Triceps Surae Research Articles

Socioeconomic disparities in children's posture defects: a comparison between private and public educational institutions

The topic of risk factors for posture pathology in Polish children is relevant at present, as it is insufficiently studied and reflects the need to investigate the relationship between family socioeconomic status and the occurrence of posture defects, to develop relevant prevention and treatment strategies in the context of current socioeconomic conditions in Poland. The research aims to study posture defects in children depending on their socioeconomic status in the example of private and public schools. A comparison of the prevalence of deformities and posture disorders of participants in private and public educational institutions from 2017 to 2020 is presented. Theoretical research methods (literature analysis, generalisation); empirical methods (study of other researchers' experience), statistical analysis, and graphical presentation of data were used. More than 1300 Polish schoolchildren from private and public schools took part in this cross-sectional study. The most common problems were flat feet (54.73%), calf muscle contracture (44.30%), and valgus deformity (21.22%). The least common problems were funnel chest (0.37%), cavus foot (0.10%), and hammer toe deformity (0.04%). The general trend shows that problems with flat feet and calf muscle contracture were more common among participants in both types of educational institutions. There was a general trend of increasing the number of nosological forms per patient in both private and public institutions over a period of three years. Private institutions had significantly fewer cases of one patient having more than one nosological form as compared to public institutions.

Toward structure and metabolism of glycogen C1-C6 in humans at 7T by localized 13C MRS using low-power bilevel broadband 1H decoupling.

This work aims to develop and implement a pulse-acquire sequence for three-dimensional (3D) single-voxel localized 13C MRS in humans at 7T, in conjunction with bilevel broadband 1H decoupling, and to test its feasibility in vitro and in vivo in human calf muscle with emphasis on the detection of glycogen C1-C6. A localization scheme suitable for measuring fast-relaxing 13C signals in humans at 7T was developed and implemented using the outer volume suppression (OVS) and one-dimensional image selected in vivo spectroscopy (ISIS-1D) schemes, similar to that which was previously reported in humans at 4T. The 3D 13C localization scheme was followed by uniform 13C adiabatic excitation, all complemented with an option for bilevel broadband 1H decoupling to improve both 13C sensitivity and spectral resolution at 7T. The performance of the pulse-acquire sequence was investigated in vitro on phantoms and in vivo in the human calf muscle of three healthy volunteers, while measuring glycogen C1-C6. In addition, T1 and T2 of glycogen C1-C6 were measured in vitro at 7T, as well as T1 of glycogen C1 in vivo. The glycerol C2 and C1,3 lipid resonances were efficiently suppressed in vitro at 7T using the OVS and ISIS-1D schemes, allowing distinct detection of glycogen C2-C6. While some glycerol remained in calf muscle in vivo, the intense lipid at 130 ppm was efficiently suppressed. The 13C sensitivity and spectral resolution of glycogen C1-C6 in vitro and glycogen C1 in vivo were improved at 7T using bilevel broadband 1H decoupling. The T1 and T2 of glycogen C1-C6 in vitro at 7T were consistent compared with those at 8.5T, while the T1 of glycogen C1 in vivo at 7T resulted similar to that in vitro. Localized 13C MRS is feasible in human calf muscle in vivo at 7T, and this will allow further extension of this method for 13C MRS measurements such as in the brain.

Vigeo Promotes Myotube Differentiation and Protects Dexamethasone-Induced Skeletal Muscle Atrophy via Regulating the Protein Degradation, AKT/mTOR, and AMPK/Sirt-1/PGC1α Signaling Pathway In Vitro and In Vivo.

Sarcopenia, a condition caused by an imbalance between muscle growth and loss, can severely affect the quality of life of elderly patients with metabolic, inflammatory, and cancer diseases. Vigeo, a nuruk-fermented extract of three plants (Eleutherococcus senticosus Maxim (ESM), Achyranthes japonica (Miq.) Nakai (AJN), and Atractylodes japonica Koidzumi (AJK)) has been reported to have anti-osteoporotic effects. However, evidence of the effects of Vigeo on muscle atrophy is not available. Here, in the in vivo model of dexamethasone (Dex)-induced muscle atrophy, Vigeo treatment significantly reversed Dex-induced decreases in calf muscle volume, gastrocnemius (GA) muscle weight, and histological cross-section area. In addition, in mRNA and protein analyses isolated from GA muscle, we observed that Vigeo significantly protected against Dex-induced mouse muscle atrophy by inhibiting protein degradation regulated by atrogin and MuRF-1. Moreover, we demonstrated that Vigeo significantly promoted C2C12 cell line differentiation, as evidenced by the increased width and length of myotubes, and the increased number of fused myotubes with three or more nuclei. Vigeo alleviated the formation of myotubes compared to the control group. Vigeo also significantly increased the mRNA and protein expression of myosin heavy chain (MyHC), MyoD, and myogenin compared to that in the control. Vigeo treatment significantly reduced the mRNA and protein expression of muscle degradation markers atrogin-1 and muscle RING Finger 1 (MuRF-1) in the C2C12 cell line in vitro. Vigeo also activated the AMP-activated protein kinase (AMPK)/silent information regulator 1 (Sirt-1)/peroxisome proliferator-activated receptor-γ co-activator-1α (PGC1α) mitochondrial biogenesis pathway and the Akt/mTOR protein synthesis signaling pathway in Dex-induced myotube atrophy. These findings suggest that Vigeo may have protective effects against Dex-induced muscle atrophy. Therefore, we propose Vigeo as a supplement or potential therapeutic agent to prevent or treat sarcopenia accompanied by muscle atrophy and degeneration.

Effect of Restless leg syndrome on the sleep quality of medical students of university in rural Sindh

Background: Restless legs syndrome a neurological condition its symptoms appear with gnawing sensation, cramps and feels like unpleasant sensations during period of rest and mid of sleep. A set of criteria for a more consistent diagnosis of this condition, which frequently causes severe sleep problems, it was devised and published by the recently established International RLS Study Group (IRLSSG) fifty years later the research has shown that, although its symptoms are preventable and manageable, but RLS is still under diagnosed since the IRLSSG criteria were published. Materials and methods: All medical students were considered as the population of the study. Convenient specific young adults selected a sample of 200 students. Besides that, students with a history of trauma and infection had exaggerated routines and recent viral infections also having pain with cramps in calf muscles, which increased during inactivity and rest at night. The questionnaires were administered from the students, with the permission of the ethical review committee of Bhitai dental & medical College Mirpurkhas. Informed consent-form taken. Data collection procedures were applied standard questionnaire used International Restless Legs Syndrome Study Group (IRLLSG). The data were analyzed by SPSS-25. Percentage, mean, standard deviation, and chi-square were applied to measure the severity and overall score of RlS. Result: The medical students 119 were male and 81 female. Participants had demographic data mean of age 1.26, (SD=.544). 57.5% male, 42.5% female in the age group of 18–28. Sleep problem were found in male had moderate 25 (21.0%) and severe in 15 (12.6%) students, in very severe of RLS symptoms were less in count 13 (10.9%), A female participant was affected with RLS moderate 54 (27.0%), mild in 43 (21.5%), moderate RLS in 26 (32.1%) some participants in severe had low 30 (15.0%) RLS found, moreover participants had none 20 (24.5%) RLS symptoms. The significant valued (p=.296). Conclusion: It was concluded that RLS is a sleep disorder it mostly in male than female students. Severity of RLS symptoms mild to moderate among participants.

Integrating musculoskeletal simulation and machine learning: a hybrid approach for personalized ankle-foot exoskeleton assistance strategies.

Introduction: Lower limb exoskeletons have shown considerable potential in assisting human walking, particularly by reducing metabolic cost (MC), leading to a surge of interest in this field in recent years. However, owing to significant individual differences and the uncertainty of movements, challenges still exist in the personalized design and control of exoskeletons in human-robot interactions. Methods: In this study, we propose a hybrid data-driven approach that integrates musculoskeletal simulation with machine learning technology to customize personalized assistance strategies efficiently and adaptively for ankle-foot exoskeletons. First, optimal assistance strategies that can theoretically minimize MC, were derived from forward muscle-driven simulations on an open-source dataset. Then, a neural network was utilized to explore the relationships among different individuals, movements, and optimal strategies, thus developing a predictive model. Results: With respect to transfer learning, our approach exhibited effectiveness and adaptability when faced with new individuals and movements. The simulation results further indicated that our approach successfully reduced the MC of calf muscles by approximately 20% compared to normal walking conditions. Discussion: This hybrid approach offers an alternative for personalizing assistance strategy that may further guide exoskeleton design.

Parameter optimization for proton density fat fraction quantification in skeletal muscle tissue at 7T.

To establish an image acquisition and post-processing workflow for the determination of the proton density fat fraction (PDFF) in calf muscle tissue at 7T. Echo times (TEs) of the applied vendor-provided multi-echo gradient echo sequence were optimized based on simulations of the effective number of signal averages (NSA*). The resulting parameters were validated by measurements in phantom and in healthy calf muscle tissue (n = 12). Additionally, methods to reduce phase errors arising at 7T were evaluated. Finally, PDFF values measured at 7T in calf muscle tissue of healthy subjects (n = 9) and patients with fatty replacement of muscle tissue (n = 3) were compared to 3T results. Simulations, phantom and in vivo measurements showed the importance of using optimized TEs for the fat-water separation at 7T. Fat-water swaps could be mitigated using a phase demodulation with an additional B0 map, or by shifting the TEs to longer values. Muscular PDFF values measured at 7T were comparable to measurements at 3T in both healthy subjects and patients with increased fatty replacement. PDFF determination in calf muscle tissue is feasible at 7T using a chemical shift-based approach with optimized acquisition and post-processing parameters.

The Combined Delivery of the Vegf, Ang, and Gdnf Genes Stimulates Angiogenesis and Improves Post-Ischemic Innervation and Regeneration in Skeletal Muscle.

In this study, the effects of different combinations of the genes Vegf, Ang, and Gdnf injected both using direct virus-mediated injection (adenovirus, Ad5) and umbilical cord blood mononuclear cells (UCBCs) on the processes of stimulation of post-ischemic innervation, angiogenesis, and regeneration in skeletal muscle were investigated in a rat hindlimb chronic ischemia model. It was shown that more pronounced stimulation of angiogenesis and restoration of post-ischemic innervation were achieved both in the early (28 days post-ischemia, dpi) and late (42 dpi) terms of the experiment in the calf muscle when UCBCs delivered the combination of Ad5-Vegf and Ad5-Ang compared to the direct injection of the same vector combination into the area of ischemia. At the same time, the inclusion of Ad5-Gdnf in the combination of Ad5-Vegf and Ad5-Ang directly injected or administered by UCBCs provided a significant increase in the number of centronuclear muscle fibers, indicating stimulation of post-ischemic reparative myogenesis. This study allowed us to determine the most effective gene combinations for angiogenesis and neurogenesis, which, in the future, may serve as the basis for the development of gene and gene cell products for the treatment of chronic lower limb ischemia.

Effect of Myofascial Release of Neck Muscles versus Calf Muscles on Blood Pressure

Effect of Myofascial Release of Neck Muscles versus Calf Muscles on Blood Pressure

Velocity-compensated intravoxel incoherent motion of the human calf muscle.

To determine whether intravoxel incoherent motion (IVIM) describes the blood perfusion in muscles better, assuming pseudo diffusion (Bihan Model 1) or ballistic motion (Bihan Model 2). IVIM parameters were measured in 18 healthy subjects with three different diffusion gradient time profiles (bipolar with two diffusion times and one with velocity compensation) and 17 b-values (0-600 s/mm2) at rest and after muscle activation. The diffusion coefficient, perfusion fraction, and pseudo-diffusion coefficient were estimated with a segmented fit in the gastrocnemius medialis (GM) and tibialis anterior (TA) muscles. Velocity-compensated gradients resulted in a decreased perfusion fraction (6.9% ± 1.4% vs. 4.4% ± 1.3% in the GM after activation) and pseudo-diffusion coefficient (0.069 ± 0.046 mm2/s vs. 0.014 ± 0.006 in the GM after activation) compared to the bipolar gradients with the longer diffusion encoding time. Increased diffusion coefficients, perfusion fractions, and pseudo-diffusion coefficients were observed in the GM after activation for all gradient profiles. However, the increase was significantly smaller for the velocity-compensated gradients. A diffusion time dependence was found for the pseudo-diffusion coefficient in the activated muscle. Velocity-compensated diffusion gradients significantly suppress the IVIM effect in the calf muscle, indicating that the ballistic limit is mostly reached, which is supported by the time dependence of the pseudo-diffusion coefficient.

Kegiatan Peningkatan Kebugaran Fisik Melalui Edukasi Pencegahan Nyeri Punggung Belakang pada Dewasa Muda di Pejagalan Jakarta Barat

Physical fitness is explored in relation to muscle strength. Back pain is a musculoskeletal complaint that often occurs in productive young adults in today's digital era. The aim of the service activity is to increase knowledge regarding muscle strength training to prevent back pain and early detection of factors that cause back pain. The method of implementing the activity is screening for BMI, back pain, muscle endurance and education on back strengthening exercises. Educational and examination activities were carried out on Friday 10 November 2023 at 15.00-18.00 attended by 25 participants with 11 male participants and 14 female participants. The average age of service participants was 24.32 years, in the range of 20-28 years. There were 15 participants with overweight and obesity nutritional status. There were 18 participants who often experienced stiffness in their shoulders and back during activities. There were 22 participants who often experienced back pain, 14 participants had never done muscle strength training and 1 participant did exercise more than 5 times in 1 week. Health education is also carried out regarding the knowledge that there is no need to be afraid to move actively if the shoulder or back muscles are weak or tense. Participants are introduced to types of exercise as well as exercises to strengthen and stabilize the inner abdominal muscles (stomach), back and pelvis, as well as stretching exercises for the calf and hip muscles. and thighs.

Muscle structure predictors of vertical jump performance in elite male volleyball players: a cross-sectional study based on ultrasonography.

The objective of this investigation is to examine the contribution of key muscle groups in the lower limbs to vertical jumping performance in elite male volleyball players. Specifically, the study focuses on the rectus femoris (RF), vastus lateralis (VL), and lateral gastrocnemius (LG), as well as exploring differences between attack jump and other vertical jump types. To achieve this, we employed B-mode ultrasound to evaluate the anatomical cross-sectional area (ACSA), muscle thickness (MT), pennation angle (PA), and fascicle length (FL) of the RF, VL, and LG in the participants. Fifteen elite male volleyball players were recruited as participants for this study. Jump heights were measured for four types of vertical jumps: attack jump (AJ), countermovement jump (CMJ), squat jump (SJ), and drop jump (DJ). We conducted regression analyses to assess whether the previously mentioned muscle structures could predict jump performance. Our findings reveal that the muscle structure of the RF does not exhibit any significant correlation with the height of any jump. However, VL-ACSA displays a significant and the most potent predictive effect on jump height for all four jump types (AJ: R 2 = 0.32, p = 0.001; CMJ: R 2 = 0.37, p = 0.005; SJ: R 2 = 0.52, p = 0.001; DJ: R 2 = 0.25, p = 0.021). Conversely, LG-FL only demonstrates a significant and stronger predictive effect on AJ jump height (R 2 = 0.18, p = 0.009). Combining VL-ACSA, LG-FL, and training age through multiple linear regression analysis resulted in a highly significant model for predicting AJ jump height (F = 13.86, R 2 = 0.73). Moreover, the model incorporating VL-ACSA and training age is also important for predicting CMJ, SJ, and DJ jump heights (F = 8.41, R 2 = 0.51; F = 13.14, R 2 = 0.63; F = 5.95, R 2 = 0.41; respectively). The muscle structure indicators in the lower limbs significantly predict jump performance among elite male volleyball players. However, different jump types are influenced by distinct indicators, particularly in the case of AJ, which is associated with LG-FL. This suggests that enhancing LG-FL may positively impact AJ ability, thereby emphasizing the importance of specificity in training. To optimize specialized jump performance in volleyball players, practitioners are advised to assess VL-ACSA and LG-FL and incorporate step-up and eccentric strength training targeting the calf muscles to yield considerable benefits.

Muscle Fibrosis, NF-κB, and TGF-β Are Differentially Altered in Two Models of Paralysis (Botox Versus Neurectomy).

Objective: Volumetric muscle loss results in intramuscular axotomy, denervating muscle distal to the injury and leading to paralysis, denervation, and loss of muscle function. Once the nerve is damaged, paralyzed skeletal muscle will atrophy and accumulate noncontractile connective tissue. The objective of this study was to determine differences in connective tissue, atrophy, and inflammatory signaling between two paralysis models, botulinum toxin (Botox), which blocks acetylcholine transmission while keeping nerves intact, and neurectomy, which eliminates all nerve-to-muscle signaling. Approach: Twenty male Sprague Dawley rats were randomized and received a sciatic-femoral neurectomy (SFN), Botox-induced muscle paralysis of the proximal femur muscles, quadriceps femoris, hamstrings, and calf muscles (BTX), or sham. Muscle force was measured 52 days postsurgery, and samples were collected for histology, protein, and mRNA assays. Results: SFN and BTX decreased twitch and tetanic force, decreased fiber size by twofold, and increased myogenic expression compared with controls. SFN increased the levels of all major extracellular matrix proteins correlating with fibrosis [e.g., laminin, fibronectin, and collagen type(s) I, III, VI]. SFN also increased profibrotic and proinflammatory mRNA compared with BTX and controls. Innovation: SFN and BTX were similar in gross morphology and functional deficiencies. However, SFN exhibited a higher amount of fibrosis in histological sections and immunoblotting. The present study shows evidence that nerve signaling changes NF-κB and TGF-β signaling, warranting future studies to determine the mechanisms involved. Conclusion: These data indicate that nerve signaling may influence fibrogenesis following denervation, but the mechanisms involved may differ as a function of the method of paralysis.

Does botulinum neurotoxin A make walking easier in children with cerebral palsy? A randomized clinical trial.

To assess the effect of single botulinum neurotoxin A (BoNT-A) injectionsinto the calf muscles on the gross energy cost of walking in children with cerebral palsy (CP) and to evaluate the effect of BoNT-A on walking capacity, physical activity, perceived changes in mobility, and pain. This was an industry-independent, randomized, quadruple-blind, placebo-controlled, multicentre trial (ClinicalTrials.gov registration: NCT02546999). Sixty-one children (33 male, median age [range] = 8 years [4-16 years]) with spastic CP and classified in Gross Motor Function Classification System (GMFCS) levels I and II allocated to single injections of either BoNT-A or 0.9% saline into the calf muscles. The main outcome was gross energy cost (J/kg/m); secondary outcomes were walking capacity, habitual physical activity, perceived change in mobility tasks, and calf pain at baseline, 4 weeks (P1), 12 weeks (P2), and 24 weeks (P3) after the injection. The mean change in energy cost did not differ significantly between groups at the primary time point P2 (-0.27 J/kg/m, 95% confidence interval - 0.91 to 0.36, p = 0.404), nor at P1 or P3. Regarding the secondary outcomes, there was some evidence of a larger reduction in pain intensity in the group given BoNT-A (p = 0.043). One treatment with BoNT-A was not superior to placebo in making walking easier in children with CP classified in GMFCS levels I and II, at least in the short term. BoNT-A may have a pain-reducing effect.

Are calves trainable? Low-intensity calf muscle training with or without blood flow restriction: a randomized controlled trial

Abstract Objectives Whether low-load resistance training (RT) without muscle failure, with or without blood flow restriction (BFR), is sufficient to increase strength and muscle growth of calf muscles in trained individuals is still unclear. This study aimed to compare the effects of low-intensity BFR RT vs. traditional low-intensity RT (noBFR) with moderate training volume on strength and circumference. Methods We designed a parallel, randomized controlled trial including 36 RT-trained participants (BFR: 7 females, 32.9 ± 8.8 years, 11 males, 28.4 ± 3.6 years; noBFR; 8 females, 29.6 ± 3.4 years; 10 males, 28.6 ± 4.9 years) who underwent eight weeks of twice-weekly low-load RT with 16 weekly RT sets (30 % of one-repetition maximum [1RM]). RT consisted of bilateral calf raises and seated unilateral calf raises, each conducted with 4 sets (30, 15, 15, 15 repetitions not to failure) of either BFR or noBFR. Outcome measures included calf circumference (CC), leg stiffness (LS), and various strength tests (seated and standing calf raise 1RM, isokinetic strength of plantar- and dorsiflexion). Results There were no significant interactions or group effects for most measures. Both groups showed significant improvements in seated calf raise strength (p=0.046, η 2 p=0.17). Pairwise comparisons indicated moderate to large effect sizes for strength improvements (standardized mean differences: 0.35–1.11), but no changes in calf circumference were observed in either group. Conclusions Low-load RT with and without BFR are useful to increase strength without necessarily affecting hypertrophy. Low-intensity BFR training did not confer additional benefits over traditional low-intensity RT for calf muscle strength or circumference, questioning its general advantage under such conditions.

Longitudinal changes in Achilles tendon and triceps surae muscle architecture during a 156-km mountain ultramarathon.

This study aimed to assess the longitudinal changes in triceps surae muscle-tendon architecture to an mountain ultramarathon. Experienced trail runners (N=55, 78% men, age: 45.2 [13.5] years) participated in a 156-km trail run (6000m climbing) consisting in six 26-km laps. The resting architectural properties of triceps surae muscle-tendon were measured using ultrasound imaging for Achilles tendon cross-sectional area (AT CSA), medial gastrocnemius muscle pennation angle, thickness, length and fiber length. Measurements were performed the day before the race (Baseline), at 52-km (T1), at 104-km (T2), at 156-km (T3) and 12 hours after the race (H12). Among finishers (n=41), there was a significant biphasic change in AT CSA during the race (P = 0.001). Firstly, a significant decrease in AT CSA occurred between Baseline and T1 (P = 0.006), with greater decrease for participants averaging speed >8 km/h (p = 0.014). Secondary, there was a significant increase in AT CSA especially between T2 and T3 (P = 0.006) that was correlated with a decrease in average speed (P = 0.001) and alteration of spaciotemporal running parameters (p < 0.05). Changes in muscle-tendon architecture was not significantly different between finishers (n=41) and non-finishers (n=14). In 47 participants (85.5%) who completed the follow-up, AT CSA at H12 was greater compared to Baseline (P = 0.010). The main finding is the significant and biphasic modification of the AT CSA during a 156-km mountain ultramarathon with an initial decrease corresponding to mechanical stress followed by a secondary increase suggesting adaptive mechanotransduction persisting after 12 hours.

Development of an initial training and evaluation programme for manual lower limb muscle MRI segmentation

BackgroundMagnetic resonance imaging (MRI) quantification of intramuscular fat accumulation is a responsive biomarker in neuromuscular diseases. Despite emergence of automated methods, manual muscle segmentation remains an essential foundation. We aimed to develop a training programme for new observers to demonstrate competence in lower limb muscle segmentation and establish reliability benchmarks for future human observers and machine learning segmentation packages.MethodsThe learning phase of the training programme comprised a training manual, direct instruction, and eight lower limb MRI scans with reference standard large and small regions of interest (ROIs). The assessment phase used test–retest scans from two patients and two healthy controls. Interscan and interobserver reliability metrics were calculated to identify underperforming outliers and to determine competency benchmarks.ResultsThree experienced observers undertook the assessment phase, whilst eight new observers completed the full training programme. Two of the new observers were identified as underperforming outliers, relating to variation in size or consistency of segmentations; six had interscan and interobserver reliability equivalent to those of experienced observers. The calculated benchmark for the Sørensen-Dice similarity coefficient between observers was greater than 0.87 and 0.92 for individual thigh and calf muscles, respectively. Interscan and interobserver reliability were significantly higher for large than small ROIs (all p < 0.001).ConclusionsWe developed, implemented, and analysed the first formal training programme for manual lower limb muscle segmentation. Large ROI showed superior reliability to small ROI for fat fraction assessment.Relevance statementObservers competent in lower limb muscle segmentation are critical to application of quantitative muscle MRI biomarkers in neuromuscular diseases. This study has established competency benchmarks for future human observers or automated segmentation methods.Key points• Observers competent in muscle segmentation are critical for quantitative muscle MRI biomarkers.• A training programme for muscle segmentation was undertaken by eight new observers.• We established competency benchmarks for future human observers or automated segmentation methods.Graphical

Generalized inhomogeneity-resilient relaxation along a fictitious field (girRAFF) for improved robustness in rotating frame relaxometry at 3T.

To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence of and field inhomogeneities. The resilience of RAFF pulses against and inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity-resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation ( ), were simulated and validated in phantom experiments. and parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility. Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom). preparations showed in phantom/calf 6.0/4.8 times higher resilience to inhomogeneities than RAFF, and a 4.7/5.3 improved resilience to inhomogeneities. In the knee cartilage, (53 14 ms) was higher than (42 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility across / inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon-based fat suppression led to a further 15-fold improvement in the robustness of girRAFF to inhomogeneities. RAFF pulses display residual sensitivity to off-resonance and pronounced sensitivity to inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required.

"Calcaneogenesis" with secondary Achilles tendon-bone allograft for repair of the loss of hindfoot function : A12-year case report

Calcanectomy and Achilles tendon resection are very hard to repair. Ilizarov's "calcaneogenesis" is possible with ankle joint preservation. Even after 3.5years of functio laesa of the triceps surae muscle it can be rebuilt. A25-year-old motorcyclist suffered a3rd degree open calcaneal dislocation fracture (type5). Osteitis and necrosis required calcanectomy, resection of the Achilles tendon and alatissimus dorsi muscle transfer. Atalus corpus osteotomy with Ilizarov distraction created in the 1st step a"neo-calcaneus". In adelayed 2nd step afresh-frozen Achilles tendon-bone block allograft was transplanted to regain active plantar flexion. The initial AOFAS score of 35points was significantly improved to 70points 12years after step1. After both operations the patient could walk without an orthosis and regained 88% of normal plantar flexion strength. Quantitative measure of health outcome according to EQ-5D-5L was marked by the patient with 80out of 100points. "Calcaneogenesis" with preservation of the ankle joint is possible and innovative. Despite 3.5years of disconnection of the triceps surae muscle, an Achilles tendon-bone block allograft could restore 88% of the push-off force even attached to aneo-calcaneus that is 1/3 smaller than normal, which is also new.

Effects of radial pressure wave irradiation on triceps surae muscle morphology and function

BackgroundRadial pressure wave (RPW) has been introduced to sports sites as an alternative tool to massage, and there have been reports of irradiating muscles. This study aimed to clarify the effects of RPW irradiation on muscles, focusing on muscle morphology and muscle/fascial elasticity. MethodsThe participants were 23 healthy, able-bodied participants. Muscle morphology (muscle thickness, pinnate angle, muscle fascicle length), muscle and fascia elasticity (deep fascia, subfascial, muscle, deep intermuscular fascia) of the gastrocnemius medial head using ultrasound imaging equipment before and after RPW irradiation intervention. The maximum ankle dorsiflexion range of motion and isometric maximum plantarflexion muscle strength were also measured. ResultsBefore and after RPW irradiation to the triceps surae muscle, muscle thickness, decreased pinnate angle, and increase in maximum ankle dorsiflexion range of motion were observed. No significant changes were observed in muscle fascicle length and maximal isometric plantarflexion strength. In addition, a significant decrease in elasticity was observed in deep fascia, subfascial, and muscle, and the change was particularly large in deep fascia and deep intermuscular fascia. ConclusionIt was suggested that RPW irradiation to muscles might improve fascial gliding and reduce muscle elasticity. It was also found to improve joint range of motion while maintaining muscle output.Trial registration number (Japan Registry of Clinical Trials (jRCT))Current Controlled Trials jRCT1032210104, May 21, 2021.

Prophylactic Dose of Rivaroxaban Versus Warfarin for the Treatment of Isolated Calf Muscle Vein Thrombosis: A Retrospective Propensity Score-Matched Analysis

BackgroundProphylactic dose of rivaroxaban is often used in treatment of isolated calf muscle vein thrombosis (ICMVT), nevertheless, its effect is less reported. This study aims to evaluate short-term outcomes in patients with ICMVT who received prophylactic dose of rivaroxaban or warfarin therapy. MethodsA retrospective analysis of 472 ICMVT patients who received two different treatment regimens was undertaken. Propensity score matching method was used to balance the confounding effect of baseline clinical data. Chi-squared test and logistic regression analysis were used to compare outcomes (venous thromboembolism events, bleeding events, complete clot resolution) according to the type of treatment regimens before and after propensity score matching. Univariate and multivariable analysis were used to investigate risk factors for incomplete clot resolution of ICMVT after propensity score matching. Results242 ICMVT patients received prophylactic dose of rivaroxaban (rivaroxaban group, RG), and 230 received warfarin (warfarin group, WG). After propensity score matching, 156 patients were included in each group; Venous thromboembolism (VTE) events occurred in 14 (9.0%) patients in the RG and 10 (6.4%) in the WG (P = 0.395); No major bleeding events occurred in each group, and clinically relevant non-major bleeding events occurred in 5 (3.2%) patients in the RG and 10 (6.4%) in the WG (P = 0.186); Complete clot resolution at 3 months occurred in 80 (51.3%) patients in the RG and 100 (64.1%) in the WG (P = 0.022). Logistic regression analysis showed that there were no significant differences between RG and WG in VTE events (odds ratio 1.439, 95% confidence interval 0.619 to 3.347, P = 0.397) and clinically relevant non-major bleeding events (odds ratio 0.483, 95% confidence interval 0.161 to 1.449, P = 0.194); it revealed that complete clot resolution rate at 3 months was different in the two groups (odds ratio 0.589, 95% confidence interval 0.375 to 0.928, P = 0.022). Treatment regimens (prophylactic dose of rivaroxaban), thrombosis (maximum diameter >7 mm) and risk factors for VTE (non-surgery risk factors, mainly referring to active malignancy) were risk factors for incomplete clot resolution of ICMVT (P < 0.05). ConclusionsIn this retrospective study with a short-term follow-up, ICMVT patients who received prophylactic dose of rivaroxaban had no significant differences in VTE and bleeding events compared to those who received warfarin therapy (the overall INR > 2.0 for >50% of the time); but it was not conducive to complete clot resolution.