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Background The bone mineral density (BMD) did not increase significantly after the normalization of serum thyroid hormone levels. Studies on the effect of muscle mass on BMD in patients with Graves’ disease are scarce. This study aimed to determine the association of decreased muscle mass with reduced bone mineral density in patients with Graves’ disease. Methods A total of 758 patients with Graves’ at diagnosis (mean age 41.2 years) were enrolled for a cross-sectional study; of these, 287 patients were enrolled for a cohort study with a median follow-up of 24 months. Meanwhile, 1164 age- and sex-matched healthy controls participants were recruited. All participants underwent dual-energy x-ray absorptiometry and muscle mass index (ASMI) measurements. The changes in ASMI and BMD were calculated from the measurements made at a gap of 2 years. Results Compared with healthy controls participants, the BMD was still significantly lower after normalizing serum thyroid hormone levels (1.131 ± 0.268 vs. 1.07 ± 0.133, p

Cancer-induced skeletal muscle mass loss is a critical characteristic of cachexia. While physical inactivity and systemic metabolic dysfunction can precede cachexia development, how these early-onset disruptions are related to cachexia's eventual severity is not well understood. The well-established Lewis Lung Carcinoma (LLC) pre-clinical cachexia model exhibits a varying degree of cachexia. Therefore, we examined if the early onset of physical inactivity and metabolic dysfunction were associated with accelerated cachexia development in LLC tumor-bearing mice. Methods Male C57BL/6 J (12 wks. age) were injected with 1 x 106 LLC cells or PBS subcutaneously in the right flank, and tissue was collected 26-28 days post cell injection. Tumor volume was measured every 5 days throughout the study to calculate the tumor growth rate. Fifteen days post tumor inoculation, a subset of PBS (n = 11) and LLC (n = 16) mice were individually housed in metabolic CLAMs cages for 5 days. Results LLC mice exhibited greater body weight loss (-5.1%), decreased muscle mass (-7%), decreased fat mass (-22%), and increased plasma IL-6 (212%) compared to PBS mice. Before the onset of cachexia, total cage activity was decreased in tumor-bearing mice. Cage activity was negatively associated to tumor mass and positively associated to hindlimb muscle mass. Additionally, LLC mice had greater lipid oxidation than PBS mice. Conclusion LLC mice exhibit early-onset physical inactivity and altered systemic lipid oxidation, which are associated with the eventual development of cachexia.

Aim: Sarcopenia is a skeletal muscle disorder associated with decreased muscle mass and functional capacity. The SARC-F questionnaire facilitates sarcopenia screening in elderly patients. The present study investigates the applicability of the SARC-F questionnaire to sarcopenia screening in patients scheduled for gastrointestinal (GI) cancer surgery and its relationship with postoperative outcomes. Methods: This cross-sectional study was carried out with elderly patients scheduled for GI cancer surgery. The study included 71 patients consisting of 47 males and 24 females. The risk of sarcopenia was assessed by the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling (SARC-F) questionnaire. Patients with a SARC-F score ≥4 were considered to be at risk of sarcopenia. The demographic data, nutritional status and comorbidity data of the patients were recorded. Statistical analysis was conducted to assess postoperative complications in those patients at risk of sarcopenia. Results: The mean age of 71 study patients was 72.6 ± 5.6 years. There were 15 (21.1%) patients with a SARC-F score ≥ 4. The postoperative complication rate was 60% in patients with a SARC-F score ≥ 4 in comparison with 28.5% of those with a SARC-F score < 4, and the difference was statistically significant (p=0.024). The SARC-F score ≥ 4 group also had a longer hospital stay (p Conclusion: We believe that the SARC-F questionnaire has a place in sarcopenia screening in patients scheduled for GI surgery, and it is possible to predict postoperative adverse outcomes.

A 14-year-old male adolescent patient with Prader–Willi syndrome (PWS) with maternal disomy 15 was reported with rectal prolapse as only the second patient in the literature. With predisposing risk factors present for rectal damage and prolapse in this syndrome, the incidence must be higher and therefore underreported. These risk factors include skin and rectal picking, self-stimulation, altered pain sensation, decreased muscle mass, strength and physical activity with hypotonia, and gastrointestinal (GI) disturbances. Pertinent literature was reviewed and analyzed that focused on clinical features and behavior seen in PWS as underrecognized risk factors for developing rectal damage and prolapse. An illustrative case is presented as the second patient reported with PWS and a prolapsed rectum. A discussion of predisposing behavioral and clinical risk factors is presented including for self-stimulation, rectal picking, chronic constipation, decreased gut motility, reduced water intake, and a restricted diet. Although a paucity of cases do exist, physical, behavioral, and GI findings common in PWS may contribute to rectal prolapse requiring better awareness and proactive surveillance, management, and treatment protocols for patients affected with this rare obesity-related genetic disorder.

Introduction Periodontitis is a chronic inflammatory disease affecting the periodontium, ultimately leading to looseness and/or loss of teeth. Sarcopenia refers to age-related reduction in muscle mass and strength. Similar to periodontitis, chronic low-grade inflammation is thought to play a key role in its development. In addition, both increase in prevalence with advancing age. Despite known associations with other diseases involving a dysregulated inflammatory response, for example rheumatoid arthritis,, the relationship between periodontitis and sarcopenia, and whether they could be driven by similar processes, remains uncertain. The aim of this study was to explore the association between periodontitis and sarcopenia. Methods Observational study of 2040 adult volunteers [age 67.18 (12.17)] enrolled in the TwinsUK cohort study. Presence of tooth mobility and number of teeth lost were used to assess periodontal health. A binary variable was created to define periodontitis. Measurements of muscle strength, muscle quality/quantity and physical performance were used to assess sarcopenia. A categorical variable was created according to the European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, to define sarcopenia (1: probable; 2: positive; 3: severe). Generalised linear mixed model analysis used on complete cases and age-matched (n = 1,288) samples to ascertain associations between periodontitis and sarcopenia. Results No significant association was found between periodontitis and sarcopenia in both the complete cases analysis and age-matched analysis. Results were consistent when analysis was adjusted for potential confounders including body mass index, frailty index, Mini Mental State Examination smoking, nutritional status and educational level. Conclusions This study found no significant association between periodontitis and sarcopenia in a cohort of 2040 adults. Although both periodontitis and sarcopenia have been linked to a dysregulated immune response and demonstrate an increase in prevalence with increasing age, our work is inconclusive due to the plethora of possible aetiopathogenetic pathways.

Introduction: Duchenne muscular dystrophy is a severe, X-linked disease characterized by decreased muscle mass and function in children. Genetic and biochemical research over the years has led to t...

There are well-documented physiologic changes that occur in the human body during the aging process, such as decreased body fat, decreased muscle mass, cellular senescence, changes in skin pH, decreased metabolism, decreased immune function, vascular changes, altered tissue perfusion, nutritional status changes, and poor hydration. These changes affect skin integrity and wound healing, and raise the risk of pressure-related skin injury. This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults.

Older adults with hyperkyphosis might have a high risk of falls since their whole body center of mass may shift to the boundary of the base of support. Body composition changes, such as low bone mineral content (BMC), decreased muscle mass, high body mass index (BMI), and increased fat mass are common in older adults with hyperkyphosis. This study aimed to investigate the relationship between body composition and balance performance using a biomechanical analysis in older adults with hyperkyphosis. Thirty older adults with hyperkyphosis were recruited. BMC, muscle mass, BMI, and fat mass were measured for body composition. Balance performances were determined with walking, quiet standing, and forward reach. Gait speed, step length, center of mass–center of pressure inclination angle of heel strike (Inc-HS) and toe off (Inc-TO) during walking, center of mass–center of pressure inclination angle during quiet standing (Inc-QS), and reaching distance were calculated. BMC had a moderately positive correlation with gait speed (r = 0.48, p

Introduction Involutional changes that occur in skeletal muscle are a feature that characterizes the aging process. In women, age-related decreases in muscle mass and function of skeletal muscles occur more rapidly with the onset of menopause. Progressive muscle dysfunction has been directly linked with an increased probability of falls, fractures, disability and mortality. Aim of the study To assess the relationship between the risk of falls and parameters of skeletal muscle assessment in a group of postmenopausal women together with the identification of patients with sarcopenia. Material and methods This study was carried among 122 women over 60 years of age. Patients had their muscular system tested with the emphasis on the sarcopenia diagnosis using: Total Body Composition, handgrip and physical performance tests. Patients also underwent a questionnaire survey assessing occurrence of falls. Results The analysis showed an over 2-fold increase (OR 2.4; 95% CI, 1.02-5.56) in risk of falls in a year among subjects with decreased muscle mass. No such correlation was noted with parameters such as falls in the last 12 months and decrease of muscle strength as well as physical performance. Sarcopenia is more likely to be diagnosed with European Working Group on Sarcopenia in Older People (EWGSOP1) criteria than EWGSOP2 (updated in 2018) (18% vs. 4.1% respectively). The increased risk of falls has not been proven in women with sarcopenia. Conclusions The decrease of muscle mass is significantly correlated with the risk of falls in the last year in postmenopausal women. Impact of sarcopenia on the risk of falls depends on diagnostic criteria.

Background/aim A bioimpedance analysis (BIA) can indicate an overhydrated state as the extracellular water/total body water (ECW/TBW) value. This study aimed to assess the clinical significance of this value in patients with chronic liver diseases (CLDs). Patients and methods A total of 552 CLD patients who received a liver biopsy and underwent anthropometric assessment and BIA-based body composition analysis were enrolled. The association of the ECW/TBW value with the liver fibrosis and nutritional status was assessed. The relationship between the ECW/TBW value and the prognosis of cirrhotic patients (N=209) was also evaluated. Results The ECW/TBW value increased as liver fibrosis progressed and was also related to decreased muscle mass/sarcopenia. The presence of overhydration was associated with a poor prognosis of cirrhotic patients. Conclusion An increased ECW/TBW value was associated with progressive liver fibrosis and malnutrition and related to the prognosis of cirrhotic patients.

Individuals with PWS require marked caloric restriction and daily exercise to prevent morbid obesity. Lower energy expenditure, hypotonia, decreased muscle mass, and cognitive impairment make exercise challenging for this population. Exercise guidelines include resistance training as an important component. Myokine responses to resistance exercise may mediate beneficial metabolic effects. We aimed to determine if young PWS adults can perform a resistance exercise program and to measure myokine responses in PWS versus age- and BMI-matched controls. Each group included 11 participants (7M/4F). Ages and BMI for PWS and controls were 30.7 ± 4.6 versus 30.1 ± 4.3 years and 28.3 ± 4.3 versus 28.2 ± 4.2 kg/m2 , respectively. Glucose, creatine kinase (CK), lactate, and myokines were measured before, after, 30, and 60 min after completing eight resistance exercises. Myokines were assayed using a multiplex myokine panel (Merck Millipore). CK was lower in PWS versus controls (62 ± 16 vs.322 ± 100 U/L, p < .04). Peak lactate was 3.7 ± 0.7 in PWS versus 7.3 ± 0.7 mmol/Lin controls (p < .001). The increase in interleukin-6 was similar in PWS and controls (41 ± 16% and 35 ± 10%, respectively). Pre- and post-exercise levels of the six myokines assayed showed no consistent differences between the PWS and control participants. PWS young adults are capable of performing resistance/strength-building exercise. The lower CK and peak lactate levels in PWS may reflect decreased muscle mass in this population. Further studies are needed to determine optimal exercise regimens and assess the role of myokines incontributing to the metabolic phenotype of PWS.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Northern Ireland Chest Heart and Stroke Background/Introduction: Cardiac cachexia (CC) is a multifactorial wasting syndrome, resulting in significant weight loss and reduction in muscle mass. This is reflected in a detrimental effect on the patients’ physical condition, quality of life and increases the patient’s risk of premature death. Nonetheless, cardiac cachexia remains frequently unrecognised in clinical practice and therefore understudied. Purpose To determine the prevalence and effect of cardiac cachexia in 200 patients with advanced heart failure (NYHA class III-IV) living in Northern Ireland. Methods A mixed methods cross sectional study of patients recruited from a regional heart failure centre. A total of 200 patients with NYHA class III-IV heart failure were consented, enrolled and detailed data collected from their records. Anthropometric measures were taken (i.e. measures of lean muscle mass and fat tissue) and each individual completed three validated questionnaires - EQ-5D-5L (quality of life), FACIT-Fatigue and FAACT (various wellbeing subscales). Results This population was predominately male (65.5%), with an average age of 74.4 years. Of the 200 NYHA class III-IV patients recruited, 30 were identified as cachectic (15%) Physically, cachectic patients were approximately 25 kg lighter than non-cachectic patients (p Conclusions This is the first prevalence study of cardiac cachexia within Northern Ireland. The 15% prevalence rate shows that the syndrome is relatively common in the advanced heart failure population. Cardiac Cachexia has severe physical consequences, attributed to an individual’s weight loss in both fat and muscle tissue. Such changes may explain the subsequent decrease in mobility and the ability of these patients to conduct their ‘usual activities’. Increased fatigue, reduced physical wellbeing and issues with diet and appetite only intensify these dire physical effects. It is hoped that these results will highlight the impact of this syndrome and promote targeted interventions.

There is emerging evidence that decreased muscle mass and cardiorespiratory fitness (CRF) are associated with increased risk of cancer-related mortality. This paper aimed to present recommendations to prescribe effective and safe exercise protocols to minimize losses, maintain or even improve muscle mass, strength, and CRF of the cancer patients who are undergoing or beyond treatment during the COVID-19 era. Overall, we recommend performing exercises with bodyweight, elastic bands, or suspension bands to voluntary interruption (i.e., interrupt the exercise set voluntarily, according to their perception of fatigue, before concentric muscular failure) to maintain or increase muscle strength and mass and CRF during COVID-19 physical distancing. Additionally, rest intervals between sets and exercises (i.e., long or short) should favor maintaining exercise intensities between 50 and 80% of maxHR and/or RPE of 12. In an exercise program with these characteristics, the progression of the stimulus must be carried out by increasing exercise complexity, number of sets, and weekly frequency. With feasible exercises attainable anywhere, modulating only the work-to-rest ratio and using voluntary interruption, it is possible to prescribe exercise for a wide range of patients with cancer as well as training goals. Exercise must be encouraged; however, exercise professionals must be aware of the patient’s health condition even at a physical distance to provide a safe and efficient exercise program. Exercise professionals should adjust the exercise prescription throughout home confinement whenever necessary, keeping in mind that minimal exercise stimuli are beneficial to patients in poor physical condition.

A decline in the body’s motor functions has been linked to decreased muscle mass and function in the oral cavity and throat; however, aging of the junctions of the muscles and bones has also been identified as an associated factor. Basic and clinical studies on the muscles, tendons and bones, each considered independently, have been published. In recent years, however, research has focused on muscle attachment as the muscle–tendon–bone complex from various perspectives, and there is a growing body of knowledge on SRY-box9 (Sox9) and Mohawk(Mkx), which has been identified as a common controlling factor and a key element. Myostatin, a factor that inhibits muscle growth, has been identified as a potential key element in the mechanisms of lifetime structural maintenance of the muscle–tendon–bone complex. Findings in recent studies have also uncovered aspects of the mechanisms of motor organ complex morphostasis in the superaged society of today and will lay the groundwork for treatments to prevent motor function decline in older adults.

Vitamin D is an important prohormone largely derived from sunlight exposure on the skin. In many older people, vitamin D levels have been found to be insufficient or frankly deficient. Alterations in body composition associated with ageing, such as decreased muscle mass and increased adipose tissue, may also decrease vitamin D levels. Low vitamin D levels are associated with an increased risk of falls and fractures and the conditions of frailty and sarcopenia, but confounding with decreased outdoor exposure from a large range of concomitant diseases partly explains these findings. The benefits of vitamin D supplementation found in randomised trials have largely been confined to frail and disabled older people. There is some evidence that bolus vitamin D supplements that achieve supraphysiological levels may increase the risk of falls.

Sarcopenia is a disease of old age characterized by decreased muscle mass and strength. Branched-chain amino acids (BCAAs) promote muscle mass synthesis and increase muscle strength. We aimed to develop a dietary amino acid database and to examine the association between BCAA intake and handgrip strength in Korean older adults. Data from the Korea National Health and Nutrition Examination Survey 2014–2018 were used. Overall, 4852 participants aged ≥65 years were included in the study. Demographic, lifestyle, and health data were obtained through interviews and questionnaires. The 24-h recall method was used to assess dietary intake. An amino acid database was established using the 9th revision of the Korean Standard Food Composition Table. The mean handgrip strength was estimated from triplicate measurements obtained using the dominant hand. Multivariable linear regression analysis was performed to assess the association between BCAA intake and handgrip strength. Grains greatly contributed to amino acid intake, however, a significant negative association was observed between handgrip strength and increased BCAA intake through grains. In the fully adjusted model, leucine intake and handgrip strength showed a positive association. Thus, consuming BCAAs (especially leucine) via a variety of food sources can help maintain muscle health in older people.

The age-dependent survival impact of body mass index (BMI) remains to be fully addressed in patients with gastric carcinoma (GC). We investigated the prognostic impacts of BMI in elderly (≥70 years) and non-elderly patients undergoing surgery for GC.In total, 1168 GC patients were retrospectively reviewed. Patients were stratified into 3 groups according to BMI; low (20), medium (20-25) and high (25). The effects of BMI on overall survival (OS) and cancer-specific survival (CSS) were assessed using univariate and multivariate Cox hazards models.There were 242 (20.7%), 685 (58.7%) and 241 (20.6%) patients in the low-, medium- and high-BMI groups, respectively. The number of patients with high BMI but decreased muscle mass was extremely small (n = 13, 1.1%). Patients in the low-BMI group exhibited significantly poorer OS than those in the high- and medium-BMI group (P 0.001). Notably, BMI classification significantly demarcated OS and CSS curves (both P 0.001) in non-elderly patients, while did not in elderly patients (OS; P = 0.07, CSS; P = 0.54). Furthermore, the survival discriminability by BMI was greater in pStage II/III disease (P = 0.006) than in pStage I disease (P = 0.047). Multivariable analysis focusing on patients with pStage II/III disease showed low BMI to be independently associated with poor OS and CSS only in the non-elderly population.BMI-based evaluation was useful for predicting survival and oncological outcomes in non-elderly but not in elderly GC patients, especially in those with advanced GC.

Background Age-related muscle mass loss is one of the main risk factors for osteoporosis and fractures among older people. Thus, prevention of muscle mass loss in older people is an important issue. We examined ethnic group-related differences in body composition and grip strength among older people living in the same area. Methods We measured body composition and grip strength among local Thai older people living in Chiang Mai Province, as well as in Japanese older people who emigrated to Chiang Mai Province in their retirement. A self-reported questionnaire regarding socio-demographic status was also administered. Measurement items were averaged and compared by sex and ethnic group. Questionnaire items were also categorized by sex and ethnic group. Results A total of 119 older people participated, including 47 Japanese participants (26 men, 21 women) and 72 Thai participants (16 men, 56 women). The average age of Japanese participants was 71.1 years (standard deviation: 4.89), and the average age of Thai participants was 68.8 years (standard deviation: 5.61). Significant differences between ethnic groups were found in percentage of body fat in women (Japanese average: 32.9% vs. Thai average: 37.6%, p Conclusions Our preliminary results suggest that Thai older people, particularly men, are weaker than Japanese older people. Decreased muscle mass is directly responsible for functional impairment, involving loss of strength, increased likelihood of falls, and loss of autonomy. Preventing muscle weakness among older people is important. In future studies, we plan to analyze and clarify the differences between Thai and Japanese older people to identify effective methods to prevent muscle mass decreases. Key messages There were significant differences in average % body fat between older Japanese and Thai women. There were significant differences in average SMI and grip strength between older Japanese and Thai men.

The decline of skeletal muscle mass and strength that leads to sarcopenia is a pathology that might represent an emergency healthcare issue in future years. Decreased muscle mass is also a condition that mainly affects master athletes involved in endurance physical activities. Skeletal muscles respond to exercise by reshaping the biochemical, morphological, and physiological state of myofibrils. Adaptive responses involve the activation of intracellular signaling pathways and genetic reprogramming, causing alterations in contractile properties, metabolic status, and muscle mass. One of the mechanisms leading to sarcopenia is an increase in reactive oxygen and nitrogen species levels and a reduction in enzymatic antioxidant protection. The present review shows the recent experimental models of sarcopenia that explore molecular mechanisms. Furthermore, the clinical aspect of sport sarcopenia will be highlighted, and new strategies based on nutritional supplements, which may contribute to reducing indices of oxidative stress by reinforcing natural endogenous protection, will be suggested.

Background and Aims One of the complications of hemodialysis therapy (HD) is the development of protein-energy wasting (PEW), which is an independent predictor of morbidity and mortality in this cohort of patients. The prevalence of PEW in hemodialysis patients in different regions of the world varies from 15% to 75% but has not been practically studied in the Russian Federation. To assess the prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation. Method 645 hemodialysis patients were examined in 9 hemodialysis centers in 5 regions of the European part of the Russian Federation. Among the patients there were 345 women and 300 men, the average age was 56.8 ± 12.8 years. The duration of hemodialysis therapy was 8.4 ± 5.3 years. The diagnosis of PEW was established in accordance with the criteria: biochemical criteria (serum albumin < 3.8 g per 100 ml; serum prealbumin (transthyretin) < 30 mg per 100 ml; serum cholesterol < 100 mg per 100 ml); low body weight, reduced total body fat, or weight loss; a decrease in muscle mass; and low protein or energy intakes. The level of blood albumin was determined using the BCG method (bromocresol green). Estimation of protein and calorie intake was performed using 3-day food diaries filled out by patients. Results Insufficient protein intake according to the International Society of Renal Nutrition and Metabolism (ISRNM) recommendations was observed in 5.5 % of patients, calories in 4.1 %, combined deficiency in protein and calorie intake in 2.7% of patients. The prevalence of PEW was 51.2 %. The relationship between age and gender was not identified. The lowest prevalence of PEW is observed in patients with a hemodialysis therapy experience of fewer than 5 years (25,4 %) and gradually increasing by 2.5 times in patients with survival rates on HD for more than 10 years (χ2 = 22,580 р = 0.0001). Conclusion The prevalence of protein-energy wasting in hemodialysis patients in the European region of the Russian Federation is 51,2 %.

Sarcopenia is a pathologic status characterized by impaired muscle strength or function accompanying decreased muscle mass. It results in increased vulnerability to chronic diseases. Despite growing clinical concerns about sarcopenia in an aging society, there are few validated biomarkers for age-related sarcopenia. We tested the potential of growth differentiation factor-15 (GDF-15) as a biomarker for sarcopenia in mice and humans across wide age ranges. We used four groups of mice (6, 10, 14, and 18 months old) to explore the association between GDF-15 levels and age, muscle mass, and endurance capacity. Among those four groups, 6- and 18-month-old mice were exposed to 8 weeks of treadmill exercise. The GDF-15 levels were measured in serum and muscle at baseline and after exercise intervention. The body composition was assessed using animal dual-energy X-ray absorptiometry (DXA). GDF-15 levels in tissue and serum increased with age in these mice. The serum levels of GDF-15 had a strong negative correlation with both muscle weight and exercise endurance capacity. Expression of GDF-15 in muscle also had a negative trend with muscle weight and endurance capacity. The muscle expression of GDF-15 was significantly attenuated after 8 weeks of exercise compared with the group without exercise, particularly in older mice. GDF-15 levels were also related to functional capacity and showed responses to therapeutic exercise intervention in this model. We also measured serum GDF-15 levels and muscle mass using DXA in healthy human adults (19 men and 18 women). As in mice, serum levels of GDF-15 were correlated positively with age, but negatively with muscle mass in these subjects. These findings support the potential of GDF-15 as a biomarker for age-related sarcopenia.

Sarcopenia is an important prognostic factor in patients with gastrointestinal and chronic liver diseases. Computed tomography and bioelectrical impedance analysis are the gold standards for measuring skeletal muscle mass for the diagnosis of decreased muscle mass, but there are some institutions where BIA and CT cannot be carried out. We evaluated the utility of simplified methods for measuring muscle mass; the psoas muscle mass index (PMI) method, simple PMI method, and arm muscle area (AMA) method. This retrospective study included 331 patients with gastrointestinal diseases and 81 patients with chronic liver diseases who were admitted from June 2018 to December 2019 at Municipal Hospital of Kofu. The skeletal muscle mass was measured using the PMI via the volume analyzer SYNAPSE VINCENT ver3.0, simple PMI based on CT imaging, and AMA method. Positive correlations were found between muscle mass measured by PMI and simple PMI, PMI and AMA, and simple PMI and AMA in patients with gastrointestinal diseases (correlation coefficients = 0.76, 0.57, 0.47, respectively, p

La sarcopenia es un síndrome frecuente en los ancianos, caracterizado por una pérdida gradual, marcada y generalizada de masa muscular esquelética, relacionada con el envejecimiento, que se evidencia en la disminución de fuerza y agilidad, la cual puede generar discapacidad física que a su vez aumenta el grado de dependencia del paciente, disminuyendo así su calidad de vida y aumentando su mortalidad. El Grupo Europeo de Trabajo sobre la Sarcopenia en Personas de Edad Avanzada (EWGSOP, por sus iniciales en inglés) emplea para el diagnóstico de sarcopenia la presencia de los siguientes criterios: masa muscular disminuida y una función muscular deficiente que es determinada por la fuerza o rendimiento del paciente, este diagnóstico se confirma con los criterios que son: 1. Masa muscular baja, 2. Menor fuerza muscular, 3. Menor rendimiento físico. El manejo actual de la sarcopenia emplea un tratamiento no farmacológico que se centra en el cambio de los estilos de vida como son aumentar la actividad física y mejorar la nutrición y, en el tratamiento farmacológico que tiene como objetivo recuperar la funcionalidad, la movilidad y la masa muscular de los pacientes.

Sarcopaenia, or decreased muscle mass, has been the subject of a large quantity of recent literature in both medical and surgical disciplines. It has been shown, as outlined below, to be of great prognostic importance, and also may be used in certain circumstances to guide treatment. The greatest volume of research into this topic is in oncological surgical populations, in whom the prevalence of sarcopaenia has been shown to be high. However it is being increasingly studied in other patient groups. Interest in using sarcopaenia as an objective and potentially modifiable marker of frailty is increasing, especially with regards to pre-operative risk stratification and amelioration. In this review we consider the current literature regarding the cause and effect of sarcopaenia, the methods by which it may be identified and the potential ways in which it may be treated, in the interest of improving outcomes for surgical patients.

Background The SarQoL® is a recently developed quality of life questionnaire specific to sarcopenia. Aim To compare the quality of life (QoL) of subjects identified as sarcopenic with that of non-sarcopenic subjects when using six different operational definitions of sarcopenia. Methods Participants of the SarcoPhAge study (Belgium) completed the SarQoL®. Among the six definitions used, two were based on low lean mass alone (Baumgartner, Delmonico), and four required both low muscle mass and decreased performance (Cruz-Jentoft, Studenski, Fielding, Morley). Physical assessments included measurements of muscle mass with dual energy X-ray absorptiometry, muscle strength with a handheld dynamometer and gait speed over a 4-m distance. Results A total of 387 subjects completed the SarQoL®. Prevalence of sarcopenia varied widely across the different definitions. Using the SarQoL®, a lower QoL was found for sarcopenic subjects compared to non-sarcopenic subjects when using the definitions of Cruz-Jentoft (56.3 ± 13.4 vs 68.0 ± 15.2, p

Sarcopenia is defined as the loss of muscle mass or function and has been associated with increased morbidity and mortality in a variety of diseased populations. Sarcopenia results from a higher rate of muscle protein degradation compared to protein synthesis and is an important marker of metabolic status related to nutrition and physical activity. The diagnosis of sarcopenia is accomplished by clinical assessment demonstrating decreased muscle function and radiographic confirmation of decreased muscle mass, via dual X-ray absorptiometry, bioelectric impedance or cross-sectional imaging with CT or MRI. However, normative data for skeletal muscle mass are lacking, especially for children and young adults. Additionally, studies of skeletal muscle mass by cross-sectional imaging in children are scarce. Here, we review the concept of sarcopenia with an emphasis on its relevance in the pediatric population.

Sarcopenia is characterized by decreased muscle mass and muscular function related to aging and is a risk factor for geriatric illnesses. There is a need for physical activity programs appropriate for older men as most existing studies have focused on women. We aimed to develop and validate the effects of a customized physical activity program for male older adults with sarcopenia in South Korea. A non-equivalent control group pre-test and post-test design was used. The experimental group was provided with group education sessions and a customized physical activity program with individual intervention for 12 weeks. The control group was advised to continue their usual lifestyle and provided with education about sarcopenia, guidelines concerning physical activities, posters, and video clips after experiment completion. The groups differed significantly in self-efficacy, insulin-like growth factor-1, lower extremity endurance, and flexibility post-intervention. The customized physical activity program for male older adults with sarcopenia effectively improved participants’ health-related outcomes. The physical activity program developed in this study was effective in improving participants’ self-efficacy, insulin-like growth factor-1, and elasticity, and in alleviating decreases in lower limb endurance. Thus, it is necessary to systematically support such physical activity programs to help older adults address their sarcopenia.

Background Sarcopenic obesity, the dual condition of decreased muscle mass with increased fat mass, can affect morbidity, mortality, and quality of life in adult cancer survivors. Objectives The purpose of this project was to determine the effects of the use of an educational toolbox on advanced practice nurses' (APNs') confidence in identifying and managing adult cancer survivors at risk for sarcopenic obesity. Methods APNs in an outpatient practice who care for adult cancer survivors received an educational toolbox with strategies to identify and manage adult cancer survivors at risk for sarcopenic obesity. Findings APNs reported being more confident in their ability to identify adult patients with cancer at risk for sarcopenic obesity and in their ability to manage these patients compared to prior to the intervention. Educational resources provided an effective tool for identifying and managing patients at risk for sarcopenic obesity.

Malnutrition is frequently observed in oncology. The consequences on patient survival, chemotherapy toxicities and quality of life need to be identified and treated appropriately. A set of tools are available that enable clinicians to diagnose and detect malnutrition. Each tool must consider three items: the patient's current nutritional status, reduced food intake and the characteristics of the underlying disease. The parameters and thresholds used to detect malnutrition differ according to the objective pursued. It can be economic, increasing the reimbursement of hospital stays, it can help define prognostic risk groups or its purpose can be to initiate nutritional treatment. Recent data support the assessment of parameters such as inflammatory markers, decreased muscle mass (i.e. sarcopenia) whose diagnosis is associated with a worse outcome and the quantification of food intake with simplified methods. The benefit for the patient of detecting malnutrition will be the initiation of a nutritional treatment when its efficacy has been demonstrated. A case in point is the nutritional support provided to malnourished patients before surgery with benefits in terms of mortality and morbidity and in certain head and neck cancer situations where nutritional support is systematically implemented. It is probably relevant to detect and initiate treatment early in order to promote muscle anabolism.

The purpose of this study was to investigate a means by which to reflect muscle mass using chest computed tomography (CT). A cross-sectional study was conducted with patients aged &ge, 65 years having abdominal and chest CT scans. The formula to predict third lumbar vertebra (L3) cross-sectional area (CSA) of the muscles from the erector muscles of the spine at the twelfth thoracic vertebra (Th12) level slice on CT was created using the five-fold cross-validation method. Correlation between predicted L3 CSA and measured L3 CSA of the muscles was assessed by intraclass correlation coefficients (ICC) and correlation coefficients (r) in the data of the development, and predictability was examined with accuracy and F-values in the validation study. The development study included 161 patients. The developed formula was as follows: &minus, 1006.38 + 16.29 &times, age + 1161.80 &times, sex (if female, 0, if male, 1) + 55.91 &times, body weight + 2.22 &times, CSA of the erector muscles at Th12. The formula demonstrated strong concordance and correlation (ICC = 0.849 [0.800&ndash, 0.887] and r = 0.858 [0.811&ndash, 0.894]). The validation study included 34 patients. The accuracy and F-value between predicted CSA and measured CSA were high (accuracy = 0.889&ndash, 0.944, F-value = 0.931&ndash, 0.968). We developed a formula predicting CSA at L3 using Th12 CT slice. This formula could be used to assess decreased muscle mass even with chest CT alone.

Background Sarcopenia, characterized by a decline of skeletal muscle plus low muscle strength and/or physical performance, has emerged to be an important prognostic factor for advanced cancer patients. Sarcopenia is diagnosed if there is decreased muscle mass and either decreased muscle function or physical activity. The diagnostic tools for evaluating muscle mass in cancer patients was using muscle index derived from abdominal CT scan. However, the practicability of using CT scan for screening decreased muscle mass has been questioned. Until know there is limited data diagnostic value of Bio-impedance analysis (BIA) in cancer patients. The aim of this study is to know the correlation between BIA and abdominal CT scan to diagnose decreased muscle mass in cancer patients. Methods This cross-sectional study included adult cancer patients who underwent abdominal CT scans in purpose for diagnostic. BIA was performed in the same day when CT-scan was performed. CT-scans was analyzed using special software. BIA was performed using standing-posture 2-electrode BIA device BC-418 (BIA, Tanita Corp, Tokyo, Japan). Height adjusted appendicular skeletal muscle mass (ASM) was calculated from BIA. Height adjusted skeletal muscle Index (SMI) was performed from a single cross-sectional CT image (slice) at third lumbar (L3) for abdominal skeletal muscle area. We calculated Pearson’s r correlation coefficient between two parameters. Results A total of 39 patients were included. Twenty-eight (71.8%) patients were female. The mean of age was 51.18 +13.83 years old. Several type of cancer such as breast, lung, gastrointestinal and genitourinary cancer were included. Eleven (28.2%) patients were in advanced stage. Mean of height adjusted BIA was 6.60 + 0.98 kg/m2. Mean of height adjusted muscle mass was 42.25 + 7.57 cm2/m2. BIA and CT-derived muscle were moderately correlated (r = 0.72, p Conclusions This study showed that BIA- and CT-derived muscle mass was moderately correlated in adult cancer patients. Further research is needed to confirm this result. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Objective: To validate calf circumference as a technology for assessing muscle mass in the elderly. Method: Cross-sectional study with 132 elderly people from Goiânia, Goiás, Brazil. Decreased muscle mass was determined by the skeletal muscle mass index (IME) using Dual Energy X-Ray Absortometry (DEXA). The cutoff circumferences (CC) cutoff points to indicate muscle mass decrease were estimated by ROC curve, sensitivity, specificity and accuracy. Results: The most accurate cut-off points for detecting decreased muscle mass in the elderly were 34 cm for men (sensitivity: 71.5%, specificity: 77.4%) and 33 cm for women (sensitivity: 80.0%; specificity: 84.6%). Conclusion: CC can be used as a measure for early identification of muscle mass decrease in routine evaluations of the elderly in primary care. RESUMEN Objetivo: Validar la circunferencia de la pantorrilla como tecnología de evaluación de masa muscular en mayores. Método: Estudio transversal con 132 mayores de Goiânia, Goiás, Brasil. La disminución de masa muscular fue determinada por el índice de masa muscular esquelética (IME) por medio de la Absorciometría por Rayos-X de Dupla Energía (DEXA). Los puntos de corte de la medida de circunferencia de la pantorrilla (CP) para indicar disminución de masa muscular fueron estimados por medio de curva ROC, sensibilidad, especificidad y precisión. Resultados: Los puntos de corte con mejor precisión para detección de masa muscular disminuida en mayores fue 34 cm para hombres (sensibilidad: 71,5%; especificidad: 77,4%) y 33 cm en mujeres (sensibilidad: 80,0%; especificidad: 84,6%). Conclusión: La CP puede ser utilizada como medida para identificación precoz de disminución de masa muscular en evaluaciones de rutina de mayores en la atención primaria. RESUMO Objetivo: Validar a circunferência da panturrilha como tecnologia de avaliação de massa muscular em idosos. Método: Estudo transversal com 132 idosos de Goiânia, Goiás, Brasil. A diminuição de massa muscular foi determinada pelo índice de massa muscular esquelética (IME) por meio da Absorciometria por Raios-X de Dupla Energia (DEXA). Os pontos de corte da medida de circunferência da panturrilha (CP) para indicar diminuição de massa muscular foram estimados por meio de curva ROC, sensibilidade, especificidade e acurácia. Resultados: Os pontos de corte com melhor acurácia para detecção de massa muscular diminuída em idosos foi 34 cm para homens (sensibilidade: 71,5%; especificidade: 77,4%) e 33 cm em mulheres (sensibilidade: 80,0%; especificidade: 84,6%). Conclusão: A CP pode ser utilizada como medida para identificação precoce de diminuição de massa muscular em avaliações de rotina de idosos na atenção primária.

We hypothesized that severity of coronary artery calcification (CAC), emphysema, muscle mass, and fat attenuation can help predict mortality in patients with lung cancer participating in the National Lung Screening Trial (NLST). Following regulatory approval from the Cancer Data Access System (CDAS), all patients diagnosed with lung cancer at the time of the screening study were identified. These subjects were classified into two groups: survivors and nonsurvivors at the conclusion of the NLST trial. These groups were matched based on their age, gender, body mass index (BMI), smoking history, lung cancer stage, and survival time. CAC, emphysema, muscle mass, and subcutaneous fat attenuation were quantified on baseline low-dose chest CT (LDCT) for all patients in both groups. Nonsurvivor group had significantly greater CAC, decreased muscle mass, and higher fat attenuation compared to the survivor group (p<0.01). No significant difference in severity of emphysema was noted between the two groups (p>0.1). We thus conclude that it is possible to create a quantitative prediction model for lung cancer mortality for subjects with lung cancer detected on screening low-dose CT (LDCT).

Research on the influence of relationships among satiety, muscle mass, and outdoor environmental factors is sparse. In this work the relationships among satiety feeling, body composition, and outdoor environmental factors on eating in healthy young Japanese women are investigated. Fifty three (53) women were examined over an approximately 2-year period. All participants ate the same lunch; feelings of satiety and body composition were measured before and immediately after lunch. Satiety was assessed using a visual analog scale. Outdoor environmental factors were recorded at the time of measurement. Results showed that satiety before lunch decreased with increased muscle mass and decreased humidity (p < 0.05). The Δ satiety increased on eating with increased outdoor temperature (p < 0.05). The Δ satiety with high outdoor temperature was significantly greater than with low outdoor temperature (p = 0.005). Decreased muscle mass more influenced Δ satiety with respect to outdoor temperature than increased muscle mass (p = 0.007). The results suggest that increased muscle mass and decreased humidity increase hunger (unlike satiety) before eating. The findings also show that outdoor temperature clearly influences the magnitude of satiety on eating. Increasing muscle mass may be useful for satiety control at various outdoor temperatures in young women.

Background: Frailty is a multifactorial geriatric syndrome characterized by progressive decline in health and associated with decreased muscle mass, strength, and functional capacity. Resistance training (RT) combined with protein or amino acids supplementation has been shown to be promising for mitigating age-related impairments. Aim: To investigate the chronic effects of different strategies of protein and derivatives supplementation in association with RT on selected health-related parameters in pre-frail and frail elderly. Methods: This is a series of double-blind, randomized, placebo-controlled, parallel-group clinical trials. Volunteers will be divided into nine groups, comprising four different sub-studies evaluating the effects of: isolated leucine supplementation (study 1); protein source (whey vs. soy – study 2); combination of whey protein and creatine (study 3); and sexual dimorphism on the response to protein intake and RT (males vs. females – study 4). Muscle cross-sectional area, fiber cross-sectional area, body composition, lower-limb maximal dynamic and isometric strength, functionality, lipid profile, biochemical parameters, renal function, quality of life, and nutritional status will be assessed before and after a 16-week intervention period. Data will be tested for normality and a mixed-model for repeated measures will be conducted to assess within- and between-group effects of the intervention on the dependent variables. Confidence intervals (95%), effect sizes, and relative changes will also be determined, with significance set at p < 0.05.

Muscle loading is important for maintaining muscle mass; when load is removed, atrophy is inevitable. However, in clinical situations such as critical care myopathy, masticatory muscles do not lose mass. Thus, their properties may be harnessed to preserve mass. We compared masticatory and appendicular muscles responses to microgravity, using mice aboard the space shuttle Space Transportation System-135. Age- and sex-matched controls remained on the ground. After 13 days of space flight, 1 masseter (MA) and tibialis anterior (TA) were frozen rapidly for biochemical and functional measurements, and the contralateral MA was processed for morphologic measurements. Flight TA muscles exhibited 20 ± 3% decreased muscle mass, 2-fold decreased phosphorylated (P)-Akt, and 4- to 12-fold increased atrogene expression. In contrast, MAs had no significant change in mass but a 3-fold increase in P-focal adhesion kinase, 1.5-fold increase in P-Akt, and 50–90% lower atrogene expression compared with limb muscles, which were unaltered in microgravity. Myofibril force measurements revealed that microgravity caused a 3-fold decrease in specific force and maximal shortening velocity in TA muscles. It is surprising that myofibril-specific force from both control and flight MAs were similar to flight TA muscles, yet power was compromised by 40% following flight. Continued loading in microgravity prevents atrophy, but masticatory muscles have a different set point that mimics disuse atrophy in the appendicular muscle.—Philippou, A., Minozzo, F. C., Spinazzola, J. M., Smith, L. R., Lei, H., Rassier, D. E., Barton, E. R. Masticatory muscles of mouse do not undergo atrophy in space.

We hypothesised that extremely premature infants would have decreased muscle mass at term-corrected age compared to term-born infants and that the degree of reduced muscle mass acquisition would correlate with the duration of invasive mechanical ventilation. The MRI brain scans of infants admitted in the neonatal unit at King's College Hospital between 1 January 2010 and 1 June 2016 were retrospectively reviewed. The coronal cross-sectional area of the left deltoid muscle (DCSA) was measured in 17 infants born 28 weeks of gestation and in 20 infants born at term. The prematurely born infants had a median (IQR) gestation age of 25 weeks (24-27) and the term infants 40 weeks (38-41). The duration of invasive mechanical ventilation for the prematurely born infants was 39 days (14-62) and that for the term infants 4 days (2-5), p 0.001. DCSA was smaller in prematurely born infants (median 189, IQR 176-223 mmOur results suggest that prolonged mechanical ventilation in infants admitted in neonatal intensive care is associated with reduced skeletal muscle mass acquisition. What is Known: • Prolonged mechanical ventilation in adult intensive care patients has been associated with skeletal muscle dysfunction and atrophy. • The cross-sectional area of the deltoid muscle has been used to evaluate muscle atrophy in infants with a previous branchial plexus birth injury. What is New: • Premature infants studied at term exhibit lower cross-sectional area of the deltoid muscle than their term counterparts. • Prolonged mechanical ventilation could be associated with skeletal muscle impairment.

Sarcopenia is one of the prevalent geriatric syndromes that adversely affects the functionality in the older adults. The diagnosis of sarcopenia requires documentation of decreased muscle mass and decreased muscle strength or physical function. The implication of user-friendly and inexpensive methods that could be used to assess sarcopenia in real-life settings is suggested in a recent debate paper. For muscle mass assessment, bioelectric impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA) were described as having the same ease for muscle mass assessment in terms of applicability. However, BIA is easier to perform, has greater availability, inexpensive, and does not require specialist trained staff. The authors proposed the use of DXA as primary tool to assess muscle mass in the primary care setting. However, BIA is recommended as a first-line method both in research and clinical practice by EWGSOP. Regarding its much easier applicability, we conclude that BIA is a more practical method for muscle mass assessment in the primary care setting than the DXA. Thus, we suggest that BIA could be the method of choice for muscle mass assessment in the primary care setting.

Antecedentes: la inmunodeficiencia común variable se distingue por la ausencia de isohemaglutininas y disminución de al menos dos desviaciones estándar de las concentraciones normales de inmunoglobulinas. Su tratamiento incluye administrar inmunoglobulina, con mayor frecuencia intravenosa (IgIV). Un efecto adverso severo es la posible insuficiencia renal secundaria a la administración de preparados que contienen sacarosa. Estos pacientes muestran reducción de peso, disminución de masa muscular asociada con trastornos gastrointestinales y con bronquiectasias que limitan su actividad física. Existen diversas fórmulas para determinar la tasa de filtración glomerular, comparamos las más utilizadas para determinar la más adecuada en esta población.Objetivo: determinar la concordancia entre la tasa de filtración glomerular mediante la fórmula MDRD, CKD-EPI y Cockroft-Gault y la obtenida a través de la depuración de creatinina en orina de 24 horas en pacientes con inmunodeficiencia común variable tratados con inmunoglobulina intravenosa.Pacientes y método: estudio transversal, observacional y descriptivo que incluyó a 19 pacientes con inmunodeficiencia común variable, 12 mujeres y 7 hombres, con edad promedio de 36 años. Se aplicó estadística descriptiva con reporte de media, mediana y desviación estándar. Para medir la concordancia de las mediciones para las variables cuantitativas se usó el coeficiente de correlación intraclase y para determinar la concordancia entre los estadios de la función renal con las diferentes fórmulas se calculó el índice de Kappa.Resultados: los valores del coeficiente de correlación intraclase mostraron una concordancia buena entre la depuración de creatinina en orina de 24 h y CKD-EPI, concordancia mediocre con MDRD y nula con la fórmula Cockroft-Gault.Conclusiones: la tasa de filtración glomerular obtenida con CKD-EPI mostró parcialmente ser de mayor utilidad, con una correlación buena en relación con la depuración de creatinina en orina de 24 horas. Se recomienda su uso rutinario sobre las otras fórmulas en pacientes de inmunodeficiencia común variable con sospecha de afección renal secundaria a la administración de inmunoglobulina intravenosa.

Recently, aging has been shown to be associated with sarcopenic obesity (SO), of which decreased muscle mass and increased fat mass are features. Sarcopenia and obesity alone are known to be associated with abnormal lipid metabolism. However, it remains unclear whether SO has greater adverse effects on dyslipidemia than on sarcopenia or obesity alone.We aimed to investigate the association between SO and dyslipidemia in elderly Koreans.This study was based on data collected during the 2008-2010 Korea National Health and Nutrition Examination Survey. We included 1,466 men and 2,017 women aged 65 years and over. Sarcopenia was indicated in participants with height- or weight-adjusted appendicular skeletal muscle that was 1 standard deviation below the sex-specific mean for the young reference group, and obesity was defined as a body mass index ≥ 25 kg/m(2). Dyslipidemia was defined according to the National Cholesterol Education Program-Adult Treatment Panel III.After adjusting for confounding factors, the SO group had a higher risk for dyslipidemia [odds ratio (OR) 2.82 (95 % confidence interval 1.76-4.51)] than the obese group [2.12 (1.11-4.07)] and sarcopenic group [1.46 (1.01-2.11)] (p0.001) only in men. Furthermore, the SO group in men had the highest OR for hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia, hyper-low-density lipoprotein cholesterolemia, and a high ratio of triglyceride to high-density lipoprotein cholesterol even after further adjustments.In Korean elderly men, SO was associated with an increased risk for dyslipidemia compared with sarcopenia or obesity alone.

Children with spinal cord injury (SCI) are at risk for the same health related complications experienced by adults with SCI; however, children are likely at increased risk due to the young age at which the injury was sustained. Common health related complications impact the cardiovascular, respiratory, and musculoskeletal systems, increasing the risk of cardiovascular disease, metabolic syndrome, and fractures, as well as impacting the ability to complete everyday tasks. The available literature shows that children and adults with SCI have a high prevalence of metabolic syndrome and decreased muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. Exercise may have an impact on these complications, thus increasing overall health and fitness. Some literature is available on the effects of exercise for adults with SCI, but few studies have examined these effects for children. Pediatric and adult studies have shown some positive effects on muscle mass, resting energy expenditure, peak oxygen consumption, and bone mineral density. However, more research is needed to develop optimal exercise programs that adequately address long-term health in children who have a long lifetime ahead.

Background: Adult growth hormone deficiency (AGHD) is characterized by impaired physical activity, diminished quality of life (QoL), weight and fat mass gain, decreased muscle mass and decreased bone mineral density (BMD). The aim of this study was to evaluate the effects of long-term treatment (7 years) with recombinant human growth hormone (rhGH) on metabolic parameters, body composition (BC), BMD, bone microarchitecture and QoL. Patients and Methods: In this prospective study, BMD and BC were assessed by dual-energy X-ray absorptiometry (DXA). Bone microarchitecture was assessed with the trabecular bone score (TBS). The QoL-AGHDA test was used to assess QoL. Results: A total of 18 AGHD patients (mean age, 37.39 ± 12.42) were included. Body weight and body mass index (BMI) showed a significant increase after 7 years ( p = 0.03 and p = 0.001, respectively). There was a significant tendency of body fat mass (BFM) ( p = 0.028) and lean body mass (LBM) ( p = 0.005) to increase during the 7 years of rhGH treatment. There was a significant increase in lumbar spine (LS) BMD ( p = 0.01). TBS showed a nonsignificant decrease after 7 years of treatment, with a change of -0.86% ± 1.95. QoL showed a large and significant improvement ( p = 0.02). Conclusion: Long-term rhGH treatment in AGHD patients induces a large and sustained improvement in QoL. Metabolic effects are variable with an increase in LBM as well as in BMI and BFM. There is a positive effect on BMD based on the increase in LS BMD, which stabilizes during long-term therapy and is not associated with a similar increase in bone microarchitecture.

A three-year-old male Labrador retriever was presented with five-month history of tetraparesis with severe atrophy in the limbs. Prior to this five-month period, the dog had been healthy. At gross necropsy several muscles were atrophic reflecting decreased muscle mass. Histologically, there were atrophic type I and type II fibres, angulated type IIC fibres and an elevated oxidative activity that showed an altered mitochondrial pattern. The rapid progression of the clinical signs and the age at onset could suggest an atypical myopahty in this dog breed.

Objective To examine the relationship between brown adipose tissue (BAT) and muscle development, two tissues that derive from a common cell lineage, during the first 6 months of postnatal life. Study design Thirty healthy term infants (15 males and females) underwent whole-body magnetic resonance imaging examinations. Measurements of BAT in the supraclavicular area as well as measures of trunk musculature and subcutaneous adiposity were obtained at birth and at 6 months of age. Results Paraspinous musculature and subcutaneous white adipose tissue (WAT) increased, and the proportion of BAT in the supraclavicular area decreased during infancy. Although measures of BAT did not correlate with paraspinous musculature through the first 6 months of life ( r = −0.35; P = .09), BAT was a significant predictor of paraspinous musculature after adjusting for weight, body length, and WAT ( P = .002); infants with the smallest decreases in BAT had the greatest gains in musculature. In contrast, changes in BAT did not predict increases in subcutaneous WAT ( P = .25) during infancy, which were primarily determined by body weight. Conclusions Changes in BAT are associated with muscle development but not WAT accumulation in healthy infants. Studies are needed to determine the mechanism(s) by which BAT could facilitate muscle growth, and the degree to which decreased muscle mass, such as in preterm and low birth weight infants, is related to a deficiency of BAT.

We present two children with hypoplasia of the left trapezius muscle and a history of ipsilateral transient neonatal brachial plexus palsy without documented trapezius weakness. Magnetic resonance imaging in these patients with unilateral left hypoplasia of the trapezius revealed decreased muscles in the left side of the neck and left supraclavicular region on coronal views, decreased muscle mass between the left splenius capitis muscle and the subcutaneous tissue at the level of the neck on axial views, and decreased size of the left paraspinal region on sagittal views. Three possibilities can explain the association of hypoplasia of the trapezius and obstetric brachial plexus palsy: increased vulnerability of the brachial plexus to stretch injury during delivery because of intrauterine trapezius weakness, a casual association of these two conditions, or an erroneous diagnosis of brachial plexus palsy in patients with trapezial weakness. Careful documentation of neck and shoulder movements can distinguish among shoulder weakness because of trapezius hypoplasia, brachial plexus palsy, or brachial plexus palsy with trapezius hypoplasia. Hence, we recommend precise documentation of neck movements in the initial description of patients with suspected neonatal brachial plexus palsy.

IntroductionPeople who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort.MethodsThis study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL.ResultsFor a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400?Nm?1 and of 1029?Nm?1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized.ConclusionBy augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.