Left Biceps Research Articles

Changes in muscle performance among older adults with myeloid malignancies engaging in a mobile health (mHealth) exercise intervention: a single arm pilot study

BackgroundOlder adults with cancer are vulnerable to declines in muscle performance (e.g., strength, speed, duration of muscular contraction), which are associated with worse cancer-related outcomes. Exercise-based interventions can mitigate these declines, but evidence of their effect among older adults with myeloid malignancies receiving outpatient treatment is limited. We explore change in muscle performance among patients in a single arm pilot study of a mobile health (mHealth) exercise intervention.MethodsPatients ≥ 60 years old with myeloid malignancies receiving outpatient chemotherapy completed a home-based resistance band and walking exercise program [EXercise for Cancer Patients (EXCAP)©®] delivered via a mobile application with symptom monitoring [(Geriatric Oncology-EXCAP (GO-EXCAP)] lasting 2 cycles of chemotherapy (approximately 8–12 weeks). Clinical exercise physiologists provided instruction and ongoing support. Upper and lower extremity peak torque (maximum force, newton-meters, Nm), total work (force over entire movement, Nm), and average power (speed of force, watts, W) were assessed using the BIODEX System 4 isokinetic dynamometer. Muscle activation (motor recruitment, millivolts, mV) was captured using the BTS FREEEMG 1000. We report descriptive statistics and within-patient differences from baseline to post-intervention using Wilcoxon signed rank tests (α = 0.10) and effect size (ES, Cohen’s d, 0.20 ≤ small < 0.50, large ≥ 0.80), and explore differences by exercise level (resistance exercise, daily steps).ResultsA total of 25 patients completed baseline assessments, 23 with muscle performance data at baseline, 16 at post-intervention. Of these, most were male (n = 10, 62.5%) and had acute myeloid leukemia (n = 9, 56.3%). From baseline to post-intervention there were improvements in left shoulder peak torque [mean change = 2.45 (Standard Deviation = 2.41), p = 0.004] and average power [2.29 (3.05), p = 0.033]. Muscle activation increased for left rectus femoris [0.04 (0.04), p = 0.074], right and left biceps brachii [0.03 (0.04), p = 0.012; 0.03 (0.05), p = 0.098, respectively], and left pectoralis major [0.02 (0.03), p = 0.064]. Several measures of peak torque/total work and all measures of muscle activation showed ES ≥ 0.20 for improvement. There were no statistically significant decreases from baseline to post-intervention.ConclusionsOlder adults with myeloid malignancies participating in a mHealth exercise intervention had stable to improved muscle performance. Further research is needed to establish the preliminary efficacy of this intervention for improving physical performance in this population at high risk for decline.Trial registrationclinicaltrials.gov NCT04035499 (registered July 29th, 2019).

Adult late-onset limb-girdle muscular dystrophy R1/2A complicated by parathyroid adenoma and sick sinus syndrome: a case report and literature review

BackgroundLimb-girdle muscular dystrophy (LGMD) is a group of hereditary myopathies. This group of diseases is highly heterogeneous in terms of genetic mode, age at onset, and disease progression; therefore, they are easily misdiagnosed and missed in clinical practice.Case presentationWe describe a case of adult late-onset LGMD R1/2A in a 56-year-old female patient. The patient experienced elevated creatine kinase levels lasting 5 years, muscle soreness of the limbs lasting 4 years, and exacerbation of limb fatigue lasting 1 month. Early in the course of the disease, the patient experienced severe bradycardia and was later diagnosed with sick sinus syndrome. In addition to cardiac involvement, our patient also had primary hyperparathyroidism during the disease course, which was confirmed pathologically as a parathyroid adenoma. A biopsy of the left biceps showed pathological manifestations of mild myogenic damage. All-exon gene sequencing confirmed the diagnosis of LGMD R1/2A, and she was treated with vitamin E, vitamin B2, and coenzyme Q. Due to atrial fibrillation secondary to sick sinus syndrome, a pacemaker was implanted.ConclusionThe patient in this case study had adult late-onset LGMD R1/2A with cardiac involvement and functional parathyroid adenoma, which is rare and clinically significant. Therefore, early clinical identification, diagnosis, as well as targeted and active treatments can improve the prognosis of such patients.

Analysis of a difficulty movement of aerobic gymnasts based on biomechanics

Background: With the progress of technology, an increasing number of studies on biomechanics in sports are being conducted. Objective: Based on biomechanical methods, the characteristics of aerobic gymnasts at different skill levels performing the difficulty movement C715 were compared to provide a reference for teaching and training. Methods: Sixteen aerobic gymnasts were divided into two groups, A and B, according to their skill levels. Kinematic data and surface electromyography were collected using modern equipment, analyzed, and compared. Results: Group A spent 0.64 ± 0.03 s during the upright restoration stage, which was longer than that of group B (p &lt; 0.05). In the pre-swing stage, the angle between the legs of group A at the moment of free leg landing was 46.52 ± 2.14°, which was significantly greater than that of group B. Muscle force was predominantly exerted on the right side, and there were obvious differences between group A and group B in the integral electromyogram (IEMG) of the right rectus abdominis, left and right gastrocnemius, and left rectus femoris (p &lt; 0.05). During the phase when the free leg swings forward, no significant differences in kinematic characteristics were found between the two groups; however, there were significant differences in IEMG of muscle activity for the right rectus abdominis, left and right biceps femoris, right gastrocnemius, and left rectus femoris (p &lt; 0.05). The right gastrocnemius force of group A reached 25.77 ± 3.64 μV·S, which was significantly higher. During the 360° leg-controlled rotation phase, the minimum angle of the right ankle in group A was significantly greater than group B (p &lt; 0.05), and the muscle activity showed significant differences in IEMG of the left biceps femoris, right biceps femoris, left gastrocnemius, left rectus femoris, and right rectus femoris. In the upright stage, the knee and ankle angles of group A were larger, and there was a remarkable difference in gastrocnemius force (p &lt; 0.05). Conclusion: There are biomechanical differences among aerobic gymnasts of varying levels when performing the difficulty movement C715.

Development of a seat support mechanism for guiding users to an appropriate posture in a seated-style echocardiography robot

Abstract This paper proposes a seat support mechanism to solve the problem of misalignment between the chest examination and probe scanning areas when the patient is bent in a seated-style echocardiography robot. To guide the patient to an appropriate body position where their chest is within the examination range of the chest examination unit while minimizing the physical load of the patient, the posture of the patient must satisfy the three following conditions. (i) The breech must be in contact with the seat surface, (ii) the legs must be vertical to the floor, and (iii) the chest and mechanism must be parallel while the probe scanning and chest examination ranges must match. The human body was modeled to derive a posture that satisfies the aforementioned conditions for the height of each individual, and a seat support mechanism with four degrees of freedom was installed to guide the user to the derived posture. By installing this mechanism, the body load of the left biceps brachii, right biceps brachii, left latissimus dorsi, and right latissimus dorsi was reduced to 64.7%, 52.7%, 86.4%, and 80.2%, respectively. The sharpness of the image contours was improved to 103.8%.

Effect of Programed Walking Exercise Using Bot Fit in Younger Adults

IntroductionPhysical inactivity and sedentary behavior both increase the risk of chronic disease and mortality. Regular participation in physical activity and reducing sedentary behavior play important roles in maintaining physical health and disease prevention.ObjectiveThe purpose of this study was to investigate the effect of programed walking exercise using a wearable hip exoskeleton, Bot Fit on muscle strength, muscle effort, and the kinematics of the pelvis in younger adults.MethodsWe designed three parallel experimental conditions and randomly assigned participants to one of three groups: those assigned to exercise using an interval program of Bot Fit (interval group), those who used a power program of Bot Fit (power group), and a control group who exercised without Bot Fit. A total of 45 young adults participated in 18 exercise-intervention sessions over six weeks, and all participants were assessed at two time points: before and after the 18 exercise sessions. Each assessment evaluated muscle strength, muscle effort, and the kinematics of the pelvis during walking. In addition, the number of steps, distance, energy expenditure, and heart rate for 30 min during the exercise sessions were recorded.ResultsA significant increase in the maximum voluntary contraction (MVC) of the left biceps femoris (BF) was evident in the interval group, while significant changes in the MVC of the bilateral BF were seen in the power group after Bot Fit exercise. A significant decrease of muscle effort in the right BF in the interval group and right lumbar erector spinae and bilateral BF in the power group were also observed. In addition, the symmetry index of pelvic tilt significantly improved in the interval group, and greater exercise volume and intensity in both the interval and power groups compared with the control group were confirmed as measured by the number of steps, distance, energy expenditure, and heart rate.ConclusionsThe results of this study confirmed the beneficial effect of programed walking exercise using the Bot Fit on muscle strength of trunk and lower extremities, muscle effort, and pelvic movement symmetry in younger adults. Personalized exercise programs can be provided for younger adults using various resistance or assistance modes of robotic device with the Bot Fit.Trial RegistrationClinicalTrials.gov, NCT05862077. Registered 22 March 2022, https://register.clinicaltrials.gov/.

Inducing ipsilateral motor-evoked potentials in the biceps brachii muscle in healthy humans.

To assess reticulospinal tract excitability, high-intensity transcranial magnetic stimulation (TMS) has been used to elicit ipsilateral motor-evoked potentials (iMEPs). However, there is no consensus on robust and valid methods for use in human studies. The present study proposes a standardized method for eliciting and analysing iMEPs in the biceps brachii. Twenty-four healthy young adults participated in this study. Electromyography (EMG) electrodes recorded contralateral MEPs (cMEPs) from the right and iMEPs from the left biceps brachii. A dynamic preacher curl task was used with ~15% of the subject's one-repetition maximum load. The protocol included maximal compound action potential (M-max) determination of the right biceps brachii muscle, TMS hotspot determination, and four sets of five repetitions where 100% stimulator output was delivered at an elbow angle of 110° of flexion. We normalized cMEP amplitude by M-max (% M-max) and iMEP by cMEP amplitude ratio (ICAR). Clear iMEPs above background EMG were observed in 21 subjects (88%, ICAR = .31 ± .19). Good-to-excellent agreement (intraclass correlation coefficient [ICC] = .795-1.000) and low bias (.01-.08 mV and .60-1.11 ms) were demonstrated when comparing two different analysis methods (i.e. fixed time-window vs. manual onset detection) to determine the cMEP and iMEP amplitude and latency, respectively. Most subjects demonstrated clear iMEPs above background EMG triggered at a pre-determined joint angle during a light-load dynamic preacher curl exercise. Similar results were obtained when comparing a single-trial manual identification of iMEP and a semi-automated time-window data analysis approach.

Using Electrical Muscle Stimulation to Enhance Electrophysiological Performance of Agonist-Antagonist Myoneural Interface.

The agonist-antagonist myoneural interface (AMI), a surgical method to reinnervate physiologically-relevant proprioceptive feedback for control of limb prostheses, has demonstrated the ability to provide natural afferent sensations for limb amputees when actuating their prostheses. Following AMI surgery, one potential challenge is atrophy of the disused muscles, which would weaken the reinnervation efficacy of AMI. It is well known that electrical muscle stimulus (EMS) can reduce muscle atrophy. In this study, we conducted an animal investigation to explore whether the EMS can significantly improve the electrophysiological performance of AMI. AMI surgery was performed in 14 rats, in which the distal tendons of bilateral solei donors were connected and positioned on the surface of the left biceps femoris. Subsequently, the left tibial nerve and the common peroneus nerve were sutured onto the ends of the connected donor solei. Two stimulation electrodes were affixed onto the ends of the donor solei for EMS delivery. The AMI rats were randomly divided into two groups. One group received the EMS treatment (designated as EMS_on) regularly for eight weeks and another received no EMS (designated as EMS_off). Two physiological parameters, nerve conduction velocity (NCV) and motor unit number, were derived from the electrically evoked compound action potential (CAP) signals to assess the electrophysiological performance of AMI. Our experimental results demonstrated that the reinnervated muscles of the EMS_on group generated higher CAP signals in comparison to the EMS_off group. Both NCV and motor unit number were significantly elevated in the EMS_on group. Moreover, the EMS_on group displayed statistically higher CAP signals on the indirectly activated proprioceptive afferents than the EMS_off group. These findings suggested that EMS treatment would be promising in enhancing the electrophysiological performance and facilitating the reinnervation process of AMI.

Translation, validity and reliability of the fall risk scale for older adults

IntroductionFalls in older adults are a common and serious threat to health and functional independence. It can cause psychological distress, inability to participate in activities of daily living, brain injury, fractures, and even death. The aim was to analyze the psychometric properties of the self-assessed fall risk scale (FRS) that measures the risk of falls in older adults in a central region of Chile, as well as to verify the concurrent validity against functional fitness tests.Materials and methodsA descriptive cross-sectional study was carried out in 222 older adults (OA) [34 males and 188 females] with an age range of 65 to 85 years. The 13-item self-perceived fall risk scale (FRS) was validated. Anthropometric measures (weight, height and waist circumference) were assessed. Five functional fitness tests were measured (right and left hand grip strength, biceps curl, up-and-go, agility and 6-minute walk test). Validation was performed by construct validation [(exploratory factor analysis (EFA) and confirmatory factor analysis (CFA)] and concurrent validity.ResultsThe EFA revealed 4 factors in the FRS scale [1: fear of falling (variance 27.1%), 2: use of assistive devices (variance 10.6%), 3: loss of sensation (variance 9.3%), and 4: limited mobility (variance 8.3%)]. Factor loadings ranged from ∼ 0.50 to 0.83 across the 4 components. The Kaiser-Meyer Olkin sample adequacy test (KMO) reflected adequate adequacy (KMO = 0.79, chi-square (X2) = 498.806, gl = 78, p = 0.00). The CFA showed a satisfactory final fit [chi-square (X2) = 126.748, Root mean squared error of approximation (RMSEA) = 0.042, Tucker-Lewis Index (TLI) = 0.946, Comparative fit index (CFI) = 0.935 y Normed fit index (NFI) = 0.90. The relationships between the FRS scale and functional fitness tests (right and left hand grip strength, biceps curl, up-and-go, agility and 6-minute walk test) ranged from low to moderate (r= -0.23 to 0.41).ConclusionThe FRS scale showed acceptable validity and reliability in older adults in central region of Chile. It is expected that this scale will be useful for assessing fall risk in clinical and epidemiological settings in the aging Chilean population.

Intrathecal Baclofen Infusion-Botulinum Toxin Combined Treatment Efficacy in the Management of Spasticity due to Cerebral Palsy.

Cerebral Palsy (CP) is a group of permanent, but not unchanging, disorders of movement and/or posture and motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain. One clinical presentation is muscle spasticity, which leads to a significant impact on the individual's functionality and quality of life. Spasticity treatment is multidisciplinary and includes pharmacological and physical intervention; intrathecal baclofen shows a positive effect in severe spasticity and suboptimal response to oral drugs, while local injection of Botulinum toxin type A (BTXA) improves muscle tone, motion and pain. The aim of this study was to evaluate the efficacy of the combined intrathecal baclofen infusion (ITB) - botulinum toxin treatment in the management of spasticity in CP. 8 patients with spastic tetraparesis were enrolled. All patients were treated with intrathecal Baclofen; in lower limbs, no spastic symptoms appeared, while marked spasticity was noted in upper limbs. We injected the right and left Biceps Brachial (BB) and Flexor Digitorum Superficialis (FDS) muscles with botulinum toxin type A. All patients underwent Myometric measurement, Ashworth Scale, Numerical Rating Scale, and Visual Analogic Scale evaluation before infiltration (T0), 30 days after injection (T1), 60 days after injection (T2), and 90 days after treatment (T3). All data demonstrated an improvement in spasticity, pain, quality of life, and self-care during the study, with p < 0.05. No side effects appeared. This study demonstrated the efficacy and safety of intrathecal baclofen infusion and botulinum toxin combined treatment in the management of spasticity, pain, quality of life, and selfcare in CP patients.

Feasibility and safety of dual-console telesurgery with the KangDuo Surgical Robot-1500 System using fifth-generation and wired networks: an animal experiment and sea-spanning clinical study.

To evaluate the feasibility and safety of dual-console telesurgery with the new KangDuo system in an animal experiment and clinical study. Six canine models were performed radical prostatectomy with dual-console KanDuo surgical robot-1500 (KD-SR-1500-RARP). The perioperative outcomes, physical and mental workload of the surgeon were collected. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with NASA-TLX. After conducting animal experiments to verify safety of dual-console KD-SR-1500-RARP, we conducted the clinical trial using 5G and wired networks. In the animal experiment, all surgeries were performed successfully. The operative time was 80.2±32.1 min. The docking time was 2.4±0.5 min. The console time was 49.7±25.3 min. There were no perioperative complications or equipment related adverse events. All dogs can micturate after catheter removal at one week postoperatively. The mental workload was at a low level (a scale ranging from 0 to 60), which scored 15.7±6.9. Among the eight recorded muscles, the fatigue degree of the right radial flexor and left biceps was the highest two (iEMG, resection, 299.8±344 uV, 109.9±16.9 uV; suture, 849.4±1252.5 uV, 423.1±621.3 uV, respectively). In the clinical study, the console time was 136 min. The mean latency time was ≤200 ms. The data pocket loss was <1%. The operation was successfully completed without malfunctions occurring throughout the entire process. Dual-console telesurgery with the KD-SR-1500 system was shown to be feasible and safe in radical prostatectomy using 5G and wired networks.

Unusual cause of muscle weakness, type II respiratory failure and pulmonary hypertension: a case report of ryanodine receptor type 1(RYR1)-related myopathy

BackgroundPatients with congenital myopathies may experience respiratory involvement, resulting in restrictive ventilatory dysfunction and respiratory failure. Pulmonary hypertension (PH) associated with this condition has never been reported in congenital ryanodine receptor type 1(RYR1)-related myopathy.Case presentation A 47-year-old woman was admitted with progressively exacerbated chest tightness and difficulty in neck flexion. She was born prematurely at week 28. Her bilateral lower extremities were edematous and muscle strength was grade IV−. Arterial blood gas analysis revealed hypoventilation syndrome and type II respiratory failure, while lung function test showed restrictive ventilation dysfunction, which were both worse in the supine position. PH was confirmed by right heart catheterization (RHC), without evidence of left heart disease, congenital heart disease, or pulmonary artery obstruction. Polysomnography indicated nocturnal hypoventilation. The ultrasound revealed reduced mobility of bilateral diaphragm. The level of creatine kinase was mildly elevated. Magnetic resonance imaging showed myositis of bilateral thigh muscle. Muscle biopsy of the left biceps brachii suggested muscle malnutrition and congenital muscle disease. Gene testing revealed a missense mutation in the RYR1 gene (exon33 c.C4816T). Finally, she was diagnosed with RYR1-related myopathy and received long-term non-invasive ventilation (NIV) treatment. Her symptoms and cardiopulmonary function have been greatly improved after 10 months.ConclusionsWe report a case of RYR1-related myopathy exhibiting hypoventilation syndrome, type II respiratory failure and PH associated with restrictive ventilator dysfunction. Pulmonologists should keep congenital myopathies in mind in the differential diagnosis of type II respiratory failure, especially in patients with short stature and muscle weakness.

Prevention of Musculoskeletal Injuries in Gastrointestinal Endoscopists

Gastroenterologists are exposed daily to musculoskeletal (MSK) stress during upper and lower gastrointestinal endoscopy, both during routine endoscopies and during long, demanding therapeutic procedures. There is evidence that endoscopy-related MSK injuries are becoming more common, particularly in the back, neck, shoulders, elbows, and hands. The aims of this study were to identify the most stressed muscle groups during endoscopy; to measure their activity using surface electromyographical (EMG) sensors; to detect areas of muscle overload; and to identify the number of microbreaks taken in specific muscles. Furthermore, we measured differences in the loading of these muscle groups with and without the use of special support systems such as a belt-like holder. Measurements were performed on 15 subjects (7 experienced endoscopists and 8 non-endoscopists). Due to this small sample size, inside each group, we achieved inconclusive results regarding statistically significant differences in different muscle groups. We increased the sample size by comparing all participants with and without the belt support system, disregarding their endoscopic background. There was a statistically significant difference (p &lt; 0.05) in muscle tension and in levels of microbreaks in the muscles of the left forearm, biceps, and trapezius muscles. No statistically significant difference was observed in the muscle tension and level of microbreaks in the left deltoid muscle (p &gt; 0.05). We hypothesize that the increased level of muscle loading and decreased level of microbreaks in the deltoid muscle are due to different muscle activity and different shoulder movements. Additionally, the deltoid muscle is not connected to the kinetic chain of body posture and stabilization. It is our belief that MSK injuries in gastrointestinal (GI) endoscopy can be prevented with the use of a belt-like support system.

A comparison of anesthesia induction by two different administration routes and doses of ketamine and medetomidine in red-eared sliders (Trachemys scripta elegans)

This study aimed to assess the efficiency of ketamine and medetomidine by two different doses and routes on anesthesia depth and cardiac stability in red-eared sliders. Each turtle was anesthetized two times, with seven days wash-out period. Induction of anesthesia consisted of a bolus combination of ketamine (10 mg/kg) and medetomidine (0.2 mg/kg) administered in the left brachial biceps in the intramuscular protocol, or a bolus combination of ketamine (20 mg/kg) and medetomidine (0.2 mg/kg) administered in subcarapacial sinus after clear blood presence confirmation in the intravenous protocol. Vital signs, reaction on the skin palpation, manual mouth opening for endotracheal intubation, palpebral and cloacal reflex, and the withdrawal reflex of the front and hind limbs were measured and recorded every 5 minutes for 60 minutes after anesthesia injection. Atipamezole (1 mg/kg) was administered in the right brachial biceps one hour after ketamine and medetomidine administration. Needle insertion and possible painful reactions to drug administration were also evaluated and recorded. Obtained data were analyzed for normality and paired t-tests, Wilcoxon, or McNamar tests were performed where appropriate. The values of P≤0.05 were considered significant. A significantly less pronounced decrease in heart rate was observed with intravenous anesthesia protocol. Both protocols recorded complete anesthesia recovery 60 minutes after intramuscular atipamezole administration. A ketamine-medetomidine dose combination administered intravenously provides a more stable and consistent anesthetic plane in red-eared sliders than ketamine-medetomidine administered intramuscularly.

Changes in hamstring contractile properties during the competitive season in young football players.

The study aimed to examine alterations and imbalances in hamstring muscle contractile properties among young football players throughout their competitive season, and to understand how these changes might contribute to the risk of muscle injuries. Hamstring injuries are particularly common in football, yet the underlying causes and effective prevention methods remain unclear. The research involved 74 young footballers who were assessed before the season (pre-test) and after 12 weeks of training (post-test). To evaluate changes in hamstring muscle contractile properties, specifically the left and right biceps femoris (BF) and semitendinosus (ST), tensiomyography (TMG) parameters were utilized. In comparison to the BF muscle, significant differences in time delay (Td) between the left and right sides in the post-test (p = 0.0193), and maximal displacement (Dm) between the left and right sides at the pre-test (p = 0.0395). However, significant differences in Dm were observed only in the left ST muscle between the pre- and post-tests (p = 0.0081). Regarding lateral symmetry, BF registered measurements of 79.7 ± 13.43 (pre-test) and 77.4 ± 14.82 (post-test), whereas ST showed measurements of 87.0 ± 9.79 (pre-test) and 87.5 ± 9.60 (post-test). These assessments provided TMG reference data for hamstring muscles in young footballers, both before the season and after 12 weeks of in-season training. The observed changes in the contractile properties and decrease in lateral symmetry of the BF in both tests suggest an increased risk of injury.

The establishment and evaluation of a swine model of deinagkistrodon acutus snakebite envenomation

ObjectiveTo establish a preclinical large-animal model of Deinagkistrodon acutus snakebite envenomation and evaluate its feasibility. MethodsThe venom of D. acutus (0 mg/kg, 1 mg/kg, 2 mg/kg, 5 mg/kg, or 10 mg/kg) was injected into the left biceps femoris of 11 male pigs. Then, the circumferences of the limbs were regularly measured, and changes in muscle injury biomarkers, blood parameters, coagulation function, vital organ function and injury biomarkers were regularly detected. At 24 h after venom injection, the animals were euthanized, and the pathological damage to the vital organs mentioned above was evaluated. ResultsThe two pigs receiving 10 mg/kg and 5 mg/kg snake venom died at 8 h and 12 h after injection, respectively. The remaining pigs were equally divided into 0 mg/kg, 1 mg/kg, and 2 mg/kg snake venom groups, and all of them survived to 24 h after injection. Compared with the pigs receiving 0 mg/kg snake venom, the pigs receiving 1 mg/kg or 2 mg/kg snake venom exhibited significant abnormities, including limb swelling; increased muscle injury biomarker creatine kinase (CK) and coagulation function indicators prothrombin time and D-dimer; and decreased blood routine indicator platelet and coagulation function indicator fibrinogen. Moreover, significant abnormalities in myocardial and cerebral function and injury biomarkers in the heart, brain, liver, kidney and intestine were also observed. In particular, the abnormalities mentioned above were significantly obvious in those pigs receiving 2 mg/kg snake venom. Pathological evaluation revealed that the morphology of muscle, heart, brain, liver, kidney, and intestine in those pigs receiving 0 mg/kg snake venom was normal; however, pathological damage was observed in those pigs receiving 1 mg/kg and 2 mg/kg snake venom. Similarly, the pathological damage was more severe in those pigs receiving 2 mg/kg snake venom. ConclusionThe intramuscular injection of 2 mg/kg D. acutus venom seems to be an optimal dose for examining the preclinical efficacy of existing and novel therapeutics for treating D. acutus envenomation in pigs.

PAINLESS NEURALGIC AMYOTROPHY (PARSONAGE-TURNER SYNDROME) – A CASE REPORT

Background: Neuralgic amyotrophy (NA) is a rare disorder typically characterized by an abrupt onset of upper extremity pain followed by progressive muscle weakness, atrophy and occasional sensory loss. Although NA has been hypothesized to be an autoimmune-mediated disorder. It is considered a primarily clinical diagnosis, electrodiagnostic evaluation is essential for the diagnosis confirmation and can exclude other etiologies. Electrodiagnostic findings can reveal patchy damage to any nerve within the brachial plexus. Case Description: In the current case report, we are presenting a 43-years-old man admitted to the Neurology Department of “UMHAT Dr. Georgi Stranski” in Pleven, Bulgaria, with decreased muscle strength and limited active movements in the left upper shoulder for approximately 3 weeks. The patient denied feeling any pain during the onset and afterwards. He had no previous infections, vaccinations and history of other diseases. The detailed neurological examination showed the left upper extremity decreased antigravity strength in the deltoid and infraspinatus muscles with marked atrophy of the same. Hyporeflexia of the left biceps and brachioradialis deep‐tendon reflexes was present. Electromyography findings showed denervation of the deltoid and infraspinatus muscles. Initial reinnervation of supraspinatus and cervical paraspinal muscles was present. The diagnosis of NA was confirmed by both the neurological examination and the electrophysiological findings. Conclusion: We are presenting a clinical case of idiopathic neuralgic amyotrophy with atypical painless presentation and discussing the most significant aspects of the disorder with regards to the difficulties in approaching the correct diagnosis. A better understanding of the NA clinical symptoms and signs variability improves the diagnostic and therapeutic approach.

Improvement of upper limb function in post-stroke patients with motion feedback training-based combination therapy: a retrospective analysis of muscle activation and recovery dynamics.

To evaluate the effectiveness of combination therapy based on motion feedback training in patients recovering from ischemic stroke. A retrospective analysis was conducted on 205 patients in the recovery phase of ischemic stroke admitted between June 2022 and June 2023. Patients were divided into two groups: the conventional treatment group (n=101), receiving standard care, and the combination therapy group (n=104), receiving additional motion feedback training for 30 days. Outcome measures included root mean square (RMS) and median frequency (MDF) of surface electromyography (sEMG) for upper limb muscles, biochemical indicators, active range of motion (AROM), Fugl-Meyer Assessment (FMA) scores, and Activities of Daily Living (ADL) scores. Combination therapy significantly improved post-treatment RMS values in muscles such as the left Biceps brachii (BB) (P=0.008), right BB (P=0.003), and right Flexor pollicis brevis (FPB) (P=0.010). MDF values also improved significantly in the left BB (P=0.002) and left FPB (P=0.027). The combination therapy group showed higher post-treatment SOD levels compared to the conventional group (P=0.001). Significant improvements were observed in AROM (P<0.001), FMA (P<0.001), and ADL scores (P=0.010) in the combination therapy group. Logistic regression analysis revealed that combination therapy was associated with better outcomes (OR, 0.518; 95% CI, 0.291-0.923; P=0.026), while higher pre-treatment right FPB RMS values were linked to poorer prognosis (OR, 1.074; 95% CI, 1.004-1.149; P=0.039). Motion feedback training-based combination therapy significantly enhances muscle activation, antioxidant biochemical pathways, functional recovery, and daily living activities in post-stroke patients compared to conventional treatment alone.

주짓수 학습자와 비학습자의 한팔업어치기 동작에 대한 근활성도 비교분석

Objectives The purpose of this study is to provide basic scientific data such as technical information and training methods necessary for Jiu-Jitsu learners by comparing and analyzing the muscle activity of Ippon Seio Nage movement between Jiu-Jitsu learners and non-learners.&#x0D; Methods Using the noraxon system, muscle activity, integrated EMG, and muscle mobilization for Left flexor carpi Radialis, Left extensor carpi Ulnaris, Left Biceps brachii, Left Triceps, Right Tibialis Anterior, Right Biceps Femoris, Right Rectus Femoris and Right Gastrocemius were measured and compared for Jiu-Jitsu learners with more than 2 years of Jiu-Jitsu experience and non-Jiu-Jitsu learners with no Jiu-Jitsu training experience.&#x0D; Results First, when looking at the aspect of muscle activity of the pull arm, the muscle activity of the learner and the non-learner showed a similar pattern, but the non-learner showed high muscle activity in Left flexor carpi Radialis, Left extensor carpi Ulnaris and Left Biceps brachii, and the learner showed high muscle activity in Left Triceps, and the major muscle was Left Biceps brachii. Second, the values of Left flexor carpi Radialis and Left ex-tensor carpi Ulnaris of non-learners were large in the Integrated EMG of the pull arm. Third, it was confirmed that learners' Right Rectus Femoris had a higher percentile than non-learners in terms of muscle mobilization of the right foot.&#x0D; Conclusions Both Jiu-Jitsu learners and non-learners have the highest muscle activity in Left Biceps brachii, in-dicating that it is the major muscle, so it is necessary to focus on Left Biceps brachii training, and moving the ante-brachial muscles to the dorsal and intestinal sides to pull the opponent is inefficient, so it is necessary to develop and apply training that can limit them.In addition, it is analyzed that training to strengthen Right Rectus Femoris that can be more efficient in throw the opponent is needed.

Effect of Physiotherapy Management of the Post-Traumatic Stiff Elbow: A Case Report

23 years old female who is a student by occupation had a history of a direct fall on her right elbow and injury takes place on her left elbow. After the injury, an orthopedic surgeon and the patient wastreated conservatively. The patient came to the physiotherapy department with a chief complaint of left elbow pain with difficulty in moving the left elbow. On examination, restriction in elbow flexion and extension assortment of motion and tightness of left biceps brachii were seen. The intervention was carried out for 6 sessions per week for 6 weeks. The patient was treated with electrotherapy and exercise therapy. After 6 weeks of intervention pain was reduced (VAS score from 7 to 3), elbow extension range of motion was improved and OES was 20 to 39. This case report results suggest that physiotherapy treatment is important in reducing pain and increasing range of motion and functional ability.

Effects of gait training with weight support feedback walker on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete spinal cord injury: A pilot randomized controlled trial

Background Spinal cord injury (SCI) is a devastating condition affecting an individual’s life, particularly through lower extremity paralysis, which limits walking and daily activities. Objectives This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI). Methods Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training. Results The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05). Conclusion WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.