Chi Zhang, Xuxi Zhang, Hao Zhang, Ping Zeng, Pengbin Yin, Zhongquan Li, Yali Zhao, Yao Yao
Background
The Barthel Index (BI) is among the most widely used instruments for evaluating physical function, yet its applicability has not been well studied in the oldest-old population.
Objective
To test the psychometric properties of the BI for evaluating physical activities of daily living (ADL) in a large representative sample of oldest-old population in China.
Methods
Participants were 1750 oldest-old adults (aged 80–116 years, 72.11% female) including 956 centenarians. ADL were assessed during face-to-face interviews. Multiple methodologies were applied to evaluate the reliability, validity and measurement invariance of the BI. An item response theory (IRT) framework was conducted to estimate the parameters of each item.
Results
48.91% participants had function dependence. Cronbach's α coefficient of the BI was 0.902, but ‘Stair climbing’ impaired the overall internal consistency. The known-group validity of the BI was confirmed by significant differences in the BI score across age (P < 0.001), gender (P < 0.001), education (P < 0.001) and ethnicity (P = 0.038). The criterion-related validity was supported by significant correlations between the BI score with depression symptoms (r = −0.36, P < 0.001), subjective well-being (r = 0.23, P < 0.001) and self-report health status (r = 0.22, P < 0.001). Factor analysis yielded a two-factor structure (somatic function and physiological self-care) with appropriate invariance. Ten items showed acceptable discrimination parameters (1.80–5.87) and difficulty parameters (−2.65–1.11) but had variant test information (1.73–10.22). ‘Bower control’ and ‘Bladder control’ were not conducive to the local independence.
Conclusions
The BI has appropriate reliability, validity and measurement precision for community-based Chinese oldest-old and centenarians, but individual items have low quality. Somatic disability and incontinence are two latent categories of functional dependence in this population. Living environment needs to be taken into consideration for ADL instrument development and modification.
{"title":"Psychometric properties of the Barthel Index for evaluating physical function among Chinese oldest-old","authors":"Chi Zhang, Xuxi Zhang, Hao Zhang, Ping Zeng, Pengbin Yin, Zhongquan Li, Yali Zhao, Yao Yao","doi":"10.1002/crt2.47","DOIUrl":"10.1002/crt2.47","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Barthel Index (BI) is among the most widely used instruments for evaluating physical function, yet its applicability has not been well studied in the oldest-old population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To test the psychometric properties of the BI for evaluating physical activities of daily living (ADL) in a large representative sample of oldest-old population in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were 1750 oldest-old adults (aged 80–116 years, 72.11% female) including 956 centenarians. ADL were assessed during face-to-face interviews. Multiple methodologies were applied to evaluate the reliability, validity and measurement invariance of the BI. An item response theory (IRT) framework was conducted to estimate the parameters of each item.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>48.91% participants had function dependence. Cronbach's α coefficient of the BI was 0.902, but ‘Stair climbing’ impaired the overall internal consistency. The known-group validity of the BI was confirmed by significant differences in the BI score across age (<i>P</i> < 0.001), gender (<i>P</i> < 0.001), education (<i>P</i> < 0.001) and ethnicity (<i>P</i> = 0.038). The criterion-related validity was supported by significant correlations between the BI score with depression symptoms (<i>r</i> = −0.36, <i>P</i> < 0.001), subjective well-being (<i>r</i> = 0.23, <i>P</i> < 0.001) and self-report health status (<i>r</i> = 0.22, <i>P</i> < 0.001). Factor analysis yielded a two-factor structure (somatic function and physiological self-care) with appropriate invariance. Ten items showed acceptable discrimination parameters (1.80–5.87) and difficulty parameters (−2.65–1.11) but had variant test information (1.73–10.22). ‘Bower control’ and ‘Bladder control’ were not conducive to the local independence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The BI has appropriate reliability, validity and measurement precision for community-based Chinese oldest-old and centenarians, but individual items have low quality. Somatic disability and incontinence are two latent categories of functional dependence in this population. Living environment needs to be taken into consideration for ADL instrument development and modification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"7 2","pages":"33-43"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41695675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra Medline, Reza Nabavizadeh, Thien-Linh Le, Dattatraya Patil, Sean Evans, Alex Sandberg, Sarah P. Psutka, Viraj A. Master
Background
Linear measurement analysis using computed tomography (CT) scans to quantify abdominal muscle mass has been validated as a clinically practical approach for screening individuals with low muscle mass. However, there is still a need to validate such analysis using magnetic resonance imaging (MRI) imaging. The aim of this study is to assess the reproducibility and concordance of CT and MRI imaging for linear measurement analyses of skeletal muscle at mid-L3.
Methods
We retrospectively analysed 66 patients with available CT and MRI images within 30 days of one other to evaluate linear measurement CT and MRI concordance. Linear measurement analysis for abdominal/pelvic CT and MRI scans for eight patients was conducted independently three times by the same person separated by at least 1 week to assess intra-rater variability. The intra-observer variability for both CT and MRI was assessed using the intraclass correlation coefficient (ICC). The concordance and correlation of CT and MRI mid-L3 for linear measurements were assessed using Pearson correlation coefficients and Bland–Altman plots.
Results
The intra-rater reliability of linear measurements for both CT and MRI was high, as measured by the ICC (CT range: 0.788–0.992; MRI range: 0.766–0.984). CT and MRI linear measurements were found to be significantly positively correlated for all psoas (total psoas r = 0.98; P < 0.0001) and paraspinal muscle measurements (total paraspinal r = 0.99; P < 0.0001). Bland–Altman analysis revealed a mean bias of 0.83 (range: 0.03–5.56) for MRI over CT linear measurements.
Conclusions
CT and MRI images were shown to be concordant for linear measurement analysis of abdominal muscle mass. T2-weighted MRI sequences can be used interchangeably with CT in the assessment of sarcopenia using linear measurement analysis.
{"title":"Magnetic resonance imaging vs. computed tomography image concordance for linear measurements and the quantification of abdominal skeletal muscle","authors":"Alexandra Medline, Reza Nabavizadeh, Thien-Linh Le, Dattatraya Patil, Sean Evans, Alex Sandberg, Sarah P. Psutka, Viraj A. Master","doi":"10.1002/crt2.46","DOIUrl":"10.1002/crt2.46","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Linear measurement analysis using computed tomography (CT) scans to quantify abdominal muscle mass has been validated as a clinically practical approach for screening individuals with low muscle mass. However, there is still a need to validate such analysis using magnetic resonance imaging (MRI) imaging. The aim of this study is to assess the reproducibility and concordance of CT and MRI imaging for linear measurement analyses of skeletal muscle at mid-L3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 66 patients with available CT and MRI images within 30 days of one other to evaluate linear measurement CT and MRI concordance. Linear measurement analysis for abdominal/pelvic CT and MRI scans for eight patients was conducted independently three times by the same person separated by at least 1 week to assess intra-rater variability. The intra-observer variability for both CT and MRI was assessed using the intraclass correlation coefficient (ICC). The concordance and correlation of CT and MRI mid-L3 for linear measurements were assessed using Pearson correlation coefficients and Bland–Altman plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intra-rater reliability of linear measurements for both CT and MRI was high, as measured by the ICC (CT range: 0.788–0.992; MRI range: 0.766–0.984). CT and MRI linear measurements were found to be significantly positively correlated for all psoas (total psoas <i>r</i> = 0.98; <i>P <</i> 0.0001) and paraspinal muscle measurements (total paraspinal <i>r</i> = 0.99; <i>P <</i> 0.0001). Bland–Altman analysis revealed a mean bias of 0.83 (range: 0.03–5.56) for MRI over CT linear measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CT and MRI images were shown to be concordant for linear measurement analysis of abdominal muscle mass. T2-weighted MRI sequences can be used interchangeably with CT in the assessment of sarcopenia using linear measurement analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"7 1","pages":"24-29"},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47876480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beatriz Y. Hanaoka, Jing Zhao, Kristen Heitman, Fahad Khan, Wael Jarjour, Jeff Volek, Guy Brock, Barbara A. Gower
Background
In rheumatoid cachexia (RC), high resting energy expenditure (REE) is associated with loss of muscle mass driven by proinflammatory cytokines. The objectives of this study were to investigate parameters associated with RC and the interaction between systemic inflammation and modifiable risk factors for RC on REE.
Methods
Thirty-five rheumatoid arthritis (RA) and 19 non-RA controls comparable in age/sex/race/body mass index (BMI) underwent measures of REE by indirect calorimetry. Homeostasis model assessment for insulin resistance (HOMA-IR) and serum interleukin-6 (IL-6) were used as parameters of IR and systemic inflammation, respectively. Regression models tested association between REE and dependent variables, including pre-specified interaction tests involving HOMA-IR and IL-6 and dietary intake of protein per weight (PPW) and IL-6.
Results
Rheumatoid arthritis subjects were mostly women (94%) and had a median age of 54 years (50.5, 70) and BMI of 30.5 kg/m2 (26.1, 36.9). Approximately two-thirds of RA participants were seropositive, with median disease duration [interquartile range (IQR)] and a DAS-28 C-reactive protein [IQR] of 7.83 years [4.89, 18.14] and 1.7 mg/day [1.21, 2.78], respectively. RA participants demonstrated significantly higher levels of HOMA-IR compared with non-RA controls (P = 0.006). Fat-free mass index (FFMI, P = 0.33), REE (P = 0.68), IL-6 (P = 0.13), and estimates of dietary intake including PPW tertiles (P = 0.83) were not significantly different between RA and non-RA. In univariate analyses, REE was positively associated with BMI (P = <0.001), FFMI and FMI (P = <0.001), and HOMA-IR (P = 0.001), but not with PPW (P = 0.10). After adjustment for age and FFMI, we did not observe significant associations of HOMA-IR [β = 4.66, 95% confidence interval (CI) [−33.16, 42.48], P = 0.80], IL-6 (β = −9.45, 95% CI [−25.61, 6.72], P = 0.24), or the interaction between HOMA-IR and IL-6 (β = 6.00, 95% CI [−5.47, 17.46], P = 0.29) with REE. In multiple regression models with IL-6, PPW, and their interaction term, we observed a significant crossover interaction effect between PPW and IL-6 on REE. The upper tertile of PPW demonstrated a significant negative correlation between REE and IL-6 (β = −19.97, 95% CI [−35.41, −4.54], P = 0.01). The lower tertile of PPW demonstrated a significant positive correlation between REE and IL-6 (β = 42.24, 95% CI [4.25, 80.23], P = 0.03). Thi
{"title":"Interaction effect of systemic inflammation and modifiable rheumatoid cachexia risk factors on resting energy expenditure in patients with rheumatoid arthritis","authors":"Beatriz Y. Hanaoka, Jing Zhao, Kristen Heitman, Fahad Khan, Wael Jarjour, Jeff Volek, Guy Brock, Barbara A. Gower","doi":"10.1002/crt2.45","DOIUrl":"10.1002/crt2.45","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In rheumatoid cachexia (RC), high resting energy expenditure (REE) is associated with loss of muscle mass driven by proinflammatory cytokines. The objectives of this study were to investigate parameters associated with RC and the interaction between systemic inflammation and modifiable risk factors for RC on REE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty-five rheumatoid arthritis (RA) and 19 non-RA controls comparable in age/sex/race/body mass index (BMI) underwent measures of REE by indirect calorimetry. Homeostasis model assessment for insulin resistance (HOMA-IR) and serum interleukin-6 (IL-6) were used as parameters of IR and systemic inflammation, respectively. Regression models tested association between REE and dependent variables, including pre-specified interaction tests involving HOMA-IR and IL-6 and dietary intake of protein per weight (PPW) and IL-6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rheumatoid arthritis subjects were mostly women (94%) and had a median age of 54 years (50.5, 70) and BMI of 30.5 kg/m<sup>2</sup> (26.1, 36.9). Approximately two-thirds of RA participants were seropositive, with median disease duration [interquartile range (IQR)] and a DAS-28 C-reactive protein [IQR] of 7.83 years [4.89, 18.14] and 1.7 mg/day [1.21, 2.78], respectively. RA participants demonstrated significantly higher levels of HOMA-IR compared with non-RA controls (<i>P</i> = 0.006). Fat-free mass index (FFMI, <i>P</i> = 0.33), REE (<i>P</i> = 0.68), IL-6 (<i>P</i> = 0.13), and estimates of dietary intake including PPW tertiles (<i>P</i> = 0.83) were not significantly different between RA and non-RA. In univariate analyses, REE was positively associated with BMI (<i>P</i> = <0.001), FFMI and FMI (<i>P</i> = <0.001), and HOMA-IR (<i>P</i> = 0.001), but not with PPW (<i>P</i> = 0.10). After adjustment for age and FFMI, we did not observe significant associations of HOMA-IR [<i>β</i> = 4.66, 95% confidence interval (CI) [−33.16, 42.48], <i>P</i> = 0.80], IL-6 (<i>β</i> = −9.45, 95% CI [−25.61, 6.72], <i>P</i> = 0.24), or the interaction between HOMA-IR and IL-6 (<i>β</i> = 6.00, 95% CI [−5.47, 17.46], <i>P</i> = 0.29) with REE. In multiple regression models with IL-6, PPW, and their interaction term, we observed a significant crossover interaction effect between PPW and IL-6 on REE. The upper tertile of PPW demonstrated a significant negative correlation between REE and IL-6 (<i>β</i> = −19.97, 95% CI [−35.41, −4.54], <i>P</i> = 0.01). The lower tertile of PPW demonstrated a significant positive correlation between REE and IL-6 (<i>β</i> = 42.24, 95% CI [4.25, 80.23], <i>P</i> = 0.03). Thi","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"7 1","pages":"12-23"},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.45","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44023302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nick Lasse Beetz, Christoph Maier, Laura Segger, Seyd Shnayien, Tobias Daniel Trippel, Norbert Lindow, Khaled Bousabarah, Malte Westerhoff, Uli Fehrenbach, Dominik Geisel
Background
To externally evaluate the first picture archiving communications system (PACS)-integrated artificial intelligence (AI)-based workflow, trained to automatically detect a predefined computed tomography (CT) slice at the third lumbar vertebra (L3) and automatically perform complete image segmentation for analysis of CT body composition and to compare its performance with that of an established semi-automatic segmentation tool regarding speed and accuracy of tissue area calculation.
Methods
For fully automatic analysis of body composition with L3 recognition, U-Nets were trained (Visage) and compared with a conventional image segmentation software (TomoVision). Tissue was differentiated into psoas muscle, skeletal muscle, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Mid-L3 level images from randomly selected DICOM slice files of 20 CT scans acquired with various imaging protocols were segmented with both methods.
Results
Success rate of AI-based L3 recognition was 100%. Compared with semi-automatic, fully automatic AI-based image segmentation yielded relative differences of 0.22% and 0.16% for skeletal muscle, 0.47% and 0.49% for psoas muscle, 0.42% and 0.42% for VAT and 0.18% and 0.18% for SAT. AI-based fully automatic segmentation was significantly faster than semi-automatic segmentation (3 ± 0 s vs. 170 ± 40 s, P < 0.001, for User 1 and 152 ± 40 s, P < 0.001, for User 2).
Conclusion
Rapid fully automatic AI-based, PACS-integrated assessment of body composition yields identical results without transfer of critical patient data. Additional metabolic information can be inserted into the patient's image report and offered to the referring clinicians.
{"title":"First PACS-integrated artificial intelligence-based software tool for rapid and fully automatic analysis of body composition from CT in clinical routine","authors":"Nick Lasse Beetz, Christoph Maier, Laura Segger, Seyd Shnayien, Tobias Daniel Trippel, Norbert Lindow, Khaled Bousabarah, Malte Westerhoff, Uli Fehrenbach, Dominik Geisel","doi":"10.1002/crt2.44","DOIUrl":"10.1002/crt2.44","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To externally evaluate the first picture archiving communications system (PACS)-integrated artificial intelligence (AI)-based workflow, trained to automatically detect a predefined computed tomography (CT) slice at the third lumbar vertebra (L3) and automatically perform complete image segmentation for analysis of CT body composition and to compare its performance with that of an established semi-automatic segmentation tool regarding speed and accuracy of tissue area calculation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For fully automatic analysis of body composition with L3 recognition, U-Nets were trained (Visage) and compared with a conventional image segmentation software (TomoVision). Tissue was differentiated into psoas muscle, skeletal muscle, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Mid-L3 level images from randomly selected DICOM slice files of 20 CT scans acquired with various imaging protocols were segmented with both methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Success rate of AI-based L3 recognition was 100%. Compared with semi-automatic, fully automatic AI-based image segmentation yielded relative differences of 0.22% and 0.16% for skeletal muscle, 0.47% and 0.49% for psoas muscle, 0.42% and 0.42% for VAT and 0.18% and 0.18% for SAT. AI-based fully automatic segmentation was significantly faster than semi-automatic segmentation (3 ± 0 s vs. 170 ± 40 s, <i>P</i> < 0.001, for User 1 and 152 ± 40 s, <i>P</i> < 0.001, for User 2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rapid fully automatic AI-based, PACS-integrated assessment of body composition yields identical results without transfer of critical patient data. Additional metabolic information can be inserted into the patient's image report and offered to the referring clinicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"7 1","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.44","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48488229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean Flickinger, Jiaxin Fan, Amanda Wellik, Rebecca Ganetzky, Amy Goldstein, Colleen C Muraresku, Allan M Glanzman, Elizabeth Ballance, Kristin Leonhardt, Elizabeth M McCormick, Brianna Soreth, Sara Nguyen, Jennifer Gornish, Ibrahim George-Sankoh, James Peterson, Laura E MacMullen, Shailee Vishnubhatt, Michael McBride, Richard Haas, Marni J Falk, Rui Xiao, Zarazuela Zolkipli-Cunningham
Background: 'Mitochondrial Myopathy' (MM) refers to genetically-confirmed Primary Mitochondrial Disease (PMD) that predominantly impairs skeletal muscle function. Validated outcome measures encompassing core MM domains of muscle weakness, muscle fatigue, imbalance, impaired dexterity, and exercise intolerance do not exist. The goal of this study was to validate clinically-meaningful, quantitative outcome measures specific to MM.
Methods: This was a single centre study. Objective measures evaluated included hand-held dynamometry, balance assessments, Nine Hole Peg Test (9HPT), Functional Dexterity Test (FDT), 30 second Sit to Stand (30s STS), and 6-minute walk test (6MWT). Results were assessed as z-scores, with < -2 standard deviations considered abnormal. Performance relative to the North Star Ambulatory Assessment (NSAA) of functional mobility was assessed by Pearson's correlation.
Results: In genetically-confirmed MM participants [n = 59, mean age 21.6 ± 13.9 (range 7 - 64.6 years), 44.1% male], with nuclear gene aetiologies, n = 18/59, or mitochondrial (mtDNA) aetiologies, n = 41/59, dynamometry measurements demonstrated both proximal [dominant elbow flexion (-2.6 ± 2.1, mean z-score ± standard deviation, SD), hip flexion (-2.5 ± 2.3), and knee flexion (-2.8 ± 1.3)] and distal muscle weakness [wrist extension (-3.4 ± 1.7), palmar pinch (-2.5 ± 2.8), and ankle dorsiflexion (-2.4 ± 2.5)]. Balance [Tandem Stance (TS) Eyes Open (-3.2 ± 8.8, n = 53) and TS Eyes Closed (-2.6 ± 2.7, n = 52)] and dexterity [FDT (-5.9 ± 6.0, n = 44) and 9HPT (-8.3 ± 11.2, n = 53)] assessments also revealed impairment. Exercise intolerance was confirmed by strength-based 30s STS test (-2.0 ± 0.8, n = 38) and mobility-based 6MWT mean z-score (-2.9 ± 1.3, n = 46) with significant decline in minute distances (slope -0.9, p = 0.03, n = 46). Muscle fatigue was quantified by dynamometry repetitions with strength decrement noted between first and sixth repetitions at dominant elbow flexors (-14.7 ± 2.2%, mean ± standard error, SEM, n = 21). All assessments were incorporated in the MM-Composite Assessment Tool (MM-COAST). MM-COAST composite score for MM participants was 1.3± 0.1(n = 53) with a higher score indicating greater MM disease severity, and correlated to NSAA (r = 0.64, p < 0.0001, n = 52) to indicate clinical meaning. Test-retest reliability of MM-COAST assessments in an MM subset (n = 14) revealed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval: 0.59-0.92) indicating good reliability.
Conclusions: We have developed and successfully validated a MM-specific Composite Assessment Tool to quantify the key domains of MM, shown to be abnormal in a Definite MM cohort. MM-COAST may hold particular utility as a meaningful
{"title":"Development of a Mitochondrial Myopathy-Composite Assessment Tool.","authors":"Jean Flickinger, Jiaxin Fan, Amanda Wellik, Rebecca Ganetzky, Amy Goldstein, Colleen C Muraresku, Allan M Glanzman, Elizabeth Ballance, Kristin Leonhardt, Elizabeth M McCormick, Brianna Soreth, Sara Nguyen, Jennifer Gornish, Ibrahim George-Sankoh, James Peterson, Laura E MacMullen, Shailee Vishnubhatt, Michael McBride, Richard Haas, Marni J Falk, Rui Xiao, Zarazuela Zolkipli-Cunningham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>'Mitochondrial Myopathy' (MM) refers to genetically-confirmed Primary Mitochondrial Disease (PMD) that predominantly impairs skeletal muscle function. Validated outcome measures encompassing core MM domains of muscle weakness, muscle fatigue, imbalance, impaired dexterity, and exercise intolerance do not exist. The goal of this study was to validate clinically-meaningful, quantitative outcome measures specific to MM.</p><p><strong>Methods: </strong>This was a single centre study. Objective measures evaluated included hand-held dynamometry, balance assessments, Nine Hole Peg Test (9HPT), Functional Dexterity Test (FDT), 30 second Sit to Stand (30s STS), and 6-minute walk test (6MWT). Results were assessed as <i>z</i>-scores, with < -2 standard deviations considered abnormal. Performance relative to the North Star Ambulatory Assessment (NSAA) of functional mobility was assessed by Pearson's correlation.</p><p><strong>Results: </strong>In genetically-confirmed MM participants [<i>n</i> = 59, mean age 21.6 ± 13.9 (range 7 - 64.6 years), 44.1% male], with nuclear gene aetiologies, <i>n</i> = 18/59, or mitochondrial (mtDNA) aetiologies, <i>n</i> = 41/59, dynamometry measurements demonstrated both proximal [dominant elbow flexion (-2.6 ± 2.1, mean <i>z</i>-score ± standard deviation, SD), hip flexion (-2.5 ± 2.3), and knee flexion (-2.8 ± 1.3)] and distal muscle weakness [wrist extension (-3.4 ± 1.7), palmar pinch (-2.5 ± 2.8), and ankle dorsiflexion (-2.4 ± 2.5)]. Balance [Tandem Stance (TS) Eyes Open (-3.2 ± 8.8, <i>n</i> = 53) and TS Eyes Closed (-2.6 ± 2.7, <i>n</i> = 52)] and dexterity [FDT (-5.9 ± 6.0, <i>n</i> = 44) and 9HPT (-8.3 ± 11.2, <i>n</i> = 53)] assessments also revealed impairment. Exercise intolerance was confirmed by strength-based 30s STS test (-2.0 ± 0.8, <i>n</i> = 38) and mobility-based 6MWT mean <i>z</i>-score (-2.9 ± 1.3, <i>n</i> = 46) with significant decline in minute distances (slope -0.9, <i>p</i> = 0.03, <i>n</i> = 46). Muscle fatigue was quantified by dynamometry repetitions with strength decrement noted between first and sixth repetitions at dominant elbow flexors (-14.7 ± 2.2%, mean ± standard error, SEM, <i>n</i> = 21). All assessments were incorporated in the MM-Composite Assessment Tool (MM-COAST). MM-COAST composite score for MM participants was 1.3± 0.1(<i>n</i> = 53) with a higher score indicating greater MM disease severity, and correlated to NSAA (<i>r</i> = 0.64, <i>p</i> < 0.0001, <i>n</i> = 52) to indicate clinical meaning. Test-retest reliability of MM-COAST assessments in an MM subset (<i>n</i> = 14) revealed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval: 0.59-0.92) indicating good reliability.</p><p><strong>Conclusions: </strong>We have developed and successfully validated a MM-specific Composite Assessment Tool to quantify the key domains of MM, shown to be abnormal in a Definite MM cohort. MM-COAST may hold particular utility as a meaningful ","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 4","pages":"109-127"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39716014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myostatin (MSTN) is a key negative regulator of muscle mass in humans and animals, having direct and indirect influences on molecular regulators of atrophy and hypertrophy, thus potentially impacting fitness and physical function. We have shown that myostatin is elevated in conditions of chronic disability (e.g. paretic limb of stroke). Our hypothesis is that myostatin would be elevated in older adults with sarcopenia. The purpose of this study was to examine the role of skeletal muscle myostatin in sarcopenia.
Methods
Sixty-four overweight to obese aged 45–81 years underwent a maximal aerobic capacity (VO2max) test, dual-energy X-ray absorptiometry (DXA) scan to determine appendicular lean tissue (ALM), and vastus lateralis muscle biopsy to determine myostatin mRNA expression by quantitative real time PCR (Q-RT-PCR). Rates of sarcopenia were determined using (ALM/BMI), and sarcopenia was defined as <0.789 in men and <0.512 in women. Subjects had low fitness (VO2max: 22.7 ± 0.7 mL/kg/min) and on average 40.9 ± 1% body fat.
Results
The prevalence of sarcopenia in this cohort was 16%. BMI, % body fat, and fat mass were higher in adults with sarcopenia than those without sarcopenia (all P < 0.001). Myostatin mRNA expression was lower in those without sarcopenia than those with sarcopenia (P < 0.05) and higher in men than women (P < 0.001). Myostatin expression was associated with BMI (r = 0.36, P < 0.01) and mid-thigh intramuscular fat (r = 0.29, P < 0.05).
Conclusion
Given that myostatin is important in muscle atrophy, fat accumulation, and sarcopenia, further work could address its implication in other aging cohorts of disability and chronic disease.
背景肌生长抑制素(Myostatin, MSTN)是人类和动物肌肉质量的关键负调控因子，直接或间接影响萎缩和肥大的分子调控因子，从而潜在地影响健康和身体功能。我们已经表明，肌肉生长抑制素在慢性残疾的情况下升高(例如中风的麻痹肢体)。我们的假设是肌肉生成抑制素在老年肌肉减少症患者中会升高。本研究的目的是研究骨骼肌肌生成抑制素在肌肉减少症中的作用。方法64例45-81岁的超重至肥胖患者进行最大有氧能力(VO2max)测试，双能x线吸收仪(DXA)扫描检测阑尾瘦组织(ALM)，股外侧肌活检检测肌生长抑制素mRNA表达(Q-RT-PCR)。使用(ALM/BMI)测定肌少症的发生率，男性肌少症的定义为0.789，女性为0.512。受试者体能低(最大摄氧量:22.7±0.7 mL/kg/min)，体脂平均为40.9±1%。结果该队列中肌肉减少症的患病率为16%。骨骼肌减少症患者的BMI、体脂百分比和脂肪量均高于无骨骼肌减少症患者(P <0.001)。肌减少症患者肌生长抑制素mRNA表达低于无肌减少症患者(P <0.05)，且男性高于女性(P <0.001)。肌生长抑制素表达与BMI相关(r = 0.36, P <0.01)和大腿中部肌内脂肪(r = 0.29, P <0.05)。结论鉴于肌肉生长抑制素在肌肉萎缩、脂肪积累和肌肉减少症中起重要作用，进一步的研究可能会揭示其在其他老年残疾和慢性疾病群体中的意义。
{"title":"Skeletal muscle myostatin gene expression and sarcopenia in overweight and obese middle-aged and older adults","authors":"Alice S. Ryan, Guoyan Li","doi":"10.1002/crt2.43","DOIUrl":"10.1002/crt2.43","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Myostatin (MSTN) is a key negative regulator of muscle mass in humans and animals, having direct and indirect influences on molecular regulators of atrophy and hypertrophy, thus potentially impacting fitness and physical function. We have shown that myostatin is elevated in conditions of chronic disability (e.g. paretic limb of stroke). Our hypothesis is that myostatin would be elevated in older adults with sarcopenia. The purpose of this study was to examine the role of skeletal muscle myostatin in sarcopenia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-four overweight to obese aged 45–81 years underwent a maximal aerobic capacity (VO<sub>2</sub>max) test, dual-energy X-ray absorptiometry (DXA) scan to determine appendicular lean tissue (ALM), and <i>vastus lateralis</i> muscle biopsy to determine myostatin mRNA expression by quantitative real time PCR (Q-RT-PCR). Rates of sarcopenia were determined using (ALM/BMI), and sarcopenia was defined as <0.789 in men and <0.512 in women. Subjects had low fitness (VO<sub>2</sub>max: 22.7 ± 0.7 mL/kg/min) and on average 40.9 ± 1% body fat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of sarcopenia in this cohort was 16%. BMI, % body fat, and fat mass were higher in adults with sarcopenia than those without sarcopenia (all <i>P</i> < 0.001). Myostatin mRNA expression was lower in those without sarcopenia than those with sarcopenia (<i>P</i> < 0.05) and higher in men than women (<i>P</i> < 0.001). Myostatin expression was associated with BMI (<i>r</i> = 0.36, <i>P</i> < 0.01) and mid-thigh intramuscular fat (<i>r</i> = 0.29, <i>P</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Given that myostatin is important in muscle atrophy, fat accumulation, and sarcopenia, further work could address its implication in other aging cohorts of disability and chronic disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 4","pages":"137-142"},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/be/nihms-1781852.PMC8932637.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40308951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Santiago Olaechea, Bhavani S. Gannavarapu, Anne Gilmore, Christian Alvarez, Puneeth Iyengar, Rodney Infante
Background
Cancer cachexia is manifested by loss in muscle, adipose, weight, and appetite. PET 18F-FDG uptake identifies tumour metabolic and inflammatory changes, potentially associated with cachexia development. We examined if primary gastroesophageal tumour 18F-FDG uptake correlates with cachexia development and survival in cancer patients.
Methods
One hundred twenty-six oesophageal (n = 87) and gastroesophageal junction (n = 39) cancer patients, with a median age at diagnosis of 63 years (IQR 54–71), evaluated between 2006 and 2014 with pre-treatment PET imaging and cachexia determination at diagnosis were included in the study cohort (22.1% female; 6.7%, 24.4%, 50.4%, and 18.5% with tumour stage I, II, III, and IV, respectively). Maximum primary tumour standardized uptake values were obtained and dichotomized based off the calculated cut-point SUVMax of 8.5 (P = 0.0018). Associations between survival, cachexia development, and primary tumour 18F-FDG uptake were evaluated using univariate and multivariate analyses.
Results
Cancer-associated weight loss (cachexia) and primary tumour SUVMax at or above the statistically determined cut-point of 8.5 were present in 54% and 57% of patients, respectively. Primary tumour SUVMax above the cut-point was significantly associated with pre-treatment cancer-associated weight loss (P = 0.0033) and, in multivariate analysis, correlated with a 2.3-fold increased risk of death (95% CI 1.4, 3.7; P = 0.0010). When divided into cohorts defined by their combined cachexia and high versus low SUVMax tumour status, positive cachexia status or/and high SUVMax tumours were associated with similar significant decrements in survival.
Conclusion
A positive association was present between cancer-associated weight loss and SUVMax of the primary tumour, suggesting greater glycolytic metabolism in gastroesophageal tumours that induce cachexia. This interpretation of routinely administered PET scans could lead to earlier categorization of patients with cachexia-inducing tumours. Both cachexia and high SUVMax status were independently associated with worsened survival outcomes, further supporting their prognostic relevance in patients with gastroesophageal cancer.
{"title":"The influence of tumour fluorodeoxyglucose avidity and cachexia development on patient survival in oesophageal or gastroesophageal junction cancer","authors":"Santiago Olaechea, Bhavani S. Gannavarapu, Anne Gilmore, Christian Alvarez, Puneeth Iyengar, Rodney Infante","doi":"10.1002/crt2.42","DOIUrl":"10.1002/crt2.42","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cancer cachexia is manifested by loss in muscle, adipose, weight, and appetite. PET <sup>18</sup>F-FDG uptake identifies tumour metabolic and inflammatory changes, potentially associated with cachexia development. We examined if primary gastroesophageal tumour <sup>18</sup>F-FDG uptake correlates with cachexia development and survival in cancer patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred twenty-six oesophageal (<i>n</i> = 87) and gastroesophageal junction (<i>n</i> = 39) cancer patients, with a median age at diagnosis of 63 years (IQR 54–71), evaluated between 2006 and 2014 with pre-treatment PET imaging and cachexia determination at diagnosis were included in the study cohort (22.1% female; 6.7%, 24.4%, 50.4%, and 18.5% with tumour stage I, II, III, and IV, respectively). Maximum primary tumour standardized uptake values were obtained and dichotomized based off the calculated cut-point SUV<sub>Max</sub> of 8.5 (<i>P</i> = 0.0018). Associations between survival, cachexia development, and primary tumour <sup>18</sup>F-FDG uptake were evaluated using univariate and multivariate analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cancer-associated weight loss (cachexia) and primary tumour SUV<sub>Max</sub> at or above the statistically determined cut-point of 8.5 were present in 54% and 57% of patients, respectively. Primary tumour SUV<sub>Max</sub> above the cut-point was significantly associated with pre-treatment cancer-associated weight loss (<i>P</i> = 0.0033) and, in multivariate analysis, correlated with a 2.3-fold increased risk of death (95% CI 1.4, 3.7; <i>P</i> = 0.0010). When divided into cohorts defined by their combined cachexia and high versus low SUV<sub>Max</sub> tumour status, positive cachexia status or/and high SUV<sub>Max</sub> tumours were associated with similar significant decrements in survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A positive association was present between cancer-associated weight loss and SUV<sub>Max</sub> of the primary tumour, suggesting greater glycolytic metabolism in gastroesophageal tumours that induce cachexia. This interpretation of routinely administered PET scans could lead to earlier categorization of patients with cachexia-inducing tumours. Both cachexia and high SUV<sub>Max</sub> status were independently associated with worsened survival outcomes, further supporting their prognostic relevance in patients with gastroesophageal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 4","pages":"128-136"},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205426/pdf/nihms-1779820.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40026222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean Flickinger, Jiaxin Fan, Amanda Wellik, Rebecca Ganetzky, Amy Goldstein, Colleen C. Muraresku, Allan M. Glanzman, Elizabeth Ballance, Kristin Leonhardt, Elizabeth M. McCormick, Brianna Soreth, Sara Nguyen, Jennifer Gornish, Ibrahim George-Sankoh, James Peterson, Laura E. MacMullen, Shailee Vishnubhatt, Michael McBride, Richard Haas, Marni J. Falk, Rui Xiao, Zarazuela Zolkipli-Cunningham
Background
‘Mitochondrial Myopathy’ (MM) refers to genetically-confirmed Primary Mitochondrial Disease (PMD) that predominantly impairs skeletal muscle function. Validated outcome measures encompassing core MM domains of muscle weakness, muscle fatigue, imbalance, impaired dexterity, and exercise intolerance do not exist. The goal of this study was to validate clinically-meaningful, quantitative outcome measures specific to MM.
Methods
This was a single centre study. Objective measures evaluated included hand-held dynamometry, balance assessments, Nine Hole Peg Test (9HPT), Functional Dexterity Test (FDT), 30 second Sit to Stand (30s STS), and 6-minute walk test (6MWT). Results were assessed as z-scores, with < −2 standard deviations considered abnormal. Performance relative to the North Star Ambulatory Assessment (NSAA) of functional mobility was assessed by Pearson's correlation.
Results
In genetically-confirmed MM participants [n = 59, mean age 21.6 ± 13.9 (range 7 – 64.6 years), 44.1% male], with nuclear gene aetiologies, n = 18/59, or mitochondrial (mtDNA) aetiologies, n = 41/59, dynamometry measurements demonstrated both proximal [dominant elbow flexion (−2.6 ± 2.1, mean z-score ± standard deviation, SD), hip flexion (−2.5 ± 2.3), and knee flexion (−2.8 ± 1.3)] and distal muscle weakness [wrist extension (−3.4 ± 1.7), palmar pinch (−2.5 ± 2.8), and ankle dorsiflexion (−2.4 ± 2.5)]. Balance [Tandem Stance (TS) Eyes Open (−3.2 ± 8.8, n = 53) and TS Eyes Closed (−2.6 ± 2.7, n = 52)] and dexterity [FDT (−5.9 ± 6.0, n = 44) and 9HPT (−8.3 ± 11.2, n = 53)] assessments also revealed impairment. Exercise intolerance was confirmed by strength-based 30s STS test (−2.0 ± 0.8, n = 38) and mobility-based 6MWT mean z-score (−2.9 ± 1.3, n = 46) with significant decline in minute distances (slope −0.9, p = 0.03, n = 46). Muscle fatigue was quantified by dynamometry repetitions with strength decrement noted between first and sixth repetitions at dominant elbow flexors (−14.7 ± 2.2%, mean ± standard error, SEM, n = 21). All assessments were incorporated in the MM-Composite Assessment Tool (MM-COAST). MM-COAST composite score for MM participants was 1.3 ± 0.1 (n = 53) with a higher score indicating greater MM disease severity, and correlated to NSAA (r = −0.64, p < 0.0001, n = 52) to indicate clinical meaning. Test–retest reliability of MM-COAST assessments in an MM subset (n = 14) revealed an intraclass correlatio
{"title":"Development of a Mitochondrial Myopathy-Composite Assessment Tool","authors":"Jean Flickinger, Jiaxin Fan, Amanda Wellik, Rebecca Ganetzky, Amy Goldstein, Colleen C. Muraresku, Allan M. Glanzman, Elizabeth Ballance, Kristin Leonhardt, Elizabeth M. McCormick, Brianna Soreth, Sara Nguyen, Jennifer Gornish, Ibrahim George-Sankoh, James Peterson, Laura E. MacMullen, Shailee Vishnubhatt, Michael McBride, Richard Haas, Marni J. Falk, Rui Xiao, Zarazuela Zolkipli-Cunningham","doi":"10.1002/crt2.41","DOIUrl":"10.1002/crt2.41","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>‘Mitochondrial Myopathy’ (MM) refers to genetically-confirmed Primary Mitochondrial Disease (PMD) that predominantly impairs skeletal muscle function. Validated outcome measures encompassing core MM domains of muscle weakness, muscle fatigue, imbalance, impaired dexterity, and exercise intolerance do not exist. The goal of this study was to validate clinically-meaningful, quantitative outcome measures specific to MM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single centre study. Objective measures evaluated included hand-held dynamometry, balance assessments, Nine Hole Peg Test (9HPT), Functional Dexterity Test (FDT), 30 second Sit to Stand (30s STS), and 6-minute walk test (6MWT). Results were assessed as <i>z</i>-scores, with < −2 standard deviations considered abnormal. Performance relative to the North Star Ambulatory Assessment (NSAA) of functional mobility was assessed by Pearson's correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In genetically-confirmed MM participants [<i>n</i> = 59, mean age 21.6 ± 13.9 (range 7 – 64.6 years), 44.1% male], with nuclear gene aetiologies, <i>n</i> = 18/59, or mitochondrial (mtDNA) aetiologies, <i>n</i> = 41/59, dynamometry measurements demonstrated both proximal [dominant elbow flexion (−2.6 ± 2.1, mean <i>z</i>-score ± standard deviation, SD), hip flexion (−2.5 ± 2.3), and knee flexion (−2.8 ± 1.3)] and distal muscle weakness [wrist extension (−3.4 ± 1.7), palmar pinch (−2.5 ± 2.8), and ankle dorsiflexion (−2.4 ± 2.5)]. Balance [Tandem Stance (TS) Eyes Open (−3.2 ± 8.8, <i>n</i> = 53) and TS Eyes Closed (−2.6 ± 2.7, <i>n</i> = 52)] and dexterity [FDT (−5.9 ± 6.0, <i>n</i> = 44) and 9HPT (−8.3 ± 11.2, <i>n</i> = 53)] assessments also revealed impairment. Exercise intolerance was confirmed by strength-based 30s STS test (−2.0 ± 0.8, <i>n</i> = 38) and mobility-based 6MWT mean <i>z</i>-score (−2.9 ± 1.3, <i>n</i> = 46) with significant decline in minute distances (slope −0.9, <i>p</i> = 0.03, <i>n</i> = 46). Muscle fatigue was quantified by dynamometry repetitions with strength decrement noted between first and sixth repetitions at dominant elbow flexors (−14.7 ± 2.2%, mean ± standard error, SEM, <i>n</i> = 21). All assessments were incorporated in the MM-Composite Assessment Tool (MM-COAST). MM-COAST composite score for MM participants was 1.3 ± 0.1 (<i>n</i> = 53) with a higher score indicating greater MM disease severity, and correlated to NSAA (<i>r</i> = −0.64, <i>p</i> < 0.0001, <i>n</i> = 52) to indicate clinical meaning. Test–retest reliability of MM-COAST assessments in an MM subset (<i>n</i> = 14) revealed an intraclass correlatio","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 4","pages":"109-127"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.41","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49089921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarcopenia has been receiving attention in the cancer field. We investigated whether evolving sarcopenia is associated with the outcome of non-small cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs).
Methods
In this retrospective study, 46 NSCLC patients who received ICIs were subjected. Skeletal muscle area at the level of the third lumbar vertebra (L3-SMA) was measured from CT images taken before and 90 days after the ICI treatment. The efficacy-related factors were determined by logistic regression analysis. The prognostic cut-off value was estimated by a receiver operating characteristic (ROC) curve. Area under curve (AUC) was evaluated. Covariate factors included age, gender, smoking history, histology, performance status, PD-L1 tumour proportion score, status of driver mutations, body mass index, serum total protein, albumin levels, and peripheral lymphocyte count. Progression free survival (PFS) and overall survival (OS) analysis were conducted by Kaplan–Meier method. Data cut off was determined to be 700 days.
Results
Patient characteristics in age (mean ± SD) and gender (male, %) were 65.5 ± 9.2 years old and 80.4%. In the multivariate analysis, only reduction rate of L3-SMA was significant (odds ratio 1.14, P = 0.02). The cut-off value was estimated to be 6% (AUC 0.84, P < 0.0001). Median PFS of patients with L3-SMA over 6% and those with less was 2.4 and 15.7 months, respectively (P < 0.0001). As for OS, the median time was 10.0 months versus not reached (P = 0.012).
Conclusions
Evolving sarcopenia assessed with CT images could be a promising prognostic factor in NSCLC patients receiving ICIs.
{"title":"The relationship between evolving sarcopenia and efficacy of immune checkpoint inhibitor in non-small cell lung cancer patients","authors":"Tomonori Makiguchi, Hisashi Tanaka, Kageaki Taima, Soichiro Tatsuo, Saya Iida, Shingo Kakeda, Sadatomo Tasaka","doi":"10.1002/crt2.40","DOIUrl":"10.1002/crt2.40","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sarcopenia has been receiving attention in the cancer field. We investigated whether evolving sarcopenia is associated with the outcome of non-small cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study, 46 NSCLC patients who received ICIs were subjected. Skeletal muscle area at the level of the third lumbar vertebra (L3-SMA) was measured from CT images taken before and 90 days after the ICI treatment. The efficacy-related factors were determined by logistic regression analysis. The prognostic cut-off value was estimated by a receiver operating characteristic (ROC) curve. Area under curve (AUC) was evaluated. Covariate factors included age, gender, smoking history, histology, performance status, PD-L1 tumour proportion score, status of driver mutations, body mass index, serum total protein, albumin levels, and peripheral lymphocyte count. Progression free survival (PFS) and overall survival (OS) analysis were conducted by Kaplan–Meier method. Data cut off was determined to be 700 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient characteristics in age (mean ± SD) and gender (male, %) were 65.5 ± 9.2 years old and 80.4%. In the multivariate analysis, only reduction rate of L3-SMA was significant (odds ratio 1.14, <i>P</i> = 0.02). The cut-off value was estimated to be 6% (AUC 0.84, <i>P</i> < 0.0001). Median PFS of patients with L3-SMA over 6% and those with less was 2.4 and 15.7 months, respectively (<i>P</i> < 0.0001). As for OS, the median time was 10.0 months versus not reached (<i>P</i> = 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Evolving sarcopenia assessed with CT images could be a promising prognostic factor in NSCLC patients receiving ICIs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 4","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.40","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43647157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wasting of muscle mass and decreasing strength have been proven to be negative prognostic indicators for patients with cancer receiving anticancer treatment. However, little is known about their role in palliative care patients. The objective of this study was to evaluate the prognostic significance of low muscle mass and strength in predicting survival among patients in palliative care.
Methods
We retrospectively examined the association between muscle mass and strength and prognosis in patients with incurable solid cancer who were supported by a palliative care team at a university hospital. Psoas muscle index (PMI) at the level of the fourth lumbar vertebra was employed as the muscle mass index. Pinch grip strength (PGS) was used as the muscle strength index. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival.
Results
A total of 78 patients were included in this study (35 male, median age 67 years). Median survival was 87.5 (95% confidence interval 50–124) days. After adjustment for age, sex, albumin, oedema, and performance status as potential confounders, loss of PMI (hazard ratio 0.998, 95% confidence interval 0.996–0.999; P = 0.003) and PGS (hazard ratio 0.73, 95% confidence interval 0.55–0.97; P = 0.030) independently predicted the overall survival.
Conclusions
Low muscle mass and strength are independent predictors of survival in patients with incurable solid cancer receiving palliative care. PMI and PGS measurements may help to better assess the prognosis of patients in palliative care.
{"title":"Prognostic role of low muscle mass and strength in palliative care patients with incurable cancer: a retrospective study","authors":"Naoharu Mori, Keisuke Maeda, Yousuke Yamanaka, Remi Matsuyama, Tomoyuki Nonogaki, Ryoko Kato, Yuria Ishida, Akio Shimizu, Junko Ueshima","doi":"10.1002/crt2.39","DOIUrl":"10.1002/crt2.39","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Wasting of muscle mass and decreasing strength have been proven to be negative prognostic indicators for patients with cancer receiving anticancer treatment. However, little is known about their role in palliative care patients. The objective of this study was to evaluate the prognostic significance of low muscle mass and strength in predicting survival among patients in palliative care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively examined the association between muscle mass and strength and prognosis in patients with incurable solid cancer who were supported by a palliative care team at a university hospital. Psoas muscle index (PMI) at the level of the fourth lumbar vertebra was employed as the muscle mass index. Pinch grip strength (PGS) was used as the muscle strength index. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 78 patients were included in this study (35 male, median age 67 years). Median survival was 87.5 (95% confidence interval 50–124) days. After adjustment for age, sex, albumin, oedema, and performance status as potential confounders, loss of PMI (hazard ratio 0.998, 95% confidence interval 0.996–0.999; <i>P</i> = 0.003) and PGS (hazard ratio 0.73, 95% confidence interval 0.55–0.97; <i>P</i> = 0.030) independently predicted the overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low muscle mass and strength are independent predictors of survival in patients with incurable solid cancer receiving palliative care. PMI and PGS measurements may help to better assess the prognosis of patients in palliative care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73543,"journal":{"name":"JCSM clinical reports","volume":"6 3","pages":"93-99"},"PeriodicalIF":0.0,"publicationDate":"2021-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/crt2.39","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43481385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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