Masseter muscle thickness measured by ultrasound as a possible link with sarcopenia, malnutrition and dependence in nursing homes

Sarcopenia is a progressive and generalized loss of skeletal muscle mass and strength. It is frequently associated with malnutrition and dependence in nursing homes. Masticatory muscle strength could be the link between sarcopenia, malnutrition and dependence. We aimed to study the relation between sarcopenia, malnutrition and dependence with masseter muscle thickness measured by ultrasound. A cross-sectional study was realized, with 464 patients from 3 public nursing homes in Zaragoza (Spain). The diagnosis of sarcopenia was assessed according to the EuropeanWorking Group on Sarcopenia in Older People 2 criteria, malnutrition by the Mini Nutritional Assessment (MNA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria and functional capacity by the Barhel Index and the texture diet. Masseter muscle thickness (MMT) was measured by ultrasound. The median age was 84.7 years, and 70% of the participants were women. Sarcopenia was confirmed in 39.2% of patients, malnutrition in 26.5% (risk 47.8%), total dependence in 37.9% and diet texture was modified in 44.6%. By logistic regression, once the model was adjusted for age, sex, Barthel index and texture diet, our analyses indicated that each 1 mm decrease in MMT increased the risk of sarcopenia by ~57% (OR: 0.43), the risk of malnutrition by MNA by ~63% (OR: 0.37) and the risk of malnutrition by GLIM by ~34% (OR: 0.66). We found that MMT was reduced in sarcopenic, malnourished and dependent patients, and it could be the common point of a vicious cycle between sarcopenia and malnutrition. Further studies are needed to establish causality. © 2021 by the authors

Muscle thickness and echogenicity measured by ultrasound could detect local sarcopenia and malnutrition in older patients hospitalized for hip fracture

Background: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. Methods: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. Results: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). Conclusion: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility

Prognostic factors for recurrence and survival in uncommon variants of vulvar cancer

Purpose: To analyze the prognostic factors of recurrence and overall survival in rare histotypes of vulvar cancer. Methods: An international multicenter retrospective study including patients diagnosed with vulvar cancer was performed. One hundred centers participated in the study and 2453 vulvar cancer cases were enrolled from January 2001 until December 2005. After exclusion of squamous vulvar cancer, Paget´s disease and vulvar melanoma 112 tumors were analyzed for the present study. Results: The mean age at diagnosis was 64.9 ± 17.2 years. 99 (88.4%) patients had a single lesion, in 25 (22.3%) cases the vulvar tumor involved the midline, and only 13 (11.5%) patients had clinically positive inguinal lymph nodes. The mean size of the lesion was 33.8 ± 33.9 mm. Regarding the surgical treatment, 2 (1.8%) patients underwent skinning vulvectomy, 63 (56.3%) local excision, 41 (36.6%) vulvectomy, 3 (2.7%) exenteration and 3 (2.7%) did not receive any surgical treatment. The mean free surgical margin was 8.2 ± 9 mm and 7 (6.2%) patients presented positive inguinal nodes. Radiotherapy was administered in 22 (19.6%) patients and it was performed postoperatively in all cases; 14 (12.5%) patients received adjuvant chemotherapy. The mean overall follow-up time was 44.1 ± 35.7 months. The risk factors associated with overall survival were chemotherapy and radiotherapy, tumor size and stromal invasion (p < 0.05). The only independent factor significantly associated with global recurrence and absence of metastasis was radiotherapy (p = 0.02 and p = 0.002, respectively). Conclusion: Postoperative radiotherapy seems to be the only independent factor associated with recurrence and overall survival in uncommon types of vulvar cancer. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature