Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses.

Purpose: To assess sinoatrial node (SAN) and atrioventricular node (AVN) doses for breast cancer (BC) patients treated with 3D-CRT and evaluate whether "large" cardiac structures (whole heart and four cardiac chambers) would be relevant surrogates. Material and methods: This single center study was based on 116 BCE patients (56 left-sided, 60 right-sided) treated with 3D-CRT without respiratory gating strategies and few IMN irradiations from 2009 to 2013. The heart, the left and right ventricles (LV, RV), the left and right atria (LA, RA) were contoured using multi-atlases for auto-segmentation. The SAN and the AVN were manually delineated using a specific atlas. Based on regression analysis, the coefficients of determination (R2) were estimated to evaluate whether "large" cardiac structures were relevant surrogates (R2 > 0.70) of SAN and AVN doses. Results: For left-sided BC, mean doses were: 3.60 ± 2.28 Gy for heart, 0.47 ± 0.24 Gy for SAN and 0.74 ± 0.29 Gy for AVN. For right-sided BC, mean heart dose was 0.60 ± 0.25 Gy, mean SAN dose was 1.57 ± 0.63 Gy (>85 % of patients with SAN doses > 1 Gy) and mean AVN dose was 0.51 ± 0.14 Gy. Among all "large" cardiac structures, RA appeared as the best surrogate for SAN doses (R2 > 0.80). Regarding AVN doses, the RA may also be an interesting surrogate for left-sided BC (R2 = 0.78), but none of "large" cardiac structures appeared as relevant surrogates among right-sided BC (all R2 < 0.70), except the LA for patients with IMN (R2 = 0.83). Conclusions: In BC patients treated 10 years ago with 3D-CRT, SAN and AVN exposure was moderate but could exceed 1 Gy to the SAN in many right-sided patients with no IMN-inclusion. The RA appeared as an interesting surrogate for SAN exposure. Specific conduction nodes delineation remains necessary by using modern radiotherapy techniques.

Intrinsic Capacity Defined Using Four Domains and Mortality Risk: A 5-Year Follow-Up of the SarcoPhAge Cohort.

OBJECTIVES: The concept of 'intrinsic capacity' (IC) offers a new way to approach another concept, that of 'healthy aging'. The first objective of the present study was to assess the ability of the construct of 'intrinsic capacity' to predict death. The second objective was to assess whether deteriorations in intrinsic capacity, measured over 1 and 2 years, are predictive of death. DESIGN: The present analysis was based on a prospective cohort study. SETTING: Community-dwelling participants. PARTICIPANTS: The study recruited older adults aged 65 years and older. MEASUREMENTS: Intrinsic capacity (IC) encompasses five domains: sensorial (not evaluated here), cognition (Mini-Mental State Examination), nutrition (Mini-Nutritional Assessment), mobility (Short Physical Performance Battery), and psychological (Geriatric Depression Scale). Each domain was considered satisfactory when its assessment, for an individual, was above the threshold defined by the initial validation of the domain assessment tool. To explore the relationship between IC and mortality risk, a Cox model was applied. The predictive value of the dynamic aspects (i.e., changes over 1 year and 2 years) was investigated using the following categorization of IC: stable, deteriorated, improved. RESULTS: The sample was composed of 481 volunteers aged 73.4±6.12 years (60.1% women). Two satisfactory IC domains appeared to be significantly associated with reduced mortality risk: the satisfactory mobility domain (adjusted HR=0.45 [0.26-0.79]) and the satisfactory psychological domain (adjusted HR = 0.56 [1.04-3.09]). When considering intrinsic capacity as a whole construct, using a composite Z-score, we noticed that the risk of death was decreased by 49% for an increase of 1 standard deviation in IC. Changes in intrinsic capacity in the mobility and psychological domains led to an increased risk of death (from 2.74 to 4.18-fold). CONCLUSION: The concept of intrinsic capacity seems highly relevant in order to assess older adults' health and well-being. This concept should be considered for integration into clinical practice.

Risk of pacemaker implantation after radiotherapy for breast cancer: A study based on French nationwide health care database sample.

BACKGROUND: Among cardiac complications of breast cancer radiotherapy (BC RT), there are very limited data on arrhythmia and conduction disorders, in particular severe cases requiring permanent pacemaker implantation (PPMI). Therefore, this exploratory study aimed to evaluate the risk of PPMI for BC patients treated with RT, compared with the general population and with BC patients not treated with RT. METHODS: The study was performed on a 1/97 representative sample of the French health care database (EGB database). Adult women with a first BC treated with or without RT between 2008 and 2016 were included, followed until 2018, and de novo PPMI were identified. We compared the PPMI incidence in BC cohort relative to the general population with standardized incidence ratio (SIR) and evaluated the risk of PPMI in RT patients compared to patients without RT with a competing risk survival analysis. RESULTS: A total of 3853 BCE patients were included. Among BC patients treated with RT, 28 PPMI cases were observed compared with 13 expected cases, corresponding to a SIR of 2.18 [95% CI: 1.45-3.06]. For BC patients not treated with RT, the SIR was 1.01 [95% CI: 0.40-1.90]. Patients treated with RT showed a borderline significant higher risk of PPMI compared with those not treated with RT (subdistribution Hazard Ratio = 2.08, 95% CI 0.87-4.97, p = 0.09). CONCLUSIONS: Our exploratory findings indicate that, over the last decade in France, BC patients treated with RT appeared to be at higher risk of PPMI than general population. Further studies are needed to expand on this topic.

An Assessment of the Toulouse Saint Louis University Mini Falls Assessment Tool to Predict Incident Falls among Older Adults Residing in Nursing Homes: A 6-Month Prospective Study.

OBJECTIVES: Toulouse Saint Louis University Mini Falls Assessment (TSLUMFA) tool has been designed to predict falls. It was initially validated in a geriatric clinic in 2018. The primary objective was to evaluate the predictive capacity of the TSLUMFA for incident falls in older adults residing in nursing homes. The secondary objective was to determine the TSLUMFA optimal cut-off value identifying those older adults with a high-risk of falling. SETTINGS: A longitudinal study was carried out over a period of six months. PARTICIPANTS: 93 older adults residing in nursing homes were evaluated for the present study. MEASUREMENTS: The TSLUMFA (made up of 7 criteria) was administered at baseline, and incident falls were recorded based on a registry of falls. Comparisons of TSLUMFA scores between fallers and non-fallers were performed using the U Mann-Whitney test or Chi². Correlation between the total TSLUMFA score (/30 points) and incident fall(s) was explored using the Cox proportional hazard model. ROC analysis enabled an optimal cut-off value to be established to identify those adults at the highest-risk of falling. RESULTS: In the study, 93 older adults (61.3% women) with a median age of 80 (69-87) years were included. The median total TSLUMFA score was 21 (19-24.5) points. During the 6-month study period, 38 subjects (40.9%) experienced at least one fall. The total TSLUMFA score in older adults with incident fall(s) was significantly lower than in those who did not fall (20 (15.75-22.25) points versus 23 (20-25) points and a p-value of <0.001). For each 1-point higher score at the total TSLUMFA a 9% less chance of falling was observed during the study period (p-value = 0.006). The AUC was 0.736 (95%CI: 0.617-0.822) and p-value <0.001, clearly demonstrating its interesting performance as a screening tool. A score of ≤ 21 points was identified as the optimal cut-off to identify those older adults at a higher-risk of falling. CONCLUSION: The TSLUMFA performed well and successfully identified older adults with a high risk of falling in a nursing home setting. Further comparisons with existing tools are warranted.

Relationship between smoking and the incidence of sarcopenia: The SarcoPhAge cohort.

INTRODUCTION: The association of tobacco use and incidence of muscle impairments has not been extensively explored in research. In this study, the relationship between smoking and the incidence of sarcopenia is investigated. METHODS: The present longitudinal study used data from the Sarcopenia and Physical Impairment with advancing Age (SarcoPhAge) cohort, which includes older adults aged ≥65 years. All individuals with follow-up data on muscle health were included in this post hoc analysis. A diagnosis of sarcopenia was established, at each year of follow-up, according to the European Working Group on Sarcopenia in older People 2 (EWGSOP2) criteria. A sensitivity analysis was performed using other diagnostic criteria for sarcopenia. The smoking status and the number of cigarettes smoked per day were self-reported. The relationship between smoking status or the number of cigarettes smoked per day and the incidence of sarcopenia/severe sarcopenia throughout the 5 years of follow-up was evaluated using the Cox proportional hazards model. RESULTS: In total, the study population included 420 participants, with a median age of 71.7 years (P25-P75 = 67.7-76.9 years) and 59.8% were female. Over the 5 years of follow-up, 78 participants (18.6%) became sarcopenic as per the EWGSOP2 criteria and 41 individuals (9.8%) developed severe sarcopenia. There were significantly more smokers than non-smokers who developed sarcopenia (35.9% vs 16.8%, P-value = 0.003). A fully adjusted Cox model confirmed this observation, yielding a hazard ratio of 2.36 (95% confidence interval [CI]: 1.31-4.26), meaning that smokers have a 2.36-fold higher risk of developing sarcopenia. Furthermore, individuals who smoked had a 2.68 times increased risk of developing severe sarcopenia (95% CI: 1.21-5.93) than those who did not smoke. Sensitivity analyses globally confirmed these findings when applying other diagnostic criteria for sarcopenia. DISCUSSION: Smoking seems to be an important predictor for the onset of sarcopenia, highlighting, once again, that tobacco use is a major public health problem.

Development and validation of a short version of the Sarcopenia Quality of Life questionnaire: the SF-SarQoL.

PURPOSE: To facilitate the measurement of quality of life in sarcopenia, we set out to reduce the number of items in the previously validated Sarcopenia Quality of Life (SarQoL®) questionnaire, and to evaluate the clinimetric properties of this new short form. METHODS: The item reduction process was carried out in two phases. First, information was gathered through item-impact scores from older people (n = 1950), a Delphi method with sarcopenia experts, and previously published clinimetric data. In the second phase, this information was presented to an expert panel that decided which of the items to include in the short form. The newly created SFSarQoL was then administered to older, community-dwelling participants who previously participated in the SarcoPhAge study. We examined discriminative power, internal consistency, construct validity, test-retest reliability, structural validity and examined item parameters with a graded response model (IRT). RESULTS: The questionnaire was reduced from 55 to 14 items, a 75% reduction. A total of 214 older, community-dwelling people were recruited for the validation study. The clinimetric evaluation showed that the SF-SarQoL® can discriminate on sarcopenia status [EWGSOP2 criteria; 34.52 (18.59-43.45) vs. 42.86 (26.56-63.69); p = 0.043], is internally consistent (α = 0.915, ω = 0.917) and reliable [ICC = 0.912 (0.847-0.942)]. A unidimensional model was fitted (CFI = 0.978; TLI = 0.975; RMSEA = 0.108, 90% CI 0.094-0.123; SRMR = 0.055) with no misfitting items and good response category separation. CONCLUSIONS: A new, 14-item, short form version of the Sarcopenia Quality of Life questionnaire has been developed and shows good clinimetric properties.

Subjective Sleep Quality among Sarcopenic and Non-Sarcopenic Older Adults: Results from the SarcoPhAge Cohort.

BACKGROUND: It seems that sleep quality could impact the physiological process related to loss of muscle mass. OBJECTIVES: We seek to compare subjective sleep quality of sarcopenic and non-sarcopenic subjects diagnosed according to 6 definitions. DESIGN: Cross-sectional data used in this analysis were collected from the SarcoPhAge (Sarcopenia and Physical Impairment with Advancing Age) cohort, a prospective study aiming to assess clinical parameters linked to sarcopenia. PARTICIPANTS: The present study was interested in communitydwelling older adults with and without sarcopenia. Measurements - A diagnosis of sarcopenia was established according to 6 definitions. Three assessments were carried out: an evaluation of lean mass, a measurement of muscle strength and an assessment of physical performance. In addition, to evaluate the parameters of subjective sleep, we used the Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire evaluating 7 components of sleep architecture. RESULTS: A total of 255 individuals aged 74.7±5.8 years were included. Based on the 6 different definitions, the prevalence of sarcopenia ranged from 5.9% to 32.5%. There was no significant difference between sarcopenic and non-sarcopenic subjects regarding most of the components of subjective sleep quality. However, the definition of Cruz-Jentoft et al. (2010) indicated that sarcopenic subjects had higher scores than non-sarcopenic subjects for two components: sleep latency and day-time dysfunction (p=0.03 and p=0.04, adjusted for confounders). Moreover, some parameters of sleep quality were correlated with components of sarcopenia. CONCLUSIONS: Some properties of subjective sleep quality seem to be associated with sarcopenia and seem correlated with at least one of the three components of the condition.

Bone health assessment in older people with or without muscle health impairment.

This study investigated the relationship between muscle and bone status in elderly individuals. Our results suggested links between sarcopenia and osteoporosis; impairment in muscle status (i.e., muscle mass, muscle strength, and physical performance) is associated with deterioration in bone mass and texture subsequently leading to an increased risk of fracture. INTRODUCTION: Accumulating evidence has shown associations between sarcopenia and osteoporosis, but existing studies face inconsistencies in the clinical definition of both conditions. Thus, we sought to investigate bone health among older individuals with or without muscle health impairment. METHODS: We conducted an analysis of cross-sectional data available from the Sarcopenia and Physical Impairment with Advancing Age (SarcoPhAge) study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP) (i.e., a low muscle mass plus either low muscle strength or low physical performance). Muscle mass and areal bone mineral density (aBMD) were determined using dual-energy X-ray absorptiometry (DEXA). Muscle strength was assessed using a hand dynamometer, and physical performance was assessed with the Short Physical Performance Battery test. Using the cutoff limits proposed by the EWGSOP, we have classified women in the "low SMI group" when its value was < 5.50 kg/m2, in the "low muscle strength group" when strength was < 20 kg, and in the "low physical performance group" when SPPB < 8 points. The thresholds of < 7.26 kg/m2 (for SMI), < 30 kg (for muscle strength), and SPPB < 8 points were used for men. The 10-year fracture risk was obtained using the FRAX® tool. Moreover, bone texture was determined using the trabecular bone score (TBS) method. RESULTS: The study sample consisted of 288 older subjects aged 74.7 ± 5.7 years, and 59.0% of the subjects were women. Sarcopenia was diagnosed in 43 individuals (14.9%), and osteoporosis was diagnosed in 36 subjects (12.5%). Moreover, aBMD values were, most of the time, lower in older men and women with muscle impairment (i.e., low muscle mass, low muscle strength, and low physical performance). For these subjects, we also noted a higher probability of fracture. When comparing bone quality, there were no significant differences in the TBS values between sarcopenic and non-sarcopenic older men and women or between those with low and high muscle mass. However, when controlling for confounders (i.e., age, BMI, number of co-morbidities, smoking status, and nutritional status), TBS values were lower in older women with low muscle strength (p = 0.04) and in older men with low physical performance (p = 0.01). CONCLUSIONS: Our study showed interrelationships between components of sarcopenia and osteoporosis, with older subjects with muscle impairment having poorer bone health.

Prevalence of Concomitant Bone and Muscle Wasting in Elderly Women from the SarcoPhAge Cohort: Preliminary Results.

BACKGROUND: Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE: The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS: Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS: A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION: Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club.

In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice.

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study.

INTRODUCTION: The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS: Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR: 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION: Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Prevalence of sarcopenia: the impact of different diagnostic cut-off limits.

INTRODUCTION: In the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), different cut-off limits are proposed for appendicular lean mass, muscle strength and gait speed. Therefore we aimed to examine the variation in prevalence of sarcopenia obtained with these cut-off limits. MATERIALS AND METHODS: Subjects aged 65 years and older were recruited in an outpatient clinic in Belgium and screened for sarcopenia using the EWGSOP definition. Appendicular lean mass was measured by Dual Energy X-Ray Absorptiometry, muscle strength by a hydraulic handgrip dynamometer and gait speed was measured on a 4-meter distance. Two different cut-off points proposed by the EWGSOP were examined for each variable and 8 diagnostic methods were thereby established. RESULTS: 400 subjects were recruited for this study. Prevalence of sarcopenia varied from 9.25% to 18% depending on the cut-offs applied. When stratified by sex, it seems that the variation in prevalence of sarcopenia was mainly attributable to women. This prevalence ranged from 6.58% to 20.2% for women and only from 13.4% to 14.7% for men. CONCLUSION: Prevalence of sarcopenia varies widely depending on the EWGSOP cut-off points applied for women. This may limit clinical researches and development of therapeutic strategies in the field of sarcopenia.

Unilateral nevoid telangiectasia and chronic liver disease. Report of a case and review of the literature.

Unilateral nevoid telangiectasia was observed on the back of the left hand and wrist in a 19-year old man with chronic liver disease and portal hypertension. Moreover, abnormalities of the elastic fibers of the skin were found. Examination of the liver biopsy showed extensive portal fibrosis with many dilated blood vessels. No usual cause of juvenile cirrhosis was detected. In the comment, the authors suggest that unilateral nevoid telangiectasia and liver disease could be manifestations of a disease involving skin and liver vessels, as in hereditary hemorrhagic telangiectasia.