Objective: The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter. Methods: Cross-sectional CT head scans were reviewed for patients undergoing carotid endarterectomy. The masseter was manually delineated and the total masseter area (TMA) and the total masseter density (TMD) calculated. Measurements of the TMA were standardised against the cranial circumference. Observer variability in measurements were assessed using Bland–Altman plots. The relationship between TMA and TMD were evaluated using Pearson’s correlation and linear regression analyses. The prognostic value of TMA and TMD were assessed using receiver operator curves and cox-regression analyses. Results: In total, 149 patients who had undergone routine CT scans prior to a carotid endarterectomy were included in this study. No significant observer variations were observed in measuring the TMA, TMD and cranium circumference. There was a significant positive correlation between standardised TMA and TMD (Pearson’s correlation 0.426, p < 0.001, adjusted R-squared 17.6%). The area under the curve for standardised TMA in predicting all-cause mortality at 30 days, 1 year and 4 years were higher when compared to TMD. Standardised TMA was only predictive of post-operative overall all-cause mortality (adjusted hazard ratio 0.38, 95% confidence interval 0.15–0.97, p = 0.043). Conclusion: We demonstrate a strong relationship between muscle size and density. However, the utilisation of muscle area is likely to be limited in routine clinical care. Advances in knowledge: Our study supports the utilisation of muscle area in clinical sarcopaenia research. We did not observe any additional prognostic advantage in quantifying muscle density.

A minority of medical school entrants draw from disadvantaged backgrounds, which remain significantly underrepresented within the medical workforce. Whilst multifactorial, this may in part relate to relative lack of information about the admissions process amongst these groups. In this article, Mohammed Abdul Waduud and colleagues offer their twelve essential tips to support students from disadvantaged backgrounds who are considering applying to medical school. The authors, all of whom are from disadvantaged backgrounds, have experience in applying to medical schools within the United Kingdom. The tips within this article should support students from disadvantaged backgrounds to decide whether a career in medicine is right for them and succeed in their applications to study medicine.

Transitioning from the pre-clinical to clinical years at medical school can be challenging and overwhelming. This paper aims to utilise the experience of healthcare professionals to provide tips for medical students to consider in order to maximise their learning opportunities.Before starting a placement, it is highly encouraged that you familiarise yourself with the curriculum, remember to bring your essentials and dress appropriately. During your placement, ensure good attendance keeping, introduce yourself to the team, manage your time well, engage in self-directed learning, ask questions to other doctors, interact with allied health care professionals and follow the patient's journey from admission to discharge. It is also key to be wary of university requirements, regularly practice history-taking and clinical examination and examination style questions. Prioritise a suitable work-life balance by enjoying hobbies and extra-curricular activities in order to avoid burn-out. These tips should ensure medical students make the most of their clinical placements as well as making it a memorable and enjoyable experience.