Accessory Muscle Research Articles

An unusual configuration of two anomalies in the extensor digitorum profundus complex in a human.

The extensor digitorum profundus complex underwent degeneration of the ulnar segments during primate adaptation and evolution. This process resulted in the preservation of only the extensor pollicis longus and extensor indicis in some apes, including humans. Consequently, anatomical variations within the digitorum profundus complex in modern humans have been well-documented, with detailed reports on their frequency and patterns in previous studies. Here, we report an unusual arrangement involving two anomalies in the extensor digitorum profundus complex, identified in a 66-year-old Japanese male cadaver. In this cadaver, two accessory muscles differentiated from both the extensor pollicis longus and extensor indicis. Notably, the latter muscle featured a tendon bifurcating towards both the thumb and index fingers, referred to as the extensor pollicis et indicis communis. Under the extensor retinaculum, the tendon of the accessory extensor pollicis longus passed through an independent compartment, whereas that of the extensor pollicis et indicis communis traversed a compartment shared by the extensor indicis and the extensor digitorum communis. Both muscles were innervated by the posterior interosseous nerve. Previous studies have reported that the accessory slip of the extensor pollicis longus and extensor pollicis et indicis communis appear at frequencies of 0.6% and 0.4-1.4%, respectively. However, to the best of our knowledge, a configuration in which both appear simultaneously has not been reported. The data from this case could provide essential insights into the variations in the extensor digitorum profundus complex in humans and non-human primates.

CRIM-negative infantile Pompe disease, long-term observation of the effect of enzyme replacement therapy: a clinical case

Background. Infantile-onset form of Pompe disease (IOPD) comprises a progressive and fatal disease in the absence of pathogenetic treatment. Enzyme replacement therapy using biologically active recombinant human alglucosidase alfa is considered as a treatment option to increase the life expectancy of patients with early diagnosis and timely initiation of therapy.Case description. A child aged 5 months was delivered to the Cardiology Department of Children’s Republican Clinical Hospital (Tatarstan, Russia) for examination and clarification of the diagnosis. The patient’s parents complained of his shortness of breath, unproductive cough, cyanosis of the nasolabial triangle when restless, weakness, lethargy during breastfeeding session, as well as decreased appetite up to refusal to eat, constantly enlarged tongue. The examination revealed macroglossia and hypersalivation, pseudohypertrophy of calf muscles, dyspnea involving the accessory muscles, hepatomegaly, diffuse muscular hypotonia. Laboratory tests revealed an increase in alanine aminotransferase level greater than four times the normal values, aspartate aminotransferase level — more than nine times, a significant rise of creatine phosphokinase and lactate dehydrogenase, as well as natriuretic peptide. Echocardiography revealed significant myocardial hypertrophy of both the left and right ventricles. Complaints, medical history, clinical examination, and all of the above changes in laboratory and instrumental examinations suggested a group of hereditary metabolic diseases (Pompe disease), confirmed by a pronounced decrease in the activity of the alpha-glucosidase enzyme to 0.12 μmol/l/h in dry blood spots with subsequent molecular genetic study and detection of compound-heterozygous mutations in the GAA gene. It was decided to initiate specific enzyme replacement therapy by intravenous administration of a recombinant form of human acidic alpha-glucosidase (alglucosidase alfa) at a dose of 20 mg/kg/injection in a frequency of once every 2 weeks. In addition, CRIM (cross-reactive immunological material)-negative status determined immune tolerance therapy, including the most studied combination of three drugs: rituximab, methotrexate, and intravenous immunoglobulin, as a response to enzyme replacement therapy. Long-term observation of the effect of enzyme replacement therapy brought positive results in the form of new motor skills, decreased content of intracellular enzymes and natriuretic peptide, reduction of myocardial hypertrophy of the left and right ventricles. In the future, the child needs lifelong treatment.Conclusion. Awareness of physicians about Pompe disease will prevent the growth in diagnostic errors and neglected cases. In case of early confirmation, the effectiveness of currently available ERT increases: the possibility to stop the disease progression, to reverse its individual clinical manifestations, and to improve the patient’s quality of life.

Immediate Unilateral Subpectoral Implant-Based Breast Reconstruction does not Impair Pulmonary Functions: A Preliminary Prospective Study.

Implant-based breast reconstruction is one of the most common procedures among women with breast cancer undergoing mastectomy. Prosthetic devices may be positioned either beneath or above the pectoralis major muscle, which is considered an accessory muscle of ventilation. This preliminary prospective study aimed to investigate whether subpectoral unilateral implant-based breast reconstruction has any effect on patients' pulmonary functions. A prospective study of fourteen women who underwent immediate unilateral implant-based subpectoral breast reconstruction by a single surgeon over 10months was conducted. Spirometry and maximal voluntary ventilation tests were conducted 1day prior to surgery, and 1- and 3months following breast reconstruction. ANOVA or Friedman test were used to compare pulmonary function tests before and after surgery. Fourteen patients completed the study protocol. No statistically significant differences were found when comparing spirometry parameters in the three time points. Pectoralis muscle release does not impair pulmonary function among patients undergoing immediate unilateral implant-based breast reconstruction following mastectomy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial.

Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. TYGH108045. NCT04500223.

The double-headed accessory iliacus muscle: a case report.

Numerous accessory muscles are present in the human body, many of which are clinically significant. We present a case of an anomalous accessory iliacus composed of two heads, whose occurrence and anatomical location indicate a high probability of causing femoral nerve compression. During a routine dissection of the posterior abdominal wall of a xx-year-old cadaver, a double headed accessory muscle was noted, measured and photographed. In addition to the normal anatomy of dissected structures from the posterior abdominal wall, an accessory iliacus muscle composed of superficial and deep heads was identified. In addition, the inferior roots of the divided femoral nerve located between the heads was found to follow an unusual course. It is important to be aware of morphological variability around structures such as double-headed accessory iliacus muscle presented in this study, due to their association with neurovascular bundles and hip joint. The reported atypical morphology is not widely known in the literature but might be of great clinical significance, therefore knowledge of such variability might be regarded in order to diagnose properly and introduce accurate treatment.

The morphological variability of the pelvic girdle muscles: a potential trap during ultrasound.

The muscles present in the pelvic girdle compartment demonstrate clinically significant anatomical variation regarding both their site of attachment and additions, such as accessory heads, muscles or tendinous slips. Many of those variations might be considered potential traps during ultrasound examination that may result in misdiagnosis. The aim of this study was to raise awareness of such possibility. A comprehensive search for morphological variations was performed in PubMed and NIH. Relevant papers were listed and citation tracking was accomplished. Although several anatomical variations of pelvic girdle muscles have been presented, few studies have examined their relevance in ultrasound imaging. The morphological variability of the pelvic girdle muscles does not vary from such incidence in other regions of the human body; however further ultrasound studies are needed of the numerous morphological variants that can be found in this region.

Uncommon Anatomical Causes of Ulnar Compression: A Narrative Review.

Some patients develop ulnar nerve compression due to rare anatomical variations or malformations. The aims of this review are to provide a comprehensive overview of anatomical structures and variations that can cause ulnar nerve compression and to evaluate treatment options. Case reports and case series about rare cases of unusual ulnar nerve compression published from January 2000 until April 2022 were obtained from databases Embase, MEDLINE, and Web of Science. A total of 48 studies describing 64 patients were included in our study. The following structures have proven to cause ulnar nerve compression: anconeus epitrochlearis, accessory abductor digiti minimi, vascular anomalies, palmaris longus, fibrous bands, and flexor carpi ulnaris. All cases except one have had a surgical release of the ulnar nerve resulting in diminished symptoms or complete recovery at follow-up. In addition to considering common compression points, it is important to be aware that proximal compression symptoms, such as pain and a positive Tinel sign at the medial elbow, may be attributed to a hypertrophic AE or vascular anomaly. Distal compression symptoms encompass swelling, along with pain and a positive Tinel sign at the distal forearm. Various structures contributing to distal compression include an accessory abductor digiti minimi muscle, an accessory or anomalous palmaris longus muscle, or an accessory or hypertrophic flexor carpi ulnaris muscle. The occurrence of fibrous bands exhibits variability, manifesting in diverse locations across the arm.Level of Evidence: IV.

Combined frequency domain near-infrared spectroscopy and diffuse correlation spectroscopy system for comprehensive metabolic monitoring of inspiratory muscles during loading.

Mechanical ventilation (MV) is a cornerstone technology in the intensive care unit as it assists with the delivery of oxygen in critically ill patients. The process of weaning patients from MV can be long and arduous and can lead to serious complications for many patients. Despite the known importance of inspiratory muscle function in the success of weaning, current clinical standards do not include direct monitoring of these muscles. The goal of this project was to develop and validate a combined frequency domain near-infrared spectroscopy (FD-NIRS) and diffuse correlation spectroscopy (DCS) system for the noninvasive characterization of inspiratory muscle response to a load. The system was fabricated by combining a custom digital FD-NIRS and DCS system. It was validated via liquid phantom titrations and a healthy volunteer study. The sternocleidomastoid (SCM), an accessory muscle of inspiration, was monitored during a short loading period in fourteen young, healthy volunteers. Volunteers performed two different respiratory exercises, a moderate load and a high load, which consisted of a one-minute baseline, a one-minute load, and a six-minute recovery period. The system has low crosstalk between absorption, reduced scattering, and flow when tested in a set of liquid titrations. Faster dynamics were observed for changes in blood flow index (), and metabolic rate of oxygen () compared with hemoglobin + myoglobin (Hb+Mb) based parameters after the onset of loads in males. Additionally, larger percent changes in , and were observed compared with Hb+Mb parameters in both males and females. There were also sex differences in baseline values of oxygenated Hb+Mb, total Hb+Mb, and tissue saturation. The dynamic characteristics of Hb+Mb concentration and blood flow were distinct during loading of the SCM, suggesting that the combination of FD-NIRS and DCS may provide a more complete picture of inspiratory muscle dynamics.

Association between computed tomography-quantified respiratory muscles and chronic obstructive pulmonary disease: a retrospective study

BackgroundThis study examined the association between chest muscles and chronic obstructive pulmonary disease (COPD) and the relationship between chest muscle areas and acute exacerbations of COPD (AECOPD).MethodsThere were 168 subjects in the non-COPD group and 101 patients in the COPD group. The respiratory and accessory respiratory muscle areas were obtained using 3D Slicer software to analysis the imaging of  computed tomography (CT). Univariate and multivariate Poisson regressions were used to analyze the number of AECOPD cases during the preceding year. The cutoff value was obtained using a receiver operating characteristic (ROC) curve.ResultsWe scanned 6342 subjects records, 269 of which were included in this study. We then measured the following muscle areas (non-COPD group vs. COPD group): pectoralis major (19.06 ± 5.36 cm2 vs. 13.25 ± 3.71 cm2, P < 0.001), pectoralis minor (6.81 ± 2.03 cm2 vs. 5.95 ± 1.81 cm2, P = 0.001), diaphragmatic dome (1.39 ± 0.97 cm2 vs. 0.85 ± 0.72 cm2, P = 0.011), musculus serratus anterior (28.03 ± 14.95 cm2 vs.16.76 ± 12.69 cm2, P < 0.001), intercostal muscle (12.36 ± 6.64 cm2 vs. 7.15 ± 5.6 cm2, P < 0.001), pectoralis subcutaneous fat (25.91 ± 13.23 cm2 vs. 18.79 ± 10.81 cm2, P < 0.001), paravertebral muscle (14.8 ± 4.35 cm2 vs. 13.33 ± 4.27 cm2, P = 0.007), and paravertebral subcutaneous fat (12.57 ± 5.09 cm2 vs. 10.14 ± 6.94 cm2, P = 0.001). The areas under the ROC curve for the pectoralis major, intercostal, and the musculus serratus anterior muscle areas were 81.56%, 73.28%, and 71.56%, respectively. Pectoralis major area was negatively associated with the number of AECOPD during the preceding year after adjustment (relative risk, 0.936; 95% confidence interval, 0.879–0.996; P = 0.037).ConclusionThe pectoralis major muscle area was negative associated with COPD. Moreover, there was a negative correlation between the number of AECOPD during the preceding year and the pectoralis major area.

Two variant muscles in the gluteal region.

The short lateral rotators of the thigh found in the gluteal region can have morphological variations. During anatomical dissection of a right lower limb, two variant structures were found in this region. The first of these accessory muscles originated from the external surface of the ramus of the ischium. Distally, it was fused with the gemellus inferior muscle. The second structure comprised tendinous and muscular parts. The proximal part originated from the external part of the ischiopubic ramus. It inserted on the trochanteric fossa. Both structures were innervated by small branches of the obturator nerve. The blood supply was via branches of the inferior gluteal artery. There was also a connection between the quadratus femoris and the superior part of the adductor magnus. These morphological variants could be clinically important.

Characteristics of asthmatic children with &lt;em&gt;Mycoplasma pneumoniae&lt;/em&gt; infection in Vietnam

Introduction: Mycoplasma pneumoniae is regarded as an involved factor in refractory asthma exacerbations. The link between Mycoplasma pneumoniae infection and asthma is not fully understood, particularly regarding clinical and paraclinical characteristics.Objectives: To determine the frequency of Mycoplasma pneumoniae infection in asthmatic children, identify clinical and paraclinical characteristics along with clinical management in children aged 6 to 15 years at Can Tho Children's Hospital, Vietnam.Method: From March 2019 to April 2021, 124 patients participated in a cross-sectional study that was done. Mycoplasma pneumoniae was detected using an immunoglobulin N (IgM) serology test.Results: Mycoplasma pneumoniae-IgM serology was positive in 32.3% asthmatic children. IgM-positive individuals had significantly greater percentages of accessory respiratory muscle contraction, coarse crackles, fever, and increased heart rate. Mycoplasma pneumoniae infection occurred in 42.3% of children who were hospitalized for the first time and had asthma diagnosis. Mycoplasma pneumoniae infection and the severity of acute asthma exacerbations had a positive association (p&lt;0.05). A longer hospital stay (6.74±1.91 days) and a higher exacerbation recurrence rate (32.4%) were observed in the IgM-positive group (p&lt;0.05). Conclusions: Mycoplasma pneumoniae infections were highly prevalent in asthmatic children. Severity of acute asthma exacerbations, first-time asthma diagnosis, and recurrence of asthma exacerbation were significantly associated with Mycoplasma pneumoniae infection.

Peripheral Nerve Stimulation for the Treatment of Superior Cluneal Neuralgia: A Cadaver Demonstration of a Novel Technique for Lead Placement.

Superior cluneal neuralgia (SCN) is a distinct cause of lower back and/or leg pain related to pathology of the superior cluneal nerve. When assessing a patient with low back pain (LBP), superior cluneal neuralgia is frequently misdiagnosed. The pathophysiology of SCN ranges from myofascial compression brought on by aberrant muscle tone to direct iatrogenic injury or trauma. In this technical report we will discuss the anatomy of superior cluneal nerve, superior cluneal neuralgia, current treatment modalities, and a novel approach to peripheral nerve stimulation (PNS) lead placement via a cadaver demonstration for SCN.

Evaluation of Smooth Muscle Myosin Heavy Chain Isoform Expressions in a Buried Penis

BackgroundA buried penis (BP) is rare in which the penile body is retracted into the prepubic adipose tissue. This research focuses on differences in smooth muscle myosin heavy chain (SMMHC) isoform expressions in the dartos fascia. MethodsA total of 82 children, 41 of whom had BPs, who applied for circumcision between May and November 2021, were included in the study. The cases were divided into four groups aged ≥6 years (NP6, n = 18) and aged ≤3 years (NP3, n = 17) with normal penile appearance, aged ≥6 years (BP6, n = 23) and aged ≤3 years (BP,n = 24) with a BP. SMMHC isoforms mRNA gene expression analyses were performed by quantitative PCR technique in dartos fascia obtained from foreskin removed by circumcision. ResultsCompared to the NP3 group, the SM1 mRNA expressed in the BP6 group was statistically significantly higher (p < 0.005). SM2 mRNA levels expressed in dartos fascia were considerably higher in NP6 and NP3 groups compared to BP6 and BP3 groups (p < 0.001). The SM2/SM1 ratio was 0.85 in the BP6 group and 1.46 in the NP6 group, which was statistically significant (p = 0.006) and increased from 0.87 in the BP3 group to 2.21 in the NP3 group (p < 0.001). ConclusionIn a buried penis, there is a difference in the expression of SMMHC isoforms. SM1 is highly expressed, while SM2 decreases, increasing the SM2/SM1 ratio. This causes increased contractility in the smooth muscle, leading to retraction of the penile body. The dartos fascia surrounding it resembles aberrant muscle tissue in boys with a BP. Level of EvidenceLevel III. Type of StudyCase-control study.

Differences of ventilatory muscle recruitment and work of breathing in COPD and ILD during exercise – a comprehensive evaluation

IntroductionChronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) are significant chronic respiratory disorders, impacting quality of life. Respiratory muscle roles and differences remains not entirely clear.ObjectivesTo evaluate the degree of recruitment of the respiratory muscles and the work of breathing (WOB) in COPD and ILD during exercise.MethodsWe compared the sensory-mechanical relationships in COPD, ILD, and healthy control (n= 20 each). They performed pulmonary function, non-invasive and invasive respiratory muscle strength, surface electromyography and work of breathing (WOB).ResultsCOPD and ILD didn't show lower static muscle strength compared to controls, but poor performance in the exercise test with increased transdiaphragmatic pressure (PDI). In ILD, there was a higher increase in oesophageal pressure (PEs) and a lower gastric pressure (PGa) on inspiration; in COPD, there was a significant increase in PGa on inspiration. In ILD, there is greater recruitment of accessory inspiratory muscles, whereas, in COPD, there is marked use of both inspiratory and expiratory muscles. The neuromechanical inefficiency (increased neural respiratory drive without the corresponding tidal volume) was found in both diseases. In COPD, there is a considerable increase in elastic work to overcome intrinsec PEEP (PEEPi) and expiratory WOB, whereas, in ILD, non-PEEPi elastic WOB is the highest part of total WOB.ConclusionsEarly and increased activity of the respiratory muscles and WOB components significantly contribute to dyspnoea, exercise intolerance, and neuromechanical inefficiency of ventilation in COPD and ILD. The mechanisms of Pdi generation were different between diseases.

Evolutionary anatomical and functional characteristics of the intrinsic shoulder and brachial muscles in the northern anteater (Tamandua mexicana).

Tamandua mexicana is an anteater species native from Mexico to Peru. This species is of great evolutionary interest because it belongs to one of the oldest clades of placental mammals in the American continent. This study aimed to describe the origin, insertion, and arterial supply of the intrinsic shoulder and brachial muscles of T. mexicana. We also compared the masses of the functional groups. Gross dissections were performed on both thoracic limbs of 13 cadavers. ANOVA followed by Tukey's test was used for statistical analyses. The subscapularis muscle presents a hiatus to the common tendon of the caput breve of the biceps brachii and coracobrachialis muscles. A variant accessory muscle, the m. articularis humeri lateralis, was found on the lateral surface of the shoulder joint. M. deltoideus pars acromialis has two bellies. The teres major muscle is perforated by the aponeurotic origin of the m. tensor fasciae antebrachii. The triceps brachii has two capita longi. The caput mediale is fused with the m. anconeus medialis. The caput laterale can have an accessory belly as an anatomical variant. Among the functional groups, a significant difference was found between the elbow extensors and flexors, with the latter having the lowest mass. In conclusion, the intrinsic muscles of T. mexicana presented unique features for the species, as well as arrangements in mass distribution that evidence a possible evolutionary convergence among species of the Superorder Xenarthra.

Short term effects of MET programme in patients diagnosed with Chronic Obstructive Pulmonary Disease: a randomised controlled trial

Background Muscle Energy Techniques have been reported to provide beneficial effects on range of movement in multiple musculoskeletal dysfunctions. Noting these physiological effects and clinical recommendations, the effects of METs are given importance through investigations on their input in managing COPD symptoms. The maintenance of such outcomes has though not been investigated. Therefore, the aim is to look into the short-term effects, 4-week post completion of the intervention, on pulmonary function, chest measurements, exercise tolerance and ADLs. Method This paper reports outcomes from a randomised controlled trial. 108 patients with COPD were recruited and assigned to 2 groups. The intervention group underwent a 4-week MET programme applied to the accessory muscles of respiration. The control group on the other hand continued with standard medical treatment. Outcome measures were assessed at baseline, at the 4th week time point on completion of the intervention, and again 4 weeks after. The outcome measures were performed in both groups which consisted of the pulmonary function tests, 6-min walk test (6MWT), chest measurements and the Manchester Respiratory Activities of Daily Living (MR-ADL) questionnaire. Results Significant improvements were observed after 4 weeks from cessation of MET intervention when compared to baseline for pulmonary function measures (p < 0.001), chest measurements (p < 0.001) and ADLs (p < 0.001), in subjects enrolled in the intervention group. Conclusions Significant short-term effects in outcome measures following 4 weeks from completion of the MET programme were observed in the intervention group. Clinical trial registration: The study was clinically registered in ClinicalTrials.gov (NCT04773860)

Examination of accessory extensor carpi radialis longus and brevis musculotendinous units for functional impact and tendon transfer suitability

IntroductionArchitectural characteristics of skeletal muscles are used to inform biomechanical analysis and candidacy for tendon transfer surgeries. Tendons of non-typical skeletal muscles may serve as optimal grafts, yet a thorough comparison of their parameters to those of typical musculature is not well represented in current literature. This study aims to analyze accessory extensor carpi radialis longus (aECRL) and accessory carpi radialis brevis (aECRB) muscles for their functional impact and suitability for use in tendon transfer surgeries. MethodsOut of 122 dissected forearms examined, one right aECRB and one left aECRL were discovered and photographed in situ. The accessory muscles, along with eleven other muscles associated with ECRL and ECRB tendon transfers from the same forearms, were analyzed for their sarcomere contraction states, structural properties, and maximal isometric force (Fmax) generating capacities. An architectural difference index was then calculated between each muscle to determine and discuss possible candidates for tendon transfer surgeries. ResultsThe Fmax of aECRL, ECRL, aECRB, and ECRB were determined to be 11.78 N, 57.24 N, 28.21 N, and 78.64 N, respectively. In this regard, aECRL and aECRB represented a 20.58% and 35.87% increase to ECRL and ECRB Fmax, respectively. The aECRL inserted with ECRB, and the aECRB inserted with ECRL. The aECRL and aECRB tendons, measuring 188.33 mm × 2.98 mm and 217.17 mm × 3.00 mm respectively, coursed independently with the ECRL and ECRB tendons to their shared insertions. The aECRL and aECRB muscles were each most structurally similar to the extensor pollicis longus and adductor pollicis muscles. ConclusionsBased on their morphology and structural characteristics, the aECRL and aECRB may be suitable grafts in adductorplasty or for extensor pollicis longus muscle/tendon repair. As the aECRL and aECRB tendons were relatively superficial and considerably long and wide, they may also be suitable for other musculotendon-based surgeries elsewhere in the body. This report may contribute new and beneficial insights for healthcare providers and medical educators when presented with cases where upper extremity musculotendinous reconstruction is warranted and/or non-typical musculoskeletal morphologies – particularly aECRL and aECRB – are present.

Evaluation of patients with chronic obstructive pulmonary disease by maximal inspiratory pressure and diaphragmatic excursion with ultrasound sonography

BackgroundDecreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia. MethodsPatients with COPD underwent spirometry, exercise tolerance (VO2peak) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography. ResultsOverall, 58 patients with COPD (median age, 76 years; median %FEV1, 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV1, Δinspiratory capacity, VO2peak, and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV1, these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index. ConclusionMeasuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia.

Microanatomy and ultrastructure of the nervous system of adult Renicola parvicaudatus (Digenea: Renicolidae)

AbstractThe digenean complex life cycle includes various morphological forms with different locomotory and behavioral activities, and the functional specialization of their nervous system is of importance for the transmission of these parasites. Adult digeneans acquire many adaptive features associated with the final settlement in a vertebrate host. Our study describes the general morphology and ultrastructure of the nervous system of the adult renicolid digenean Renicola parvicaudatus parasitizing the renal tubules of herring gulls. Using immunocytochemical and electron microscopic methods, we identified the distinctive characteristics of ganglia and synapses in the studied species. A comparative analysis of the organization of the nervous system of adult individuals and their continuously‐swimming stylet cercariae revealed a number of stage‐related differences in the composition of ganglia, the distribution of serotonin‐ and FMRFamide‐immunoreactive neurons, the cytomorphology of neuron somata and free sensory endings. Thus, in adults, the presence of FMRFamide‐positive neuron somata, accessory muscle bundles in the ganglionic cortex, and eight types of neuronal vesicles was detected, but no glia‐like elements were identified. Their neurons are characterized by a larger volume of cytoplasm and also show greater ultrastructural diversity. Although the sensory papillae of adults do not vary in their external morphology as much as those of larvae, their sensory bulbs are more diverse in cytomorphology. Following our previous data on the “support” cell processes related to various tissues of the larvae and considered as glia‐like structures, we also briefly present the identified features of the parenchyma, attachment organs and excretory system of adult individuals. The excretory system of adult R. parvicaudatus is characterized by the presence of unique terminal cells with several flame tufts, which are not typical either for the larvae of this species or for other digeneans studied so far. We also used molecular phylogenetic analysis to clarify species identification.

Clinical Evaluation of Dyspnoea in Obstructive Lung Disease – Progressing from Psychometrics to Physiology

Dyspnoea is a common symptom that afflicts persons with myriad medical conditions. Among sufferers of lung disorders such as chronic obstructive pulmonary disease, dyspnoea, together with effort intolerance, are the major complaints. Dyspnoea is a marker of disease severity and adverse prognosis of chronic obstructive pulmonary disease, and the need for symptom alleviation in improving health status is ever-present, but the quantification of this symptom is challenging in clinical practice, and is mostly limited to the use of questionnaires and self-reports currently. Numerous psychometric tools have been developed to measure the severity of dyspnoea clinically, but their utility is vitiated by the complexity and multidimensional nature of the symptom. The lack of a universally accepted and accurate measurement tool is likely to hinder future progress in developing novel treatments for relieving dyspnoea. Physiological measurements have been used to complement or supplant psychometric evaluation of dyspnoea but simple stationary lung function tests do not correlate sufficiently well with dyspnoea severity in patients with chronic obstructive pulmonary disease, while complex exercise testing is impractical or limited to specialized research labs. In recent years, the use of non-invasive surface electromyography of the diaphragm and/or accessory muscles of respiration is gaining attention as a promising physiological assessment of dyspnoea with potential for widespread clinical applications. Although substantial technological gaps still exist between bench and bedside, the current interest, as evidenced by the number of med-tech collaborations in surface respiratory electromyography, appears to be well justified. This review aims to summarize the past and present methodologies as well as future developments in evaluating and quantifying dyspnoea, especially in patients with chronic obstructive pulmonary disease.