Prevalence and Nonpharmacological Interventions for Sarcopenia among Cirrhotic Patients

Sarcopenia is the most common feature of hepatic cirrhosis characterized by progressive loss of muscle mass and function and increases permanently the mortality and morbidity rates among those patients. The incidence of sarcopenia in cirrhotic patients ranged 40-70% associating with impaired quality of life and augmented rates of infection. Based on these issues, this review is aimed at determining the prevalence and main causes of sarcopenia among cirrhotic patients and recognizing the recent diagnostic and physical treatment modalities that prevent risk factors for sarcopenia in those patients. No ideal modality is currently demonstrated for diagnosing sarcopenia in hepatic diseases, particularly cirrhosis; however, recent studies reported different diagnostic modalities for muscle function in different individuals including handgrip strength, skeletal muscle index, six-min walk test, liver frailty index, short physical performance battery, and radiological assessments for quadriceps and psoas muscles. Exercise training and therapeutic nutrition are strongly recommended for controlling sarcopenia in cirrhotic patients. The exercise program is designed and carried out on a frequent basis within an extensive scheduled time aimed at improving functional performance, aerobic capacity, and healthy conditions. Finally, a combination of exercise training and therapeutic nutrition is powerfully recommended to control sarcopenia in cirrhosis.

Download Full-text

Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

World Journal of Urology ◽

10.1007/s00345-020-03556-7 ◽

2021 ◽

Author(s):

M. T. Walach ◽

M. F. Wunderle ◽

N. Haertel ◽

J. K. Mühlbauer ◽

K. F. Kowalewski ◽

...

Keyword(s):

Active Surveillance ◽

Surgical Outcome ◽

Frailty Index ◽

Treatment Decision ◽

Solitary Kidney ◽

Tumor Ablation ◽

Renal Masses ◽

Skeletal Muscle Index ◽

Decision Tools ◽

Modified Frailty Index

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

Download Full-text

Challenges in the Management of Ruptured and Unruptured Brainstem Arteriovenous Malformations: Outcome After Conservative, Single-Modality, or Multimodality Treatments

Neurosurgery ◽

10.1227/neu.0b013e31822670ac ◽

2011 ◽

Vol 70 (1) ◽

pp. 155-161 ◽

Cited By ~ 8

Author(s):

Laurent Thines ◽

Amir R. Dehdashti ◽

Leodante da Costa ◽

Michael Tymianski ◽

Karel G. ter Brugge ◽

...

Keyword(s):

Scale Score ◽

Odds Ratio ◽

Arteriovenous Malformations ◽

Negative Impact ◽

Multimodality Treatment ◽

Treatment Modalities ◽

Modified Rankin Scale ◽

Mortality And Morbidity ◽

Cure Rates ◽

Single Modality

Abstract BACKGROUND Brainstem arteriovenous malformations are challenging lesions, and benefits of treatment are uncertain. OBJECTIVE To study the clinical course of Brainstem arteriovenous malformations and the influence of treatments on outcome. METHODS We reviewed a prospective series of 31 brainstem arteriovenous malformations. Demographic, morphological, and clinical characteristics were recorded. Factors determining initial and final outcomes (modified Rankin Scale), results of treatments (cure rates, complications), and disease course were analyzed. RESULTS Brainstem arteriovenous malformations were symptomatic and bled in 93% and 61% of cases, respectively. Examination was abnormal and initial modified Rankin Scale score was > 3 in 71% and 86% of patients, respectively. The average follow-up time was 6.2 years, and 26% of patients rebled (5.9 %/y). Treatment modalities included conservative, radiosurgical, endovascular, surgical, and multimodality treatment in 13%, 58%, 35%, 16%, and 26% of cases, respectively. The obliteration rate was 60% overall and 39% after radiosurgery, 40% after embolization, and 75% after microsurgery, with respective complication-free cure rates of 71%, 50%, and 0%. Overall procedural mortality and morbidity were 2.3% and 18.6%, respectively. Final modified Rankin Scale score was > 3 in 77% of cases. Neurological deterioration (35%) was related to treatment complications in 74% of cases with a negative impact of surgery (P = .04), palliative embolization (odds ratio = 16), and multimodality treatments (odds ratio = 24). Radiosurgery was inversely associated with worsening (odds ratio = 0.06). CONCLUSION Brainstem arteriovenous malformations require individualized treatment decisions. Single-modality treatments with a reasonable chance of complete cure and low complication rate (such as radiosurgery) should be favored.

Download Full-text

Prevalence of sarcopenia in patients with gastroesophageal and lung malignancies undergoing surgical resection and its impact on immediate postoperative outcomes: A prospective observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18617 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18617-e18617

Author(s):

Sudhakar Gunasekar ◽

SVS Deo ◽

Sunil Kumar ◽

Ekta Dhamija ◽

Sandeep Kumar Bhoriwal

Keyword(s):

Lung Cancer ◽

Weight Loss ◽

Grip Strength ◽

Handgrip Strength ◽

Ct Images ◽

Control Group ◽

Gastroesophageal Cancer ◽

Combined Method ◽

Skeletal Muscle Index ◽

Strength Based

e18617 Background: The study evaluated the prevalence & impact of sarcopenia in gastroesophageal cancer (GC) & lung cancer (LC) patients undergoing resection. Methods: An observational prospective study was conducted in department of surgical oncology, AIIMS, New Delhi. All patients aged under 65 years with resectable GC & LC were included. Skeletal muscle index (SMI) using cross-sectional CT images at the level of L3 & Hand grip strength (dynamometer) were used to assess sarcopenia. Random benign patients with CT images were used as control group. Patients were categorized into sarcopenic and non-sarcopenic and outcome parameters were compared. Results: In the study population (n = 66), GC & LC constituted 44 (66.67%) & 22(33.33%) respectively. Mean age was 53.4 years. The prevalence of sarcopenia based on the combined method (CT imaging & handgrip strength) was 57.58%, CT based sarcopenia was 33.34% & handgrip strength-based sarcopenia was 43.93%. Mild and moderate sarcopenia was seen in 37.88% (n = 25) & 19.7 % (n = 13) respectively. Among patients with GC, prevalence of sarcopenia was 59.09% by combined method, 36.36% and 43.18% by CT based method alone & handgrip strength-based method alone respectively. Among LC prevalence of sarcopenia was 54.54% by combined method, 27.27% and 45.45% by CT based & handgrip-based method. The concordance between CT muscle mass & grip strength was 62.12%. Most female patients had weak handgrip strength despite having normal SMI. In control group (n = 44) mean age was 54.5 years, the prevalence of CT based sarcopenia was 34.09%. Weight loss history & BMI correlated with the degree of sarcopenia. Out of 66 patients 13% (n = 9) patients were unresectable. Moderate sarcopenia group had more statistically significant (P -0.02) unresectable disease compared to mild and non-sarcopenic groups. In postoperative period, sarcopenic group (64.51% vs 38.36 %) had more grade 2 complications though statistically insignificant. There was no difference in hospital stay between the two groups. In patients with GC , postoperative respiratory complication occurred in 11.53% (n = 3) of sarcopenic patients and 5.5%(n = 1) of non-sarcopenic patients, anastomotic leak occurred in 7.69% (n = 2) of sarcopenic patients and 5.5% (n = 1) of nonsarcopenic patients. Conclusions: The prevalence of sarcopenia is higher in patients with gastroesophageal cancer compared to lung cancer. The important factors that affect the sarcopenia include age and body mass index and weight loss history. The study has showed a trend towards increased post-operative complications and increased unresectable cases in patients with mild to moderate sarcopenia. Further larger studies are required to validate if sarcopenia can be used as an adjunct to predict resectability and post-operative outcomes.

Download Full-text

Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease

BioMed Research International ◽

10.1155/2018/9849475 ◽

2018 ◽

Vol 2018 ◽

pp. 1-36 ◽

Cited By ~ 8

Author(s):

Egle Tamuleviciute-Prasciene ◽

Kristina Drulyte ◽

Greta Jurenaite ◽

Raimondas Kubilius ◽

Birna Bjarnason-Wehrens

Keyword(s):

Heart Disease ◽

Exercise Training ◽

Muscle Mass ◽

Valvular Heart Disease ◽

Daily Living ◽

Frailty Index ◽

Psychosocial Health ◽

Clinical Frailty Scale ◽

Frailty Assessment ◽

Elder Patients

The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.

Download Full-text

P86 Treatment modalities in peripheral facial nerve palsy in children and adolescents

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-esdppp.124 ◽

2019 ◽

Vol 104 (6) ◽

pp. e53.1-e53

Author(s):

J Samardzic ◽

B Kukolj ◽

M Jovanovic ◽

O Djuric ◽

J Jancic

Keyword(s):

Recovery Rate ◽

Combined Therapy ◽

Recovery Period ◽

Treatment Modalities ◽

P Value ◽

Physical Treatment ◽

Therapeutic Modalities ◽

Peripheral Facial Palsy ◽

Younger Age ◽

Peripheral Facial Nerve Palsy

BackgroundBell´s palsy is the most common type of peripheral facial palsy in pediatrics. Recent studies strongly support the combined therapy with corticosteroids (CS), antiviral drugs and vitamins B. Our study aims to assess the effectiveness of proposed therapeutic modalities, including the relation between the patients‘ recovery and their age, etiological factors and applied treatment.MethodsThe retrospective analysis involved 88 patients (52 females/36 males), between 18 months and 18 years old; the average age was 11.7 years. Data was obtained from the documentation of patients hospitalized at the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade, from 2000 to 2017. House Brackmann´s scale was used for the assessment of disease course and outcome. Pearson´s χ2 test, Friedman´s test and general linear model were applied for statistical data processing.ResultsThe majority of patients were treated with combined CS/vitamins (42.0%) and CS/antiviral/vitamins (17.0%), whereas CS only received 22.7% of patients, all with an appropriate physical treatment. The group of idiopathic paralysis makes 62.5%, while the incidence of symptomatic paralysis is 37.5%; however, the recovery rate between these groups has not been shown (p=0.309). Patients received CS therapy were divided into 4 groups: CS only, CS+antiviral, CS+vitamins B, and CS+antiviral+vitamins B. The statistically significant recovery was registered in each group (p< 0.001); however, no difference was found between the groups in term of recovery rate (p=865). For the assessment of recovery period in relation to the age, the obtained p value was 0.054, a borderline level, suggesting a faster recovery of children at younger age.ConclusionThe acute one-sided mimic musculature weakness is mostly idiopathic. The effectiveness of the CS therapy was strongly supported, suggesting CS as a core treatment for the Bell´s palsy. It has been shown the faster recovery of children at younger age.Disclosure(s)Nothing to disclose

Download Full-text

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318606 ◽

2020 ◽

Vol 105 (4) ◽

pp. 449-454

Author(s):

Emily J J Horn-Oudshoorn ◽

Ronny Knol ◽

Arjan B Te Pas ◽

Stuart B Hooper ◽

Suzan C M Cochius-den Otter ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Management Strategies ◽

Fetal Surgery ◽

Adverse Outcomes ◽

Delivery Room ◽

Treatment Modalities ◽

Mortality And Morbidity ◽

Early Predictors ◽

Stabilisation Period

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

Download Full-text

Simplified morphological evaluation of skeletal muscle mass and maximum muscle strength in healthy young women: Comparison between thigh and calf

Women s Health ◽

10.1177/1745506520962009 ◽

2020 ◽

Vol 16 ◽

pp. 174550652096200

Author(s):

Tomohiro Yasuda

Keyword(s):

Skeletal Muscle ◽

Regression Analysis ◽

Muscle Mass ◽

Young Women ◽

Skeletal Muscle Mass ◽

Handgrip Strength ◽

Muscle Thickness ◽

Skeletal Muscle Index ◽

Stand Test ◽

Sit To Stand

Objectives: The purpose of this study was to examine the prediction of skeletal muscle mass and maximum muscle strength using simplified morphology evaluation in young Japanese women from the thigh and calf perspective. Methods: A total of 249 Japanese young women (aged 18–25 years) were used for data analyses in this study. Thigh and calf girths were measured using a tape measure at 50% of thigh length and at 30% proximal of calf length, respectively. Muscle thickness was measured using B-mode ultrasound at the anterior and posterior thigh (at 50% of thigh length) and at the posterior lower leg (at 30% proximal of calf length), respectively. The measurements were carried out on the right side of the body while the participants stood with their elbows extended and relaxed. A stepwise multiple regression analysis (method of increasing and decreasing the variables; criterion set at p < 0.05) was performed for skeletal muscle index (defined by appendicular skeletal muscle mass/height2), handgrip strength, or sit-to-stand test and five variable factors (girth (thigh and calf) and muscle thickness (anterior and posterior thigh and posterior calf)). Results: Unlike the sit-to-stand test, skeletal muscle index or handgrip strength was correlated ( p < 0.001) with the girth or muscle thickness for both thigh and calf. Unlike the sit-to-stand test, the prediction equations for skeletal muscle index and handgrip strength estimation showed significant correlations with multiple regression analysis of data obtained from the calf girth and muscle thickness. In both skeletal muscle index and handgrip strength, calf girth was adopted as a Step 1, respectively. Conclusion: Our results indicated that skeletal muscle index and handgrip strength could be evaluated by the simplified morphology methods, especially that for the calf girth measurement, which may be a good indicator of screening/preventing for sarcopenia in healthy Japanese young women.

Download Full-text

Medical management of brain metastases

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa015 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Adam Lauko ◽

Yasmeen Rauf ◽

Manmeet S Ahluwalia

Keyword(s):

Brain Metastases ◽

Checkpoint Inhibitors ◽

Treatment Options ◽

Tumor Biology ◽

Therapeutic Benefit ◽

Treatment Modalities ◽

Primary Tumors ◽

Mortality And Morbidity ◽

Novel Approaches ◽

Neurocognitive Decline

Absrtract The development of brain metastases occurs in 10–20% of all patients with cancer. Brain metastases portend poor survival and contribute to increased cancer mortality and morbidity. Despite multimodal treatment options, which include surgery, radiotherapy, and chemotherapy, 5-year survival remains low. Besides, our current treatment modalities can have significant neurological comorbidities, which result in neurocognitive decline and a decrease in a patient’s quality of life. However, innovations in technology, improved understanding of tumor biology, and new therapeutic options have led to improved patient care. Novel approaches in radiotherapy are minimizing the neurocognitive decline while providing the same therapeutic benefit. In addition, advances in targeted therapies and immune checkpoint inhibitors are redefining the management of lung and melanoma brain metastases. Similar approaches to brain metastases from other primary tumors promise to lead to new and effective therapies. We are beginning to understand the appropriate combination of these novel approaches with our traditional treatment options. As advances in basic and translational science and innovative technologies enter clinical practice, the prognosis of patients with brain metastases will continue to improve.

Download Full-text