scholarly journals Dural Sinus Thrombosis after Resection of Vestibular Schwannoma using Suboccipital Retrosigmoid Approach - Thrombosis Classification and Management Proposal.

2021 ◽  
Author(s):  
Kamil Krystkiewicz ◽  
Dawid Wrona ◽  
Marcin Tosik ◽  
Marcin Birski ◽  
Łukasz Szylberg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Vestibular Schwannoma ◽  
Sinus Thrombosis ◽  
Significant Risk ◽  
Retrosigmoid Approach ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
External Compression ◽  
Postoperative Changes

Abstract ObjectiveDural sinus thrombosis is one of the complications after posterior fossa surgery. However, that topic is not described well with regard to vestibular schwannoma surgery using the unique suboccipital retrosigmoid approach.MethodsWe analyzed retrospectively medical records and radiological investigations of 116 patients. The including criteria were: histopathologically confirmed vestibular schwannoma operated on using the retrosigmoid approach, preoperative and postoperative contrast enhanced MRI, at least 1-year follow-up. ResultsThe patient group included 36% males, 64% females. The average age was 47.3±13.9 years. 60% of tumors were classified as T4b according to the Hannover scale and their mean volume was 13.73±10.28 cm3. There were no signs of thrombosis preoperatively. In 26 (22%) cases, postoperative changes in the dural sinuses were found. In 7 (27%) cases there was an external compression by the hemostatic agent, in 19 (73%) cases a thrombus was visualized in the sinus lumen. The size of the sinus, age, tumor size were not risk factors for thrombosis, whereas an intraoperative sinus injury was a statistically significant risk factor (p=0.0012). All of the patients diagnosed with thrombosis were in good clinical condition in distant follow-up (mRankin=0). Complete recanalization was observed in 58% of cases after 1-year follow-up.ConclusionsPostoperative changes in the dural venous sinuses are a frequent finding after vestibular schwannoma surgery using the suboccipital retrosigmoid approach. Intraoperative dural injury is a risk factor for thrombosis. Thrombosis in that group of patients is usually asymptomatic and does not influence the prognosis.

scholarly journals Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines

2018 ◽  
Vol 45 (1) ◽  
pp. E4 ◽  
Author(s):  
Hussam Abou-Al-Shaar ◽  
Yair M. Gozal ◽  
Gmaan Alzhrani ◽  
Michael Karsy ◽  
Clough Shelton ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Evidence Based ◽  
Posterior Fossa Surgery ◽  
Venous Sinus Thrombosis ◽  
True Incidence

OBJECTIVEPostoperative cerebral venous sinus thrombosis (CVST) is an uncommon complication of posterior fossa surgery. The true incidence of and optimal management strategy for this entity are largely unknown. Herein, the authors report their institutional incidence and management experience of postoperative CVST after vestibular schwannoma surgery.METHODSThe authors undertook a retrospective review of all vestibular schwannoma cases that had been treated with microsurgical resection at a single institution from December 2011 to September 2017. Patient and tumor characteristics, risk factors, length of stay, surgical approaches, sinus characteristics, CVST management, complications, and follow-up were analyzed.RESULTSA total of 116 patients underwent resection of vestibular schwannoma. The incidence of postoperative CVST was 6.0% (7 patients). All 7 patients developed lateral CVST ipsilateral to the lesion. Four cases occurred after translabyrinthine approaches, 3 occurred after retrosigmoid approaches, and none occurred following middle cranial fossa approaches. Patients were managed with anticoagulation or antiplatelet therapy. Although patients were generally asymptomatic, one patient experienced intraparenchymal hemorrhage, epidural hemorrhage, and obstructive hydrocephalus, likely as a result of the anticoagulation therapy. However, all 7 patients had a modified Rankin scale score of 1 at the last follow-up.CONCLUSIONSPostoperative CVST is an infrequent complication, with an incidence of 6.0% among 116 patients who had undergone vestibular schwannoma surgery at one institution. Moreover, the management of postoperative CVST with anticoagulation therapy poses a serious dilemma to neurosurgeons. Given the paucity of reports in the literature and the low incidence of CVST, additional studies are needed to better understand the cause of thrombus formation and help to establish evidence-based guidelines for CVST management and prevention.

Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

1999 ◽  
Vol 91 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Glenn L. Keiper ◽  
Jonathan D. Sherman ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Sinus Thrombosis ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Dural Sinus Thrombosis ◽  
Mr Venography ◽  
Content Type ◽  
Suboccipital Craniotomy ◽  
Fine Print

Object. The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.Methods. The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.Conclusions. First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

2007 ◽  
Vol 37 (12) ◽  
pp. 1731-1741 ◽  
Author(s):  
MICHAEL C. MONUTEAUX ◽  
STEPHEN V. FARAONE ◽  
LARA MICHELLE GROSS ◽  
JOSEPH BIEDERMAN
Keyword(s):  
Sexual Behavior ◽  
Risk Factor ◽  
Longitudinal Study ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Sexual Behavior Problems ◽  
Hyperactivity Disorder ◽  
Girls With Adhd

ABSTRACTBackgroundResearch on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.MethodWe conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16·7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.ResultsBaseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5·8, 95% confidence interval (CI) 2·9–11·5, p<0·001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (⩾12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.ConclusionsADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.

Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long-Term Follow-Up-Study

2003 ◽  
Vol 128 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Bernhard Schaller ◽  
Ariane Baumann
Keyword(s):  
Fibrin Glue ◽  
Aseptic Meningitis ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Bone Flap ◽  
Posterior Aspect ◽  
Dural Closure ◽  
Postoperative Headache

OBJECTIVE: Our goal was to study the occurrence and source of origin of postcraniotomy headache syndrome after removal of vestibular schwannoma via the retrosigmoid approach. METHODS: A retrospective chart analysis was conducted of all patients with headache at 3 months after removal of vestibular schwannoma from January 1981 through March 1997 and with a minimum of 24 months of follow-up. Diagnosis was made according to the headache classification and was graded using the HARNER scale. Recovery outcome was compared in selected groups of patients with and without headache. A descriptive statistical analysis was used to analyze differences between groups. RESULTS: Of the patients who underwent retrosigmoid craniotomy for removal of vestibular schwannomas, 52 of 155 patients (34%) reported having severe headache of requiring medication every day and/or feeling incapacitated 3 months after surgery. Headache was more prevalent in those who had the bone flap replaced (94% versus 27%), if there was duraplastic or direct dura closure (0% versus 100%). Laboratory-proven aseptic meningitis, most likely due to the use of fibrin glue and drilling of posterior aspect of the internal auditory canal, was mainly associated with postoperative headache (81% versus 2%). In 75% of these cases, calcifications along the brainstem had been noted. CONCLUSION: The origin of postoperative headaches after retrosigmoid vestibular schwannoma resections is not yet fully understood. Different factors may play a role in preventing or reducing headache: dural adhesions to nuchal muscles or to subcutaneous tissues and dural tension in the case of direct dural closure may explain postoperative headache from dural tension. Intradural drilling and the use of fibrin glue may be the source of aseptic meningitis as the etiology of persistent postoperative headache. Prevention of postoperative headache may include the replacement of bone flap at the end of surgery, duraplastic instead of direct dural closure, and prevention of the use of fibrin glue or extensive drilling of the posterior aspect of internal auditory canal.

Transverse Sinus Thrombosis after Posterior Fossa Surgery for Cerebellar Tumor Treated by Endovascular Thrombectomy

2007 ◽  
Vol 20 (5) ◽  
pp. 562-565
Author(s):  
A. Della Puppa ◽  
L. Tosatto ◽  
P. Amistà ◽  
M. Munari ◽  
R. Scienza
Keyword(s):  
Posterior Fossa ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Anticoagulation Therapy ◽  
Young Male ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Cerebellar Tumor ◽  
Dural Sinus Thrombosis

Dural sinus thrombosis is a rare complication after posterior fossa surgery, particularly in cerebellar tumour surgery. The authors describe the case of a young male patient who presented a postoperative neurological deterioration due to transverse sinus thrombosis after surgery for cerebellar medulloblastoma. He was treated by mechanical clot thrombectomy using an endovascular catch system technique without anticoagulation therapy. Final angiographic recanalization was obtained. This kind of endoluminal mechanical revascularization is an efficacious method to treat dural sinus thrombosis during perioperative time but speed in diagnosis is crucial for clinical outcome.

scholarly journals Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Alyssa Denton ◽  
Lilian Thorpe ◽  
Alexandra Carter ◽  
Adriana Angarita-Fonseca ◽  
Karen Waterhouse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Drug Resistant ◽  
Age Group ◽  
Drug Resistant Epilepsy ◽  
New Diagnosis

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

scholarly journals Post-Anticoagulation Cessation D-Dimer Testing and VTE Recurrence in Real-World Australian Audit

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1227-1227
Author(s):  
Julie Wang ◽  
Rowena Brook ◽  
Alison Slocombe ◽  
Lisa Hong ◽  
Prahlad Ho
Keyword(s):  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Recurrent Vte ◽  
Residual Thrombus ◽  
Repeat Imaging ◽  
D Dimer

Abstract Aim Elevated D-dimer post-anticoagulation cessation is a recognised risk factor for recurrent venous thromboembolic events (VTE). In particular, raised D-dimer post cessation has been associated with increased risk of recurrence in unprovoked major VTE. Currently in Australia, D-dimer has not been widely used in practice to stratify the risk of VTE recurrence. This study aims to retrospectively analyse the effect of routine D-dimer testing and it's association with VTE recurrence. Methods A retrospective evaluation was performed on 1024 patients with a diagnosis of VTE at a tertiary hospital in Australia between January 2013 and December 2016. Data collected included demographics, results and timing of D-dimer testing and serial imaging results. Results 1024 patients were reviewed with a total median follow up of 12 months (range 0-59 months). D-dimer was tested in 189 patients (18.5%) within 90 days after cessation of anticoagulation. Of these patients, median age was 58 (18-92) and 55.3% (n=105) were female. 33.3% (n=63) had isolated distal deep vein thrombosis (IDDVT), 66.3% (n=126) had above knee DVT (AKDVT)/pulmonary embolus (PE), 54.5% (n=103) of VTE were provoked. Abnormal post cessation D-dimer (>500) was found in 72 patients (37.9%). Of these, 25 patients were restarted on anticoagulation; one had recurrent VTE whilst on low dose apixaban 2.5mg BD and one had recurrence after cessation of anticoagulation at a later date. Patients with elevated D-dimer post cessation had a higher rate of recurrence with the highest risk in patients with D-dimer >1000 (RR 7.38, p=<0.01) outlined in Table 1. Of the 164 patients with post cessation D-dimer testing who remained off anticoagulation there were a total of 24 (12.6%) episodes of recurrent VTE. Elevated D-dimer post anticoagulation cessation was a significant risk factor for recurrence in both provoked VTE (RR 4.21, p=0.01) and unprovoked VTE cohorts (RR 4.55, p=0.008) outlined in Table 2. When provoked VTE were sub-categorised, raised D-dimer demonstrated the most statistical significance in VTE provoked by travel (RR 13.5 p=0.06). Of the patients with post anticoagulation cessation D-dimer testing 170 patients (89.9%) had repeat imaging to assess for residual thrombus. In the subgroup of patients with no residual thrombus, elevated D-dimer was a significant risk factor for VTE recurrence (RR 6.4, p=<0.01). Patients with normal D-dimer and no residual thrombus had the lowest rate of recurrence 5.4% (n=4) see Table 3. When stratified by type of VTE, elevated D-dimer post anticoagulation cessation was significantly related to risk for recurrence in the overall IDDVT sub-cohort (RR 4.09, p=0.007). This was not significant for the AKDVT/PE sub cohort (RR 3.24, p=0.079). However, for patients with unprovoked AKDVT or PE, having D-dimer tested post anticoagulation, regardless of result, was associated with lower rates of VTE recurrence RR 0.30 (p=0.02) compared to those who had no D-dimer testing as part of follow-up. Conclusion Post treatment D-dimer testing may have a clinical role in stratifying the risk of VTE recurrence along with repeat imaging to detect residual thrombus. Elevated D-dimer post anticoagulation cessation is associated with increased risk of VTE recurrence for both provoked and unprovoked VTE with highest risk in patients with D-dimer >1000. Patients with no residual thrombus and a negative D-dimer post anticoagulation cessation had the lowest rate of recurrence. In the subgroup of patients with provoked VTE and IDDVT a positive D-dimer post cessation was associated with 4.21 and 4.09 relative risk of recurrence respectively, suggesting that the role of D-dimer testing can be extended to these subpopulations. Interestingly, in patients with unprovoked AKDVT or PE, having post-cessation D-dimer testing performed, regardless of result, was associated with a significantly lower rate of VTE recurrence compared to patients without D-dimer testing, which may be related to specialist review and recommencement of anticoagulation in high-risk patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals MON-662 Diabetes Risk for Non-Obese Subjects in a Japanese Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yoshimi Tatsukawa ◽  
Hiroko Kitamura ◽  
Michiko Yamada ◽  
Waka Ohishi ◽  
Ayumi Hida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Risk Factor ◽  
Blood Glucose ◽  
Fatty Liver ◽  
Handgrip Strength ◽  
Fasting Blood Glucose ◽  
Significant Risk ◽  
Metabolic Abnormality

Abstract [Background] Obesity is a major risk factor of developing diabetes and cardiovascular diseases, though not all obese people develop these conditions and diseases. Because Asian populations have a lower frequency of obesity in comparison with populations in the United States and Europe, it is important to detect risk factors for developing diabetes in non-obese Japanese populations. [Objectives] To examine risk factors for diabetes, and to consider countermeasures against diabetes development in Japanese populations, especially non-obese individuals. [Methods] This study examined 1,794 individuals (514 males and 1,280 females) who participated in both Adult Health Study health examinations on A-bomb survivors and their controls in Hiroshima and Nagasaki between 1994–1996 (baseline) and 2008–2011. They were aged 48–79 years and had not been diagnosed with diabetes at baseline or cancer. Obesity was defined as a BMI of 23 kg/m2 or greater based on the WHO recommendation for Asians. In accordance with AHA/NHLBI criteria for diagnosis of metabolic syndrome, we defined a diagnosis of metabolic abnormality as having at least two of the criteria other than abdominal obesity. The diagnostic criteria for diabetes were a fasting blood glucose ≥126 mg/dL, a non-fasting blood glucose ≥200mg/dL, a self-report of a diabetes diagnosis, or the initiation of medical treatment for diabetes during the follow-up period. We compared presences of fatty liver and metabolic abnormality, BMI at baseline, and changes of body weight from baseline between the group that developed diabetes and the group did not over a 15-year follow-up. [Results] During the follow-up period until 2001, 66 (7.0%) individuals and 127 individuals (14.8%) from the non-obese and obese groups, respectively, developed diabetes. BMI at baseline and presences of fatty liver and metabolic abnormality were associated with developing diabetes in both non-obese and obese groups. Changes in body weight from baseline were not a significant risk factor of diabetes in this study. Furthermore, we analyzed the association between diabetes risk and appendicular lean mass/height2 (ALM/H2) and handgrip strength based on the diagnostic criteria for sarcopenia among 676 subjects with information of these measurements at baseline. Occurrences of low ALM/H2 were associated with developing diabetes, but an association between low handgrip strength and developing diabetes was not observed. [Conclusion] Regardless of whether obesity was observed or not, presences of metabolic abnormality and fatty liver were significant risk factors. Increased risk of developing diabetes was observed among non-obese individuals with suspected sarcopenia. This study suggests that maintenance of muscle mass may be an effective countermeasure to reduce the risk of developing diabetes.

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