Is sarcopenia effective on survival in patients with metastatic gastric cancer?

BACKGROUND Sarcopenia is a progressively diminishing state characterized by the reduction of muscle mass and density,which is frequently observed in malignancies of solid organs.AIM To assess how sarcopenia affects the overall survival of individuals who have been diagnosed with metastatic gastric cancer.METHODS The study retrospectively included individuals who had been diagnosed with metastatic gastric cancer between January 2008 and December 2020.Sarcopenia was identified through the calculation of the average Hounsfield units(HUAC)using computed tomography(CT)images taken at the time of diagnosis in patients.RESULTS A total of 118 patients with metastatic gastric cancer were evaluated.Sarcopenia was detected in 29 patients(24.6%).The median survival of all patients was 8(1-43)mo.The median survival of patients with sarcopenia was 2 mo,while it was 10 mo for those without sarcopenia(P<0.001).A significant relationship was found between sarcopenia and survival.CONCLUSION Sarcopenia has been observed to impact survival outcomes in various types of solid tumor cancers.Sarcopenic patients can be identified in a short time,easily and inexpensively,by HUAC measurements from CT images used for diagnosis,and survival could be promoted with nutritional support.

Value of the controlling nutritional status score and psoas muscle thickness per height in predicting prognosis in liver transplantation

BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.

Impact of sarcopenia on mortality in patients undergoing liver retransplantation

BACKGROUND Sarcopenia,which is a loss of skeletal muscle mass,has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant.Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures.However,there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation(re-OLT).AIM To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.METHODS This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1,2007 to January 1,2017.We divided patients into sarcopenia and no sarcopenia groups.“TeraRecon AquariusNet 4.4.12.194”software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT,to calculate the Psoas muscle area at L3-L4 intervertebral disc.We defined cutoffs for sarcopenia as<1561 mm2 for males and<1464 mm2 for females.The primary outcome was to compare 90 d,one,and 5-year survival rates.We also compared complications after re-OLT,length of stay,and readmission within 30 d.Survival analysis was performed with Kaplan-Meier survival analysis.Continuous variables were evaluated with Wilcoxon rank-sum tests.Categorical variables were evaluated with Fisher’s exact tests.RESULTS Fifty-seven patients were included,32 males:25 females,median age 50 years.Two patients were excluded due to incomplete information.Overall,47%(26)of patients who underwent re-OLT had sarcopenia.Females were found to have significantly more sarcopenia than males(73%vs 17%,P<0.001).Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups.Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant(36.5 mo vs 16.7 mo).Biological markers,outcome parameters,and survival at 90 d,1 and 5 years,were similar between the two groups.Sarcopenia in re-OLT at our center was noted to be twice as common(47%)as historically reported in patients undergoing primary liver transplantation.CONCLUSION Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.

A study to investigate needle insertion at Shenshu(BL23) to puncture psoas major muscle

OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.

Magnetic resonance imaging： a valuable method for diagnosing chronic lumbago caused by lumbar muscle strain and monitoring healingprocess

Background Magnetic resonance imaging （MRI） is the most sensitive technique for evaluating the healing process and should be performed before the patients return to their exercise routines. The aim of this research was to diagnose chronic lumbago associated with lumbar muscle strain and to monitor healing process by MRI. Methods Sixty-five symptomatic cases of chronic lumbago caused by lumbar muscle strain were collected from March 2009 to October 2011. MRI was used to examine, diagnose and monitor the healing process. The control group included 65 random cases of asymptomatic volunteers. MRI methods included routine sequences of GRE TlWl, TSE T2WI and special sequences of T2-STIR-FS, combined with DWI. We compared the MRI characteristics of symptomatic cases before and after healing and with asymptomatic controls. Results The important MRI characteristics of chronic lumbago with lumbar muscle strain included： （1） The low back muscle showed edema. （2） The low back intermuscular spaces showed edema and/or fluid. （3） The low back spaces beside the spinous process showed edema and/or fluid. （4） The low back vertebral articular process fossae or transverse process fossae showed fluid. Of these image characteristics, the intermuscular space edema provided the best diagnostic sensitivity, Se=83%, with Y1=0.63, Tr=74%. The low back muscle edema provided the best diagnostic specificity, Sp=100%, with Y1=0.66, Tr=83%. And the spaces edema beside the spinous process provided the best diangnostic accuracy, Tr=86%, with YI = 0.71, Se=80%, Sp=91%. The diagnosis accurate could be improved by combining multiple MRI characteristics. The diagnostic accuracy could achieve n=93%, with Y1=0.86, Se=100% and Sp=86% when two characteristics were combined. After rehabilitation care, the edema disappeared on the repeated MRI. Conclusions MRI may well be a useful diagnostic method for lumbago with lumbar muscle strain. Combining routine sequences with T2-STIR-FS and DWI sequences could demonstrate the pathological changes of lumbar muscle strain and monitor the healing.

Observation on the Therapeutic Effect of Acupuncture for Treatment of Acute Waist Sprain

To compare the clinical effect of needling the Ashi point (4 cm lateral to the lower border of the spinous process of cervical vertebra) plus Yaotongdian on the hand and point injection on the Ashi point with Triamoninde. The curative effect of acupuncture was better than that of point injection. Key Words Sprain, Acute - Psoas Muscles - Acupuncture Therapy Author: ZOU Min (1961-), female, junor consultant doctorTranslator: WU Xue-fei