1
|
Flor-Rufino C, Pérez-Ros P, Martínez-Arnau FM. Influence of physical exercise on respiratory muscle function in older adults: A systematic review and meta-analysis. Geriatr Nurs 2024; 57:189-198. [PMID: 38685166 DOI: 10.1016/j.gerinurse.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Respiratory function decreases with aging. The literature showed that non-ventilatory specific exercise could have a positive impact on respiratory muscles. A systematic literature review was conducted to assess the effects of non-ventilatory specific exercise on maximal inspiratory (MIP) and expiratory pressure (MEP) and peak expiratory flow (PEF) in older adults. The included 9 trials investigated the effects of resistance training, yoga, Pilates, physical activity based on walking, and whole-body vibration training. The meta-analysis showed no statistically significant differences in MIP, MEP, and PEF after implementation of a non-ventilatory specific exercise program in older individuals. Between-study heterogeneity was substantial for MIP and MEP outcomes but it was not statistically significant for PEF. Further RCTs will be necessary to determine the effects of physical exercise interventions. PROSPERO registry CRD42023478262.
Collapse
Affiliation(s)
- Cristina Flor-Rufino
- Department of Physiotherapy, Universitat de Valencia, Gascó Oliag 5, 46010, Valencia, Spain; Department of Physiotherapy, Universidad Europea de Valencia, Paseo de la Alameda, 7, 46010, Valencia
| | - Pilar Pérez-Ros
- Department of Nursing, Universitat de Valencia, Menéndez Pelayo, 19, 46010, Valencia, Spain; Frailty and cognitive impairment Research Group (FROG), University of Valencia, Menéndez y Pelayo, 19, 46010, Valencia, Spain..
| | - Francisco M Martínez-Arnau
- Department of Physiotherapy, Universitat de Valencia, Gascó Oliag 5, 46010, Valencia, Spain; Frailty and cognitive impairment Research Group (FROG), University of Valencia, Menéndez y Pelayo, 19, 46010, Valencia, Spain
| |
Collapse
|
2
|
Dreessen L, Debain A, Lieten S, Bravenboer B, Vermeiren S, Vella-Azzopardi R, Knoop V, Costenoble A, Smeys C, Iranyeza RA, Van der Meulen KEY, Vanderhelst E, Schuermans D, Bautmans I. Respiratory Muscle Strength Is Related to Handgrip Performance in Community-Dwelling Persons Aged 80+ from the BUTTERFLY Study. Gerontology 2024; 70:526-535. [PMID: 38316117 DOI: 10.1159/000536361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old. METHODS Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80-97 years). RESULTS The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p < 0.05 and r = 0.257 for female participants, p < 0.01) and MEP (r = 0.200 for male, p < 0.01 and r = 0.191 for female participants, p < 0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p < 0.01 and r = 0.343, p < 0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p < 0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p < 0.001). CONCLUSIONS Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated.
Collapse
Affiliation(s)
- Lisa Dreessen
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Aziz Debain
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Siddhartha Lieten
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Bert Bravenboer
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sofie Vermeiren
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Roberta Vella-Azzopardi
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Veerle Knoop
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Axelle Costenoble
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Celeste Smeys
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rock-Ange Iranyeza
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kristof E Y Van der Meulen
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eef Vanderhelst
- Department of Respiratory Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Daniel Schuermans
- Department of Respiratory Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Ivan Bautmans
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
3
|
Chen WZ, Lin F, Yu DY, Ren Q, Zhang FM, Shen ZL, Chen WH, Dong QT, Yu Z. Clinical impact of sarcopenia for overweight or obese patients with colorectal cancer. Jpn J Clin Oncol 2024; 54:23-30. [PMID: 37850297 DOI: 10.1093/jjco/hyad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Sarcopenia, overweight and obesity are all dynamic changes in body composition, which may have a negative effect on the prognosis for patients with colorectal cancer. The aim of this study was to investigate the predictive role of sarcopenia on overweight or obese patients with colorectal cancer. METHODS We conducted an observative study on the population of overweight or obese patients with colorectal cancer who underwent curative surgeries in two centers between 2015 and 2021. They were grouped by the presence of sarcopenia. Propensity score match analysis was used to balance the baseline of clinicopathologic characteristics of the two groups. Then, the postoperative outcomes between the two groups were compared. Independent risk factors were evaluated for complications using univariate and multivariate analysis. RESULTS Of 827 patients enrolled, 126 patients were matched for analysis. Patients with sarcopenia had a higher incidence of total complication and medical complications, a higher rate of laparoscopic surgery performed and higher hospitalization costs. Old age (≥65 years, P = 0.012), ASA grade (III, P = 0.008) and sarcopenia (P = 0.036) were independent risk factors for total complications. ASA grade (III, P = 0.002) and sarcopenia (P = 0.017) were independent risk factors for medical complications. CONCLUSIONS Sarcopenia was prevalent among overweight or obese patients with colorectal cancer and was associated with negative postoperative outcomes. Early recognition of changes in body composition could help surgeons be well prepared for surgical treatment for overweight or obese patients.
Collapse
Affiliation(s)
- Wei-Zhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Feng Lin
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Ding-Ye Yu
- Department of General Surgery, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai
| | - Qi Ren
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Zi-Le Shen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| | - Wen-Hao Chen
- Department of General Surgery, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai
| | - Qian-Tong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai
| |
Collapse
|
4
|
Palmisano A, Gnasso C, Cereda A, Vignale D, Leone R, Nicoletti V, Barbieri S, Toselli M, Giannini F, Loffi M, Patelli G, Monello A, Iannopollo G, Ippolito D, Mancini EM, Pontone G, Vignali L, Scarnecchia E, Iannaccone M, Baffoni L, Spernadio M, de Carlini CC, Sironi S, Rapezzi C, Esposito A. Chest CT opportunistic biomarkers for phenotyping high-risk COVID-19 patients: a retrospective multicentre study. Eur Radiol 2023; 33:7756-7768. [PMID: 37166497 PMCID: PMC10173240 DOI: 10.1007/s00330-023-09702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To assess the value of opportunistic biomarkers derived from chest CT performed at hospital admission of COVID-19 patients for the phenotypization of high-risk patients. METHODS In this multicentre retrospective study, 1845 consecutive COVID-19 patients with chest CT performed within 72 h from hospital admission were analysed. Clinical and outcome data were collected by each center 30 and 80 days after hospital admission. Patients with unknown outcomes were excluded. Chest CT was analysed in a single core lab and behind pneumonia CT scores were extracted opportunistic data about atherosclerotic profile (calcium score according to Agatston method), liver steatosis (≤ 40 HU), myosteatosis (paraspinal muscle F < 31.3 HU, M < 37.5 HU), and osteoporosis (D12 bone attenuation < 134 HU). Differences according to treatment and outcome were assessed with ANOVA. Prediction models were obtained using multivariate binary logistic regression and their AUCs were compared with the DeLong test. RESULTS The final cohort included 1669 patients (age 67.5 [58.5-77.4] yo) mainly men 1105/1669, 66.2%) and with reduced oxygen saturation (92% [88-95%]). Pneumonia severity, high Agatston score, myosteatosis, liver steatosis, and osteoporosis derived from CT were more prevalent in patients with more aggressive treatment, access to ICU, and in-hospital death (always p < 0.05). A multivariable model including clinical and CT variables improved the capability to predict non-critical pneumonia compared to a model including only clinical variables (AUC 0.801 vs 0.789; p = 0.0198) to predict patient death (AUC 0.815 vs 0.800; p = 0.001). CONCLUSION Opportunistic biomarkers derived from chest CT can improve the characterization of COVID-19 high-risk patients. CLINICAL RELEVANCE STATEMENT In COVID-19 patients, opportunistic biomarkers of cardiometabolic risk extracted from chest CT improve patient risk stratification. KEY POINTS • In COVID-19 patients, several information about patient comorbidities can be quantitatively extracted from chest CT, resulting associated with the severity of oxygen treatment, access to ICU, and death. • A prediction model based on multiparametric opportunistic biomarkers derived from chest CT resulted superior to a model including only clinical variables in a large cohort of 1669 patients suffering from SARS- CoV2 infection. • Opportunistic biomarkers of cardiometabolic comorbidities derived from chest CT may improve COVID-19 patients' risk stratification also in absence of detailed clinical data and laboratory tests identifying subclinical and previously unknown conditions.
Collapse
Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Chiara Gnasso
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Riccardo Leone
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Simone Barbieri
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | | | | | | | | | | | | | - Elisa Scarnecchia
- ASST Valtellina and Alto Lario, Eugenio Morelli Hospital, Sondalo, Italy
| | | | - Lucio Baffoni
- Casa Di Cura Villa Dei Pini, Civitanova Marche, Italy
| | | | | | | | - Claudio Rapezzi
- Azienda Ospedaliero-Universitaria Di Ferrara, Cona, FE, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
| |
Collapse
|
5
|
Oh J, Lim H, Jeong CW, Kim MS, Lee J, Kang WS, An UR, Park JU, Ahn Y, Kim YR, Park C. Clinical implication of thoracic skeletal muscle volume as a predictor of ventilation-weaning failure in brain-injured patients: A retrospective observational study. Medicine (Baltimore) 2023; 102:e35847. [PMID: 37904365 PMCID: PMC10615541 DOI: 10.1097/md.0000000000035847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/06/2023] [Indexed: 11/01/2023] Open
Abstract
Sarcopenia, a generalized loss of skeletal muscle mass that is primarily evident in the respiratory musculature, is associated with adverse outcomes in critically ill patients. However, the relationship between sarcopenia and ventilation-weaning outcomes has not yet been fully studied in patients with brain injuries. In this study, we examined the effect of reduced respiratory muscle mass on ventilation weaning in patients with brain injury. This observational study retrospectively reviewed the medical records of 73 patients with brain injury between January 2017 and December 2019. Thoracic skeletal muscle volumes were measured from thoracic CT images using the institute's three-dimensional modeling software program of our institute. The thoracic skeletal muscle volumes index (TSMVI) was normalized by dividing muscle volume by the square of patient height. Sarcopenia was defined as a TSMVI of less than the 50th sex-specific percentile. Among 73 patients with brain injury, 12 (16.5%) failed to wean from mechanical ventilation. The patients in the weaning-failure group had significantly higher sequential organ failure assessment scores [7.8 ± 2.7 vs 6.1 ± 2.2, P = .022] and lower thoracic skeletal muscle volume indexes [652.5 ± 252.4 vs 1000.4 ± 347.3, P = .002] compared with those in the weaning-success group. In multivariate analysis, sarcopenia was significantly associated with an increased risk of weaning failure (odds ratio 12.72, 95% confidence interval 2.87-70.48, P = .001). Our study showed a significant association between the TSMVI and ventilation weaning outcomes in patients with brain injury.
Collapse
Affiliation(s)
- Jimi Oh
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyun Lim
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Chang Won Jeong
- Smart Health IT Center, Wonkwang University Hospital, Iksan-si, South Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University, College of Medicine, Cheonan-si, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin-si, South Korea
| | - Wu Seong Kang
- Department of Trauma Surgery, Cheju Halla General Hospital, Jeju-si, South Korea
| | - Ui Ri An
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Joo Un Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Youngick Ahn
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University School of Medicine, Iksan-si, South Korea
| | - Chul Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan-si, South Korea
| |
Collapse
|
6
|
Xie T, Li L, Yang X, Wu X, Wang M, Chen W, Dong Q, Chen X, Li J. Effect of perioperative airway management on postoperative outcomes of colorectal cancer patients with sarcopenia. Eur J Oncol Nurs 2023; 66:102418. [PMID: 37713967 DOI: 10.1016/j.ejon.2023.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND It is common for colorectal cancer patients to have sarcopenia as a comorbidity, which has been shown to have a negative impact on prognosis after surgery. This study explored whether implementing a novel care program could improve postoperative outcomes in colorectal cancer patients with sarcopenia. METHODS We retrospectively analyzed the clinical data of patients diagnosed with sarcopenia before undergoing radical colorectal cancer surgery. We divided the patients into two groups according to the time point of program implementation and, compared the clinical characteristics and postoperative outcomes of these two groups. RESULTS A total of 227 patients were included in the study. The baseline clinical characteristics of the two groups were similar. Compared with the control group, patients in the implementation group had a significantly lower rate of total complications (18.5% vs. 30.3%, P = 0.041), a significantly lower rate of pulmonary complications (2.8% vs. 10.9%, P = 0.017), and a significantly shorter postoperative hospital stay (12 days vs. 14 days, P = 0.001). Implementation of perioperative airway management (P = 0.018) was shown to be a protective factor against pulmonary complications in colorectal cancer patients with sarcopenia. CONCLUSION The perioperative airway management program implemented at our center was easy to perform and can effectively improve short-term postoperative outcomes in colorectal cancer patients with sarcopenia.
Collapse
Affiliation(s)
- Tingting Xie
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liyuan Li
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangxiang Yang
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofen Wu
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minmin Wang
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weizhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiantong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaolei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Jiang Li
- Department of Gastrointestinal Surgery Nursing Unit, Ward 442, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
7
|
Hyodo Y, Jiroumaru T, Mori K, Hattori T, Oka Y, Kuroda M, Ochi J, Shichiri N, Fujikawa T. Comparison of the effect of respiratory muscle strength on dynamic and static balance assessment between sarcopenia and non-sarcopenia groups. J Phys Ther Sci 2023; 35:703-707. [PMID: 37790998 PMCID: PMC10542420 DOI: 10.1589/jpts.35.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 10/05/2023] Open
Abstract
[Purpose] We compared differences in the association between respiratory muscle strength and static and dynamic balance in sarcopenia and non-sarcopenia groups, for fall risk assessment. [Participants and Methods] The study included 37 participants aged ≥65 years, who were certified to receive long-term care. Inspiratory and expiratory muscle strength, hand grip strength, Timed Up and Go Test scores, and one-leg standing task scores were recorded. Pearson's correlation coefficients and multiple regression analysis were used for data analysis. [Results] Only the expiratory muscle and hand grip strength were correlated in the sarcopenia group. Expiratory and inspiratory muscle strength was correlated with both one-leg standing task scores and hand grip strength, and inspiratory muscle strength was correlated with the Timed Up and Go Test scores in the non-sarcopenia group. Multiple regression analysis revealed that expiratory muscle strength was an explanatory variable for the one-leg standing task and inspiratory muscle strength for the Timed Up and Go Test in the non-sarcopenia group. [Conclusion] Combined evaluation of expiratory muscle strength and the Timed Up and Go Test scores may be useful to assess the fall risk.
Collapse
Affiliation(s)
- Yutaro Hyodo
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | | | - Kenji Mori
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | - Tomoka Hattori
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
| | - Yasumasa Oka
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
- Department of Applied Biology, Kyoto Institute of
Technology, Japan
| | - Minoru Kuroda
- Kanazawa Orthopaedic and Sports Medicine Clinic: 881 Ono,
Ritto, Shiga 520-3016, Japan
- Department of Clinical Nursing, Division of Psychiatric and
Mental Health Nursing, Shiga University, Japan
| | - Junko Ochi
- Department of Physical Therapy, Bukkyo University,
Japan
| | | | | |
Collapse
|
8
|
Kim MY, Kim SY, Shin HJ, Kweon KH, Park J, Kim NY. Effect of Sarcopenia on Pneumonia after Endoscopic Submucosal Resection in Patients Aged ≥65 Years: A Retrospective Study. Cancers (Basel) 2023; 15:4753. [PMID: 37835447 PMCID: PMC10572055 DOI: 10.3390/cancers15194753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
We aimed to investigate the association between sarcopenia and incidence of pneumonia after endoscopic submucosal dissection (ESD) in patients aged ≥65 years. Patients with (n = 1571) and without sarcopenia (n = 1718) who underwent ESD for gastric neoplasm were included. Propensity score matching (PSM) was performed between the groups (n = 785) at a 1:1 ratio. The primary endpoint was the effect of sarcopenia on the incidence of pneumonia after ESD. Among the included patients, 2.2% (n = 71) developed pneumonia after ESD. After PSM, the incidence rate of pneumonia was significantly higher in patients with sarcopenia than that in patients without sarcopenia (p = 0.024). Sarcopenia and age ≥73 years were significantly associated with the incidence of pneumonia (sarcopenia and age <73 years, odd ratio (OR) = 1.22 [95% confidence interval (CI): 0.46-3.22]; sarcopenia and age ≥73 years, OR = 3.92 [95% CI: 1.79-8.74]). Patients with sarcopenia had an increased risk of developing pneumonia after ESD, even after adjusting for other factors, resulting in a higher incidence of leukocytosis and a longer duration of post-ESD hospitalization. The combination of sarcopenia and age ≥73 years could be an effective predictive factor for screening high-risk groups for pneumonia after ESD.
Collapse
Affiliation(s)
- Min-Yu Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.-Y.K.); (S.Y.K.); (K.H.K.); (J.P.)
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.-Y.K.); (S.Y.K.); (K.H.K.); (J.P.)
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Ki Hong Kweon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.-Y.K.); (S.Y.K.); (K.H.K.); (J.P.)
| | - Jooeun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.-Y.K.); (S.Y.K.); (K.H.K.); (J.P.)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.-Y.K.); (S.Y.K.); (K.H.K.); (J.P.)
| |
Collapse
|
9
|
MacAskill W, Hoffman B, Johnson MA, Sharpe GR, Rands J, Wotherspoon SE, Gevorkov Y, Kolbe‐Alexander TL, Mills DE. The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men. Physiol Rep 2023; 11:e15794. [PMID: 37604647 PMCID: PMC10442526 DOI: 10.14814/phy2.15794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.
Collapse
Affiliation(s)
- William MacAskill
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- Rural Clinical SchoolGriffith UniversityToowoombaQueenslandAustralia
| | - Ben Hoffman
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
| | - Michael A. Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Graham R. Sharpe
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamshireUK
| | - Joshua Rands
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
| | | | - Yaroslav Gevorkov
- Institute of Vision Systems, Hamburg University of TechnologyHamburgGermany
| | - Tracy L. Kolbe‐Alexander
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Research Unit for Exercise Science and Sports Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Dean E. Mills
- School of Health and Medical SciencesUniversity of Southern QueenslandIpswichQueenslandAustralia
- Respiratory and Exercise Physiology Research Group, School of Health and WellbeingUniversity of Southern QueenslandIpswichQueenslandAustralia
- Centre for Health ResearchInstitute for Resilient Regions, University of Southern QueenslandIpswichQueenslandAustralia
| |
Collapse
|
10
|
Ramos TL, Santos de Sousa Fernandes M, Fabricio de Souza R. Comment on "Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19" Clinical nutrition 2022. Clin Nutr 2023; 42:1235-1236. [PMID: 37150710 PMCID: PMC10122963 DOI: 10.1016/j.clnu.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023]
Affiliation(s)
| | - Matheus Santos de Sousa Fernandes
- Programa de Pós-graduação em Neuropsiquiatria e Ciências do Comportamento, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil.
| | | |
Collapse
|
11
|
Bai ZM, Sun YT, Liang WM, Truskauskaitė I, Yan ME, Li CR, Xiao J, Aihemaiti M, Yuan L, Rukšėnas O. Respiratory Movements at Different Ages. Medicina (Kaunas) 2023; 59:1024. [PMID: 37374227 DOI: 10.3390/medicina59061024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The current study aimed to better understand the changes in respiration that occur with aging in men and women to provide accurate recommendations for breathing exercises to improve health. Materials and Methods: A total of 610 healthy subjects, aged 20 to 59, participated in the study. They performed quiet breathing while wearing two respiration belts (Vernier, Beaverton, OR, USA) at the height of the navel and at the xiphoid process to record abdominal motion (AM) and thoracic motion (TM), respectively. Vital capacity, representing maximal inhalation movement, was measured using a spirometer (Xindonghuateng, Beijing, China). After exclusion, 565 subjects (164 men, aged 41 ± 11; 401 women, aged 42 ± 9) were included for statistical analysis using the Kruskal-Wallis U test and stepwise multiple linear regression. Results: Abdominal motion and its contribution to spontaneous breathing were significantly larger for older men, while the contribution of thoracic motion was smaller for older men. There was no significant difference in thoracic motion between the younger and older men. The differences in women's respiratory movements among various ages were mild and negligible. The contribution of thoracic motion to spontaneous breathing in women was larger than in men for those of older ages (40-59 years), but not for those of younger ages (20-39 years). Additionally, men's and women's vital capacities were less in those of older ages, and the men's were larger than the women's. Conclusions: The findings indicate that men's abdominal contribution to spontaneous breathing increased from 20 to 59 years of age due to increased abdominal motion. Women's respiratory movements did not change much with aging. The maximal inhalation movement became smaller with aging for men and women. Healthcare professionals should focus on improving thoracic mobility when addressing health concerns about aging.
Collapse
Affiliation(s)
- Zhen-Min Bai
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Yi-Ting Sun
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Wen-Ming Liang
- Life Sciences Center, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Inga Truskauskaitė
- Institute of Psychology, Vilnius University, LT-01513 Vilnius, Lithuania
| | - Miao-E Yan
- Department of Traditional Chinese Medicine, Maternal and Children's Healthcare Hospital of Beijing Dongcheng District, Beijing 100007, China
| | - Chun-Ri Li
- College of Acupuncture and Moxibustion, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
- Faculty of Health, Slovak Medical University, 974 05 Banská Bystrica, Slovakia
| | - Jing Xiao
- Department of Physiotherapy and Rehabilitation, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Maiwulamu Aihemaiti
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Lei Yuan
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
| | - Osvaldas Rukšėnas
- Life Sciences Center, Vilnius University, LT-01513 Vilnius, Lithuania
| |
Collapse
|
12
|
Tabor Gray L, McElheny KL, Vasilopoulos T, Wymer J, Smith BK, Plowman EK. Predictors of Peak Expiratory Cough Flow in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2023; 38:719-725. [PMID: 35931882 DOI: 10.1007/s00455-022-10503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Dystussia is prevalent in individuals with amyotrophic lateral sclerosis (ALS), leading to a diminished physiologic capacity to effectively defend the airway. We aimed to identify predictors of peak expiratory cough flow rate in individuals with ALS. One hundred and thirty-four individuals with a confirmed diagnosis of ALS (El-Escorial criteria revised) completed the ALS Functional Rating Scale-Revised (ALSFRS-R) and underwent pulmonary function and cough spirometry testing. Pearson's correlation coefficients and hierarchical multiple regression modeling were conducted to determine predictors of voluntary cough peak expiratory flow rate (p < 0.05). The full model including age, bulbar disease, cough spirometry metrics, and respiratory parameters had a marginal R2 = 0.635, F (7, 126) = 30.241, p < 0.0005, adjusted R2 = 0.61. Maximum expiratory pressure, compression phase, and vital capacity did not contribute and were therefore removed (p < 0.05). The most parsimonious predictive model included age, bulbar disease, peak inspiratory flow rate and duration, peak expiratory rise time, and inspiratory pressure generation with a marginal R2 = 0.543. Although expiratory pressure generation has historically served as the therapeutic target to improve dystussia in ALS, the current dataset highlighted that the inability to quickly and forcefully inspire during the inspiratory phase of voluntary cough places patients at a mechanical disadvantage to generate subsequent high-velocity expiratory airflow to clear the airway. Thus, therapeutic training programs that include both inspiratory and expiratory strength targets may optimize airway clearance capacity in this challenging patient population.
Collapse
Affiliation(s)
- Lauren Tabor Gray
- Center for Collaborative Research, NOVA Southeastern University, Fort Lauderdale, FL, USA.
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.
| | - Kasey L McElheny
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology and Orthopedics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - James Wymer
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Barbara K Smith
- Department of Physical Therapy and Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Emily K Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Speech, Language and Hearing Science Department, University of Florida, Gainesville, FL, USA
| |
Collapse
|
13
|
Abstract
Coronavirus disease 2019 (COVID-19) spread rapidly and became a severe global public health threat. Older adults have a high risk of COVID-19 and its associated mortality. Sarcopenia has emerged as a predictor of poor outcomes in COVID-19 patients, including lengthy hospital stays, mortality, intensive care unit admission, need for invasive mechanical ventilation, and poor rehabilitation outcomes. Chronic inflammation, immune dysfunction, respiratory muscle dysfunction, and swallowing dysfunction may underlie the association between sarcopenia and the poor outcomes of COVID-19 patients. Interleukin 6 receptor blockers (tocilizumab or sarilumab) are recommended for treating patients with severe COVID-19, and their therapeutic effects on sarcopenia are of great interest. This review aimed to analyze the current reports on the association between sarcopenia and COVID-19 and provide an update on the contribution of sarcopenia to the severity and adverse outcomes of COVID-19 and its underlying mechanisms. We also aimed to explore the different screening tools for sarcopenia concurrent with COVID-19, and advocate for early diagnosis and treatment of sarcopenia. Given that the fight against the COVID-19 pandemic may be long-term, further research into understanding the effects of sarcopenia in patients infected with the Omicron variant is necessary.
Collapse
Affiliation(s)
- Yuhan Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Shuwen Tan
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Qihui Yan
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Ying Gao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| |
Collapse
|
14
|
Flor-Rufino C, Barrachina-Igual J, Pérez-Ros P, Pablos-Monzó A, Martínez-Arnau FM. Resistance training of peripheral muscles benefits respiratory parameters in older women with sarcopenia: Randomized controlled trial. Arch Gerontol Geriatr 2023; 104:104799. [PMID: 36070636 DOI: 10.1016/j.archger.2022.104799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THE RESEARCH Ageing entails a decrease in muscle mass and strength, known as sarcopenia, which also affects respiratory function. Physical exercise is an appropriate intervention to treat both conditions. This study aims to assess the efficacy of high-intensity resistance training (HIRT) on clinical parameters of respiratory function and health-related quality of life (QoL) in community-dwelling older women with sarcopenia. METHODS Fifty-one sarcopenic community-dwelling women aged 70 years and older were randomized to either six months of HIRT (n = 24) or control (n = 27). At baseline and post-intervention, participants were assessed for skeletal-muscle sarcopenia; respiratory sarcopenia status; respiratory function: spirometry (FEV1, FVC, FEV1/FVC, and FEF25-75) and expiratory (MEP) and inspiratory (MIP) respiratory muscle strength parameters; and health-related QoL (EURO-QOL 5D-3 L). RESULTS A group-by-time interaction effect for MEP (p = 0.044, Ƞ2=0.108) was observed. CG showed a significant decrease in FEV1 (mean difference [MD] -0.12 L; 95% confidence interval [CI] -0.20, -0.05; p = 0.002); and FVC (MD -0.18 L; 95% CI -0.33, -0.03; p = 0.024) after six months, whereas the HIRT maintained respiratory function without change. Post-intervention, mean EQ-VAS increased in the HIRT and decreased in CG, resulting in a significant between-group difference (mean 73.0 standard deviation [SD] 16.99 vs 61.1 SD 18.2 points, respectively; p = 0.044). Respiratory sarcopenia status was reverted in the HIRT. CONCLUSIONS HIRT increased muscle strength and halted age-related respiratory function decline in sarcopenic old women. A strength intervention could benefit health-related QoL and physical well-being. REGISTERED IN CLINICALTRIALS.GOV: NCT03834558.
Collapse
|
15
|
Mechanick JI, Christofides EA, Marchetti AE, Hoddy KK, Joachim J, Hegazi R, Hamdy O. The syndromic triad of COVID-19, type 2 diabetes, and malnutrition. Front Nutr 2023; 10:1122203. [PMID: 36895277 PMCID: PMC9988958 DOI: 10.3389/fnut.2023.1122203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.
Collapse
Affiliation(s)
- Jeffrey I Mechanick
- The Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Albert E Marchetti
- Medical Education and Research Alliance (Med-ERA, Inc.), New York, NY, United States.,Rutgers New Jersey Medical School, Newark, NJ, United States
| | | | - Jim Joachim
- Internal Medicine and Medical Nutrition, San Diego, CA, United States
| | | | - Osama Hamdy
- Joslin Diabetes Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| |
Collapse
|
16
|
Damanti S, Cristel G, Ramirez GA, Bozzolo EP, Da Prat V, Gobbi A, Centurioni C, Di Gaeta E, Del Prete A, Calabrò MG, Calvi MR, Borghi G, Zangrillo A, De Cobelli F, Landoni G, Tresoldi M. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clin Nutr 2022; 41:2965-2972. [PMID: 34465493 PMCID: PMC8364854 DOI: 10.1016/j.clnu.2021.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia. METHODS This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available. RESULTS A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00-1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95-0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96-0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01-1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β -0.07, 95% C.I. -0.13 - -0.002, p = 0.03), length of hospitalization (Β -1.36, 95% C.I. -2.21 - -0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78-0.99, p = 0.046). CONCLUSIONS Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.
Collapse
Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy,Corresponding author. Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Giulia Cristel
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Valentina Da Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Ettore Di Gaeta
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Del Prete
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| |
Collapse
|
17
|
Parlak S, Beşler MS, Gökhan MB. Association of diaphragm thickness and density measured on chest CT with disease severity in COVID-19 patients. Am J Emerg Med 2022; 61:29-33. [PMID: 36029668 PMCID: PMC9387025 DOI: 10.1016/j.ajem.2022.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction A decrease in muscle mass of the diaphragm could be a significant risk factor for pneumonia. The aim of our study was to evaluate whether diaphragm thickness (DT) and density measured on chest computed tomography (CT) were associated with clinical course and mortality in adult patients with coronavirus disease 2019 (COVID-19) in emergency department admission. Methods We retrospectively analyzed 404 patients with a positive polymerase chain reaction test for COVID-19 and pneumonia findings on chest CT between September 1 and November 1, 2020. Bilateral DT measurements were performed at the level of the celiac artery origin, and the total mean diaphragm thickness (TMDT) was estimated. Hemidiaphragm density was measured at the level of the celiac artery origin. The relationship between demographic characteristics, comorbidities, TMDT, mean hemidiaphragm density (MHD) and clinical outcomes was investigated using the logistic regression analyses. The reliability of the measurement of the two observers was evaluated by intraclass correlation analyses. Results Intraclass correlation analyses demonstrated almost perfect inter-observer agreement for TMDT and substantial agreement for MHD. There was a statistically significant relationship between the presence of a thinner diaphragm and mortality (p < 0.001). Bilateral diaphragm densities were lower in the patients with severe disease and mortality (p < 0.001). The threshold values of TMDT were 3.67 mm and 3.47 mm for the prediction of ICU admission and mortality, respectively. TMDT (odds ratio [OR]: 0.634, 95% confidence interval [CI]: 0.447–0.901), age (OR: 1.053, 95% CI: 1.027–1.081) and MHD (OR: 0.920, 95% CI: 0.883–0.959) were found to be independent predictors for severe disease in the multivariable model. In addition, MHD (OR: 0.883, 95% CI: 0.827–0.942) and age (OR: 1.040, 95% CI: 1.003–1.078) were independent risk factors for mortality. Conclusion Our study demonstrated that a low diaphragm thickness and density measured on chest CT were associated with severe disease in patients with COVID-19 and could be evaluated as poor prognostic markers.
Collapse
Affiliation(s)
- Selçuk Parlak
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | | | | |
Collapse
|
18
|
Nogami E, Miyai N, Zhang Y, Onishi S, Sakaguchi M, Yokoi K, Utusmi M, Arita M. Effects of cigarette smoking on the association between respiratory muscle strength and skeletal muscle mass in middle-aged and older adults: the Wakayama Study. Eur Geriatr Med 2022; 13:805-815. [PMID: 35705784 DOI: 10.1007/s41999-022-00662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to examine whether cumulative smoking exposure affects the association between peak expiratory flow rate (PEFR) and skeletal muscle mass in middle-aged and older adults. METHODS The study participants comprised 832 community-dwelling individuals aged 50-89 years (mean age: 69 years) without chronic obstructive pulmonary disease. Bioelectrical impedance analysis was performed to estimate the skeletal muscle mass of each participant. PEFR was assessed using an electronic spirometer. Cumulative smoking exposure was expressed in pack years, that is a product of the average number of packs of cigarettes smoked per day and smoking duration in years. RESULTS The whole-body skeletal muscle mass progressively reduced with decreasing PEFR levels in both males and females. In the multiple regression analysis, PEFR was found to be significantly associated with skeletal muscle mass, independent of the potential confounding factors. When participants were stratified based on the cumulative smoking exposure, the association between low PEFR and reduced skeletal muscle mass persisted in individuals with non-smoking and light-to-moderate smoking exposure (< 30 pack-years). However, this association was not clearly observed in individuals with heavy smoking exposure (≥ 30 pack-years). CONCLUSION The findings of this study support the notion that PEFR declines with a reduction in systemic skeletal muscle mass due to aging. However, chronic cigarette smoking induces respiratory dysfunction exceeding the expected values by age, and thus a low PEFR level may not be used as a marker of reduced muscle mass in older adults exposed to heavy smoking.
Collapse
Affiliation(s)
- Eriko Nogami
- Graduate School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, P.O. Box 641-0011, Wakayama, Japan
| | - Nobuyuki Miyai
- Graduate School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, P.O. Box 641-0011, Wakayama, Japan.
| | - Yan Zhang
- Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shuhei Onishi
- Graduate School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, P.O. Box 641-0011, Wakayama, Japan
| | - Masato Sakaguchi
- Graduate School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, P.O. Box 641-0011, Wakayama, Japan.,Department of Cardiology, Sumiya Rehabilitation Hospital, Wakayama, Japan
| | - Katsushi Yokoi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| | - Miyoko Utusmi
- Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, Japan
| | - Mikio Arita
- Department of Cardiology, Sumiya Rehabilitation Hospital, Wakayama, Japan
| |
Collapse
|
19
|
Graca FA, Rai M, Hunt LC, Stephan A, Wang YD, Gordon B, Wang R, Quarato G, Xu B, Fan Y, Labelle M, Demontis F. The myokine Fibcd1 is an endogenous determinant of myofiber size and mitigates cancer-induced myofiber atrophy. Nat Commun 2022; 13:2370. [PMID: 35501350 PMCID: PMC9061726 DOI: 10.1038/s41467-022-30120-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2022] [Indexed: 12/19/2022] Open
Abstract
Decline in skeletal muscle cell size (myofiber atrophy) is a key feature of cancer-induced wasting (cachexia). In particular, atrophy of the diaphragm, the major muscle responsible for breathing, is an important determinant of cancer-associated mortality. However, therapeutic options are limited. Here, we have used Drosophila transgenic screening to identify muscle-secreted factors (myokines) that act as paracrine regulators of myofiber growth. Subsequent testing in mouse myotubes revealed that mouse Fibcd1 is an evolutionary-conserved myokine that preserves myofiber size via ERK signaling. Local administration of recombinant Fibcd1 (rFibcd1) ameliorates cachexia-induced myofiber atrophy in the diaphragm of mice bearing patient-derived melanoma xenografts and LLC carcinomas. Moreover, rFibcd1 impedes cachexia-associated transcriptional changes in the diaphragm. Fibcd1-induced signaling appears to be muscle selective because rFibcd1 increases ERK activity in myotubes but not in several cancer cell lines tested. We propose that rFibcd1 may help reinstate myofiber size in the diaphragm of patients with cancer cachexia.
Collapse
Affiliation(s)
- Flavia A Graca
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mamta Rai
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Liam C Hunt
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Anna Stephan
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yong-Dong Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Brittney Gordon
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
- Xenograft Core, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ruishan Wang
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Giovanni Quarato
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yiping Fan
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Myriam Labelle
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Fabio Demontis
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, United States.
- Solid Tumor Program, Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, United States.
| |
Collapse
|
20
|
Martinez-Arnau FM, Buigues C, Fonfría-Vivas R, Cauli O. Respiratory function correlates with fat mass index and blood triglycerides in institutionalized older individuals. Endocr Metab Immune Disord Drug Targets 2022; 22:1029-1039. [PMID: 35352657 DOI: 10.2174/1871530322666220329150813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the relationship between respiratory function measured by spirometry analysis and anthropometric variables (skeletal and fat mass) and nutritional status in the institutionalized elderly, particularly at high risk of adverse outcomes after respiratory infections and malnutrition. DESIGN A multicenter cross-sectional study with quantitative approach among older people institutionalized living in nursing homes. METHODS Respiratory function was assessed by measuring the forced vital capacity, forced expiratory volume in the first second, the ratio between FEV1 and FVC (FEV1/FVC), and peak expiratory flow in percentage by means of spirometric analysis (values of the forced expiratory volume measured during the first second of the forced breath (FEV1) and forced vital capacity (FVC)). Nutritional assessment and anthropometry analysis were done to evaluate under or over nutrition/weight. RESULTS There was a significant (p<0.05) and positive correlation between FEV1 and skeletal muscle mass index, whereas fat mass index correlated significantly (p<0.01) with the FEV1/FVC index. FEV1/FVC values were both significantly (p<0.05) associated with high body mass index and triglyceride levels in blood. The prevalence of individuals with ventilator restrictive pattern (FEV1/FVC>70% with FEV1 and FVC<80%) was 27.6% and 12 individuals (21.1%) receive daily bronchodilators as part of the pharmacological treatment for respiratory disorders. A logistic regression was performed to identify predictors of restrictive respiratory pattern. The following variables were entered into the model: age group, female gender, Charlson comorbidity index, body-mass index (BMI), fat mass index, skeletal muscle mass index, total cholesterol and triglycerides concentration. The model was statistically significant (p < 0.05; R2 = 0.39), correctly classifying 70.0% of cases, with a sensitivity of 89.3% and a specificity of 50.0%. Area under curve was 0.71 (IC95% 0.54-0.88; p=0.023). The highest OR for restrictive respiratory pattern were for BMI (OR=5.09) and triglycerides concentration in blood (>150 mg/dl) (OR=5.59). CONCLUSION The relationship between a restrictive pattern of respiratory function and fat mass which deserves future investigation to manage these parameters as possible modifiable factor of altered respiratory function in overweight institutionalized older individuals.
Collapse
Affiliation(s)
- Francisco Miguel Martinez-Arnau
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
| | - Cristina Buigues
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Rosa Fonfría-Vivas
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Omar Cauli
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| |
Collapse
|
21
|
Pedreira RBS, Fernandes MH, Brito TA, Pinheiro PA, Coqueiro RDS, Carneiro JAO. Are maximum respiratory pressures predictors of sarcopenia in the elderly? J Bras Pneumol 2022; 48:e20210335. [PMID: 35137870 PMCID: PMC8836635 DOI: 10.36416/1806-3756/e20210335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To compare maximum respiratory pressures and spirometric parameters among elderly individuals classified as having no sarcopenia, probable sarcopenia, and confirmed sarcopenia, and to test the ability of these variables to discriminate sarcopenia in a community-dwelling elderly population. Methods: This was a cross-sectional study involving 221 elderly (≥ 60 years of age) individuals of both sexes. Sarcopenia was diagnosed in accordance with the new consensus of the European Working Group on Sarcopenia in Older People. Maximum respiratory pressures and spirometry parameters were assessed. Results: The prevalences of probable sarcopenia and confirmed sarcopenia were 20.4% and 4.1%, respectively. Regardless of the sex, those with confirmed sarcopenia had significantly lower MEP than those with no sarcopenia and probable sarcopenia, whereas only males with confirmed sarcopenia presented with significantly lower MIP than did the other individuals. There was an inverse association of MIP and MEP with sarcopenia, indicating that the decrease by 1 cmH2O in these parameters increases the chance of sarcopenia by 8% and 7%, respectively. Spirometric parameters were not associated with sarcopenia. Cutoff points for MIP and MEP, respectively, were ≤ 46 cmH2O and ≤ 50 cmH2O for elderly women, whereas they were ≤ 63 cmH2O and ≤ 92 cmH2O for elderly men, and both were identified as predictors of sarcopenia (area under the ROC curve > 0.70). Conclusions: Sarcopenia was associated with lower maximum respiratory pressures, but not with spirometric parameters. Maximum respiratory pressures can be used as markers of sarcopenia in a community-dwelling elderly population regardless of the sex.
Collapse
Affiliation(s)
| | | | - Thaís Alves Brito
- . Universidade Estadual do Sudoeste da Bahia - UESB - Jequié (BA) Brasil
| | | | | | | |
Collapse
|
22
|
Kogure E, Ohnuma T, Sugita Y, Hara T. Comparison of respiratory function, physical function, and activities of daily living among community-dwelling patients with respiratory and non-respiratory disease. J Phys Ther Sci 2022; 34:213-217. [PMID: 35291480 PMCID: PMC8918101 DOI: 10.1589/jpts.34.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the differences in respiratory
function, physical function, and Activities of Daily Living (ADL) between respiratory and
non-respiratory patients using community-based home rehabilitation. [Participations and
Methods] Maximum Phonation Time (MPT), upper and lower limb muscle strength, and ADL were
compared in two groups: a respiratory disease group including respiratory patients and
those with respiratory comorbidities, and a non-respiratory disease group. Cutoff values
were determined for items that showed significant differences between groups. [Results]
There were no significant differences between the two groups in assessments other than
MPT. MPT was significantly lower in the respiratory disease group, with an MPT cutoff
value of 10.1 sec and an area under the curve of 0.74. [Conclusion] Use of the MPT cutoff
value may help to determine whether respiratory function is impaired in patients with
respiratory disease.
Collapse
Affiliation(s)
- Eisuke Kogure
- Rehabilitation Progress Center Inc.: 2-11 Hikawa-chou, Itabashi-ku, Tokoy 173-0013, Japan
| | - Takeshi Ohnuma
- Rehabilitation Progress Center Inc.: 2-11 Hikawa-chou, Itabashi-ku, Tokoy 173-0013, Japan
| | - Yuta Sugita
- Nishinasuno General Home Care Center Tochigi, Japan
| | - Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Japan
| |
Collapse
|
23
|
Formenti P, Coppola S, Umbrello M, Froio S, Caccioppola A, De Giorgis V, Galanti V, Lusardi AC, Ferrari E, Noè D, Carnier S, Folli F, Chiumello D. Time course of the Bioelectrical Impedance Vector Analysis and muscular ultrasound in critically ill patients. J Crit Care 2021; 68:89-95. [PMID: 34952476 DOI: 10.1016/j.jcrc.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Several different tools have been developed to integrate the clinical and biochemical nutritional evaluations in critical care patients. Aims of this study were to evaluate the changes in the Bioelectrical Impedance Vector Analysis (BIVA) and ultrasonographic features of the diaphragm (DTee) and rectus femoris (RFCSA) during the first week of ICU stay. MATERIALS AND METHODS Ninety-six adult mechanically ventilated patients enrolled within 24 h after the admission to the ICU (T1). RFCSA and diaphragm end-expiratory thickness were measured, as well as BIVA parameters. Anthropometric data and biochemical parameters were collected. The measurements were repeated on the 3rd (T3) and 7th (T7) days of ICU stay. RESULTS During the study period, the phase angle significantly decreased by 21%, reactance by 27%, and resistance by 11%. Both RFCSA and DTee significantly decreased, while neither were correlated to any BIVA parameter. DTee was considerably higher in survivors vs. non-survivors. CONCLUSIONS Body composition is significantly modified after one week of ICU stay. BIVA may be useful in the definition of hydration state, while it does not seem to track muscle mass. Different temporal trends of specific BIVA and muscle ultrasound parameters were found in patients with high or low severity of illness.
Collapse
Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Michele Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Sara Froio
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessio Caccioppola
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Valentina De Giorgis
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Valentina Galanti
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Andrea Clarissa Lusardi
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Erica Ferrari
- Dipartimento di fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Donatella Noè
- SSD Servizio Dietetico e Nutrizione Clinica- ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy
| | - Simone Carnier
- Endocrinology and Metabolism, Department of Health Science, University of Milan - ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, University of Milan - ASST Santi Paolo e Carlo, Ospedali San Paolo e San Carlo Borromeo, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy; Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
24
|
Morisawa T, Kunieda Y, Koyama S, Suzuki M, Takahashi Y, Takakura T, Kikuchi Y, Matsuda T, Fujino Y, Sawa R, Sakuyama A, Saitoh M, Takahashi T, Fujiwara T. The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults. Int J Environ Res Public Health 2021; 18:13257. [PMID: 34948865 DOI: 10.3390/ijerph182413257] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.
Collapse
|
25
|
Lage VKDS, de Paula FA, Dos Santos JM, Costa HS, da Silva GP, Lima LP, Santos JNV, de Almeida HC, Figueiredo PHS, Bernardo-Filho M, Taiar R, Teixeira AL, Lacerda ACR, Mendonça VA. Are oxidative stress biomarkers and respiratory muscles strength associated with COPD-related sarcopenia in older adults? Exp Gerontol 2021; 157:111630. [PMID: 34813902 DOI: 10.1016/j.exger.2021.111630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often present with sarcopenia, a condition marked by the loss in quality and quantity of muscle mass that can affect the strength of respiratory muscles. COPD and sarcopenia are also independently associated with oxidative stress. This study aimed to investigate whether oxidative stress biomarkers and respiratory muscle strength are associated with sarcopenia in COPD patients. METHODS In a cross-sectional study, 86 elderly subjects, including subjects with and without COPD were assessed for body composition, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and oxidative stress parameters [substances reactive to thiobarbituric acid (TBARS), ferric reducing ability of plasma (FRAP), superoxide dismutase (SOD), and catalase (CAT)]. RESULTS The sample was mainly composed by males (72.1%) and eutrophic subjects. COPD-related sarcopenia was evidenced in 51.1% (22/43) of subjects with COPD. The highest TBARS and CAT, and lower MIP and MEP were associated with a high probability of having COPD-related sarcopenia. In the multivariate analysis, TBARS (OR: 4.89, 95% CI 1.52 to 15.54, p = 0.006), CAT (OR: 1.22, 95% CI 1.03 to 1.45, p = 0.020) and MEP (OR: 0.97, 95% CI 0.95 to 0.99, p = 0.020) were independent determinants of COPD-related sarcopenia. CONCLUSION The increase in oxidative stress-related factors and the reduction of respiratory muscle strength are associated with COPD-related sarcopenia.
Collapse
Affiliation(s)
- Vanessa Kelly da Silva Lage
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Fabiana Angélica de Paula
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Jousielle Márcia Dos Santos
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Henrique Silveira Costa
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Guilherme Pinto da Silva
- Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Liliana Pereira Lima
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Joyce Noelly Vítor Santos
- Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Hellen Cristina de Almeida
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes and Policlínica Américo Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Redha Taiar
- MATIM, Moulin de la Housse, Université de Reims Champagne Ardenne, Reims Cedex 2 51687, France
| | - Antônio Lúcio Teixeira
- Instituto de Ensino e Pesquisa Santa Casa BH, Belo Horizonte, Brazil; McGovern Medical School, UT Health Houston, Houston, USA
| | - Ana Cristina Rodrigues Lacerda
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Vanessa Amaral Mendonça
- Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Sociedade Brasileira de Fisiologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Laboratório de Inflamação e Metabolismo - LIM, CIPq Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
| |
Collapse
|
26
|
Miarka M, Gibiński K, Janik MK, Główczyńska R, Zając K, Pacho R, Raszeja-Wyszomirska J. Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients. Life (Basel) 2021; 11:740. [PMID: 34440484 DOI: 10.3390/life11080740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.
Collapse
|
27
|
Wakefield CJ, Jochum SB, Hejna E, Hamati F, Peterson S, Vines D, Shah P, Balk RA, Hayden DM. Novel application of respiratory muscle index obtained from chest computed tomography to predict postoperative respiratory failure after major non-cardiothoracic surgery. Am J Surg 2021; 222:1029-1033. [PMID: 33941359 DOI: 10.1016/j.amjsurg.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative respiratory failure (PRF) is a serious complication associated with significant morbidity and mortality. We propose a new method to predict PRF by utilizing computed tomography (CT) of the chest to assess degree of respiratory muscle wasting prior to surgery. METHODS Patients who received a chest CT and required invasive mechanical ventilation (MV) after major non-cardiothoracic surgery were included. Exclusion criteria included cardiothoracic surgery. Respiratory muscle index (RMI) was calculated at the T6 vertebra measured on Slice-O-Matic® software. RESULTS Thirty three patients met inclusion with a mean (±SD) age, BMI, and APACHE II score of 62.2 years (±12.1), 28.1 kg/m2 (±7.8), and 14.1 (±4.7). Most patients were female (n = 22 [67%]). Eleven patients (33%) developed PRF with a mean of 6.0 (±10.7) initial ventilation days. There was no difference in baseline demographics between groups. RMI values for the PRF group were significantly lower when compared to the non-PRF group: 22.7 cm2/m2 (±5.3) vs. 28.5 cm2/m2 (±5.9) (p = 0.008). CONCLUSION Presence of respiratory muscle wasting prior to surgery was found to be associated with postoperative respiratory failure.
Collapse
Affiliation(s)
- Connor J Wakefield
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States.
| | - Sarah B Jochum
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Emily Hejna
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Fadi Hamati
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Sarah Peterson
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, United States
| | - David Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, United States
| | - Palmi Shah
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, United States
| | - Robert A Balk
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, United States
| | - Dana M Hayden
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| |
Collapse
|
28
|
Puri S, Panza G, Mateika JH. A comprehensive review of respiratory, autonomic and cardiovascular responses to intermittent hypoxia in humans. Exp Neurol 2021; 341:113709. [PMID: 33781731 PMCID: PMC8527806 DOI: 10.1016/j.expneurol.2021.113709] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 01/08/2023]
Abstract
This review explores forms of respiratory and autonomic plasticity, and associated outcome measures, that are initiated by exposure to intermittent hypoxia. The review focuses primarily on studies that have been completed in humans and primarily explores the impact of mild intermittent hypoxia on outcome measures. Studies that have explored two forms of respiratory plasticity, progressive augmentation of the hypoxic ventilatory response and long-term facilitation of ventilation and upper airway muscle activity, are initially reviewed. The role these forms of plasticity might have in sleep disordered breathing are also explored. Thereafter, the role of intermittent hypoxia in the initiation of autonomic plasticity is reviewed and the role this form of plasticity has in cardiovascular and hemodynamic responses during and following intermittent hypoxia is addressed. The role of these responses in individuals with sleep disordered breathing and spinal cord injury are subsequently addressed. Ultimately an integrated picture of the respiratory, autonomic and cardiovascular responses to intermittent hypoxia is presented. The goal of the integrated picture is to address the types of responses that one might expect in humans exposed to one-time and repeated daily exposure to mild intermittent hypoxia. This form of intermittent hypoxia is highlighted because of its potential therapeutic impact in promoting functional improvement and recovery in several physiological systems.
Collapse
Affiliation(s)
- Shipra Puri
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States of America; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Gino Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States of America; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI 48201, United States of America; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48201, United States of America; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48201, United States of America.
| |
Collapse
|
29
|
Schiaffino S, Albano D, Cozzi A, Messina C, Arioli R, Bnà C, Bruno A, Carbonaro LA, Carriero A, Carriero S, Danna PSC, D'Ascoli E, De Berardinis C, Della Pepa G, Falaschi Z, Gitto S, Malavazos AE, Mauri G, Monfardini L, Paschè A, Rizzati R, Secchi F, Vanzulli A, Tombini V, Vicentin I, Zagaria D, Sardanelli F, Sconfienza LM. CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19. Radiology 2021; 300:E328-E336. [PMID: 33724065 PMCID: PMC7971428 DOI: 10.1148/radiol.2021204141] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Lower muscle mass is a known predictor of unfavorable outcomes, but its prognostic impact on patients with COVID-19 is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in patients with COVID-19. Materials and Methods Clinical or laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. The extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation by paravertebral muscles were measured on axial CT images at the T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation of odds ratios (ORs) with 95% CIs, were used to build four models to predict ICU admission and death, which were tested and compared by using receiver operating characteristic curve analysis. Results A total of 552 patients (364 men and 188 women; median age, 65 years [interquartile range, 54-75 years]) were included. In a CT-based model, lower-than-median T5 paravertebral muscle areas showed the highest ORs for ICU admission (OR, 4.8; 95% CI: 2.7, 8.5; P < .001) and death (OR, 2.3; 95% CI: 1.0, 2.9; P = .03). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle areas still showed the highest ORs for both ICU admission (OR, 4.3; 95%: CI: 2.5, 7.7; P < .001) and death (OR, 2.3; 95% CI: 1.3, 3.7; P = .001). At receiver operating characteristic analysis, the CT-based model and the model including clinical variables showed the same area under the receiver operating characteristic curve (AUC) for ICU admission prediction (AUC, 0.83; P = .38) and were not different in terms of predicting death (AUC, 0.86 vs AUC, 0.87, respectively; P = .28). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT images was independently associated with intensive care unit admission and in-hospital mortality. © RSNA, 2021 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Simone Schiaffino
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Domenico Albano
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Andrea Cozzi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Carmelo Messina
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Roberto Arioli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Claudio Bnà
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Antonio Bruno
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Luca A Carbonaro
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alessandro Carriero
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Serena Carriero
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Pietro S C Danna
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Elisa D'Ascoli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Claudia De Berardinis
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Gianmarco Della Pepa
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Zeno Falaschi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Salvatore Gitto
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alexis E Malavazos
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Giovanni Mauri
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Lorenzo Monfardini
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alessio Paschè
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Roberto Rizzati
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Francesco Secchi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Angelo Vanzulli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Valeria Tombini
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Ilaria Vicentin
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Domenico Zagaria
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Francesco Sardanelli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Luca M Sconfienza
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| |
Collapse
|
30
|
DE Robertis E, Cammarota G. Diaphragmatic ultrasound in COVID-19 patients: you will know it only if you try it! Minerva Anestesiol 2021; 87:394-396. [PMID: 33591155 DOI: 10.23736/s0375-9393.21.15573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Edoardo DE Robertis
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy -
| | - Gianmaria Cammarota
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| |
Collapse
|
31
|
Espino-Gonzalez E, Tickle PG, Benson AP, Kissane RWP, Askew GN, Egginton S, Bowen TS. Abnormal skeletal muscle blood flow, contractile mechanics and fibre morphology in a rat model of obese-HFpEF. J Physiol 2021; 599:981-1001. [PMID: 33347612 PMCID: PMC7898698 DOI: 10.1113/jp280899] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
KEY POINTS Heart failure is characterised by limb and respiratory muscle impairments that limit functional capacity and quality of life. However, compared with heart failure with reduced ejection fraction (HFrEF), skeletal muscle alterations induced by heart failure with preserved ejection fraction (HFpEF) remain poorly explored. Here we report that obese-HFpEF induces multiple skeletal muscle alterations in the rat hindlimb, including impaired muscle mechanics related to shortening velocity, fibre atrophy, capillary loss, and an impaired blood flow response to contractions that implies a perfusive oxygen delivery limitation. We also demonstrate that obese-HFpEF is characterised by diaphragmatic alterations similar to those caused by denervation - atrophy in Type IIb/IIx (fast/glycolytic) fibres and hypertrophy in Type I (slow/oxidative) fibres. These findings extend current knowledge in HFpEF skeletal muscle physiology, potentially underlying exercise intolerance, which may facilitate future therapeutic approaches. ABSTRACT Peripheral skeletal muscle and vascular alterations induced by heart failure with preserved ejection fraction (HFpEF) remain poorly identified, with limited therapeutic targets. This study used a cardiometabolic obese-HFpEF rat model to comprehensively phenotype skeletal muscle mechanics, blood flow, microvasculature and fibre atrophy. Lean (n = 8) and obese-HFpEF (n = 8) ZSF1 rats were compared. Skeletal muscles (soleus and diaphragm) were assessed for in vitro contractility (isometric and isotonic properties) alongside indices of fibre-type cross-sectional area, myosin isoform, and capillarity, and estimated muscle PO2 . In situ extensor digitorum longus (EDL) contractility and femoral blood flow were assessed. HFpEF soleus demonstrated lower absolute maximal force by 22%, fibre atrophy by 24%, a fibre-type shift from I to IIa, and a 17% lower capillary-to-fibre ratio despite increased capillary density (all P < 0.05) with preserved muscle PO2 (P = 0.115) and isometric specific force (P > 0.05). Soleus isotonic properties (shortening velocity and power) were impaired by up to 17 and 22%, respectively (P < 0.05), while the magnitude of the exercise hyperaemia was attenuated by 73% (P = 0.012) in line with higher muscle fatigue by 26% (P = 0.079). Diaphragm alterations (P < 0.05) included Type IIx fibre atrophy despite Type I/IIa fibre hypertrophy, with increased indices of capillarity alongside preserved contractile properties during isometric, isotonic, and cyclical contractions. In conclusion, obese-HFpEF rats demonstrated blunted skeletal muscle blood flow during contractions in parallel to microvascular structural remodelling, fibre atrophy, and isotonic contractile dysfunction in the locomotor muscles. In contrast, diaphragm phenotype remained well preserved. This study identifies numerous muscle-specific impairments that could exacerbate exercise intolerance in obese-HFpEF.
Collapse
Affiliation(s)
- Ever Espino-Gonzalez
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Peter G Tickle
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alan P Benson
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Roger W P Kissane
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, UK
| | - Graham N Askew
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Stuart Egginton
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
32
|
Nagano A, Wakabayashi H, Maeda K, Kokura Y, Miyazaki S, Mori T, Fujiwara D. Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment. J Nutr Health Aging 2021; 25:507-515. [PMID: 33786569 PMCID: PMC7799157 DOI: 10.1007/s12603-021-1587-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 01/31/2023]
Abstract
The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.
Collapse
Affiliation(s)
- A Nagano
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
| | | | | | | | | | | | | |
Collapse
|
33
|
Han JW, Song H, Kim SH. The association between L1 skeletal muscle index derived from routine CT and in-hospital mortality in CAP patients in the ED. Am J Emerg Med 2020; 42:49-54. [PMID: 33450707 DOI: 10.1016/j.ajem.2020.12.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Low muscle mass is associated with an increased mortality risk due to medical comorbidities such as chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease. Computed tomography (CT) has been identified as the gold standard for measuring body composition. We evaluated the relationship between the L1 SMI measured from CT and in-hospital mortality in patients with community-acquired pneumonia (CAP). METHODS From January 2015 to June 2015, 311 patients who were diagnosed with CAP and underwent CT in the ED were retrospectively analyzed. Multivariate binary logistic regression analysis was used to assess independent predictors of in-hospital mortality. All variables with a significance level < 0.1 by univariate analysis were included in a multivariate logistic regression model. The primary outcome was all-cause in-hospital mortality. RESULTS Among the 311 patients, 33 (10.6%) died. We divided the patients into two groups based on the optimal sex-specific cut-off value of the L1 SMI (45 cm2/m2 in males and 40 cm2/m2 in females). A low L1 SMI was present in 90 (28.9%) of the 311 patients. In multivariate analysis, low L1 SMI, diabetes mellitus, albumin and APACHE II score were significantly associated with in-hospital mortality (aOR 3.39, 3.73, 0.09 and 1.10, respectively). CONCLUSION SMI assessment at L1 is achievable in patients with CAP receiving routine chest CT, and the L1 SMI is associated with high in-hospital mortality, more hospitalizations and ventilator application in patients with CAP in the ED. This could help establish an early strategy for critical care of patients with L1 SMI obtained by chest CT for diagnosis in CAP patients in the ED.
Collapse
Affiliation(s)
- Jeong Woo Han
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Song
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
34
|
Yegorova S, Yegorov O, Ferreira LF. RNA-sequencing reveals transcriptional signature of pathological remodeling in the diaphragm of rats after myocardial infarction. Gene 2020; 770:145356. [PMID: 33333219 DOI: 10.1016/j.gene.2020.145356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022]
Abstract
The diaphragm is the main inspiratory muscle, and the chronic phase post-myocardial infarction (MI) is characterized by diaphragm morphological, contractile, and metabolic abnormalities. However, the mechanisms of diaphragm weakness are not fully understood. In the current study, we aimed to identify the transcriptome changes associated with diaphragm abnormalities in the chronic stage MI. We ligated the left coronary artery to cause MI in rats and performed RNA-sequencing (RNA-Seq) in diaphragm samples 16 weeks post-surgery. The sham group underwent thoracotomy and pericardiotomy but no artery ligation. We identified 112 differentially expressed genes (DEGs) out of a total of 9664 genes. Myocardial infarction upregulated and downregulated 42 and 70 genes, respectively. Analysis of DEGs in the framework of skeletal muscle-specific biological networks suggest remodeling in the neuromuscular junction, extracellular matrix, sarcomere, cytoskeleton, and changes in metabolism and iron homeostasis. Overall, the data are consistent with pathological remodeling of the diaphragm and reveal potential biological targets to prevent diaphragm weakness in the chronic stage MI.
Collapse
Affiliation(s)
- Svetlana Yegorova
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA.
| | - Oleg Yegorov
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA.
| | - Leonardo F Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA.
| |
Collapse
|
35
|
Borders JC, Brandimore AE, Troche MS. Variability of Voluntary Cough Airflow in Healthy Adults and Parkinson's Disease. Dysphagia 2021; 36:700-6. [PMID: 32975653 DOI: 10.1007/s00455-020-10190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/14/2020] [Indexed: 01/21/2023]
Abstract
Cough is an important airway protective behavior responsible for ejecting material from the airway to prevent pneumonia, a leading cause of death in older adults and individuals with Parkinson's disease (PD). Variability of motor performance for both spinal and bulbar functions has been documented; however, there are no studies examining variability of cough motor control in PD and healthy controls. The present study examined the effects of age and PD on variability of voluntary cough performance. Twenty-five healthy younger adults (HYA), 26 healthy older adults (HOA), and 16 participants with PD completed three trials of sequential voluntary cough with spirometry. Coefficients of variation were used to examine variability between groups. Increased variability of cough expired volume (p = 0.012) and inspiratory volume (p = 0.006) was appreciated in HOAs compared to HYAs. Participants with PD demonstrated increased variability of cough expired volume (p = 0.029), peak expiratory flow rise time (p = 0.016), and cough volume acceleration (p = 0.034) compared to HOAs. Though participants with PD descriptively demonstrated increased peak expiratory flow rate compared to HOAs, this finding was statistically nonsignificant after adjusting for multiple comparisons (p = 0.072). This study identified that variability in cough airflow increases in healthy aging and Parkinson's disease. These motor control impairments may be attributed to age and disease-related sensorimotor changes in the peripheral and central nervous system. Future research will be necessary to examine the relationship between inconsistent cough motor output, airway invasion, and aspiration pneumonia in PD.
Collapse
|
36
|
Gea J, Ausín P, Martínez-Llorens JM, Barreiro E. Respiratory muscle senescence in ageing and chronic lung diseases. Eur Respir Rev 2020; 29:29/157/200087. [PMID: 32943414 DOI: 10.1183/16000617.0087-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/09/2020] [Indexed: 12/28/2022] Open
Abstract
Ageing is a progressive condition that usually leads to the loss of physiological properties. This process is also present in respiratory muscles, which are affected by both senescent changes occurring in the whole organism and those that are more specific for muscles. The mechanisms of the latter changes include oxidative stress, decrease in neurotrophic factors and DNA abnormalities. Ageing normally coexists with comorbidities, including respiratory diseases, which further deteriorate the structure and function of respiratory muscles. In this context, changes intrinsic to ageing become enhanced by more specific factors such as the impairment in lung mechanics and gas exchange, exacerbations and hypoxia. Hypoxia in particular has a direct effect on muscles, mainly through the expression of inducible factors (hypoxic-inducible factor), and can result in oxidative stress and changes in DNA, decrease in mitochondrial biogenesis and defects in the tissue repair mechanisms. Intense exercise can also cause damage in respiratory muscles of elderly respiratory patients, but this can be followed by tissue repair and remodelling. However, ageing interferes with muscle repair by tampering with the function of satellite cells, mainly due to oxidative stress, DNA damage and epigenetic mechanisms. In addition to the normal process of ageing, stress-induced premature senescence can also occur, involving changes in the expression of multiple genes but without modifications in telomere length.
Collapse
Affiliation(s)
- Joaquim Gea
- Dept of Respiratory Medicine, Hospital del Mar - IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona Respiratory Network, Barcelona, Spain
| | - Pilar Ausín
- Dept of Respiratory Medicine, Hospital del Mar - IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona Respiratory Network, Barcelona, Spain
| | - Juana Ma Martínez-Llorens
- Dept of Respiratory Medicine, Hospital del Mar - IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona Respiratory Network, Barcelona, Spain
| | - Esther Barreiro
- Dept of Respiratory Medicine, Hospital del Mar - IMIM, DCEXS, Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona Respiratory Network, Barcelona, Spain
| |
Collapse
|
37
|
Martínez-Arnau FM, Buigues C, Fonfría-Vivas R, Cauli O. Respiratory Muscle Strengths and Their Association with Lean Mass and Handgrip Strengths in Older Institutionalized Individuals. J Clin Med 2020; 9:E2727. [PMID: 32847002 PMCID: PMC7563242 DOI: 10.3390/jcm9092727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022] Open
Abstract
The study of reduced respiratory muscle strengths in relation to the loss of muscular function associated with ageing is of great interest in the study of sarcopenia in older institutionalized individuals. The present study assesses the association between respiratory muscle parameters and skeletal mass content and strength, and analyzes associations with blood cell counts and biochemical parameters related to protein, lipid, glucose and ion profiles. A multicenter cross-sectional study was performed among patients institutionalized in nursing homes. The respiratory muscle function was evaluated by peak expiratory flow, maximal respiratory pressures and spirometry parameters, and skeletal mass function and lean mass content with handgrip strength, walking speed and bioimpedance, respectively. The prevalence of reduced respiratory muscle strength in the sample ranged from 37.9% to 80.7%. Peak expiratory flow significantly (p < 0.05) correlated to handgrip strength and gait speed, as well as maximal inspiratory pressure (p < 0.01). Maximal expiratory pressure significantly (p < 0.01) correlated to handgrip strength. No correlation was obtained with muscle mass in any of parameters related to reduced respiratory muscle strength. The most significant associations within the blood biochemical parameters were observed for some protein and lipid biomarkers e.g., glutamate-oxaloacetate transaminase (GOT), urea, triglycerides and cholesterol. Respiratory function muscle parameters, peak expiratory flow and maximal respiratory pressures were correlated with reduced strength and functional impairment but not with lean mass content. We identified for the first time a relationship between peak expiratory flow (PEF) values and GOT and urea concentrations in blood which deserves future investigations in order to manage these parameters as a possible biomarkers of reduced respiratory muscle strength.
Collapse
Affiliation(s)
- Francisco Miguel Martínez-Arnau
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain; (C.B.); (R.F.-V.)
| | - Cristina Buigues
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain; (C.B.); (R.F.-V.)
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - Rosa Fonfría-Vivas
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain; (C.B.); (R.F.-V.)
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain; (C.B.); (R.F.-V.)
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| |
Collapse
|
38
|
Petermann-Rocha F, Ho FK, Welsh P, Mackay D, Brown R, Gill JMR, Sattar N, Gray SR, Pell JP, Celis-Morales CA. Physical capability markers used to define sarcopenia and their association with cardiovascular and respiratory outcomes and all-cause mortality: A prospective study from UK Biobank. Maturitas 2020; 138:69-75. [PMID: 32471663 DOI: 10.1016/j.maturitas.2020.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION It is unclear what combinations of physical capability markers used to define sarcopenia have the strongest associations with health outcomes. AIM To compare the associations between different combinations of physical capability markers of sarcopenia with cardiovascular and respiratory outcomes and all-cause mortality. STUDY DESIGN 469,830 UK Biobank participants were included in this prospective study. Four groups were derived based on combinations of three physical capability markers used to define sarcopenia or severe sarcopenia: gait speed, grip strength and muscle mass. Outcomes studied were all-cause mortality, as well as incidence and mortality from cardiovascular disease (CVD), respiratory disease and chronic obstructive pulmonary disease (COPD). RESULTS All combinations of physical capability markers used to define sarcopenia or severe sarcopenia identified individuals at increased risk of respiratory disease and all-cause mortality. However, the definition most strongly associated with a wide range of adverse health outcomes was the combination of slow gait speed plus low muscle mass, followed by severe sarcopenia, and the combination of slow gait speed plus low grip strength. The current definition of sarcopenia (low grip strength plus low muscle mass) had the weakest associations with all-cause (HR: 1.35 [95% CI: 1.07 to 1.71]) and respiratory mortality (HR: 1.88 [95% CI: 1.15 to 3.10]), as well as respiratory disease (HR: 1.38 [95% CI: 1.11 to 1.73]) and COPD incidence (HR: 2.08 [95% CI: 1.14 to 3.79]). CONCLUSIONS Associations of sarcopenia with adverse outcomes were strongest when sarcopenia was defined as slow gait speed plus low muscle mass, followed by severe sarcopenia, suggesting that this combination of physical capability markers should be still considered in the diagnosis of sarcopenia.
Collapse
Affiliation(s)
- Fanny Petermann-Rocha
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rosemary Brown
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos A Celis-Morales
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; Centre of Exercise Physiology Research (CIFE), Universidad Mayor, Chile; Research Group in Education, Physical Activity and Health (GEEAFyS), Universidad Católica del Maule, Talca, Chile.
| |
Collapse
|
39
|
Kim KW, Cho HJ, Khaliq SA, Son KH, Yoon MS. Comparative Analyses of mTOR/Akt and Muscle Atrophy-Related Signaling in Aged Respiratory and Gastrocnemius Muscles. Int J Mol Sci 2020; 21:ijms21082862. [PMID: 32326050 PMCID: PMC7215274 DOI: 10.3390/ijms21082862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia is the degenerative loss of skeletal muscle mass and function associated with aging and occurs in the absence of any underlying disease or condition. A comparison of the age-related molecular signaling signatures of different muscles has not previously been reported. In this study, we compared the age-related molecular signaling signatures of the intercostal muscles, the diaphragm, and the gastrocnemii using 6-month and 20-month-old rats. The phosphorylation of Akt, ribosomal S6, and Forkhead box protein O1 (FoxO1) in diaphragms significantly increased with age, but remained unchanged in the intercostal and gastrocnemius muscles. In addition, ubiquitin-proteasome degradation, characterized by the levels of MuRF1 and Atrogin-1, did not change with age in all rat muscles. Interestingly, an increase in LC3BII and p62 levels marked substantial blockage of autophagy in aged gastrocnemii but not in aged respiratory muscles. These changes in LC3BII and p62 levels were also associated with a decrease in markers of mitochondrial quality control. Therefore, our results suggest that the age-related signaling events in respiratory muscles differ from those in the gastrocnemii, most likely to preserve the vital functions played by the respiratory muscles.
Collapse
Affiliation(s)
- Kun Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, Korea;
| | - Hye-Jeong Cho
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 21999, Korea; (H.-J.C.); (S.A.K.)
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Korea
| | - Sana Abdul Khaliq
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 21999, Korea; (H.-J.C.); (S.A.K.)
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Korea
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, Korea;
- Correspondence: (K.H.S.); (M.-S.Y.); Tel.: +82-32-460-3666 (K.H.S.); +82-32-899-6067 (M.-S.Y.)
| | - Mee-Sup Yoon
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 21999, Korea; (H.-J.C.); (S.A.K.)
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Korea
- Correspondence: (K.H.S.); (M.-S.Y.); Tel.: +82-32-460-3666 (K.H.S.); +82-32-899-6067 (M.-S.Y.)
| |
Collapse
|
40
|
Martínez-Arnau FM, Fonfría-Vivas R, Buigues C, Castillo Y, Molina P, Hoogland AJ, van Doesburg F, Pruimboom L, Fernández-Garrido J, Cauli O. Effects of Leucine Administration in Sarcopenia: A Randomized and Placebo-controlled Clinical Trial. Nutrients 2020; 12:E932. [PMID: 32230954 DOI: 10.3390/nu12040932] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022] Open
Abstract
Treating sarcopenia in older individuals remains a challenge, and nutritional interventions present promising approaches in individuals that perform limited physical exercise. We assessed the efficacy of leucine administration to evaluate whether the regular intake of this essential amino acid can improve muscle mass, muscle strength and functional performance and respiratory muscle function in institutionalized older individuals. The study was a placebo-controlled, randomized, double-blind design in fifty participants aged 65 and over (ClinicalTrials.gov identifier NCT03831399). The participants were randomized to a parallel group intervention of 13 weeks’ duration with a daily intake of leucine (6 g/day) or placebo (lactose, 6 g/day). The primary outcome was to study the effect on sarcopenia and respiratory muscle function. The secondary outcomes were changes in the geriatric evaluation scales, such as cognitive function, functional impairment and nutritional assessments. We also evaluated whether leucine administration alters blood analytical parameters and inflammatory markers. Administration of leucine was well-tolerated and significantly improves some criteria of sarcopenia in elderly individuals such as functional performance measured by walking time (p = 0.011), and improved lean mass index. For respiratory muscle function, the leucine-treated group improved significantly (p = 0.026) in maximum static expiratory force compared to the placebo. No significant effects on functional impairment, cognitive function or nutritional assessment, inflammatory cytokines IL-6, TNF-alpha were observed after leucine administration compared to the placebo. The use of l-leucine supplementation can have some beneficial effects on sarcopenia and could be considered for the treatment of sarcopenia in older individuals.
Collapse
|
41
|
Azzolino D, Arosio B, Marzetti E, Calvani R, Cesari M. Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People. Nutrients 2020; 12:E444. [PMID: 32050677 PMCID: PMC7071235 DOI: 10.3390/nu12020444] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/22/2022] Open
Abstract
Fatigue is an often-neglected symptom but frequently complained of by older people, leading to the inability to continue functioning at a normal level of activity. Fatigue is frequently associated with disease conditions and impacts health status and quality of life. Yet, fatigue cannot generally be completely explained as a consequence of a single disease or pathogenetic mechanism. Indeed, fatigue mirrors the exhaustion of the physiological reserves of an older individual. Despite its clinical relevance, fatigue is typically underestimated by healthcare professionals, mainly because reduced stamina is considered to be an unavoidable corollary of aging. The incomplete knowledge of pathophysiological mechanisms of fatigue and the lack of a gold standard tool for its assessment contribute to the poor appreciation of fatigue in clinical practice. Inadequate nutrition is invoked as one of the mechanisms underlying fatigue. Modifications in food intake and body composition changes seem to influence the perception of fatigue, probably through the mechanisms of inflammation and/or mitochondrial dysfunction. Here, we present an overview on the mechanisms that may mediate fatigue levels in old age, with a special focus on nutrition.
Collapse
Affiliation(s)
- Domenico Azzolino
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (E.M.); (R.C.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy; (E.M.); (R.C.)
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| |
Collapse
|
42
|
Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Rittayamai N, Harhay MO, Reid WD, Tomlinson G, Rozenberg D, McClelland W, Riegler S, Slutsky AS, Brochard L, Ferguson ND, Goligher EC. Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults. JAMA Netw Open 2020; 3:e1921520. [PMID: 32074293 DOI: 10.1001/jamanetworkopen.2019.21520] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Low diaphragm muscle mass at the outset of mechanical ventilation may predispose critically ill patients to poor clinical outcomes. OBJECTIVE To determine whether lower baseline diaphragm thickness (Tdi) is associated with delayed liberation from mechanical ventilation and complications of acute respiratory failure (reintubation, tracheostomy, prolonged ventilation >14 days, or death in the hospital). DESIGN, SETTING, AND PARTICIPANTS Secondary analysis (July 2018 to June 2019) of a prospective cohort study (data collected May 2013 to January 2016). Participants were 193 critically ill adult patients receiving invasive mechanical ventilation at 3 intensive care units in Toronto, Ontario, Canada. EXPOSURES Diaphragm thickness was measured by ultrasonography within 36 hours of intubation and then daily. Patients were classified as having low or high diaphragm muscle mass according to the median baseline Tdi. MAIN OUTCOMES AND MEASURES The primary outcome was time to liberation from ventilation accounting for the competing risk of death and adjusting for age, body mass index, severity of illness, sepsis, change in Tdi during ventilation, baseline comorbidity, and study center. Secondary outcomes included in-hospital death and complications of acute respiratory failure. RESULTS A total of 193 patients were available for analysis; the mean (SD) age was 60 (15) years, 73 (38%) were female, and the median (interquartile range) Sequential Organ Failure Assessment score was 10 (8-13). Median (interquartile range) baseline Tdi was 2.3 (2.0-2.7) mm. In the primary prespecified analysis, baseline Tdi of 2.3 mm or less was associated with delayed liberation from mechanical ventilation (adjusted hazard ratio for liberation, 0.51; 95% CI, 0.36-0.74). Lower baseline Tdi was associated a higher risk of complications of acute respiratory failure (adjusted odds ratio, 1.77; 95% CI, 1.20-2.61 per 0.5-mm decrement) and prolonged weaning (adjusted odds ratio, 2.30; 95% CI, 1.42-3.74). Lower baseline Tdi was also associated with a higher risk of in-hospital death (adjusted odds ratio, 1.47; 95% CI, 1.00-2.16 per 0.5-mm decrement), particularly after discharge from the intensive care unit (adjusted odds ratio, 2.68; 95% CI, 1.35-5.32 per 0.5-mm decrement). CONCLUSIONS AND RELEVANCE In this study, low baseline diaphragm muscle mass in critically ill patients was associated with prolonged mechanical ventilation, complications of acute respiratory failure, and an increased risk of death in the hospital.
Collapse
Affiliation(s)
- Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Dres
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- AP-HP, Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Nuttapol Rittayamai
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Siriraj Hospital, Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Michael O Harhay
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - W Darlene Reid
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - William McClelland
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Stephen Riegler
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Nucci RAB, de Souza RR, Suemoto CK, Busse AL, Maifrino LBM, Anaruma CA, Pasqualucci CA, Jacob-Filho W. Diaphragm muscle structure in the elderly: Findings from an autopsy study. Acta Histochem 2020; 122:151487. [PMID: 31843226 DOI: 10.1016/j.acthis.2019.151487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023]
Abstract
Sarcopenia is characterized as aging-related weakness and atrophy, which decreases the diaphragm force generating capacity leading to a decrease of expulsive non-ventilatory motor behaviors, which are critical for airway clearance. Thus, this study aimed to analyze the histopathology of the diaphragm in postmortem samples. Thirty individuals were included. Diaphragm samples were stained with hematoxylin and eosin for histopathological analysis. Picrosirius stain was used to highlight the collagen fibers. We observed a positive association between advancing age and histopathological findings in the diaphragm structure. We suggest that age is a key factor in increasing diaphragm muscle histopathology. However, further clinicopathological studies are needed to confirm our findings.
Collapse
|
44
|
Abstract
The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Bruno Morabito
- Physical Medicine and Rehabilitation, School of Osteopathic Centre for Research and Studies, Milan, ITA
| | - Marta Simonelli
- Integrative/Complimentary Medicine, French-Italian School of Osteopathy, Pisa, ITA
| |
Collapse
|
45
|
Buchard B, Boirie Y, Cassagnes L, Lamblin G, Coilly A, Abergel A. Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice? Nutrients 2020; 12:E186. [PMID: 31936597 PMCID: PMC7020005 DOI: 10.3390/nu12010186] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is a common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver diseases. It has a major impact on both morbi-mortality before and after liver transplantation. Being now integrated in the definition of malnutrition and recognized as a new entity in the international classification of diseases, physicians have taken great interest in sarcopenia. Its negative consequences on the fate of patients with cirrhosis are well-demonstrated. The concept of frailty has recently been enlarged to chronic liver diseases as symptoms of impaired global physical functioning. In this article, we will discuss the definitions of malnutrition and emphasize its links with sarcopenia and frailty. We will show the relevance of frailty and sarcopenia in the course of liver diseases. The emerging role of muscle depletion on the cardiorespiratory system will also be highlighted. The importance of body composition will be demonstrated and the main tools reviewed. Finally, we adapted the definition of malnutrition to patients with cirrhosis based on the assessment of sarcopenia together with reduced food intakes.
Collapse
Affiliation(s)
- Benjamin Buchard
- Service de Médecine Digestive et Hépatobiliaire, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (G.L.); (A.A.)
| | - Yves Boirie
- Service de Nutrition Clinique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
- Unité de Nutrition Humaine, UMR 1019 INRA-Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lucie Cassagnes
- Service de radiologie adultes, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
- Institut Pascal, Thérapies guidées par l’image, UMR 6602 CNRS-SIGMA-Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Géraldine Lamblin
- Service de Médecine Digestive et Hépatobiliaire, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (G.L.); (A.A.)
| | - A. Coilly
- Centre Hépatobiliaire, AP-HP Hôpital Paul-Brousse, UMR 1193 INSERM-Université Paris Sud, 94800 Villejuif, France;
| | - Armando Abergel
- Service de Médecine Digestive et Hépatobiliaire, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (G.L.); (A.A.)
- Institut Pascal, Thérapies guidées par l’image, UMR 6602 CNRS-SIGMA-Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| |
Collapse
|
46
|
Vang P, Vasdev A, Zhan W, Gransee HM, Sieck GC, Mantilla CB. Diaphragm muscle sarcopenia into very old age in mice. Physiol Rep 2020; 8:e14305. [PMID: 31908152 PMCID: PMC6944709 DOI: 10.14814/phy2.14305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia is the age-related decline of skeletal muscle mass and function. Diaphragm muscle (DIAm) sarcopenia may contribute to respiratory complications, a common cause of morbidity and mortality in the elderly. From 6 to 24 months (mo) of age, representing ~100% and ~80% survival in C57BL/6 × 129 male and female mice, there is a significant reduction in DIAm force generation (~30%) and cross-sectional area (CSA) of type IIx and/or IIb muscle fibers (~30%), impacting the ability to perform high force, non-ventilatory behaviors. To date, there is little information available regarding DIAm sarcopenia in very old age groups. The present study examined DIAm sarcopenia in C57BL/6 × 129 male and female mice at 24, 27, and 30 mo, representing ~80%, ~60%, and ~30% survival, respectively. We hypothesized that survival into older ages will show no further worsening of DIAm sarcopenia and functional impairment in 30 mo mice compared to 24 or 27 mo C57BL/6 × 129 mice. Measurements included resting ventilation, transdiaphragmatic pressure (Pdi) generation across a range of motor behaviors, muscle fiber CSA, and proportion of type-identified DIAm fibers. Maximum Pdi and resting ventilation did not change into very old age (from 24 to 30 mo). Type IIx and/or IIb fiber CSA and proportions did not change into very old age. The results of the study support a critical threshold for the reduction in DIAm force and Pdi such that survival into very old age is not associated with evidence of progression of DIAm sarcopenia or impairment in ventilation.
Collapse
Affiliation(s)
- Pangdra Vang
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesota
| | - Amrit Vasdev
- Department of Anesthesiology & Perioperative MedicineMayo ClinicRochesterMinnesota
| | - Wen‐Zhi Zhan
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesota
| | - Heather M. Gransee
- Department of Anesthesiology & Perioperative MedicineMayo ClinicRochesterMinnesota
| | - Gary C. Sieck
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesota
- Department of Anesthesiology & Perioperative MedicineMayo ClinicRochesterMinnesota
| | - Carlos B. Mantilla
- Department of Physiology & Biomedical EngineeringMayo ClinicRochesterMinnesota
- Department of Anesthesiology & Perioperative MedicineMayo ClinicRochesterMinnesota
| |
Collapse
|
47
|
Ohara DG, Pegorari MS, Oliveira Dos Santos NL, de Fátima Ribeiro Silva C, Oliveira MSR, Matos AP, Jamami M. Cross-Sectional Study on the Association between Pulmonary Function and Sarcopenia in Brazilian Community-Dwelling Elderly from the Amazon Region. J Nutr Health Aging 2020; 24:181-187. [PMID: 32003408 DOI: 10.1007/s12603-019-1290-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the obtained and expected values of pulmonary function variables between sarcopenic and non-sarcopenic elderly; verify the association between the pulmonary function and the indicators and diagnosis of sarcopenia; and establish cut-off points for pulmonary function variables to predict sarcopenia. DESIGN Cross-sectional study. LOCATION Macapá, Brazil. PARTICIPANTS community-dwelling elderly ≥ 60 years old (n=383), both sexes. MEASURES Were evaluated according to variables of pulmonary function (spirometry) and sarcopenia, according to the EWGSOP consensus. The association between pulmonary function and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. RESULTS The prevalence of sarcopenia was 12.53% (n = 48). Sarcopenic individuals had significantly lower mean values for FVC, FEV1, FEF25-75% and PEF than non-sarcopenic. After adjustment, spirometric variables were inversely associated with sarcopenia (the increase by one unit of liter in FVC, FEV1 and FEF25-75% decreased the probability of sarcopenia by 59%, 67% and 39%, respectively), and the majority of these variables with the muscular strength indicator. Cut-off points, for elderly men and women, were discriminant criteria for the presence of sarcopenia: FVC (≤2.52 L and ≤1.82 L), FEV1 (≤2.1 L and ≤1.39 L), PEF (≤3.45 L/s and ≤2.93 L/s) and FEF5-75% (≤1.97 L/s and ≤1.74 L/s). CONCLUSIONS There was loss of pulmonary function in sarcopenic elderly patients and an inverse association with the diagnosis of sarcopenia and its indicators. Cut-off points of pulmonary function variables can be used as a useful tool to discriminate sarcopenia.
Collapse
Affiliation(s)
- D G Ohara
- Maycon Sousa Pegorari, Federal University of Amapá, Department of biological and health sciences, Physical Therapy Course. Address: Road Juscelino Kubitschek, Km - 02, Jardim Marco Zero, Macapá - AP, CEP 68903-419 - Phone number: (+55 96) 4009-2944 E-mail:
| | | | | | | | | | | | | |
Collapse
|
48
|
Okazaki T, Ebihara S, Mori T, Izumi S, Ebihara T. Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int 2019; 20:7-13. [DOI: 10.1111/ggi.13839] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Tatsuma Okazaki
- Department of Physical Medicine and RehabilitationTohoku University graduate School of Medicine Sendai Japan
| | - Satoru Ebihara
- Department of Rehabilitation MedicineToho University Graduate School of Medicine Tokyo Japan
| | - Takashi Mori
- Department of Physical Medicine and RehabilitationTohoku University graduate School of Medicine Sendai Japan
- Department of Oral and Maxillofacial SurgeryDysphagia Rehabilitation Center, Southern Tohoku General Hospital Koriyama Japan
| | - Shinichi Izumi
- Department of Physical Medicine and RehabilitationTohoku University graduate School of Medicine Sendai Japan
- Department of Physical Medicine and RehabilitationTohoku University Graduate School of Biomedical Engineering Sendai Japan
| | - Takae Ebihara
- Department of Geriatric MedicineKyorin University School of Medicine Tokyo Japan
| |
Collapse
|
49
|
Bhanji RA, Montano-Loza AJ, Watt KD. Sarcopenia in Cirrhosis: Looking Beyond the Skeletal Muscle Loss to See the Systemic Disease. Hepatology 2019; 70:2193-2203. [PMID: 31034656 DOI: 10.1002/hep.30686] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
Sarcopenia is a common complication of cirrhosis and is defined as a progressive and generalized loss of skeletal muscle mass, strength, and function. Sarcopenia is associated with poor prognosis and increased mortality. How sarcopenia and muscle wasting relate to such poor outcomes requires looking beyond the overt muscle loss and at this entity as a systemic disease that affects muscles of vital organs including cardiac and respiratory muscles. This review explores the pathophysiological pathways and mechanisms that culminate in poor outcomes associated with sarcopenia. This provides a launching pad to identify potential targets for therapeutic intervention and optimization to improve patient outcomes.
Collapse
Affiliation(s)
- Rahima A Bhanji
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.,Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Aldo J Montano-Loza
- Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
50
|
Khurram OU, Fogarty MJ, Sarrafian TL, Bhatt A, Mantilla CB, Sieck GC. Impact of aging on diaphragm muscle function in male and female Fischer 344 rats. Physiol Rep 2019; 6:e13786. [PMID: 29981218 PMCID: PMC6035336 DOI: 10.14814/phy2.13786] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022] Open
Abstract
The diaphragm muscle (DIAm) is the primary inspiratory muscle in mammals and is active during ventilatory behaviors, but it is also involved in higher-force behaviors such as those necessary for clearing the airway. Our laboratory has previously reported DIAm sarcopenia in rats and mice characterized by DIAm atrophy and a reduction in maximum specific force at 24 months of age. In Fischer 344 rats, these studies were limited to male animals, although in other studies, we noted a more rapid increase in body mass from 6 to 24 months of age in females (~140%) compared to males (~110%). This difference in body weight gain suggests a possible sex difference in the manifestation of sarcopenia. In mice, we previously measured transdiaphragmatic pressure (Pdi) to evaluate in vivo DIAm force generation across a range of motor behaviors, but found no evidence of sex-related differences. The purpose of this study in Fischer 344 rats was to evaluate if there are sex-related differences in DIAm sarcopenia, and if such differences translate to a functional impact on Pdi generation across motor behaviors and maximal Pdi (Pdimax ) elicited by bilateral phrenic nerve stimulation. In both males and females, DIAm sarcopenia was apparent in 24-month-old rats with a ~30% reduction in both maximum specific force and the cross-sectional area of type IIx and/or IIb fibers. Importantly, in both males and females, Pdi generated during ventilatory behaviors was unimpaired by sarcopenia, even during more forceful ventilatory efforts induced via airway occlusion. Although ventilatory behaviors were preserved with aging, there was a ~20% reduction in Pdimax , which likely impairs the ability of the DIAm to generate higher-force expulsive airway clearance behaviors necessary to maintain airway patency.
Collapse
Affiliation(s)
- Obaid U Khurram
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Tiffany L Sarrafian
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Arjun Bhatt
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Carlos B Mantilla
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gary C Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|