Bilateral Muscle Research Articles

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

Patient metabolic profile defined by liver and muscle 18F-FDG PET avidity is independently associated with overall survival in gastric cancer.

PET-CT-based patient metabolic profiling is a novel concept to incorporate patient-specific metabolism into gastric cancer care. Staging PET-CTs, demographics, and clinicopathologic variables of gastric cancer patients were obtained from a prospectively maintained institutional database. PET-CT avidity was measured in tumor, liver, spleen, four paired muscles, and two paired fat areas in each patient. The liver to rectus femoris (LRF) ratio was defined as the ratio of SUVmean of liver to the average SUVmean of the bilateral rectus femoris muscles. Kaplan-Meier and Cox-proportional hazards models were used to identify the impact of LRF ratio on OS. Two hundred and one patients with distal gastroesophageal (48%) or gastric (52%) adenocarcinoma were included. Median age was 65years, and 146 (73%) were male. On univariate analysis, rectus femoris PET-CT avidity and LRF ratio were significantly associated with overall survival (p < 0.05). LRF ratio was significantly higher in males, early-stage cancer, patients with an ECOG 0 or 1 performance status, patients with albumin > 3.5mg/dL, and those with moderately differentiated tumor histology. In multivariable regression, gastric cancer stage, albumin, and LRF ratio were significant independent predictors of overall survival (LRF ratio HR = 0.73 (0.56-0.96); p = 0.024). Survival curves showed that the prognostic impact of LRF was associated with metastatic gastric cancer (p = 0.009). Elevated LRF ratio, a patient-specific PET-CT-based metabolic parameter, was independently associated with an improvement in OS in patients with metastatic gastric cancer. With prospective validation, LRF ratio may be a useful, host-specific metabolic parameter for prognostication in gastric cancer.

Clinical characteristics and prognosis of 8 cases of severe infant botulism

Objective: To summarize the clinical characteristics and prognosis of severe infant botulism and evaluate the therapeutic effect of botulinum antitoxin in the pediatric intensive care unit (PICU). Methods: The clinical data of 8 cases diagnosed with infantile botulism were retrospectively analyzed in the PICU of Beijing Children's Hospital from October 2019 to August 2023. Data of basic demographic information, clinical manifestations, laboratory tests, treatment and prognosis of each child were collected and analyzed using descriptive statistical methods. Results: Eight laboratory-confirmed cases of infant botulism were included in this study, all of which were male infants with an age of 6.0 (3.3,6.8) months. Three of the children were from Inner Mongolia Autonomous Region, 2 of them were from Hebei, and the other 3 were from Beijing, Shandong and Xinjiang Uyghur Autonomous Region, respectively. All the patients were previously healthy. In 4 of these cases, the possible cause was the ingestion of either honey and its products or sealed pickled food by the mother or child before the onset of the disease. The first symptom was poor milk intake (4 cases), followed by shallow shortness of breath (7 cases), limb weakness (7 cases) and so on. The typical signs were bilateral dilated pupils (8 cases) and decreased limb muscle strength (8 cases). The main subtype was type B (7 cases), and only 1 case was classified as type A. Six of the children were treated with antitoxin therapy for a duration of 24 (19, 49) d. Seven of them had invasive mechanical ventilation. All the patients survived upon discharge with a follow-up period of 29 d to 3 years and 8 months. Six patients had fully recovered, and 2 recently discharged patients were gradually recovering. Conclusions: For infants with suspected contact or ingestion of botulinum and presented with bilateral pupillary paralysis, muscle weakness and clear consciousness, the stool should be collected for diagnostic testing using a mouse bioassay as soon as possible. Type B was the most common type. The antitoxin treatment was effectiveness and the prognosis was well.

Testing the effect of functional orthopedic appliance Simões network 6 (SN6) through surface electromyography on rest mandibular position – a pilot study

The maintenance of the lower level of muscle contraction is fundamental for the development and health of the stomatognathic system (SS). Malocclusion leads to unbalance muscle activity, since Class II treatment is not the most prevalent malocclusion in the general population but is the more frequent to search for treatment in dental offices and the most prevalent skeletal component in the class II malocclusion is the retrognathia this pilot investigation aims to study the effect of rest electric activity of bilateral anterior temporal, masseter and suprahyoid muscle in individuals undergoing class II treatment with functional orthopedic appliance Simões Network 6 (SN6). Surface electromyography recordings of bilateral anterior temporal, masseter and suprahyoid muscle in rest position was obtained before and 8 minutes after the functional appliance insertion in mouth. Results showed improvement of electric muscle activity in rest position and balance of bilateral muscle electric activity in all muscle. Based on the preliminary results it can be conclude that jaw functional orthopedics (JFO) provides alteration of the resting records in the mandibular rest position of the studied muscles, indicating relaxation of the muscles studied and a more symmetrical electric activity. Further studies are necessary for a better understanding of the effects of functional orthopedic appliances in the electric activity of stomatognathic muscle in the mandibular rest position.

Comparative analysis of paraspinal muscle imbalance between idiopathic scoliosis and congenital scoliosis from the transcriptome aspect.

Previous studies have analyzed paraspinal muscle imbalance in idiopathic scoliosis (IS) with methods including imaging, histology and electromyography. However, whether paraspinal muscle imbalance is the cause or the consequence of spinal deformities in IS remains unclear. Comparison of paraspinal muscle imbalance between IS and congenital scoliosis (CS) may shed some light on the causality of paraspinal muscle imbalance and IS. This study aimed to elucidate the generality and individuality of paraspinal muscle imbalance between IS and CS from gene expression. Five pairs of surgical-treated IS and CS patients were matched. Bilateral paraspinal muscles at the apex were collected for transcriptome sequencing. Differentially expressed genes (DEGs) between the convexity and concavity in both IS and CS were identified. Comparison of DEGs between IS and CS was conducted to discriminate IS-specific DEGs from DEGs shared by both IS and CS. Bioinformatics analysis was performed. The top 10 hub genes in the protein-protein interaction (PPI) network of IS-specific DEGs were validated by quantitative PCR (qPCR) in 10 pairs of IS and CS patients. A total of 370 DEGs were identified in IS, whereas 380 DEGs were identified in CS. Comparison of DEGs between IS and CS identified 59 DEGs shared by IS and CS, along with 311 DEGs specific for IS. These IS-specific DEGs were enriched in response to external stimulus and signaling receptor binding in GO terms and calcium signaling pathway in KEGG pathways. The top 10 hub genes in the PPI network of IS-specific DEGs include BDKRB1, PRH1-TAS2R14, CNR2, NPY4R, HTR1E, CXCL3, ICAM1, ALB, ADIPOQ, and GCGR. Among these hub genes, the asymmetrical expression of PRH1-TAS2R14 and ADIPOQ in IS but not CS were validated by qPCR. Transcriptomic differences in bilateral paraspinal muscles between the convexity and concavity in IS share few similarities with those in CS.

Moment arm and torque generating capacity of semitendinosus following tendon harvesting for anterior cruciate ligament reconstruction: A simulation study.

Altered semitendinosus (ST) morphology and distal tendon insertion following anterior cruciate ligament reconstruction (ACLR) may reduce knee flexion torque generating capacity of the hamstrings via impaired ST force generation and/or moment arm. This study used a computational musculoskeletal model to simulate mechanical consequences of tendon harvest for ACLR on ST function by modeling changes in ST muscle tendon insertion point, moment arm, and torque generating capacity across a physiological range of motion. Simulated ST function was then compared between ACLR and uninjured contralateral limbs. Magnetic resonance imaging from 18 individuals with unilateral history of ACLR involving a hamstring autograft was used to analyse bilateral hamstring muscle (ST, semimembranosus, bicep femoris long head and short head) morphology and distal ST tendon insertion. The ACLR cohort was sub-grouped into those with and without ST regeneration. For each participant with ST regeneration (n = 7), a personalized musculoskeletal model was created including postoperative remodeling of ST using OpenSim 4.1. Knee flexion and internal rotation moment arms and torque generating capacities of hamstrings were evaluated. Bilateral differences were calculated with an asymmetry index (%) ([unaffected limb-affected limb]/[unaffected limb + affected limb]*100%). Smaller moment arms or knee torques within injured compared to uninjured contralateral limbs were considered a deficit. Compared to uninjured contralateral limbs, ACLR limbs with tendon regeneration (n = 7) had minor reductions in knee flexion (5.80% [95% confidence interval (CI) = 3.97-7.62]) and internal rotation (4.92% [95% CI = 2.77-7.07]) moment arms. Decoupled from muscle morphology, altered ST moment arms in ACLR limbs with tendon regeneration resulted in negligible deficits in knee flexion (1.20% [95% CI = 0.34-2.06]) and internal rotation (0.24% [95% CI = 0.22-0.26]) torque generating capacity compared to uninjured contralateral limbs. Coupled with muscle morphology, ACLR limbs with tendon regeneration had substantial deficits in knee flexion (19.32% [95% CI = 18.35-20.28]) and internal rotation (15.49% [95% CI = 14.56-16.41]) torques compared to uninjured contralateral limbs. Personalized musculoskeletal models with measures of ST distal insertion and muscle morphology provided unique insights into post-ACLR ST and hamstring function. Deficits in knee flexor and internal rotation moment arms and torque generating capacities were evident in those with ACLR even when tendon regeneration occurred. Future studies may wish to implement this framework in personalized musculoskeletal models following ACLR to better understand individual muscle function for injury prevention and treatment evaluation.

Checking the manufacturing of Simões Network 10 – SN10 through surface electromyography (sEMG) – Case report Study

Use of functional orthopedic appliances (FOA) in the treatment of malocclusion and Temporomandibular Disorders (TMD) has been proved to be effective but there is still questions to be answered like the muscular action of the referred appliances. The aim of this study is checking through a proven protocol of surface electromyography (sEMG) to study muscular action of FOA to check to check if it is correctly manufactured. The appliance studied is a Simões Network 10 – SN10 to treat Class II malocclusion of retrognathia. The sEMG was collected 1 patients with class II malocclusion with retrognathia who belong to a 164 volunteers with malocclusion, in two times T1 before installation of the FOA in mouth, T2 15 minutes after the FOA installation in the mouth. sEMG data of bilateral masseter, bilateral temporal and bilateral suprahyoid muscles using conditioner signals module from Lynx Electronics Ltda with 8 channels, model EMG1000; software AqDAnalysis 4,18 from Lynx Electronics Ltda.; Software Lynx BioInspector 1,8r; passive surface electrodes (Ag/AgCl) from Noraxon Dual Electrodes (USA); dischargeable reference electrodes Kendall Meditrace (Ag/AgCl) – Canada were used for the sEMG measurements. Frequency calibration was 2000 Hz, with 2048 sample by channel and time 1,024 seconds, and filters regulation was 20 Hz and 1000 Hz. With the FOA in the mouth all measurements improved with a more simetrical sEMG in T2 in rest and isometric contraction measurements. The protocol used to check the manufacturing of functional orthopedic appliances using surface EMG proved to be a valid tool in this case report study. Further investigations are needed to confirm this protocol and check if the same happens with other types of functional orthopedics appliances.

Postabsorptive and postprandial myofibrillar protein synthesis rates at rest and after resistance exercise in women with postmenopause.

Feeding and resistance exercise stimulate myofibrillar protein synthesis (MPS) rates in healthy adults. This anabolic characterization of "healthy adults" has been namely focused on males. Therefore, the purpose of this study was to examine the temporal responses of MPS and anabolic signaling to resistance exercise alone or combined with the ingestion of protein in postmenopausal females and compare postabsorptive rates with young females. Sixteen females [60 ± 7 yr; body mass index (BMI) = 26 ± 12 kg·m-2] completed an acute bout of unilateral resistance exercise before consuming either: a fortified whey protein supplement (WHEY) or water. Participants received primed continuous infusions of L-[ring-13C6]phenylalanine with bilateral muscle biopsies before and after treatment ingestion at 2 h and 4 h in nonexercised and exercised legs. Resistance exercise transiently increased MPS above baseline at 0-2 h in the water condition (P = 0.007). Feeding after resistance exercise resulted in a late phase (2-4 h) increase in MPS in the WHEY condition (P = 0.005). In both conditions, resistance exercise did not enhance the cumulative (0-4 h) MPS response. In the nonexercised leg, MPS did not differ at 0-2 h, 2-4 h, or 0-4 h of the measurement periods (all, P > 0.05). Likewise, there were no changes in the phosphorylation of p70S6K, AMPKα, or total and phosphorylated yes-associated protein on Ser127. Finally, postabsorptive MPS was lower in premenopausal versus postmenopausal females (P = 0.023). Our results demonstrate that resistance exercise-induced changes in MPS are temporally regulated, but do not result in greater cumulative (0-4 h) MPS in postmenopausal women.NEW & NOTEWORTHY An adequate quality and quantity of skeletal muscle is relevant to support physical performance and metabolic health. Muscle protein synthesis (MPS) is an established remodeling marker, which can be hypertrophic or nonhypertrophic. Importantly, protein ingestion and resistance exercise are two strategies that support healthy muscle by stimulating MPS. Our study shows postmenopause modulates baseline MPS that may diminish the MPS response to the fundamental anabolic stimuli of protein ingestion and resistance exercise in older females.

Sudden Loss of Motor Evoked Response Followed by Clinical Recovery After Resection of an Intradural Dorsal Meningioma: A Unique Case of a ClinicalNeurophysiological Dissociation

In the neuromonitoring era, resection surgery of spinal intradural lesions is guided by Intraoperative Neurophysiological Monitoring (IONM) of Motor Evoked Potentials (MEP). We describe a single case of a 70s-year-old patient who underwent surgery as a treatment for a voluminous dorsal intradural juxtamedullary meningioma: during surgery, we observed a sudden loss of bilateral lower limbs muscle MEPs, followed by a rapid recurrence of normal responses exclusively in the right side, but not in the left one. After awakening, the patient presented a transitory complete monoplegia of the left inferior limb for 30 minutes, and then it was resolved with rapid restoration of the neurological status.

Prediction Of Palmaris Longus Tendon Length And Thickness Through Simple Anthropometric Measurements.

This study aimed to test whether palmaris longus tendon (PLT) length and thickness can be predicted from simple anthropometric measurements. 120 healthy volunteers with bilateral PL muscles were enrolled in this prospective study. PLT length and thickness were measured by ultrasonographic examination. Anthropometric measurements included body height, weight, forearm length, and wrist circumference. Correlation, linear regression, and Bland-Altman plot were used for analysis. The mean PLT length and thickness were 10.8±1.4 cm and 4.0±0.9 mm, respectively. Body height and PLT length had a moderate positive correlation (r:0.407, p:0.001), and forearm length and PLT thickness had a weak positive correlation (r:0.229, p:0.001). The regression analysis showed that body height was the best predictor for PLT length, and forearm length was the best predictor for PLT thickness. The regression equations were as follows: PLT length=0.276+(0.062×height) (r2=0.165, p<0.001) and PLT thickness=1.373+(0.108×forearm length) (r2=0.052, p<0.001). The predicted PLT lengths and thicknesses were calculated using these regression formulas and compared with the actual thicknesses and lengths using the Bland-Altman plot. The upper and lower limits of agreement (95% CI) ranged from -2.54 cm to 2.51 cm for actual PLT length and predicted PLT length and from -1.76 mm to 1.74 mm for actual PLT thickness and predicted PLT thickness in the Bland-Altman plot with a weak agreement and proportional bias. These findings indicate that height and forearm length have limited accuracy in predicting PLT length and thickness. The preoperative ultrasonographic examination can provide valuable assistance, particularly in cases that require grafts with precise length and thickness requirements.

Zygomaticus activation through facial neuromuscular electrical stimulation (fNMES) induces happiness perception in ambiguous facial expressions and affects neural correlates of face processing.

The role of facial feedback in facial emotion recognition remains controversial, partly due to limitations of the existing methods to manipulate the activation of facial muscles, such as voluntary posing of facial expressions or holding a pen in the mouth. These procedures are indeed limited in their control over which muscles are (de)activated when and to what degree. To overcome these limitations and investigate in a more controlled way if facial emotion recognition is modulated by one's facial muscle activity, we used computer-controlled facial neuromuscular electrical stimulation (fNMES). In a pre-registered EEG experiment, ambiguous facial expressions were categorised as happy or sad by 47 participants. In half of the trials, weak smiling was induced through fNMES delivered to the bilateral Zygomaticus Major muscle for 500 ms. The likelihood of categorising ambiguous facial expressions as happy was significantly increased with fNMES, as shown with frequentist and Bayesian linear mixed models. Further, fNMES resulted in a reduction of P1, N170 and LPP amplitudes. These findings suggest that fNMES-induced facial feedback can bias facial emotion recognition and modulate the neural correlates of face processing. We conclude that fNMES has potential as a tool for studying the effects of facial feedback.

Trans-spinal magnetic stimulation induces co-activation of the diaphragm and biceps in healthy subjects.

The present study was designed to examine the effect of trans-spinal magnetic stimulation on bilateral respiratory and forelimb muscles in healthy subjects. Two wings of a figure-of-eight magnetic coil were placed on the dorsal vertebrae, from the fifth cervical to the second thoracic dorsal vertebra with a center at the seventh cervical vertebra. The surface electromyograms of bilateral diaphragm and biceps were recorded in response to trans-spinal magnetic stimulation with 20%-100% maximum output of the stimulatory device in male (n = 12) and female participants (n = 8). Trans-spinal magnetic stimulation can induce a co-activation of bilateral diaphragm and biceps when the stimulation intensity is above 60%. The onset latency was comparable between the left and right sides of the muscles, suggesting bilateral muscles could be simultaneously activated by trans-spinal magnetic stimulation. In addition, the intensity-response curve of the biceps was shifted upward compared with that of the diaphragm in males, indicating that the responsiveness of the biceps was greater than that of the diaphragm. This study demonstrated the feasibility of utilizing trans-spinal magnetic stimulation to co-activate the bilateral diaphragm and biceps. We proposed that this stimulatory configuration can be an efficient approach to activate both respiratory and forelimb muscles.

Optimization of modularity during development to simplify walking control across multiple steps.

Walking in adults relies on a small number of modules, reducing the number of degrees of freedom that needs to be regulated by the central nervous system (CNS). While walking in toddlers seems to also involve a small number of modules when considering averaged or single-step data, toddlers produce a high amount of variability across strides, and the extent to which this variability interacts with modularity remains unclear. Electromyographic activity from 10 bilateral lower limb muscles was recorded in both adults (n = 12) and toddlers (n = 12) over 8 gait cycles. Toddlers were recorded while walking independently and while being supported by an adult. This condition was implemented to assess if motor variability persisted with reduced balance constraints, suggesting a potential central origin rather than reliance on peripheral regulations. We used non-negative matrix factorization to model the underlying modular command with the Space-by-Time Decomposition method, with or without averaging data, and compared the modular organization of toddlers and adults during multiple walking strides. Toddlers were more variable in both conditions (i.e. independent walking and supported by an adult) and required significantly more modules to account for their greater stride-by-stride variability. Activations of these modules varied more across strides and were less parsimonious compared to adults, even with diminished balance constraints. The findings suggest that modular control of locomotion evolves between toddlerhood and adulthood as the organism develops and practices. Adults seem to be able to generate several strides of walking with less modules than toddlers. The persistence of variability in toddlers when balance constraints were lowered suggests a link with the ability to explore rather than with corrective mechanisms. In conclusion, the capacity of new walkers to flexibly activate their motor command suggests a broader range of possible actions, though distinguishing between modular and non-modular inputs remains challenging.

Association between bilateral condylar resorption and reduced volumes of the craniofacial skeleton and masticatory muscles in adult patients: A retrospective study

ObjectivesThis retrospective cohort study aimed to analyze volumes of craniomaxillofacial bone and masticatory muscles of young adults with bilateral idiopathic condylar resorption. MethodsThis was a retrospective cohort study of 84 adults with bilateral idiopathic condylar resorption (BCR) and 48 adults with normal temporal-mandibular joint (TMJ) matched for age and sex (mean age, 23.2 ± 3.6 years). The volumes of craniomaxillofacial bone and masticatory muscles, as well as intercondylar angle were measured. Unpaired t-tests and Pearson correlation tests were applied to analyze the data. Multivariable linear regression models were used to estimate the association between bilateral condylar volume and volumes of craniomaxillofacial bone and masticatory muscles adjusted for age, sex, and disc status. ResultsCompared to the control group, the BCR group displayed significant decreased volumes of craniomaxillofacial bone (p < 0.001), craniomaxillofacial bone without mandible (p < 0.001), mandible (p < 0.001), mandible without mandibular condylar process (p < 0.001), bilateral masseter muscle (p < 0.001) and bilateral temporalis muscle (p < 0.001), as well as the intercondylar angle (p < 0.001). These variables were significantly correlated to the volume of mandibular condylar process (0.5< r < 0.8; p < 0.001). By linear regression analyses, significant associations were found for the bilateral condylar volume with craniomaxillofacial bone volume and mandible bone volume. ConclusionsYoung adults with BCR displayed smaller volumes of craniomaxillofacial skeleton and masticatory muscles, and smaller intercondylar angle than the normal patients. The craniofacial musculoskeletal volume and intercondylar angle are associated with mandibular condylar process volume.

An analysis of muscle growth after proton beam therapy for pediatric cancer.

Retardation of growth and development is a well-known late effect after radiotherapy for pediatric patients. The goal of the study was to examine the effect of proton beam therapy (PBT) on the growth of muscles included in the irradiated area. The subjects were 17 pediatric patients (age ≤ 5years) who received PBT with a treatment field including a muscle on only one side out of a pair of symmetrical bilateral muscles and had imaging evaluations for at least 1year after PBT. The thicknesses of the irradiated and non-irradiated (contralateral) muscles were measured retrospectively on CT or MRI axial images collected before and after PBT. The change of thickness divided by the period (years) for each muscle was compared between the irradiated and contralateral sides. Correlations of muscle growth with irradiation dose and age at the start of treatment were also evaluated. The median observation period was 39.2months. The measurement sites included the erector spinae (n = 9), gluteus maximus (n = 5) and rhomboids + trapezius (n = 3) muscles. The average changes in muscle thickness were 0.24mm/year on the irradiated side and 1.19mm/year on the contralateral side, showing significantly reduced growth on the irradiated side (P = 0.001). Younger patients had greater muscle growth. Irradiation dose was not significant, but muscle growth tended to decrease as the dose increased, and muscles irradiated at >50Gy (RBE) showed little growth. These results show that muscle growth is affected by PBT and that long-term follow-up is needed to evaluate muscle growth retardation.

Prognostic impact of ectopic fat deposition within psoas muscle in patients undergoing systemic chemotherapy for stage IV gastric cancer.

285 Background: Sarcopenia is a progressive condition characterized by loss of skeletal muscle mass, muscle strength, and physical function, and is identified as an important prognostic factor in malignant tumors. The patients of gastrointestinal (GI) malignancies are often poor nutrition, weight loss, and loss of skeletal muscle mass due to pathophysiology such as the dysfunction of nutritional absorption and GI obstruction. The prevalence of sarcopenia is high in GI malignancies, especially in advanced gastric cancer (GC), which is reported to be 30%. Recently, in assessing sarcopenia, muscle quality as well as skeletal muscle mass has been considered important and some studies suggest that intramuscular adipose tissue is useful in assessing muscle quality. In this study, we focused on the fat ratio within psoas muscle (FRPM) and sought to clarify the impact of FRPM on overall survival (OS) in GC patients undergoing systemic chemotherapy. Methods: We retrospectively analyzed the patients with histologically confirmed stage IV GC receiving at least one systemic chemotherapy between February 2017 and March 2021 in our hospital. We measured PMI (Psoas Muscle Index: bilateral muscle mass (cm2)/height squared(m2)) and FRPM both at the lumber three level on the CT images before chemotherapy. PMI and FRPM values were classified into two groups, High and Low, according to whether they were higher or lower than the median, and differences in OS were analyzed for each group. Results: The analysis included 79patients (median age: 69 years, 59 males). The median FRPM was 1.67%. The FRPM-high group and the FRPM-low group were 40/39patients, respectively. The median PMI in male and female patients was 4.35 cm2/m2 and 2.88 cm2/m2. Thirty male patients and ten female patients were defined as the PMI-high group, and the remaining 39 patients were in the PMI-low group. The 1, 2 and 3year cumulative OS rate in patients with FRPM-high and FRPM-low was 67.3%, 14.3% and 7.6% in the FRPM-high group and 74.8%, 40.5% and 32.4% in the FRPM-low group ( P = 0.0341). The 1, 2 and 3year cumulative OS rate in patients with PMI-high and PMI-low was 86.7%, 40.4% and 30.0% in the PMI-high group and 55.8%, 12.8% and 6.4% in the PMI-low group ( P &lt; 0.0001). In the multivariate analysis of factors associated with OS, PMI ( P = 0.0047) and FRPM ( P = 0.0019) were independent predictors for the OS. Conclusions: High-FRPM may be associated with declined physical activity, suggesting that skeletal muscle function may be an important prognostic factor in patients with GC receiving systemic chemotherapy.

An X across the Chest: A Rare Case of a Criss-crossed Sternalis Muscle.

The present case study aims at drawing attention to a very rare presentation of the sternalis muscle noticed during routine dissection, and is intended to highlight the clinical significance and usefulness of this unique muscle in reconstructive surgeries, especially of the breast. Though many morphological variants of the muscle have been reported, we came across a unique bilateral sternalis muscle during routine dissection for undergraduate medical teaching, in an 80-year-old male cadaver. The muscle originates on both sides from the external oblique aponeurosis from the fleshy belly, and after becom-ing tendinous, converges in the midline to form a common tendon at the level of the sternal angle, and then splits again into two tendons which become continuous with the ipsilateral sternocleidomastoid. Notwithstanding the fact that the presence of a sternalis can be misdiagnosed as a wide range of anterior chest wall lesions and tumors, especially with misdiag-nosis of breast masses in routine mammograms, it has great use as a muscular flap for reconstructive surgeries of the anterior chest wall, head, neck and breast.

Platelet-rich plasma does not accelerate the healing of damaged muscle following muscle strain.

Although platelet-rich plasma (PRP)has been widely used regardless of the severity of muscle strain, there have been very few basic studies in which its effects on muscle injury were examined by using models that accurately mimic the clinical muscle strain injury process. Therefore, the aim of this study was to confirm by physiological and structural analyses whether PRP purified by a general preparation method has a muscle healing effect on muscle damage caused by eccentric contraction (ECC).Male Wistar rats were subjected to muscle injury induced by ECC in bilateral plantar flexor muscles using electrical stimulation and an automatically dorsiflexing footplate. The rats were randomly assigned to three groups by type of injection: phosphate-buffered saline (PBS),leukocyte-poor PRP (LP-PRP),or leukocyte-rich PRP (LR-PRP)injection into gastrocnemius muscles three times at weekly intervals. The platelet concentrations of the LP-PRPand LR-PRPwere three to five times higher than that of whole blood. The recovery process of torque strength in the plantar flexor muscle, signal changes in MRI images, and histological evaluation 3 weeks after injury showed no obvious differences among the three groups, and every muscle recovered well from the injury without marked fibrosis. The results that neither LP-PRPnor LR-PRPwas found to accelerate healing of muscle injuries suggested that conventional preparation and use of PRP for simple muscle injuries caused by muscle strain should be carefully considered, and further basic research using models that accurately mimic clinical practice should be carried out to determine the optimal use of PRP.

Application of unilateral biportal endoscopy technique to resect a thoracic spinal intradural extramedullary meningioma: technical report and review of the literature

BackgroundMeningiomas are common intradural extramedullary spinal tumors, which arise from arachnoid cap cells in the leptomeninges surrounding the brain or spinal cord. Sensory and motor dysfunction as well as pain were the most common presenting symptoms. Surgical resection remains the primary treatment for spinal intradural extramedullary meningiomas. Traditionally, spinal meningiomas excision requires longer skin incision, bilateral subperiosteal muscle stripping, and total laminectomy. We report a new technique for the treatment of thoracic spinal intradural extramedullary meningioma, which involves the use of unilateral biportal endoscopy (UBE) technique to resect the tumor, and reviewed and analyzed relevant literature.Case presentationA 69-year-old female patient presented with back pain accompanied by slowly progressive lower limb paresis, and severe pain in the right lower limb. Magnetic resonance imaging suggests a thoracic spinal intradural extramedullary meningioma. She underwent meningioma resection using UBE technique with complete recovery at the follow-up examination 3 months after surgery.ConclusionThis case confirmed the UBE technique can be a good choice for resection of spinal intradural extramedullary meningioma.

Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI

BackgroundSarcopenia is frequently found in patients with heart failure with reduced ejection fraction (HFrEF) and is associated with reduced exercise capacity, poor quality of life and adverse outcomes. Recent evidence suggests that axial thoracic skeletal muscle size could be used as a surrogate to assess sarcopenia in HFrEF. Since diabetes mellitus (DM) is one of the most common comorbidities with HFrEF, we aimed to explore the potential association of axial thoracic skeletal muscle size with left ventricular (LV) remodeling and determine its prognostic significance in this condition.MethodsA total of 243 diabetes patients with HFrEF were included in this study. Bilateral axial thoracic skeletal muscle size was obtained using cardiac MRI. Patients were stratified by the tertiles of axial thoracic skeletal muscle index (SMI). LV structural and functional indices, as well as amino-terminal pro-B-type natriuretic peptide (NT-proBNP), were measured. The determinants of elevated NT-proBNP were assessed using linear regression analysis. The associations between thoracic SMI and clinical outcomes were assessed using a multivariable Cox proportional hazards model.ResultsPatients in the lowest tertile of thoracic SMI displayed a deterioration in LV systolic strain in three components, together with an increase in LV mass and a heavier burden of myocardial fibrosis (all P < 0.05). Moreover, thoracic SMI (β = -0.25; P < 0.001), rather than body mass index (β = -0.04; P = 0.55), was independently associated with the level of NT-proBNP. The median follow-up duration was 33.6 months (IQR, 20.4–52.8 months). Patients with adverse outcomes showed a lower thoracic SMI (40.1 [34.3, 47.9] cm2/m2 vs. 45.3 [37.3, 55.0] cm2/m2; P < 0.05) but a similar BMI (P = 0.76) compared with those without adverse outcomes. A higher thoracic SMI indicated a lower risk of adverse outcomes (hazard ratio: 0.96; 95% confidence interval: 0.92–0.99; P = 0.01).ConclusionsWith respect to diabetes patients with HFrEF, thoracic SMI is a novel alternative for evaluating muscle wasting in sarcopenia that can be obtained by a readily available routine cardiac MRI protocol. A reduction in thoracic skeletal muscle size predicts poor outcomes in the context of DM with HFrEF.