decanoylcarnitine, decenoylcarnitine, and octanoylcarnitine. Muscle-to-fascia was positively associated with metabolites including acetylcarnosine (β = 0.34; 95% CI, 0.21-0.47; P = 1.27 × 10-6). Conclusions and Relevance In cohort study of patients with metastatic PDA, BMI was not associated with survival. Higher visceral fat density, subcutaneous fat area, and muscle-to-fascia ratio were associated with survival independent of BMI. The latter 2 were associated with higher levels of animal product metabolism. These findings could represent novel focuses for prognostication and intervention to improve survival of patients with PDA.
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Affiliation(s)
- Valerie Gunchick
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Brown
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Juan Liu
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Jason W. Locasale
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Philip A. Philip
- Department of Oncology, Wayne State University, School of Medicine, Karmanos Cancer Center, Detroit, Michigan
| | - Stewart C. Wang
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Grace L. Su
- Morphomics Analysis Group, University of Michigan, Ann Arbor
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
- Gastroenterology Section, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Vaibhav Sahai
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor
- University of Michigan Rogel Cancer Center, Ann Arbor
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Shaffrey EC, Ly N, Seitz AJ, Ziemlewicz TJ, Poore SO, Michelotti BF. Evaluation of Morphometric Measurements on Preoperative CT Angiograms to Determine Risk of Abdominal Donor Site Complications-A Retrospective Review of 174 Patients. Plast Surg (Oakv) 2024; 32:434-444. [PMID: 39104940 PMCID: PMC11298133 DOI: 10.1177/22925503221128987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 08/07/2024] Open
Abstract
Introduction: Autologous breast reconstruction remains a popular surgical option following mastectomy; however, it is not without complications. Preoperative CT angiograms (CTAs) are often obtained for surgical planning, and morphometric data such as fat and muscle distribution can be measured. This study aimed to assess if CTA morphometric data predicts abdominal donor site complications in patients undergoing abdominally based autologous breast reconstruction. Methods: A retrospective cohort study was performed for patients who underwent abdominally based autologous breast reconstruction from 2013 to 2018. Along with population and operative characteristics, preoperative morphometric variables were assessed for the following: subcutaneous adipose tissue, visceral adipose tissue, skeletal muscle area and index, rectus and psoas cross-sectional area, and bone density. Statistical comparison to abdominal donor site complications was performed using logistic regression analysis for every 100-unit change. Results: A total of 174 patients were included in this study. Visceral adipose tissue was significantly associated with the development of infection (P = .005), epidermolysis (P = .031), and seroma (P = .04). Subcutaneous adipose tissue, skeletal muscle index, cross-sectional muscle area, and bone density were not associated with abdominal donor site complications. Obesity (P = .024), history of smoking (P = .049), and the number of perforators harvested (P = .035) significantly increased the likelihood of delayed abdominal healing. Conclusions: This study demonstrates that increased visceral adipose tissue, as measured by CTA, is significantly associated with an increased risk of abdominal donor site complications. CTA morphometric data and identifying high-risk patient characteristics can help guide preoperative counseling and better inform surgical risks.
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Affiliation(s)
- Ellen C. Shaffrey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Nancy Ly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Allison J. Seitz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Timothy J. Ziemlewicz
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Samuel O. Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Brett F. Michelotti
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
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Horbal SR, Belancourt PX, Zhang P, Holcombe SA, Saini S, Wang SC, Sales AE, Su GL. Independent Associations of Aortic Calcification with Cirrhosis and Liver Related Mortality in Veterans with Chronic Liver Disease. Dig Dis Sci 2024; 69:2681-2690. [PMID: 38653948 PMCID: PMC11258161 DOI: 10.1007/s10620-024-08450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Abdominal aortic calcifications (AAC) are incidentally found on medical imaging and useful cardiovascular burden approximations. The Morphomic Aortic Calcification Score (MAC) leverages automated deep learning methods to quantify and score AACs. While associations of AAC and non-alcoholic fatty liver disease (NAFLD) have been described, relationships of AAC with other liver diseases and clinical outcome are sparse. This study's purpose was to evaluate AAC and liver-related death in a cohort of Veterans with chronic liver disease (CLD). METHODS We utilized the VISN 10 CLD cohort, a regional cohort of Veterans with the three forms of CLD: NAFLD, hepatitis C (HCV), alcohol-associated (ETOH), seen between 2008 and 2014, with abdominal CT scans (n = 3604). Associations between MAC and cirrhosis development, liver decompensation, liver-related death, and overall death were evaluated with Cox proportional hazard models. RESULTS The full cohort demonstrated strong associations of MAC and cirrhosis after adjustment: HR 2.13 (95% CI 1.63, 2.78), decompensation HR 2.19 (95% CI 1.60, 3.02), liver-related death HR 2.13 (95% CI 1.46, 3.11), and overall death HR 1.47 (95% CI 1.27, 1.71). These associations seemed to be driven by the non-NAFLD groups for decompensation and liver-related death [HR 2.80 (95% CI 1.52, 5.17; HR 2.34 (95% CI 1.14, 4.83), respectively]. DISCUSSION MAC was strongly and independently associated with cirrhosis, liver decompensation, liver-related death, and overall death. Surprisingly, stratification results demonstrated comparable or stronger associations among those with non-NAFLD etiology. These findings suggest abdominal aortic calcification may predict liver disease severity and clinical outcomes in patients with CLD.
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Affiliation(s)
- Steven R Horbal
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | | | - Peng Zhang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Sven A Holcombe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Sameer Saini
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Anne E Sales
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Colombia, MO, USA
| | - Grace L Su
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
- Gastroenterology Section, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
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Fereydooni A, Johnson CE, Brooke BS, Arya S. Decision making in the frail vascular surgery patient: A scoping review. Semin Vasc Surg 2024; 37:224-239. [PMID: 39152001 PMCID: PMC11967909 DOI: 10.1053/j.semvascsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 08/19/2024]
Abstract
Increasing evidence highlights the adverse impact of frailty and reduced physiologic reserve on surgical outcomes. Therefore, identification of frailty is essential for older adults being evaluated for vascular surgery procedures. Numerous frailty assessment tools are available to quantify the level of frailty and assist in preoperative decision making for these older patients. This review evaluates traditional and novel frailty metrics for their scientific validation, limitations, and clinical utility in vascular surgery decision-making.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304
| | - Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304; Surgery Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.
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Ikeda N, Yokoyama K, Ito Y, Tanaka H, Yamada M, Sugie A, Takami T, Wanibuchi M, Kawanishi M. Factors influencing slippage after microsurgical single level lumbar spinal decompression surgery - Are the psoas and multifidus muscles involved? Acta Neurochir (Wien) 2024; 166:26. [PMID: 38252278 DOI: 10.1007/s00701-024-05924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients. METHODS Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5 years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2 mm was assessed on the last follow-up X-ray. RESULTS We included 95 patients with average age and follow-up periods of 69 ± 8.2 years and 7.51 ± 2.58 years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression. CONCLUSION Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.
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Affiliation(s)
- Naokado Ikeda
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan.
| | - Kunio Yokoyama
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Akira Sugie
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
| | - Toshihiro Takami
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Neuroendoscope Center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan
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Delrieu L, Blanc D, Bouhamama A, Reyal F, Pilleul F, Racine V, Hamy AS, Crochet H, Marchal T, Heudel PE. Automatic deep learning method for third lumbar selection and body composition evaluation on CT scans of cancer patients. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2024; 3:1292676. [PMID: 39355015 PMCID: PMC11440831 DOI: 10.3389/fnume.2023.1292676] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/04/2023] [Indexed: 10/03/2024]
Abstract
Introduction The importance of body composition and sarcopenia is well-recognized in cancer patient outcomes and treatment tolerance, yet routine evaluations are rare due to their time-intensive nature. While CT scans provide accurate measurements, they depend on manual processes. We developed and validated a deep learning algorithm to automatically select and segment abdominal muscles [SM], visceral fat [VAT], and subcutaneous fat [SAT] on CT scans. Materials and Methods A total of 352 CT scans were collected from two cancer centers. The detection of the third lumbar vertebra and three different body tissues (SM, VAT, and SAT) were annotated manually. The 5-fold cross-validation method was used to develop the algorithm and validate its performance on the training cohort. The results were validated on an external, independent group of CT scans. Results The algorithm for automatic L3 slice selection had a mean absolute error of 4 mm for the internal validation dataset and 5.5 mm for the external validation dataset. The median DICE similarity coefficient for body composition was 0.94 for SM, 0.93 for VAT, and 0.86 for SAT in the internal validation dataset, whereas it was 0.93 for SM, 0.93 for VAT, and 0.85 for SAT in the external validation dataset. There were high correlation scores with sarcopenia metrics in both internal and external validation datasets. Conclusions Our deep learning algorithm facilitates routine research use and could be integrated into electronic patient records, enhancing care through better monitoring and the incorporation of targeted supportive measures like exercise and nutrition.
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Affiliation(s)
- Lidia Delrieu
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France
| | - Damien Blanc
- QuantaCell, Pessac, France
- IMAG, Université de Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France
- Department of Surgical Oncology, Institut Curie, University Paris, Paris, France
| | - Frank Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France
| | | | - Anne Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Hugo Crochet
- Data and Artificial Intelligence Team, Centre Léon Bérard, Lyon, France
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Hou X, Hu H, Kong C, Zhang S, Wang W, Lu S. Psoas muscle index and psoas muscle density are associated with functional status in patients with degenerative lumbar spinal stenosis. J Back Musculoskelet Rehabil 2024; 37:921-928. [PMID: 38306020 DOI: 10.3233/bmr-230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND The factors affecting lumbar spinal function in patients with degenerative lumbar spinal stenosis (DLSS) are still unclear. OBJECTIVE This study explored psoas major muscle morphology in patients with DLSS and its association with their functional status. METHODS A retrospective study was conducted on 288 patients with DLSS and 260 control subjects. Psoas major muscle evaluation included three morphometric parameters at the L3/4 disc level: psoas major index (PMI), muscle attenuation, and psoas major morphological changes (MPM). The association between psoas major morphology and functional status was assessed using the Oswestry disability index (ODI). RESULTS Both female and male patients with DLSS had a higher PMI and lower muscle attenuation. PMI and muscle attenuation were inversely correlated with age in the DLSS group. After multivariable analyses, the PMI and psoas major muscle attenuation were positively correlated with patients' functional status. CONCLUSION The PMI and muscle attenuation were positively correlated with functional status in patients with DLSS. These findings have important implications for physiotherapy programs of postoperative rehabilitation and conservative management of DLSS.
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Affiliation(s)
- Xiaofei Hou
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hailiang Hu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sitao Zhang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Liu S, Matvekas A, Naimi T, Ghanem A, Li R, Rajanayake K, Derstine B, Ross B, Sullivan J, Yun HG, Regenbogen S, Byrn J, Su G, Wang S, Pai MP. Morphomics-informed population pharmacokinetic and physiologically-based pharmacokinetic modeling to optimize cefazolin surgical prophylaxis. Pharmacotherapy 2024; 44:77-86. [PMID: 37728152 PMCID: PMC10841046 DOI: 10.1002/phar.2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Cefazolin is the leading antibiotic used to prevent surgical site infections worldwide. Consensus guidelines recommend adjustment of the cefazolin dose above and below 120 kg without regard to body composition. Algorithms exist to repurpose radiologic data into body composition (morphomics) and inform dosing decisions in obesity. OBJECTIVES To compare the current standard of body weight to morphomic measurements as covariates of cefazolin pharmacokinetics and aid dose stratification of cefazolin in patients with obesity undergoing colorectal surgery. METHODS This prospective study measured cefazolin plasma, fat, and colon tissue concentrations in colorectal surgery patients in order to develop a morphomics-informed population pharmacokinetic (PopPK) model to guide dose adjustments. A physiologically-based pharmacokinetic (PBPK) model was also constructed to inform tissue partitioning in morbidly obese patients (n = 21, body mass index ≥35 kg/m2 with one or more co-morbid conditions). RESULTS Morphomics and pharmacokinetic data were available in 58 patients with a median [min, max] weight and age of 95.9 [68.5, 148.8] kg and 55 [25, 79] years, respectively. The plasma-to-subcutaneous fat partition coefficient was predicted to be 0.072 and 0.060 by the PopPK and PBPK models, respectively. The estimated creatinine clearance (eCLcr ) and body depth at the third lumbar vertebra (body depth_L3) were identified as covariates of cefazolin exposure. The probability of maintaining subcutaneous fat concentrations above 2 μg/mL for 100% of a 4-h surgical period was below 90% when eCLcr ≥105 mL/min and body depth_L3 ≥ 300 mm and less sensitive to the rate of infusion between 5 and 60 min. CONCLUSIONS Kidney function and morphomics were more informative than body weight as covariates of cefazolin target site exposure. Data from more diverse populations, consensus on target cefazolin exposure, and comparative studies are needed before a change in practice can be implemented.
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Affiliation(s)
- Shuhan Liu
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | - Aleksas Matvekas
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | - Tamara Naimi
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | - Aws Ghanem
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | - Ruiting Li
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | | | - Brian Derstine
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian Ross
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - June Sullivan
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Hyun Gi Yun
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
| | - Scott Regenbogen
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - John Byrn
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Grace Su
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Stewart Wang
- University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Manjunath P. Pai
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan, USA
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Hayashi T, Kataoka Y. Association Between Sarcopenic Complications and Readmission in a Kaifukuki Rehabilitation Ward: A Retrospective Cohort Study. Cureus 2023; 15:e50067. [PMID: 38186508 PMCID: PMC10769531 DOI: 10.7759/cureus.50067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives This study investigated the association between sarcopenia and readmission to the Kaifukuki Rehabilitation Ward. Methods We conducted a retrospective observational study in a Kaifukuki Rehabilitation Ward in Japan. Muscle mass was evaluated using a body composition analyzer (InBody, Tokyo, Japan). Grip strength was measured using a grip dynamometer, and walking speed was measured using a 10-meter walk test. Sarcopenia was characterized based on the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. The presence or absence of readmission was calculated from the medical charts. This study used Rstudio for statistical analysis (Posit, Boston, USA). To examine the effect of sarcopenia on readmissions, we used the Kaplan-Meier method to estimate readmissions. Differences between curves were assessed using the log-rank test. Results A total of 131 patients were selected during the target period (March 1, 2020, to August 31, 2021). Of these, 12 (9%) were readmitted during the study period. The median patient age was 83 years. The study population consisted of 53 males (40%) and 78 females (60%). Sixty (50%) patients in the no-readmission group and seven (58%) patients in the readmission group had sarcopenia. For readmission, the presence of sarcopenia yielded an unadjusted hazard ratio of 1.37 (95% confidence interval: 0.41 to 4.56) and an adjusted hazard ratio of 1.74 (95% confidence interval: 0.52 to 5.83). Conclusions Sarcopenia may be a prognostic factor for readmission in Kaifukuki Rehabilitation Wards. Therefore, further evaluation is necessary.
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Affiliation(s)
- Tomoki Hayashi
- Department of Rehabilitation, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Kyoto, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
- Department of Systematic Reviewers, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
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Duarte CK, de Abreu Silva L, Castro CF, Ribeiro MV, Saldanha MF, Machado AM, Jansen AK. Prediction equations to estimate muscle mass using anthropometric data: a systematic review. Nutr Rev 2023; 81:1414-1440. [PMID: 37815928 DOI: 10.1093/nutrit/nuad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
CONTEXT Reduced muscle mass is linked to poor outcomes in both inpatients and outpatients, highlighting the importance of muscle mass assessment in clinical practice. However, laboratory methods to assess muscle mass are not yet feasible for routine use in clinical practice because of limited availability and high costs. OBJECTIVE This work aims to review the literature on muscle mass prediction by anthropometric equations in adults or older people. DATA SOURCES The following databases were searched for observational studies published until June 2022: MEDLINE, Embase, Scopus, SPORTDiscus, and Web of Science. DATA EXTRACTION Of 6437 articles initially identified, 63 met the inclusion criteria for this review. Four independent reviewers, working in pairs, selected and extracted data from those articles. DATA ANALYSIS Two studies reported new equations for prediction of skeletal muscle mass: 10 equations for free-fat mass and lean soft tissue, 22 for appendicular lean mass, 7 for upper-body muscle mass, and 7 for lower-body muscle mass. Twenty-one studies validated previously proposed equations. This systematic review shows there are numerous equations in the literature for muscle mass prediction, and most are validated for healthy adults. However, many equations were not always accurate and validated in all groups, especially people with obesity, undernourished people, and older people. Moreover, in some studies, it was unclear if fat-free mass or lean soft tissue had been assessed because of an imprecise description of muscle mass terminology. CONCLUSION This systematic review identified several feasible, practical, and low-cost equations for muscle mass prediction, some of which have excellent accuracy in healthy adults, older people, women, and athletes. Malnourished individuals and people with obesity were understudied in the literature, as were older people, for whom there are only equations for appendicular lean mass. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42021257200.
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Affiliation(s)
- Camila Kümmel Duarte
- are with the Postgraduate Program in Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana de Abreu Silva
- are with the Postgraduate Program in Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Fernandes Castro
- are with the Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Vassallo Ribeiro
- are with the Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelle Ferreira Saldanha
- are with the Postgraduate Program in Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriane Moreira Machado
- is with the Department of Nutrition, Faculdade Dinâmica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil
| | - Ann Kristine Jansen
- are with the Postgraduate Program in Nutrition and Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Tokumoto H, Akita S, Kosaka K, Kubota Y, Mitsukawa N. Correlation between abdominal visceral volume measured by a simple procedure and bulging at the abdominal free flap donor site for breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:295-301. [PMID: 37385141 DOI: 10.1016/j.bjps.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Breast reconstructions using autologous abdominal tissue result in breasts with a natural shape and consistency. One of the major complications is abdominal bulging. Because of the increased abdominal wall tension, high visceral volume (not visceral fat alone) may increase the occurrence rate of abdominal bulging. A simple procedure involving CT imaging was used to assess this relationship in patients undergoing an abdominal free flap for unilateral breast reconstruction. METHODS A total of 278 patients were enrolled in this study. The patients' demographics, the thicknesses of visceral volume were compared (Bulging (+) vs. Bulging (-)). Visceral volume was investigated based on the horizontal thickness, which was measured at the thickest part at the level of the umbilical fossa between both sides under the transverse abdominis muscles. RESULTS Bulging (+) consisted of 39 patients (14.0%), whereas Bulging (-) included 239 patients. Patients with Bulging (+) were significantly older, had higher gestational history rate, and had thin rectus abdominis muscle. In terms of visceral volume, the Bulging (+) group had significantly higher horizontal thicknesses (median 233 mm vs. 219 mm, P < 0.001). No significant differences were observed with respect to other factors (age, BMI, history of laparotomy, and operative details). The multivariate logistic regression analysis revealed that the thickness of the rectus abdominis muscle, horizontal visceral volume, and gestational history were independently significant predictors. CONCLUSIONS Not only the patients with thin rectus abdominis muscle but also patients with a thick horizontal visceral volume may have a higher risk of abdominal bulging.
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Affiliation(s)
- Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, 666-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan.
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 666-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Kentaro Kosaka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 666-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 666-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 666-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
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Horbal SR, Derstine BA, Brown E, Su GL, Wang SC, Holcombe SA. Reference distributions of aortic calcification and association with Framingham risk score. Sci Rep 2023; 13:9421. [PMID: 37296154 PMCID: PMC10256704 DOI: 10.1038/s41598-023-36565-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Evidence supporting aortic calcification as a leverageable cardiovascular risk factor is rapidly growing. Given aortic calcification's potential as a clinical correlate, we assessed granular vertebral-indexed calcification measurements of the abdominal aorta in a well curated reference population. We evaluated the relationship of aortic calcification measurements with Framingham risk scores. After exclusion, 4073 participants from the Reference Analytic Morphomic Population with varying vertebral levels were included. The percent of the aortic wall calcified was used to assess calcification burden at the L1-L4 levels. Descriptive statistics of participants, sex-specific vertebral indexed calcification measurements, relational plots, and relevant associations are reported. Mean aortic attenuation was higher in female than male participants. Overall, mean aortic calcium was higher with reference to inferior abdominal aortic measurements and demonstrated significant differences across all abdominal levels [L3 Area (mm[Formula: see text]): Females 6.34 (sd 16.60), Males 6.23 (sd 17.21); L3 Volume (mm[Formula: see text]): Females 178.90 (sd 474.19), Males 195.80 (sd 547.36); Wall Calcification (%): Females (L4) 6.97 (sd 16.03), Males (L3) 5.46 (13.80)]. Participants with elevated calcification had significantly higher Framingham risk scores compared to participants with normal calcification scores. Opportunistically measuring aortic calcification may inform further cardiovascular risk assessment and enhance cardiovascular event surveillance efforts.
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Affiliation(s)
- Steven R Horbal
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian A Derstine
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Edward Brown
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Grace L Su
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
- Gastroenterology Section, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stewart C Wang
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sven A Holcombe
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
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Tahir I, Cahalane AM, Saenger JA, Leppelmann KS, Abrishami Kashani M, Marquardt JP, Silverman SG, Shyn PB, Mercaldo ND, Fintelmann FJ. Factors Associated with Hospital Length of Stay and Adverse Events following Percutaneous Ablation of Lung Tumors. J Vasc Interv Radiol 2023; 34:759-767.e2. [PMID: 36521793 DOI: 10.1016/j.jvir.2022.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation of lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 men [51%]; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation and 57 microwave ablation) from 2006 to 2019. Age-adjusted Charlson Comorbidity Index, sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery-to-aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using univariable and multivariable generalized linear models. RESULTS In univariable analysis, HLOS was associated with current smoking (incidence rate ratio [IRR], 4.54 [1.23-16.8]; P = .02), COPD (IRR, 3.56 [1.40-9.04]; P = .01), cryoablations with ≥3 pleural punctures (IRR, 3.13 [1.07-9.14]; P = .04), general anesthesia (IRR, 10.8 [4.18-27.8]; P < .001), and sarcopenia (IRR, 2.66 [1.10-6.44]; P = .03). After multivariable adjustment, COPD (IRR, 3.56 [1.57-8.11]; P = .003) and general anesthesia (IRR, 12.1 [4.39-33.5]; P < .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (P = .03). CONCLUSIONS Identified preprocedural risk factors from the surgical literature may aid in risk stratification for HLOS after percutaneous ablation of lung tumors, but were not associated with adverse events.
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Affiliation(s)
- Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexis M Cahalane
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medical School, Sigmund Freud University, Vienna, Austria
| | - Konstantin S Leppelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Peter Marquardt
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Bradford JM, Cardenas TCP, Lara S, Olson K, Teixeira PG, Aydelotte JD, Trust MD, DuBose J, Ali S, Brown CV. The more you have, the more you lose: Muscle mass changes in trauma patients with prolonged hospitalizations. Injury 2023; 54:1102-1105. [PMID: 36801130 DOI: 10.1016/j.injury.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Sarcopenia is a clinically relevant loss of muscle mass with implications of increased morbidity and mortality in adult trauma populations. Our study aimed to evaluate loss of muscle mass change in adult trauma patients with prolonged hospital stays. METHODS Retrospective analysis using institutional trauma registry to identify all adult trauma patients with hospital length of stay >14 days admitted to our Level 1 center between 2010 and 2017. All CT images were reviewed, and cross-sectional area (cm2) of the left psoas muscle was measured at the level of the third lumbar vertebral body to determine total psoas area (TPA) and Total Psoas Index (TPI) normalized for patient stature. Sarcopenia was defined as a TPI on admission below gender specific thresholds of 5.45(cm2/m2) in men and 3.85(cm2/m2) in women. TPA, TPI, and rates of change in TPI were then evaluated and compared between sarcopenic and non-sarcopenic adult trauma patients. RESULTS There were 81 adult trauma patients who met inclusion criteria. The average change in TPA was -3.8 cm2 and TPI was -1.3 cm2. On admission, 23% (n = 19) of patients were sarcopenic while 77% (n = 62) were not. Non-sarcopenic patients had a significantly greater change in TPA (-4.9 vs. -0.31, p<0.0001), TPI (-1.7 vs. -0.13, p<0.0001), and rate of decrease in muscle mass (p = 0.0002). 37% of patients who were admitted with normal muscle mass developed sarcopenia during admission. Older age was the only risk factor independently associated with developing sarcopenia (OR: 1.04, 95%CI 1.00-1.08, p = 0.045). CONCLUSION Over a third of patients with normal muscle mass at admission subsequently developed sarcopenia with older age as the primary risk factor. Patients with normal muscle mass at admission had greater decreases in TPA and TPI, and accelerated rates of muscle mass loss compared to sarcopenic patients.
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Affiliation(s)
- James M Bradford
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA.
| | - Tatiana C P Cardenas
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Sabino Lara
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Kristofor Olson
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Jayson D Aydelotte
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Marc D Trust
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Joseph DuBose
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Sadia Ali
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
| | - Carlos Vr Brown
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA
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20
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Chu LP, Chen KT, Lu HK, Lai CL, Huang HC, Hsieh KC. Preliminary study on the application of bioimpedance analysis to measure the psoas major muscle in older adults. PLoS One 2023; 18:e0275884. [PMID: 36996063 PMCID: PMC10062543 DOI: 10.1371/journal.pone.0275884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
For the assessment of sarcopenia or other geriatric frailty syndromes, psoas major area may be one of the primary indicators. Aim to develop and cross-validate the psoas cross-sectional area estimation equation of L3-L4 of the elderly over 60 years old by bioelectrical impedance analysis (BIA). Ninety-two older adults with normal mobility were enrolled (47 females, 45 males), and were randomly divided into a modeling group (MG, n = 62) and validation group (VG, n = 30). Computed tomography (CT) was used to measure the psoas major area at the' L3-L4 lumbar vertebrae height as a predictor. Estimated variables were height (h), whole body impedance (Zwhole), whole body impedance index (h2/Zwhole, WBI), age, gender (female = 0, male = 1), and body weight (weight) by standing BIA. Relevant variables were estimated using stepwise regression analysis. Model performance was confirmed by cross-validation. BIA estimation equation for PMM obtained from the MG was: (PMMBIA = 0.183 h2/Z- 0.223 age + 4.443 gender + 5.727, r2 = 0.702, n = 62, SEE = 2.432 cm2, p < 0.001). The correlation coefficient r obtained by incorporating the VG data into the PMM equation was 0.846, and the LOA ranged from -4.55 to 4.75 cm2. PMMBIA and PMMCT both correlate highly with MG or VG with small LOA. The fast and convenient standing BIA for measuring PMM may be a promising method that is worth developing.
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Affiliation(s)
- Lee-Ping Chu
- Department of Applied Math, National Chung Hsing University, Taichung, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| | - Kuen-Tsann Chen
- Department of Applied Math, National Chung Hsing University, Taichung, Taiwan
| | - Hsueh-Kuan Lu
- General Education Center, National Taiwan University of Sport, Taichung, Taiwan
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Puzi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
- Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Hsing-Ching Huang
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Kuen-Chang Hsieh
- Department of Research and Development, Starbia Meditek Co., Ltd, Taichung, Taiwan
- Big Data Center, National Chung-Hsing University, Taichung, Taiwan
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21
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Vitagliano T, Garieri P, Lascala L, Ferro Y, Doldo P, Pujia R, Pujia A, Montalcini T, Greco M, Mazza E. Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results. Nutrients 2023; 15:nu15020352. [PMID: 36678221 PMCID: PMC9867292 DOI: 10.3390/nu15020352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.
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Affiliation(s)
- Tiziana Vitagliano
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Pietro Garieri
- Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo, 20900 Monza, Italy
| | - Lidia Lascala
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Yvelise Ferro
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Manfredi Greco
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
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22
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Fujikawa T, Kondo S, Saito T, Inoue T, Otake K, Misu S, Sakai H, Ono R, Tomioka H. Impact of sarcopenia defined by carina-level skeletal muscle mass on the long-term prognosis of patients with idiopathic pulmonary fibrosis. Respir Med Res 2022; 82:100965. [DOI: 10.1016/j.resmer.2022.100965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/29/2022]
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Oh HJ, Kim JH, Kim HR, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom J, Song YG. The impact of sarcopenia on short-term and long-term mortality in patients with septic shock. J Cachexia Sarcopenia Muscle 2022; 13:2054-2063. [PMID: 35478354 PMCID: PMC9397556 DOI: 10.1002/jcsm.12995] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite medical advances, septic shock remains one of the main causes of high mortality in critically ill patients. Although sarcopenia is considered a predictor of mortality in septic shock patients, most studies have only investigated short-term mortality, and those on long-term prognosis are limited. We investigated the impact of sarcopenia on long-term mortality in a large patient population with septic shock. METHODS A retrospective cohort study comprising 905 patients with septic shock was conducted from 2008 to 2019. Sarcopenia was defined based on the measurement of the total abdominal muscle area, assessed using abdominal computed tomography scans. Thereafter, we stratified the patients into two groups-sarcopenia and non-sarcopenia groups-and compared the impact of sarcopenia on short-term (28 days) and long-term (1 year and overall) mortality using multivariable Cox proportional analysis. RESULTS A total of 905 patients were included, and the mean age was 65.7 ± 15.1 years. Among them, 430 (47.5%) patients were male and 407 (45.0%) had sarcopenia. We found that the 28 day, 1 year, and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (13.8% vs. 6.4%, P < 0.001; 41.8% vs. 21.7%, P < 0.001; 62.2% vs. 35.7%, P < 0.001, respectively). Univariable Cox analysis showed that the sarcopenia group had a significant association with the increase in each mortalities compared with the non-sarcopenia group (28 day mortality, hazard ratio (HR) = 2.230, 95% confidence interval (CI) [1.444-3.442], P < 0.001; 1 year mortality, HR = 2.189, 95% CI [1.720, 2.787], P < 0.001; overall mortality, HR = 2.254, 95% CI [1.859, 2.734], P < 0.001). Multivariable Cox analysis showed that both the short-term and long-term mortality rates remained significantly higher in the sarcopenia group than in the non-sarcopenia group, even after adjusting for confounding variables (28 day mortality, HR = 2.116, 95% CI [1.312, 3.412], P = 0.002; 1 year mortality, HR = 1.679, 95% CI [1.291, 2.182], P < 0.001; overall mortality, HR = 1.704, 95% CI [1.381, 2.102], P < 0.001). CONCLUSIONS Sarcopenia was associated with both short-term and long-term mortality in patients with septic shock. In clinical settings, close attention should be paid to these patients for both short-term and long-term outcomes.
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Affiliation(s)
- Hyung Jung Oh
- Department of NephrologySheikh Khalifa Specialty HospitalRas al KhaimahUnited Arab Emirates
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
| | - Jung Ho Kim
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Hye Rim Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems InformaticsYonsei University College of MedicineSeoulKorea
| | - Jin Young Ahn
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Su Jin Jeong
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Nam Su Ku
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Jun Yong Choi
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Joon‐Sup Yeom
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
| | - Young Goo Song
- Department of Internal MedicineYonsei University College of MedicineSeoulKorea
- AIDS Research InstituteYonsei University College of MedicineSeoulSeodaemun‐guKorea
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24
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Tay W, Quek R, Kaur B, Lim J, Henry CJ. Use of Facial Morphology to Determine Nutritional Status in Older Adults: Opportunities and Challenges. JMIR Public Health Surveill 2022; 8:e33478. [PMID: 35849429 PMCID: PMC9345026 DOI: 10.2196/33478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Undiagnosed malnutrition is a significant problem in high-income countries, which can reduce the quality of life of many individuals, particularly of older adults. Moreover, it can also inflate the costs of existing health care systems because of the many metabolic complications that it can cause. The current methods for assessing malnutrition can be cumbersome. A trained practitioner must be present to conduct an assessment, or patients must travel to facilities with specialized equipment to obtain their measurements. Therefore, digital health care is a possible way of closing this gap as it is rapidly gaining traction as a scalable means of improving efficiency in the health care system. It allows for the remote monitoring of nutritional status without requiring the physical presence of practitioners or the use of advanced medical equipment. As such, there is an increasing interest in expanding the range of digital applications to facilitate remote monitoring and management of health issues. In this study, we discuss the feasibility of a novel digital remote method for diagnosing malnutrition using facial morphometrics. Many malnutrition screening assessments include subjective assessments of the head and the face. Facial appearance is often used by clinicians as the first point of qualitative indication of health status. Hence, there may be merit in quantifying these subtle but observable changes using facial morphometrics. Modern advancements in artificial intelligence, data science, sensors, and computing technologies allow facial features to be accurately digitized, which could potentially allow these previously intuitive assessments to be quantified. This study aims to stimulate further discussion and discourse on how this emerging technology can be used to provide real-time access to nutritional status. The use of facial morphometrics extends the use of currently available technology and may provide a scalable, easily deployable solution for nutritional status to be monitored in real time. This will enable clinicians and dietitians to keep track of patients remotely and provide the necessary intervention measures as required, as well as providing health care institutions and policy makers with essential information that can be used to inform and enable targeted public health approaches within affected populations.
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Affiliation(s)
- Wesley Tay
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Joseph Lim
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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25
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Lee O, Shin YC, Ryu Y, Shin SH, Heo JS, Lim CS, Han IW. Adverse Effects of Sarcopenic Obesity on Postoperative Complications after Major Hepatectomy in Patients with Hilar Cholangiocarcinoma. J Clin Med 2022; 11:jcm11071860. [PMID: 35407468 PMCID: PMC8999157 DOI: 10.3390/jcm11071860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenic obesity (SO), which is defined as a high ratio of visceral adipose tissue to skeletal muscle, is a well-known risk factor for post-hepatectomy outcomes in patients with hepatocellular carcinoma. However, few studies have evaluated the effect of SO on postoperative outcomes in patients with hilar cholangiocarcinoma (CCC). This retrospective study aimed to evaluate the effect of preoperative SO on postoperative outcomes in patients with hilar CCC following major hepatectomy. Preoperative SO was assessed in 328 patients undergoing hepatectomy for hilar CCC at three institutions between 2006 and 2016. SO was calculated from cross-sectional visceral fat and muscle area displayed on preoperative CT imaging. Preoperative SO was present in 98 patients (29.9%). The major complication rate in patients with SO was higher than in those without SO (54.1% vs. 37.0%, p = 0.004). Additionally, postoperative hospital stays were prolonged in patients with SO (18.5 vs. 16.5 days, p = 0.038). After multivariable analysis, SO was identified as an independent risk factor for major complications after hepatectomy in hilar CCC patients (OR = 0.866, 95% CI: 1.148–3.034, p = 0.012). Careful postoperative management is needed after major hepatectomy in hilar CCC patients with SO.
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Affiliation(s)
- Okjoo Lee
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea;
| | - Youngju Ryu
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Sang Hyun Shin
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Jin Seok Heo
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
| | - Chang-Sup Lim
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 03088, Korea
- Correspondence: (C.-S.L.); (I.W.H.); Tel.: +82-2-870-3291 (C.-S.L.); +82-2-3410-0772 (I.W.H.); Fax: +82-2-831-2826 (C.-S.L.); +82-2-3410-6980 (I.W.H.)
| | - In Woong Han
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-gu, Seoul 06355, Korea; (O.L.); (Y.R.); (S.H.S.); (J.S.H.)
- Correspondence: (C.-S.L.); (I.W.H.); Tel.: +82-2-870-3291 (C.-S.L.); +82-2-3410-0772 (I.W.H.); Fax: +82-2-831-2826 (C.-S.L.); +82-2-3410-6980 (I.W.H.)
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Psoas muscle size, possible sarcopenia and frailty, and long-term survival in elderly patients after isolated surgical aortic valve replacement for aortic stenosis. Indian J Thorac Cardiovasc Surg 2022; 38:134-141. [PMID: 35210714 PMCID: PMC8857356 DOI: 10.1007/s12055-021-01253-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose This study investigated the use of psoas muscle area index (PAI) as an indicator of mortality risk in relation to survival in elderly patients after isolated surgical aortic valve replacement (SAVR) for aortic valve stenosis (AS). Methods Between January 2005 and March 2015, 140 patients with AS, aged ≥ 70 years, and with preoperative abdominal computed tomography scans, underwent elective, primary, isolated SAVR. PAI showed the ratio of the psoas muscle cross-sectional area at the fourth lumbar vertebral level to body surface area, and PAI less than the gender-specific lowest 20th percentile we called “low PAI” for the purposes of this study. Patients were classified as low PAI (n = 29) or normal PAI (n = 111). Results The mean age in the low-PAI group was significantly older than in the normal-PAI group (81.0 vs. 77.3 years; p = 0.001). The mean follow-up was 4.25 years. The low-PAI group had a lower survival rate than the normal-PAI group at 1 year (89.7 ± 5.7% vs. 96.3 ± 1.8%), at 3 years (71.6 ± 9.3% vs. 91.5 ± 2.7%), and overall (53.0 ± 13.4% vs. 76.0 ± 5.6%; p = 0.039). The prognostic factors of mortality included low PAI (hazard ratio 2.95; 95% confidence interval 1.084–8.079; p = 0.034). Conclusions PAI was associated with reduced overall survival after isolated SAVR in elderly people. PAI measurement may help to predict patient risks.
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Tan Y, Duan T, Li B, Zhang B, Zhu Y, Yan K, Song J, Lv T, Yang J, Jiang L, Yang J, Wen T, Yan L. Sarcopenia defined by psoas muscle index independently predicts long-term survival after living donor liver transplantation in male recipients. Quant Imaging Med Surg 2022; 12:215-228. [PMID: 34993073 DOI: 10.21037/qims-21-314] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023]
Abstract
Background The effect of sarcopenia on long-term outcomes in recipients after living donor liver transplantation (LDLT), including overall survival and hepatocellular carcinoma (HCC) recurrence, remains unclear, especially in China. Methods From 2009 to 2015, 117 adult patients underwent LDLT in our center. In all, 82 patients who had computed tomography images reaching the third lumbar vertebra level within 1 month of LDLT were included; 70 male patients were included in the final analysis after excluding 12 female patients because of poor performance of the calculated cutoff value. Sarcopenia was defined according to the psoas muscle index (PMI) cutoff value, which was calculated based on dynamic time-dependent outcomes using X-tile software. Cox proportional hazards models were used to assess multivariate-adjusted hazards ratios (HRs) to seek potential correlations between sarcopenia and posttransplant outcomes. Results According to the cutoff value of PMI (6.25 cm2/m2), 38 patients (54.3%) were diagnosed with sarcopenia. After an average of 63.3 months of follow-up, 21 patients died after LDLT, 16 in the sarcopenia group and 5 in the non-sarcopenia group, respectively. Sarcopenia was identified as being significantly associated with worse posttransplant overall survival in multivariate analysis, resulting in an HR of 3.22 [95% confidence interval (CI), 1.15-8.98]. Among the 50 recipients with HCC, sarcopenia was significantly associated with HCC recurrence in univariate analysis (HR 2.87, 95% CI, 1.06-7.80) but was not detected as an independent risk factor of HCC recurrence in multivariate analysis, although a trend (tendency)towards significance was observed (HR 2.60, 95% CI, 0.95-7.10; P=0.062). Conclusions Sarcopenia defined by PMI is a feasible and reliable independent predictor of posttransplant overall survival in male LDLT candidates. However, its correlation with posttransplant HCC recurrence remains uncertain.
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Affiliation(s)
- Yifei Tan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Duan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Li
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Bohan Zhang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yunfeng Zhu
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ke Yan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Jiulin Song
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Lv
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jian Yang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Li Jiang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiayin Yang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tianfu Wen
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lunan Yan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
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Horbal SR, Brown E, Derstine BA, Zhang P, Bidulescu A, Sullivan JA, Ross BE, Su GL, Holcombe SA, Wang SC. A correction score to compare aortic calcification in contrast enhanced and non-contrast measurements from computed tomography scans. Clin Imaging 2021; 83:51-55. [PMID: 34954502 DOI: 10.1016/j.clinimag.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Aortic wall calcification shows strong promise as a cardiovascular risk factor. While useful for visual enhancement of vascular tissue, enhancement creates heterogeneity between scans with and without contrast. We evaluated the relationship between aortic calcification in routine abdominal computed tomography scans (CT) with and without contrast. METHODS Inclusion was limited to those with abdominal CT-scans with and without contrast enhancement within 120 days. Analytic Morphomics, a semi-automated computational image processing system, was used to provide standardized, granular, anatomically indexed measurements of aortic wall calcification from abdominal CT-scans. Aortic calcification area (ACA) and aortic wall calcification percent (ACP) and were the outcomes of interest. Multiple linear regression was used to evaluate the relationship of aortic measurements. Models were further controlled for age and sex. Stratification of measurements by vertebral level was also performed. RESULTS A positive association was observed for non-contrast calcification in ACP β 0.74 (95% CI 0.72, 0.76) and ACA β 0.44 (95% 0.43, 0.45). Stratified results demonstrated the highest coefficient of determination at L2 for percent and L3 for area models [R2 0.91 (ACP) 0.74 (ACA)]. Adjusted lumber-level associations between non-contrast and contrast measurements ranged from (β 0.69-0.82) in ACP and (β 0.37-0.54) in ACA. CONCLUSION A straightforward correction score for comparison of abdominal aortic calcification measurements in contrast-enhanced and non-contrast scans is discussed. Correction of aortic calcification from CT scans can reduce scan heterogeneity and will be instrumental in creating larger cardiovascular cohorts as well as cardiovascular risk surveillance programs.
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Affiliation(s)
- Steven R Horbal
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Edward Brown
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian A Derstine
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Peng Zhang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | | | - June A Sullivan
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Brian E Ross
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Grace L Su
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Sven A Holcombe
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA.
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Zou WY, Enchakalody BE, Zhang P, Shah N, Saini SD, Wang NC, Wang SC, Su GL. Automated Measurements of Body Composition in Abdominal CT Scans Using Artificial Intelligence Can Predict Mortality in Patients With Cirrhosis. Hepatol Commun 2021; 5:1901-1910. [PMID: 34558818 PMCID: PMC8557320 DOI: 10.1002/hep4.1768] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Abstract
Body composition measures derived from already available electronic medical records (computed tomography [CT] scans) can have significant value, but automation of measurements is needed for clinical implementation. We sought to use artificial intelligence to develop an automated method to measure body composition and test the algorithm on a clinical cohort to predict mortality. We constructed a deep learning algorithm using Google's DeepLabv3+ on a cohort of de-identified CT scans (n = 12,067). To test for the accuracy and clinical usefulness of the algorithm, we used a unique cohort of prospectively followed patients with cirrhosis (n = 238) who had CT scans performed. To assess model performance, we used the confusion matrix and calculated the mean accuracy of 0.977 ± 0.02 (0.975 ± 0.018 for the training and test sets, respectively). To assess for spatial overlap, we measured the mean intersection over union and mean boundary contour scores and found excellent overlap between the manual and automated methods with mean scores of 0.954 ± 0.030, 0.987 ± 0.009, and 0.948 ± 0.039 (0.983 ± 0.013 for the training and test set, respectively). Using these automated measurements, we found that body composition features were predictive of mortality in patients with cirrhosis. On multivariate analysis, the addition of body composition measures significantly improved prediction of mortality for patients with cirrhosis over Model for End-Stage Liver Disease alone (P < 0.001). Conclusion: The measurement of body composition can be automated using artificial intelligence and add significant value for incidental CTs performed for other clinical indications. This is proof of concept that this methodology could allow for wider implementation into the clinical arena.
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Affiliation(s)
- Winnie Y Zou
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | | | - Peng Zhang
- Department of SurgeryUniversity of MichiganAnn ArborMIUSA
| | - Nidhi Shah
- Department of SurgeryUniversity of MichiganAnn ArborMIUSA
| | - Sameer D Saini
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMIUSA.,Gastroenterology SectionVA Ann Arbor Healthcare SystemAnn ArborMIUSA.,VA Ann Arbor Center for Clinical Management ResearchAnn ArborMIUSA
| | | | - Stewart C Wang
- Department of SurgeryUniversity of MichiganAnn ArborMIUSA
| | - Grace L Su
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMIUSA.,Gastroenterology SectionVA Ann Arbor Healthcare SystemAnn ArborMIUSA
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30
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Tee YS, Cheng CT, Wu YT, Hsu CP, Kang SC, Hsieh CH, Derstine BA, Su GL, Wang SC, Fu CY, Liao CH. Predicting outcomes of abdominal surgical emergencies in the elderly population using a CT muscle gauge. Aging Clin Exp Res 2021; 33:2479-2490. [PMID: 33818749 DOI: 10.1007/s40520-020-01769-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frailty has been shown to be an independent negative predictor of surgical outcomes in geriatric patients. Traditional measurements of muscle strength and mass are impractical in emergency settings, and computed tomography (CT)-measured skeletal muscle mass has been proposed as an alternative. However, the cutoff values for low muscle mass are still unknown, and their impact on abdominal emergencies in the elderly population is unclear. METHODS A total of 462 young trauma patients aged 18-40 years were analyzed to establish sex-specific reference cutoff values for the CT-measured muscle index (MI) and muscle gauge (MG) values. The impacts of low MI and MG values were investigated in 1192 elderly patients (aged ≥ 65 years) undergoing abdominal surgery. RESULTS The sex-specific cutoff values for MI and MG were determined by adopting European Working Group on Sarcopenia in Older People 2 guidelines. The correlation between MG and aging was significantly stronger than that between MI and ageing. With regard to the MG, the L4 psoas muscle gauge (L4 PMG) was further investigated in an elderly cohort owing to its high predictive value and ease of use in the clinical setting. A low L4 PMG value was an independent risk factor for overall complications and mortality in elderly patients with abdominal emergencies. CONCLUSION The current study was the largest study investigating the correlations between MG values and aging in the Asian population. A low L4 PMG value may help surgeons during preoperative decision making regarding geriatric patients with abdominal emergencies.
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Affiliation(s)
- Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Yu-Tung Wu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chih-Po Hsu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Shih-Ching Kang
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC.
| | - Brian A Derstine
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Grace L Su
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stewart C Wang
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
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Atala NA, Bongiovanni SL, Galich AM, Bruchmann MG, Rossi LA, Tanoira I, Ranalletta M. Is sarcopenia a risk factor for rotator cuff tears? J Shoulder Elbow Surg 2021; 30:1851-1855. [PMID: 33157241 DOI: 10.1016/j.jse.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Currently, it is considered an independent risk factor for falls and fractures, disability, postoperative complications, and mortality. Rotator cuff tears are known to be influenced by systemic diseases such as diabetes mellitus, hypercholesterolemia, thyroid disease, and osteoporosis. The aim of our study was to determine if there is a correlation between sarcopenia prevalence and rotator cuff tears. METHODS This is a prospective case-control study. Between May 2017 and May 2018, 106 patients were evaluated and divided into 2 groups. Group 1 (cases) included 53 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 72 ± 5 years), and group 2 (controls) included 53 patients without rotator cuff tears (mean age, 71 ± 6 years). Sarcopenia was diagnosed with the presence of 2 of 3 criteria: low skeletal muscle mass, inadequate muscle strength, and inadequate physical performance. Rotator cuff integrity was evaluated with magnetic resonance imaging in all patients. RESULTS No significant differences were found in baseline data and demographic factors between the groups, except for the smoking habit (P = .02). The prevalence of sarcopenia was not significantly different between the groups, nor were gait speed, grip strength, and skeletal muscle mass index (P = .15, .99, and .9, respectively). CONCLUSION The prevalence of sarcopenia in patients with rotator cuff tears was similar to an age- and sex-matched control population. Thus, with these results, we are not able to consider sarcopenia as an independent risk factor for rotator cuff tears.
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Affiliation(s)
- Nicolás A Atala
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Santiago L Bongiovanni
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana M Galich
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María G Bruchmann
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciano A Rossi
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Shoulder Unit, Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients. Life (Basel) 2021; 11:life11080740. [PMID: 34440484 PMCID: PMC8401329 DOI: 10.3390/life11080740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.
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Kelly-Schuette KA, Prentice A, Orr A, Levine A, Zarnke A, Pardington E, Pounders S, Lypka M, Krech L, Iskander G, Chapman AJ, Gibson CJ, Steensma E, Durling L. Rib Fracture Mortality: Are there clues in the core? J Surg Res 2021; 268:25-32. [PMID: 34280662 DOI: 10.1016/j.jss.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sarcopenia is associated with increased morbidity and mortality in the trauma patient. The primary objective of this study was to determine the relationship of psoas cross sectional area with hospital mortality in patients with rib fractures over the age of 55 years. MATERIALS AND METHODS We retrospectively reviewed 1223 patients presenting to a Level 1 Trauma Center between 1/1/2002 and 1/31/2019. Psoas cross sectional area was measured using a polygonal tracing tool. Patients were stratified into four quartiles based on sex-specific values. RESULTS There was increased in-hospital mortality for patients with a lower psoas cross sectional area (10 %, 8%, 6%, and 4%, Q1-Q4 respectively; P=0.021). The logistic regression model determined for every increase in psoas cross sectional area by 1 cm2 the odds of in-hospital mortality decreased by 4%. CONCLUSIONS In-hospital mortality is multifactorial; however, psoas cross sectional area may provide a clue in predicting adverse outcomes after traumatic rib fractures.
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Affiliation(s)
- Kathrine A Kelly-Schuette
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI.
| | - Anthony Prentice
- Spectrum Health Department of Nursing, Surgical Services, Grand Rapids, MI
| | - Adam Orr
- Spectrum Health/Michigan State University College of Human Medicine Diagnostic Radiology Residency, Grand Rapids, MI
| | - Anna Levine
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Allison Zarnke
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Emily Pardington
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Steffen Pounders
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Matthew Lypka
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Gaby Iskander
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Alistair J Chapman
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Charles J Gibson
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Elizabeth Steensma
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Luke Durling
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
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Muñoz-Largacha JA, Wei B. Commentary: Analytic Morphomics and LVRS - A Story of Frailty and Fibrosis. Semin Thorac Cardiovasc Surg 2021; 34:1091-1092. [PMID: 34242755 DOI: 10.1053/j.semtcvs.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Juan A Muñoz-Largacha
- Department of Surgery, General Surgery Residency Program, University of Alabama at Birmingham, Birmingham Alabama
| | - Benjamin Wei
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham Alabama.
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Mazzola A, Brustia R, Magro B, Atif M, Ouali N, Tourret J, Barrou B, Scatton O, Conti F. Impact of sarcopenia on clinical outcomes of patients undergoing simultaneous liver and kidney transplantation: a cohort study. Clin Res Hepatol Gastroenterol 2021; 45:101692. [PMID: 33848672 DOI: 10.1016/j.clinre.2021.101692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of sarcopenia in patients undergoing simultaneous liver and kidney transplantation (SLKT) has not been fully delineated. The aim of this single-centre-cohort-study was to evaluate the impact of sarcopenia on the clinical outcomes. METHODS Between 2003 and 2018, 79 patients underwent SLKT. Sarcopenia was assessed via the total psoas muscle area (TPA) at the level of the 3rd. lumbar vertebra. Sarcopenia threshold was TPA < 1460 mm2 (women) and <1560 mm2 (men). We identified post-operative biliary, vascular and digestive complications. Survival analysis was performed by the Kaplan Meier method (log-rank test). RESULTS We included 43/79 SLKT recipients (56%male, median age of 58 [53-63] years). The prevalence of cirrhosis was 74% (n = 32) with median MELD-score of 21 (20-22) and that of polycystic-liver-disease was 26% (n = 11). End-stage-renal-disease of unknown origin was 36.2% (n = 12). Dialysis before transplantation was performed in 54,8% (n = 23) of patients. The median TPA was 1138 (926-1510) mm2, and sarcopenia was detected in 72% of patients (n = 31). No difference in patient or death-censored graft-survival between sarcopenic and non-sarcopenic groups at 1 year was reported. Also, no differences at 6-months' post-transplant-complication-free and infection-free-survival rates were found. CONCLUSION In this cohort of patients, no differences were observed in patients, grafts, complications or infection-free survival between sarcopenic or no sarcopenic SLKT patients. Future multi-centre studies are needed to validate and extend the generalisability of these findings.
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Affiliation(s)
- Alessandra Mazzola
- APHP, Unité Médicale de Transplantation Hépatique Hôpital Pitié Salpêtrière, Boulevard de l'Hôpital 47-83 75013 Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Raffaele Brustia
- APHP, Unité de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié Salpêtrière, Boulevard de l'Hôpital 47-83 75013 Paris, France; Research Unit BQR SSPC, Université de Picardie Jules Verne, Amiens, France
| | - Bianca Magro
- APHP, Unité Médicale de Transplantation Hépatique Hôpital Pitié Salpêtrière, Boulevard de l'Hôpital 47-83 75013 Paris, France; Di.BIMIS Gastroenterology, University of Palermo, Piazza delle Cliniche N2, 90100 Palermo, Italy
| | - Muhammad Atif
- APHP, Centre d'Immunologie et Maladies Infectieuses, Sorbonne Université, Paris, France
| | - Nassera Ouali
- AP-HP, Department of Nephrology and Transplantation, Tenon Hospital, Sorbonne University, Paris, France
| | - Jérôme Tourret
- Sorbonne Université, APHP, Service de Transplantation Rénale, Pitié Salpêtrière, Paris, France
| | - Benoit Barrou
- Sorbonne Université, APHP, Service de Transplantation Rénale, Pitié Salpêtrière, Paris, France
| | - Olivier Scatton
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France; APHP, Unité de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié Salpêtrière, Boulevard de l'Hôpital 47-83 75013 Paris, France; Sorbonne Université, INSERM, Institute of Cardiometabolisme and Nutrition (ICAN), Paris, France
| | - Filomena Conti
- APHP, Unité Médicale de Transplantation Hépatique Hôpital Pitié Salpêtrière, Boulevard de l'Hôpital 47-83 75013 Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Sorbonne Université, INSERM, Institute of Cardiometabolisme and Nutrition (ICAN), Paris, France
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Lin J, Weir WB, Grenda T, Zhang P, Derstine BA, Enchakalody B, Underhill J, Reddy RM, Chang AC, Wang SC. Analytic Morphomics Are Related to Outcomes After Lung Volume Reduction Surgery. Semin Thorac Cardiovasc Surg 2021; 34:1084-1090. [PMID: 34166813 PMCID: PMC8763534 DOI: 10.1053/j.semtcvs.2021.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023]
Abstract
:Lung volume reduction surgery continues to have a high morbidity despite National Emphysema Treatment Trial selection criteria. This study evaluated the association between analytic morphomics on chest computed tomography scans and outcomes after lung volume reduction surgery. In a retrospective review of 85 lung volume reduction surgery patients from 1998-2013, dorsal muscle group area, subcutaneous and visceral fat area, and bone mineral density were assessed using analytic morphomics. Lung density was divided into five levels of increasing density (Lung density 1, emphysema; 2, normal lung; 4-5, scarring). Outcomes including survival, hospital length of stay, readmission at 30 days, and pulmonary complications were analyzed using univariate and multivariable techniques. Pulmonary complications developed in 27.1% (23/85). Mortality at 90 days was 9.4% (8/85). On multivariable analysis, lower bone mineral density (Odds ratio 0.61; 95% confidence interval 0.39-0.95) was associated with decreased survival, longer length of stay (0.83; 0.77-0.89), and readmissions (0.39; 0.15-1.00). Higher lung density 5:lung density 2 volume (1.84; 1.05-3.23), possibly due to scarring, was associated with pulmonary complications and longer length of stay (1.32; 1.23-1.41) while lower subcutaneous fat area:height was associated with readmissions which may reflect decreased metabolic reserve (0.35; 0.13-0.93). Patients with signs of frailty including lower bone mineral density may be at increased risk of adverse outcomes including decreased survival after lung volume reduction surgery. The results of this hypothesis-generating study will need to be confirmed in larger, multicenter trials to determine whether analytic morphomics can improve risk stratification and patient selection.
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Affiliation(s)
- Jules Lin
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan..
| | - William B Weir
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tyler Grenda
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Peng Zhang
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brian A Derstine
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Binu Enchakalody
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joshua Underhill
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew C Chang
- Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stewart C Wang
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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Roccamatisi L, Gianotti L, Paiella S, Casciani F, De Pastena M, Caccialanza R, Bassi C, Sandini M. Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of antimicrobial-resistant infections after major abdominal oncologic surgery: A prospective trial. Nutrition 2021; 86:111184. [PMID: 33676330 DOI: 10.1016/j.nut.2021.111184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Infectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections. METHODS This was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters. RESULTS Data from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (-0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354-6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of -0.3. CONCLUSIONS In surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.
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Affiliation(s)
- Linda Roccamatisi
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Fabio Casciani
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Marta Sandini
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy; Department of General Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Kim JE, Park SJ, Kim YC, Min SI, Ha J, Kim YS, Yoon SH, Han SS. Deep Learning-Based Quantification of Visceral Fat Volumes Predicts Posttransplant Diabetes Mellitus in Kidney Transplant Recipients. Front Med (Lausanne) 2021; 8:632097. [PMID: 34113628 PMCID: PMC8185023 DOI: 10.3389/fmed.2021.632097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Because obesity is associated with the risk of posttransplant diabetes mellitus (PTDM), the precise estimation of visceral fat mass before transplantation may be helpful. Herein, we addressed whether a deep-learning based volumetric fat quantification on pretransplant computed tomographic images predicted the risk of PTDM more precisely than body mass index (BMI). Methods: We retrospectively included a total of 718 nondiabetic kidney recipients who underwent pretransplant abdominal computed tomography. The 2D (waist) and 3D (waist or abdominal) volumes of visceral, subcutaneous, and total fat masses were automatically quantified using the deep neural network. The predictability of the PTDM risk was estimated using a multivariate Cox model and compared among the fat parameters using the areas under the receiver operating characteristic curves (AUROCs). Results: PTDM occurred in 179 patients (24.9%) during the median follow-up period of 5 years (interquartile range, 2.5–8.6 years). All the fat parameters predicted the risk of PTDM, but the visceral and total fat volumes from 2D and 3D evaluations had higher AUROC values than BMI did, and the best predictor of PTDM was the 3D abdominal visceral fat volumes [AUROC, 0.688 (0.636–0.741)]. The addition of the 3D abdominal VF volume to the model with clinical risk factors increased the predictability of PTDM, but BMI did not. Conclusions: A deep-learning based quantification of visceral fat volumes on computed tomographic images better predicts the risk of PTDM after kidney transplantation than BMI.
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Affiliation(s)
- Ji Eun Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Sang Joon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Radiology, UMass Memorial Medical Center, Worcester, MA, United States
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Furyk C, Senthuran S, Nye D, Ho YH, Leicht AS. Prehabilitation for Frail Patients Undergoing Colorectal Surgery: Lessons Learnt From a Randomised Feasibility Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:650835. [PMID: 36188831 PMCID: PMC9397917 DOI: 10.3389/fresc.2021.650835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022]
Abstract
There is substantial interest by clinicians to improve the health outcomes of older and frail patients following major surgery, with prehabilitation a potential and important component of future standard patient care. We studied the feasibility of a randomised controlled trial of pre-operative prehabilitation in frail patients scheduled for colorectal surgery in regional Australia. We conducted a single blind, parallel arm, randomised controlled trial in a regional referral centre where colorectal surgical patients aged over 50 were invited to participate and screened for frailty. Frail patients were randomised to undertake either a 4-week supervised exercise program with dietary advice, or usual care. The primary outcome was 6-min-walk-distance at baseline, pre-surgery (4 weeks later) and at follow-up (4–6 weeks post-operation). Secondary outcomes included physical activity level, health-related quality of life, and post-surgical complications. Feasibility outcomes were numbers of patients reaching each stage and barriers or reasons for withdrawal. Of 106 patients eligible for screening during the 2-year study period, only five were able to be randomised, of which one alone completed the entire study to follow-up. Fewer patients than expected met the frailty criteria (23.6%), and many (22.6%) were offered surgery in a shorter timeframe than the required 4 weeks. Physical and psychological aspects of frailty and logistical issues were key for patients declining study participation and/or not complying with the intervention and/or all outcome assessments. Feasibility for a large randomised controlled trial of prehabilitation for frail colorectal patients was poor (~5%) for our regional location. Addressing barriers, examination of a large, dense population base, and utilisation of a frailty-screening tool validated in surgical patients are necessary for future studies to identify the impact of prehabilitation for frail patients.
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Affiliation(s)
- Claire Furyk
- Department of Anaesthesia, Townsville University Hospital, Townsville, QLD, Australia
- Department of Anaesthesia, Geelong Hospital, Geelong, VIC, Australia
| | - Siva Senthuran
- Department of Anaesthesia, Townsville University Hospital, Townsville, QLD, Australia
| | - Dia Nye
- Surgical Services, Townsville University Hospital, Townsville, QLD, Australia
| | - Yik H. Ho
- Department of Surgery, Townsville University Hospital, Townsville, QLD, Australia
| | - Anthony S. Leicht
- Sport and Exercise Science, James Cook University, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- *Correspondence: Anthony S. Leicht
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Hain E, Barat M, Da Costa C, Dautry R, Baillard C, Bonnet S, Dousset B, Soyer P, Dohan A, Fuks D, Gaujoux S. Preoperative assessment of patient comorbidities before left colectomy: Comparison between ASA performance status scale and a new computed tomography physical status score. Diagn Interv Imaging 2020; 102:313-319. [PMID: 33257202 DOI: 10.1016/j.diii.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare a newly developed preoperative computed tomography physical status (CT-PS) score with the American Society of Anesthesiology performance status (ASA-PS) scale in the assessment of patient preoperative health status and stratification of perioperative risk before left colectomy. MATERIALS AND METHODS Preoperative chest-abdomen-pelvis CT examinations of patients who were scheduled to undergo elective laparoscopic left colonic resection for cancer in two centers were reviewed by two radiologists blinded to clinical data for the presence of several key imaging features in order to assess general, cardiac, pulmonary, abdominal, renal, vascular and musculoskeletal status. CT examinations of patients from center 1 were used to build a CT-PS score to predict ASA-PS≥III. CT-PS score was further validated using an external cohort of patients from center 2. RESULTS During a 2-year period, 117 consecutive patients (63 men, 54 women; mean age, 65±13 [SD] years; age range: 53-90 years) who underwent laparoscopic left colectomy for cancer in center 1 (66 patients, building cohort) and center 2 (51 patients, validation cohort) were retrospectively included. Ninety-one percent of patients were ASA-PS 1-2. Overall postoperative morbidity was 23% and severe morbidity 12%. The area under the receiver operating characteristic curve of CT-PS score was 0.968 (95% CI: 0.901-1.000) in the building cohort and 0.828 (95% CI: 0.693-0.963) in the validation cohort. The optimal thresholds yielded 87% (95% CI: 83-91%) sensitivity and 100% (95% CI: 91-100%) specificity in the building cohort and 75% (95% CI: 69-81%) sensitivity and 83% (95% CI: 77-88%) specificity in the validation cohort for the prediction of ASA-PS. CONCLUSION Preoperative chest-abdomen-pelvis CT thoroughly and wisely read is highly accurate to differentiate patients with ASA-PS I/II from those with ASA-PS III/IV before left colectomy.
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Affiliation(s)
- Elisabeth Hain
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Maxime Barat
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Inserm U1016, CNRS UMR 8104, Institut Cochin, 75014 Paris, France.
| | - Carla Da Costa
- Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Christophe Baillard
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Stéphane Bonnet
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Monsouris, 75013 Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - Philippe Soyer
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Cochin hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - David Fuks
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Monsouris, 75013 Paris, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
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Hanley C, Donahoe L, Slinger P. "Fit for Surgery? What's New in Preoperative Assessment of the High-Risk Patient Undergoing Pulmonary Resection". J Cardiothorac Vasc Anesth 2020; 35:3760-3773. [PMID: 33454169 DOI: 10.1053/j.jvca.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
Advances in perioperative assessment and diagnostics, together with developments in anesthetic and surgical techniques, have considerably expanded the pool of patients who may be suitable for pulmonary resection. Thoracic surgical patients frequently are perceived to be at high perioperative risk due to advanced age, level of comorbidity, and the risks associated with pulmonary resection, which predispose them to a significantly increased risk of perioperative complications, increased healthcare resource use, and costs. The definition of what is considered "fit for surgery" in thoracic surgery continually is being challenged. However, no internationally standardized definition of prohibitive risk exists. Perioperative assessment traditionally concentrates on the "three-legged stool" of pulmonary mechanical function, parenchymal function, and cardiopulmonary reserve. However, no single criterion should exclude a patient from surgery, and there are other perioperative factors in addition to the tripartite assessment that need to be considered in order to more accurately assess functional capacity and predict individual perioperative risk. In this review, the authors aim to address some of the more erudite concepts that are important in preoperative risk assessment of the patient at potentially prohibitive risk undergoing pulmonary resection for malignancy.
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Affiliation(s)
- Ciara Hanley
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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Navin PJ, Moynagh MR, Atkinson EJ, Tirumanisetty P, LeBrasseur NK, Kumar A, Khosla S, Takahashi N. Establishment of normative biometric data for body composition based on computed tomography in a North American cohort. Clin Nutr 2020; 40:2435-2442. [PMID: 33176926 DOI: 10.1016/j.clnu.2020.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Accurate and reproducible biomarkers are required to allow a more personalized approach to patient care. Body composition is one such biomarker affecting outcomes in a range of surgical and oncological conditions. The aim of this study is to determine the age and sex specific distribution of body composition data, based on information gathered from computed tomography (CT). METHODS This prospective study used healthy subjects from the medical records linkage of the Rochester Epidemiology Project, based in Minnesota, USA. Each patient had a CT scan without intravenous contrast performed between 1999 and 2001. Quantification was performed using previously validated semi-automated in-house developed software for body composition analysis. Subcutaneous adipose tissue area, visceral adipose tissue area, intermuscular adipose tissue area and skeletal muscle area were measured and indexed to subject height. Generalized Additive Models for Location, Scale and Shape were used to assess the location, scale, and shape of each variable across age, stratified by sex. Z-scores specific to sex were assessed for each of the parameters analyzed. Age-specific z-scores were calculated using the formula: Z = (Index Variable - μ)/σ or Z = (√ (Index Variable) - μ)/σ. RESULTS There were 692 subjects enrolled in the study. The fitted model equation was offered for each variable with values presented for μ and σ. Modelling with penalized splines was performed for VAT index, IMAT index and total adipose tissue index. Scatterplots of each variable were produced with lines of Z-scores as a visual representation. CONCLUSION This study offers comparative data to allow comparison amongst multiple populations. This will form an important reference for future research and clinical practice.
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Affiliation(s)
- P J Navin
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - M R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - E J Atkinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - P Tirumanisetty
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - N K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - A Kumar
- Department of Gynecological Surgery, Mayo Clinic, Rochester, USA
| | - S Khosla
- Department of Endocrinology, Mayo Clinic, Rochester, USA
| | - N Takahashi
- Department of Radiology, Mayo Clinic, Rochester, USA.
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Sarcopenia Aneurysm Scoring System Predicts Early and Midterm Mortality After Endovascular Repair for Abdominal Aortic Aneurysm. Ann Surg 2020; 276:e247-e254. [PMID: 33002942 DOI: 10.1097/sla.0000000000004230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to develop a better model of prediction after EVAR using the psoas muscle index (PMI). SUMMARY BACKGROUND DATA The Glasgow Aneurysm Score (GAS), the modified Leiden Score (mLS), the Comorbidity Severity Score (CSS), and the Euro Score (ES) are known prognostic scoring after EVAR. Similarly, sarcopenia measured by PMI has been reported to be an important predictor. This study investigated a new scoring system using PMI predicting short and midterm overall mortality after EVAR. METHODS Three hundred ten patients were retrospectively evaluated. The primary endpoint was all-cause death. One hundred three patients were assigned to the derivation cohort and 207 patients to the validation cohort. RESULTS The all-cause mortality rates were 8.8% at 1 year, 23.5% at 3 years, and 32.8% at 5 years. In a multivariate analysis, age, aneurysm diameter, eGFR, and PMI were associated with all-cause mortality in the derivation cohort. The SAS system was defined as the sum of the following factors: elderly (75 years), large aneurysm (65 mm), low eGFR (30 mL/min/1.73 m), and low PMI (males: 48.2 cm/m, females: 36.8 cm/m). We compared the SAS with the other prognostic scoring for 5-year mortality evaluating the area under the receiver operating characteristic curves in the validation cohort (GAS: 0.731, mLS: 0. 718, CSS: 0. 646, ES: 0.661, and SAS: 0.785, P = 0.013). CONCLUSION We developed the SAS to predict all-cause mortality after elective EVAR and this scoring showed excellent predictive performance.
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The Value of Morphometric Measurements in Risk Assessment for Donor-Site Complications after Microsurgical Breast Reconstruction. J Clin Med 2020; 9:jcm9082645. [PMID: 32823954 PMCID: PMC7465816 DOI: 10.3390/jcm9082645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Microsurgical abdominally-based reconstruction is considered the gold standard in autologous breast reconstruction. Despite refined surgical procedures, donor-site complications still occur, reducing patient satisfaction and quality of life. Recent work has outlined the potential of morphometric measurements in risk assessment for postoperative hernia development. With rising demand for personalised treatment, the goal of this study was to investigate their potential in risk assessment for any donor site complication. In this retrospective cohort study, 90 patients were included who each received microsurgical breast reconstruction at the hands of one surgeon between January 2015 and May 2017. Donor-site complications formed the primary outcome and were classified according to Clavien-Dindo. Morphometric measurements were taken on a routinely performed computed tomographic angiogram. Complications occurred in 13 of the 90 (14.4%) cases studied. All patients who developed any type of postoperative donor site complication had a history of abdominal surgery. The risk of postoperative complications increased by 3% with every square centimetre of omental fat tissue (OR 1.03, 95% CI 1.00-1.06, and p-value = 0.022). Morphometric measurements provide valuable information in risk assessment for donor-site complications in abdominally-based breast reconstruction. They may help identify personalised reconstructive options for maximal postoperative patient satisfaction and quality of life.
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Automated Measurements of Muscle Mass Using Deep Learning Can Predict Clinical Outcomes in Patients With Liver Disease. Am J Gastroenterol 2020; 115:1210-1216. [PMID: 32467506 PMCID: PMC7415547 DOI: 10.14309/ajg.0000000000000662] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There is increasing recognition of the central role of muscle mass in predicting clinical outcomes in patients with liver disease. Muscle size can be extracted from computed tomography (CT) scans, but clinical implementation will require increased automation. We hypothesize that we can achieve this by using artificial intelligence. METHODS Using deep convolutional neural networks, we trained an algorithm on the Reference Analytic Morphomics Population (n = 5,268) and validated the automated methodology in an external cohort of adult kidney donors with a noncontrast CT scan (n = 1,655). To test the clinical usefulness, we examined its ability to predict clinical outcomes in a prospectively followed cohort of patients with clinically diagnosed cirrhosis (n = 254). RESULTS Between the manual and automated methodologies, we found excellent inter-rater agreement with an intraclass correlation coefficient of 0.957 (confidence interval 0.953-0.961, P < 0.0001) in the adult kidney donor cohort. The calculated dice similarity coefficient was 0.932 ± 0.042, suggesting excellent spatial overlap between manual and automated methodologies. To assess the clinical usefulness, we examined its ability to predict clinical outcomes in a cirrhosis cohort and found that automated psoas muscle index was independently associated with mortality after adjusting for age, gender, and child's classification (P < 0.001). DISCUSSION We demonstrated that deep learning techniques can allow for automation of muscle measurements on clinical CT scans in a diseased cohort. These automated psoas size measurements were predictive of mortality in patients with cirrhosis showing proof of principal that this methodology may allow for wider implementation in the clinical arena.
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Broyles JM, Smith JM, Phillips BT, Mericli AF, Selber JC, Largo RD, Baumann DP, Liu J, Schaverien MV. The effect of sarcopenia on perioperative complications in abdominally based free-flap breast reconstruction. J Surg Oncol 2020; 122:1240-1246. [PMID: 32673425 DOI: 10.1002/jso.26120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/27/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. METHODS A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. RESULTS Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). CONCLUSIONS Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.
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Affiliation(s)
- Justin M Broyles
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey M Smith
- Division of Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Brett T Phillips
- Division of Plastic and Reconstructive Surgery, Duke University Hospital, Durham, North Carolina
| | - Alex F Mericli
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Jesse C Selber
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Rene D Largo
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Donald P Baumann
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Jessie Liu
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Mark V Schaverien
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
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Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer. Ann Surg 2020; 275:e708-e715. [DOI: 10.1097/sla.0000000000004040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sun C, Anraku M, Kawahara T, Karasaki T, Kitano K, Nagayama K, Sato M, Nakajima J. Prognostic significance of low pectoralis muscle mass on preoperative chest computed tomography in localized non-small cell lung cancer after curative-intent surgery. Lung Cancer 2020; 147:71-76. [PMID: 32673829 DOI: 10.1016/j.lungcan.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 07/04/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The impact of sarcopenia on the outcome in patients following resection of non-small cell lung cancer is yet to be fully determined. This study aimed to evaluate the clinical utility of a computed tomography-based pectoralis muscle assessment, which reflects sarcopenia, to predict the risk of postoperative outcomes. MATERIALS AND METHODS This retrospective study included 347 consecutive patients undergoing curative-intent resection of non-small cell lung cancer from 2009 to 2013. The pectoralis muscle index (pectoralis muscle area/body mass index) was assessed at the level of the fourth thoracic vertebra on chest axial images. The primary outcomes were compared between the lowest gender-specific quintile (sarcopenia) and the other quintiles according to the index. The prognostic significance of low pectoralis muscle index was calculated by the Cox proportional hazards regression model. A propensity score matching analysis was performed to adjust the differences in clinical characteristics. RESULTS Sixty-nine patients were identified with sarcopenia according to the lowest gender-specific quintile of pectoralis muscle index. Patients with sarcopenia exhibited worse 5-year overall survival rate compared with patients without sarcopenia (64.2 % vs. 86.7 %, P < 0.001). Even in stage I non-small cell lung cancer, the rate of 5-year overall survival in the sarcopenia group was lower than that in the non-sarcopenia group (74.2 % vs. 92.4 %, P = 0.001). Multivariate analysis revealed that low pectoralis muscle index was independently associated with adverse overall survival (hazard ratio: 2.09, 95 % confidence interval: 1.20-3.62, P = 0.009). After propensity score matching, the prognostic impact of sarcopenia based on low pectoralis muscle index was also robust for overall survival (hazard ratio: 3.23, 95 % confidence interval: 1.38-7.60, P = 0.007). CONCLUSIONS Low pectoralis muscle index was significantly associated with poor long-term outcomes in patients with localized non-small cell lung cancer after curative surgery. This may help assist preoperative risk stratification and longitudinal management after surgery.
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Affiliation(s)
- Changbo Sun
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - Takuya Kawahara
- Biostatistics Division of Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takahiro Karasaki
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Schlosser KA, Maloney SR, Thielan ON, Prasad T, Kercher KW, Augenstein VA, Heniford BT, Colavita PD. Sarcopenia in Patients Undergoing Open Ventral Hernia Repair. Am Surg 2020. [DOI: 10.1177/000313481908500940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Radiologic indicators of sarcopenia have been associated with adverse operative outcomes in some surgical populations. This study assesses the association of radiologic indicators of frailty with outcomes after open ventral hernia repair (OVHR). A prospective, institutional, herniaspecific database was queried for patients undergoing OVHR from 2007 to 2018 with preoperative CT. Psoas muscle cross-sectional area at L3 was measured and adjusted for height (skeletal muscle index (SMI)). L3 vertebral body density (L3 VBD) was measured. Demographics and outcomes were evaluated as related to SMI and L3 VBD. Of 1178 patients, 9.7 per cent of females and 15.8 per cent of males had sarcopenia and 11.6 per cent of females and 9.2 per cent of males had osteopenia. Neither sarcopenia nor osteopenia were associated with outcomes of wound infection, read-mission, reoperation, hernia recurrence, or major complications. When examined as continuous variables or by quartile, SMI and L3 VBD were not associated with adverse outcomes, including in subsets of male or female patients, the elderly, contaminated cases, and the obese. Radiologic markers of sarcopenia and osteopenia are not associated with adverse outcomes after OVHR. Further study should examine age or other potential predictors of outcomes in this patient population, such as independent status.
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Affiliation(s)
| | - Sean R. Maloney
- From the Carolinas Medical Center, Charlotte, North Carolina
| | - Otto N. Thielan
- From the Carolinas Medical Center, Charlotte, North Carolina
| | | | - Kent W. Kercher
- From the Carolinas Medical Center, Charlotte, North Carolina
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Park JW, Lee H, Jeon BJ, Pyon JK, Mun GH. Assessment of the risk of bulge/hernia formation after abdomen-based microsurgical breast reconstruction with the aid of preoperative computed tomographic angiography-derived morphometric measurements. J Plast Reconstr Aesthet Surg 2020; 73:1665-1674. [PMID: 32522519 DOI: 10.1016/j.bjps.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/28/2019] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND No preoperative risk assessment tool is available to predict postoperative bulge formation after abdomen-based breast reconstruction. The authors evaluated the association between clinical variables and morphometric measurements on preoperative computed tomographic (CT) angiography and postoperative abdominal wall morbidity. METHODS The authors evaluated all cases of postoperative bulge/hernia and normal controls in patients who underwent preoperative CT angiography and abdomen-based microsurgical breast reconstruction between July 2009 and January 2018. CT-based abdominal wall profiles, including abdominal wall protrusion, abdominopelvic cavity cross-sectional area (CSA), and abdominopelvic cavity-to-total body CSA ratio, were obtained and analyzed. A novel risk stratification scoring system to stratify the risk of bulge/hernia was developed. RESULTS Among 463 patients who underwent abdomen-based breast reconstruction, 23 were diagnosed as having a bulge/hernia. Age (OR 2.912; 95% CI 1.157-7.333), lateral row perforator (OR 5.065; 95% CI 1.834-13.986), and abdominal wall protrusion (OR 3.687; 95% CI 1.494-9.100) were significant risk factors associated with postoperative bulge/hernia in the multivariate analysis. Using the risk stratification scoring system, the incidence rates of postoperative bulge/hernia were 1.7%, 4.8%, and 19.0% for low-, intermediate-, and high-risk patients, respectively (p<0.001). CONCLUSIONS Age, lateral row perforator, and abdominal wall protrusion were significantly associated with postoperative bulge/hernia formation after abdomen-based microsurgical breast reconstruction. The authors' risk score based on the three variables may help predict and minimize donor-site morbidity.
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Affiliation(s)
- Jin-Woo Park
- Department of Plastic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Hojune Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
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