Skeletal muscle mass increases after viral eradication with direct-acting antivirals in patients with chronic hepatitis C: A longitudinal study

BACKGROUND

Results of studies evaluating the effect of viral eradication following direct-acting antiviral (DDA) therapy on skeletal muscle mass of patients with chronic hepatitis C (CHC) are scarce.

AIM

To assess the components of sarcopenia (low muscle mass, low muscle strength and low physical performance) in a cohort of CHC individuals before and after DAA therapy.

METHODS

We performed a longitudinal study of patients with CHC who underwent body composition assessment before (T0), and at 12 (T1) and 48 (T2) weeks after DDA therapy. Bioelectrical Impedance Analysis was used to assess skeletal mass muscle (SM) and phase angle (PhA). SM index (SMI) was calculated by dividing the SM by squared height. Muscle function was evaluated by hand grip strength (HGS) and timed up-and-go (TUG) test. Mixed-effects linear regression models were fitted to SMI, HGS and physical performance and were used to test the effect of HCV eradication by DAA.

RESULTS

62 outpatients (mean age, 58.6 ± 10.8 years; 58% with compensated cirrhosis) were included. Significant decreases in liver fibrosis markers and an increase of 0.20 and 0.22 kg/m2 in the SMI were observed at T1 and T2. Following DAA therapy, an increase of one unit of PhA was associated with a reduction of 0.38 min in TUG.

CONCLUSION

HCV eradication with DAA therapy was associated with a dynamic reduction of non-invasive markers of liver fibrosis and increased muscle mass in 62 patients with CHC who had an undetectable HCV load at 12 weeks after completion of antiviral treatment.

Agreement and diagnostic differences among three definitions of sarcopenia in patients with chronic hepatitis C

BACKGROUND

There is neither a gold standard definition nor a universal consensus to diagnose sarcopenia in patients with chronic hepatitis C. Thus, we aimed to compare the prevalence of sarcopenia and the agreement and discrepancies between European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, and Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project (FNIH) definitions in chronic hepatitis C.

METHODS

Dual-energy x-ray absorptiometry was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for squared height (ALM/ht2) or for body mass index (ALMBMI). Muscle function was evaluated by handgrip strength. Subjective Global Assessment was used to assess the nutrition status.

RESULTS

This cross-sectional study included 103 outpatients (mean age, 50.6 ± 11.3 years; 33.0% with compensated cirrhosis). Sarcopenia prevalence was 8.7%, 9.7%, and 9.7%, according to EWGSOP1, EWGSOP2, and FNIH definitions, respectively. There was neither a sex- nor a liver disease severity-specific difference in the prevalence of sarcopenia between the criteria applied. Sixteen (15.5%) patients fulfilled at least one of these criteria, and 3 out of 16 (18.8%) simultaneously had sarcopenia by consensus of the three criteria. Sarcopenic obesity was identified in 9 out of 16 (56.3%) patients, and 6 out of 9 (66.7%) of these only met FNIH consensus.

CONCLUSIONS

In patients without cirrhosis or with compensated cirrhosis, and with chronic hepatitis C, the agreement between EWGSOP1 and EWGSOP2 classifications was substantial for sarcopenia diagnosis. Concerning EWGSOP and FNIH criteria, a fair agreement and limited overlap were found in these patients.

Editorial: Hepatitis C virus eradication improves skeletal muscle mass-Authors' reply

This article is linked to Coelho et al papers. To view these articles, visit https://doi.org/10.1111/apt.17950 and https://doi.org/10.1111/apt.17978

Radiotherapy skin marking with lancets versus electric marking pen - Comfort, satisfaction, effectiveness and cosmesis results from the randomized, double-blind COMFORTATTOO trial

INTRODUCTION

Set-up skin markings are performed, in several centers, for radiotherapy (RT) treatments. This study aimed to compare two permanent methods: lancets and an electric marking pen, the Comfort Marker 2.0® (CM).

METHODS

This was a prospective, unicentric, randomized study. Patients aged 18 years or older referred to our department to receive RT were recruited. Patients were randomly assigned, in a 1:1 ratio, to receive set-up markings using lancets or CM. The markings arrangement followed our departmental protocols. The coprimary endpoints were patients' comfort and effectiveness. Secondary endpoints included radiation therapists (RTTs) satisfaction and cosmesis.

RESULTS

Between October 2021 and January 2022, 100 patients were enrolled (50 received lancets and 50 CM) and assessed for the comfort and satisfaction outcomes. CM was significantly less painful than the lancets, with 44% and 16% of the patients, respectively, considering the tattooing process painless (RR = 2.75; 95% IC: 1.36 - 5.58). On the RTT-reported satisfaction, CM had significantly easier processes than lancets (98.0% vs. 78.0%, respectively; RR = 1.26; 95% CI: 1.08 - 1.46). For effectiveness and cosmesis assessment, 98 patients were analyzed (48 received lancets and 50 CM). Patients receiving CM had a significantly higher proportion of markings graded as good and excellent compared to those receiving lancets (98.0% and 50.0%, respectively, had ≥75% of the tattoos assessed as good/excellent, RR = 1.96; 95% CI: 1.47 - 2.61). On the cosmetic evaluation, patients receiving CM had significantly better cosmetic markings, with a median score of 4.4 (vs. 3.5 for lancets, p <0.001).

CONCLUSION

The trial results demonstrated that tattooing with the CM is significantly less painful, more effective, easier to apply, and cosmetically superior to tattooing with lancets.

IMPLICATIONS FOR PRACTICE

Tattooing with CM allows for better results regarding pain, quality, ease and cosmesis.

A robust DF-REML framework for variance components estimation in genetic studies

Motivation

In genetic association studies, linear mixed models (LMMs) are used to test for associations between phenotypes and candidate single nucleotide polymorphisms (SNPs). These same models are also used to estimate heritability, which is central not only to evolutionary biology but also to the prediction of the response to selection in plant and animal breeding, as well as the prediction of disease risk in humans. However, when one or more of the underlying assumptions are violated, the estimation of variance components may be compromised and therefore so may the estimates of heritability and any other functions of these. Considering that datasets obtained from real life experiments are prone to several sources of contamination, which usually induce the violation of the assumption of the normality of the errors, a robust derivative-free restricted-maximum likelihood framework (DF-REML) together with a robust coefficient of determination are proposed for the LMM in the context of genetic studies of continuous traits.

Results

The proposed approach, in addition to the robust estimation of variance components and robust computation of the coefficient of determination, allows in particular for the robust estimation of SNP-based heritability by reducing the bias and increasing the precision of its estimates. The performance of both classical and robust DF-REML approaches is compared via a Monte Carlo simulation study. Additionally, three examples of application of the methodologies to real datasets are given in order to validate the usefulness of the proposed robust approach. Although the main focus of this article is on plant breeding applications, the proposed methodology is applicable to both human and animal genetic studies.

Availability and implementation

Source code implemented in R is available in the Supplementary Material.

Contact

vmml@fct.unl.pt.

Supplementary information

Supplementary data are available at Bioinformatics online.

Robust linear regression methods in association studies

MOTIVATION

It is well known that data deficiencies, such as coding/rounding errors, outliers or missing values, may lead to misleading results for many statistical methods. Robust statistical methods are designed to accommodate certain types of those deficiencies, allowing for reliable results under various conditions. We analyze the case of statistical tests to detect associations between genomic individual variations (SNP) and quantitative traits when deviations from the normality assumption are observed. We consider the classical analysis of variance tests for the parameters of the appropriate linear model and a robust version of those tests based on M-regression. We then compare their empirical power and level using simulated data with several degrees of contamination.

RESULTS

Data normality is nothing but a mathematical convenience. In practice, experiments usually yield data with non-conforming observations. In the presence of this type of data, classical least squares statistical methods perform poorly, giving biased estimates, raising the number of spurious associations and often failing to detect true ones. We show through a simulation study and a real data example, that the robust methodology can be more powerful and thus more adequate for association studies than the classical approach.

AVAILABILITY

The code of the robustified version of function lmekin() from the R package kinship is provided as Supplementary Material.

[Anticipation and quality of life in depression: 2 cognitive concepts?]

This study purports to investigate the relation between negative predictions and quality of life occurring in dysthymia and non-melancholic depression according DSM-IV, in the absence of any personality disorders. The relation between anticipation and quality of life (QoL) is also examined. The results suggest that both anticipatory cognitions and the QoL discriminate the two depressive entities and may have some nosological prediction potential. It is curious to observe the similar behaviour of the two concepts, anticipation and QoL, when implemented with the chosen scales. Moreover, their strong mutual correlation suggests a conceptual proximity or even a concurrent criteria validity. In conclusion, the possibility that both concepts belong to a cognitive sphere should not be ruled out.

The value of the Ecological Station of Jataí's ecosystem services and natural capital

The capacity of a given natural ecosystem to provide certain goods and services that satisfy human needs depends on its environmental characteristics (natural processes and components). It was described the availability of these goods and services (environmental functions) controlled and sustained by ecological processes operating in Ecological Station of Jataí (Luiz Antônio, SP). The environmental functions identified were grouped in four main categories. To make environmental values an integrated factor in planning and decision making it was assessed their socio-economic importance in qualitative terms and, if possible their monetary value. The combined potential annual return from identified functions of Ecological Station of Jataí is at least US$ 708.83/ha/year. In comparison to calculations made for other natural ecosystems this is a rather moderate estimate. The Ecological Station of Jataí is poorly protected and managed, it too is still threatened by human activity (agriculture) and many development plans. Although present day market economics do not recognize the monetary value of most environmental functions, such calculations do provide a revealing insight into the great socio-economic importance of Ecological Station of Jataí. More awareness of these values may provide an important incentive for their preservation and sustainable use.

Effects of trazodone on insomnia and anxiety in depressed patients: a clinical and sleep EEG study

Clinical and sleep EEG effects of trazodone in major depression were investigated using a 5-week single-blind study design. Nine patients with DSM-N major depression were selected. Trazodone (50-250 mg) was given following a 2-week placebo run-in period. Both sleep and psychiatric evaluations were performed at different time points. Early and persistent sleep-inducing effects were detected, including the improvement of objective insomnia features and increased amounts of slow wave sleep. However, no significant changes of REM sleep measures were found. The sleep EEG changes seem to be related to the clinical improvement of both anxiety and insomnia, but there is no apparent relationship with the antidepressant action, which occurs at a later stage of the treatment. Trazodone may be useful in depressed patients, either as a hypnotic-like agent or as an effective antidepressant drug with beneficial effects on sleep.

[Psoas muscular abscess in children]

Symptoms of psoas muscular abscess in children are nonspecific and differential diagnosis is made among diseases included in childreńs acute hip pain syndrome, imaging tests being necessary for diagnostic confirmation. During the first semester of 1995, 48,550 children were examined in Pronto Socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, four of them diagnosed as having psoas muscular abscess (2 females and 2 males, ages varying from 1 to 12 years). All of them had nonspecific clinical features and diagnosis was confirmed by abdominal ultrasound and/or computerized tomography. Staphylococcus aureus was isolated as the etiologic agent in 3 children, findings similar to the ones in literature.