Start with muscle mass or muscle strength in diagnosis and management of sarcopenia? A systematic review of guidance documents.

BACKGROUND AND OBJECTIVES: Sarcopenia has garnered extensive attention in clinical practice since its high prevalence and significant impact on clinical outcomes. Multiple organizations have published guidance documents on sarcopenia, offering evidence-based recommendations for clinical practice and/or research. We aimed to appraise the methodological quality of the included documents and synthesize available recommendations for the screening, diagnosis, and intervention of sarcopenia. METHODS AND STUDY DESIGN: We conducted a search on PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, guideline database, and guideline organizations and professional societies websites for clinical practices, consensus statements and position papers in terms of sarcopenia, muscle atrophy or muscle loss published before April 17, 2023. The AGREE II instrument was used by three independent reviewers to assess the methodological quality of these documents. RESULTS: Thirty-six guidance documents published between 2010 and 2023 were included. Seven documents fulfilled ≥ 50% of all the AGREE II domains. Seven underwent a Delphi process and six graded the strength of the recommendations. The process of screening (n=21), early diagnosis of sarcopenia (n=12), diagnosis of sarcopenia and severe sarcopenia (n=10), and management (n=21) were increasingly recommended. SARC-F (n=14) was the most recommended screening tool, and the assessment of muscle function was considered the first step in diagnosing sarcopenia. The management strategy for both age-related and disease-related sarcopenia mainly focused on exercise and nutrition intervention. CONCLUSIONS: The guidance documents have provided referential recommendations that have great guiding significance. But the inconsistency in recommendations and variation in methodological rigour suggests that high-quality evidence is lacking yet.

Validity of the modified versions of SARC-F+EBM for sarcopenia screening and diagnosis in China: the PPLSS study.

BACKGROUND AND OBJECTIVES: It is recommended by Asian Working Group for Sarcopenia to early identify people at risk for sarcopenia using simple screening tools like SARC-F. The modified version SARC-F+EBM showed higher diagnostic performance. However, this cut-off value of body mass index (BMI) remained uncertain to be used in Chinese population. In this study, we used appropriate BMI recommended for Chinese older population and further modified SARC-F+EBM by combining calf circumference. METHODS AND STUDY DESIGN: Diagnostic tests were performed and the receiver operating characteristics analyses were conducted between the SARC-F, SARC-F+EBM (cut-off of BMI: ≤ 21 kg/m2), SARC-F+EBM (CN) (cut-off of BMI: ≤ 22 kg/m2), SARC-CalF and SARC-CalF+EBM (CN) (cut-off of BMI: ≤ 22 kg/m2) in 1660 community-dwelling participants aged ≥ 65 years from China. RESULTS: The participants had an average age of 71.7±5.1 years, of which 56.8% were women. All the modified models could enhance the areas under the receiver operating characteristic curve (AUC) of original SARC-F (all p<0.001). The SARC-F+EBM (CN) also showed a significantly higher sensitivity of 47.4% (p<0.001) and an AUC of 0.809 (p=0.005) than SARC-F+EBM. SARC-CalF+EBM (CN) was validated to be of great diagnostic value of the highest AUC of 0.88 among these sarcopenia screening tools, including SARC-F, SARC-CalF and SARC-F+EBM (CN) (all p<0.001). Using this study population as a reference, the optimal cut-off value of SARC-CalF+EBM (CN) is ≥12 points, with a sensitivity of 79.3% and a specificity of 80.7%. CONCLUSIONS: The SARC-F+EBM (CN) and SARC-CalF+EBM (CN) could enhance the diagnostic performance of SARC-F and SARC-F+EBM and are suitable sarcopenia screening tools for Chinese population.

Nutrition Risk Screening and Related Factors Analysis of Non-hospitalized Cancer Survivors: A Nationwide Online Survey in China.

Purposes: This study investigated the nutritional problems and risks of Chinese non-hospitalized cancer survivors through an online survey. Methods: The survey included nutritional and clinical questions distributed to non-hospitalized cancer survivors. All data were screened and analyzed with strict quality control. Nutrition Risk Screening-2002 (NRS-2002) was adopted and the related factors were analyzed. Results: Six thousand six hundred eighty-five questionnaires were included. The prevalence of nutritional risk was 33.9%, which varied according to age, sex, cancer type, TNM staging, oncologic treatment, time interval since last treatment, etc. In the regression analysis, nutritional risk was associated with age, TNM staging, and nutrition support. Patients with leukemia and digestive cancer had the highest NRS-2002 score (3.33 ± 1.45 and 3.25 ± 1.61); the prevalence of nutritional risk (NRS-2002 ≥ 3) was 66.7 and 55.1%, respectively. Patients with a higher TNM stage had higher NRS-2002 scores in non-digestive cancer, which was not seen in digestive cancer. Among digestive, bone, nervous, and respiratory cancer patients, the NRS-2002 score mainly consisted of "impaired nutritional status," which coincided with the "disease severity score" in leukemia patients. Nutrition intervention was achieved in 79.7 and 15.2% of patients with nutritional risk and no risk. Of the patients, 60.3% exhibited confusion about nutritional problems, but only 25.1% had professional counseling. Conclusions: Regular nutritional risk screening, assessment, and monitoring are needed to cover non-hospitalized cancer survivors to provide nutrition intervention for better clinical outcome and quality of life. By online survey, the nutritional risk of non-hospitalized cancer survivors was found high in China, but the nutrition support or professional consultation were not desirable. The composition of nutritional risk should also be aware of.

High-power low spatial coherence random fiber laser.

A high-power multi-transverse modes random fiber laser (RFL) is investigated by combining a master oscillator power-amplifier (MOPA) configuration with a segment of extra-large mode area step-index multimode fiber (MMF). Spatial coherence of the high-power multi-transverse modes RFL has been analyzed, which shows that speckle contrast is reduced dramatically with the output power increasing. In this way, considerably low speckle contrast of ~0.01 is achieved under high laser power of ~56 W, which are the records for multi-transverse modes RFLs in both spatial coherence and output power. This work paves a way to develop high-power RFLs with very low spatial coherence for wide-range speckle-free imaging and free-space communication applications.

Healthcare for servicewomen on military missions.

Increases in the number of women in critical positions on military missions place new demands for specialised healthcare services to promote performance. The main health problems servicewomen facing are musculoskeletal injuries, reproductive diseases, iron deficiency and mental health problems. Herein, we propose several suggestions based on the rich experiences of our hospital. First is to offer preventive measures for servicewomen health. Second is to equip servicewomen with portable medicine packet to treat common diseases. Third is to provide people-centred integrated care.

Decoherence of fiber supercontinuum light source for speckle-free imaging.

Speckle-free imaging is attractive in laser-illuminated imaging systems. The evolutionary process of supercontinuum decoherence in extra-large mode area step-index multimode fiber is analyzed to provide high-quality broadband light source for speckle-free imaging. It is found that spectral bandwidth, number of spatial transverse modes, and decoherence among different modes all greatly contribute to speckle reduction. The combination of supercontinuum and extra-large mode area step-index multimode fiber can considerably increase the efficiency of decoherence process for speckle-free imaging. This work may enrich the research of speckle-free imaging and also provide guidance on speckle-free imaging using fiber-optics based light source.

Behavioural effect of low-dose BPA on male zebrafish: Tuning of male mating competition and female mating preference during courtship process.

The ubiquity of environmental pollution by endocrine disrupting chemicals (EDCs) such as bisphenol A (BPA) is progressively considered as a major threat to aquatic ecosystems worldwide. Numerous toxicological studies have proved that BPA are hazardous to aquatic environment, along with alterations in the development and physiology of aquatic vertebrates. However, generally, there is a paucity in knowledge of behavioural and physiological effects of BPA with low concentration, for example, 0.22 nM (50 ng/L) and 2.2 nM (500 ng/L). Here we show that treatment of adult male zebrafish (Danio rerio) with 7 weeks low-dose (0.22 nM-2.2 nM) BPA, resulted in alteration in histological structure of testis tissue and abnormality in expression levels of genes involved in testicular steroidogenesis. Furthermore, low-dose BPA treatment decreased the male locomotion during courtship; and was associated with less courtship behaviours to female but more aggressive behaviours to mating competitor. Interestingly, during the courtship test, we observed that female preferred control male to male under low-dose BPA exposure. Subsequently, we found that the ability of female to chose optimal mating male through socially mutual interaction and dynamics of male zebrafish, which was based on visual discrimination. In sum, our results shed light on the potential behavioural and physiological effect of low-dose BPA exposure on courtship behaviours of zebrafish, which could exert profound consequences on natural zebrafish populations.