Muscle Thickness Measurements Research Articles

The relationship between temporal muscle thickness and triglyceride glucose index in sarcopenia with mortality and third-month functional outcomes in patients after acute stroke.

Especially in recent years, temporal muscle thickness has been used as an important parameter for sarcopenia in neurological disorders. In addition, triglyceride glucose index was evaluated separately in studies conducted in terms of coronary diseases, diabetes, high blood pressure, body mass index and acute stroke. In this clinical study, unlike the others, both temporal muscle thickness and triglyceride glucose index were evaluated together in acute stroke patients in terms of sarcopenia. We aimed to investigate the relationship between temporal muscle thickness and triglyceride glucose index, which is atherosclerotic index, with mortality and 3rd month functional outcomes in acute stroke patients. In this retrospective study, 147 patients admitted to Ankara City Hospital with the diagnosis of acute ischemic stroke between January 2021 and September 2022 were evaluated. Fasting triglyceride glucose indexes of the patients were calculated. The temporal muscle thickness measurement of the patients was performed by the radiologist using computed tomography images. Those who scored 3 or higher on the modified Rankin Scale (mRS) at the third month were considered to have poor functional outcome. A significant cutoff point was found for estimating mortality for the temporal muscle thickness parameter [area under the curve for a receiver operating characteristic curve (AUC) = 0.636; P = .012]. The cutoff point was obtained as ≤ 5.2. Sensitivity value was 65%, specificity value was 65%, the positive predictive value (PPV) value was 42.62% and the negative predictive value (NPV) value was 82.28%. Similarly, for the triglyceride glucose index parameter, there was a significant cutoff point in estimating mortality (AUC = 0.673; P = .003). The cutoff point was obtained as ≥ 8.23. Sensitivity value was 91.18%, specificity value was 13%, PPV value was 26.96% and NPV value was 81%. Temporal muscle thickness and triglyceride glucose index parameters were found to be statistically important parameters of sarcopenia. It was concluded that the evaluation of these 2 parameters in terms of both mortality and sarcopenia in acute stroke patients is important in the evaluation of neurological and cardiac disorders.

The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain.

The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls. Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability. The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data. This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

The value of ultrasound measurement of muscle thickness at different sites and shear wave elastography in Parkinson's disease with sarcopenia: a pilot study.

Patients with Parkinson's disease (PD) and sarcopenia often exhibit resilience, frailty, disability, and depression, highlighting the complex and interrelated nature of these conditions. Despite the presence of clinical manifestations of muscle atrophy in both PD and sarcopenia, accurately discerning the coexistence of sarcopenia in PD patients remains a challenging task with significant implications for treatment strategies and prognostic assessments. This study aims to elucidate the specific ultrasonic diagnostic parameters associated with PD accompanied by sarcopenia through a comparative analysis of muscle ultrasound parameters in patients with PD, thereby presenting a novel approach for rapid identification of this condition. A total of 110 participants were enrolled in this study, including patients with PD and control subjects. Demographic data, clinical characteristics, physical performance tests, appendicular skeletal muscle mass index (ASMI), bioelectrical impedance analysis and muscle ultrasound measurements were collected from all participants. The muscle ultrasound measurements encompassed assessments of muscle thickness, pennation angle and shear wave elastography at various anatomical sites. Parkinson's disease patients exhibited decreased muscle strength and physical performance, and increased shear wave elastography value. In PD patients with sarcopenia, body circumference, including calf circumference, mid-arm circumference, Waist-to-Hip Ratio and body mass index (BMI) were all significantly decreased. Biceps brachii muscle thickness (MT) and gastrocnemius MT decreased in PD patients with sarcopenia and low ASMI. Binary logistic regression analysis revealed that male PD patients, BMI and gastrocnemius MT were predictive factors for ASMI in PD patients. Biceps brachii MT and gastrocnemius MT are important indicators for distinguishing whether PD patients have sarcopenia. Male patients, low BMI and gastrocnemius MT were identified as valid predictors of low ASMI in PD patients. The findings of this study provide important insights into the use of muscle ultrasound in the diagnosis of PD with sarcopenia.

Assessing the effectiveness of Compare Assistant for improving intra-rater reliability of ultrasound-measured muscle thickness.

Muscle thickness measured via ultrasound is commonly used to assess muscle size. The purpose of this study was to determine if the reliability of this measurement will improve if using the Compare Assistant tool, and whether this depends on technician experience and the muscle being assessed. Individuals came to the laboratory for two visits each separated by 24h. On day 1, two ultrasound images were taken on the individual's anterior upper arm (elbow flexors) and anterior lower leg (tibialis anterior) by two inexperienced and one experienced ultrasound technician. On day 2, three images were taken: (1) without looking at the previous images taken on day 1; (2) after re-examining the images taken on day 1, and (3) side-by-side with the images taken on day 1 via Compare Assistant. Bayes Factors (BF10) were used to provide evidence for the null (< 0.33) or alternative (> 3) hypotheses. There was no rater by measurement technique interaction (upper body: BF10 = 0.04, lower body: BF10 = 0.138), nor was there a main effect of measurement technique (upper body: BF10 = 0.052, lower body: BF10 = 0.331), indicating that reliability measures were not improved for either the upper body (CV%, no look: 2.92 vs. Compare Assistant: 2.87) or lower body (CV%, no look: 1.81 vs. Compare Assistant: 1.34) as a result of using Compare Assistant. The results of this study suggest that day-to-day reliability of muscle thickness measurement may be limited by random biological variability as opposed to technician error.

Suitable ultrasound screening method for older adults with disability to identify low muscle mass.

This study aimed to investigate the accuracy and consistency of different ultrasound protocols for the measurement of gastrocnemius muscle (GM) thickness and to identify a suitable ultrasound scheme that can be used to detect the low muscle mass in older with disability. In this cross-sectional study, each participant underwent three different ultrasound protocols for the measurement of the GM thickness, and each measurement was repeated three times. The three measurement schemes were as follows: method A, lying on the examination bed in a prone position with legs stretched and relaxed and feet hanging outside the examination bed; method B, lateral right side lying position with legs separated (left leg flexed and right leg in a relaxed state); and method C, right side lying position with legs together and lower limb muscles in a relaxed state. The low muscle mass was determined by averaging two or three measurements of the GM thickness determined using different sonographic protocols. The study included 489 participants. The difference in the prevalence of low muscle mass identified between two and three replicates of the same measurement protocol ranged from 0 to 1.3%. Considering the three repeated measurements of the method A as the reference, the area under the curve (AUC) in different measurement schemes were 0.977-1 and 0.973-1 in males and females, respectively. Furthermore, male and female Kappa values from low to high were 0.773, 0.801, 0.829, 0.839, and 0.967 and 0.786, 0.794, 0.804, 0.819, and 0.984, respectively. Different ultrasound measurement protocols showed high accuracy and consistency in identifying low muscle mass. Repeating the measurements two or three times was found to be feasible.

FRI170 Ultrasound-Based Evaluation Of Muscles And Tendons In Patients With Cushing Syndrome

Abstract Disclosure: B. Bolayir: None. F. Gogus: None. B. Demir: None. M.M. Yalcin: None. J. Meray: None. A. Altinova: None. F.S. Toruner: None. M.Y. Akturk: None. Background: Myopathy, being induced by antianabolic and catabolic effects of excess corticosteroids is one of the characteristic features of Cushing Syndrome (CS). Muscle thickness which has been shown to be correlated with muscle cross sectional area can be used as an indicator of muscle mass. Although many studies have demonstrated effects of corticosteroids on collagen metabolism and case reports documented rupture of tendons in patients with chronic exposure to corticosteroids, tendon changes of patients with endogenous hypercortisolism have not been studied. Ultrasound, although not studied well in this group of patients, can be an alternative imaging method that provides information about muscle and tendon thickness. The aim of this study was to investigate muscle, tendon thicknesses and serum levels of myostatin in patients with CS. Methods: Twenty-two patients with CS and nineteen healthy control subjects similar for age, sex, height and weight were enrolled. Lower extremity tendon and muscle groups’ thickness were evaluated by ultrasound. Serum myostatin levels were measured by ELISA. Results: Age, height, weight and body mass index were similar between groups (p&amp;gt;0.05). The thicknesses of rectus femoris, vastus medialis, vastus lateralis, gastrocnemius medialis and gastrocnemius lateralis were lower in the CS group than control group (p≤0.001). However, thickness of soleus muscle was not significantly different between the groups (p &amp;gt; 0.05). No significant difference was revealed between groups in terms of Achilles and patellar tendon thickness (p&amp;gt;0.05). Median serum myostatin levels were found to be lower in the CS group than the control group (p&amp;lt;0.001).Conclusions: Ultrasound based measurement of muscle thickness can be used to assess and monitor steroid-induced changes of muscle mass. The fact that the thickness of the proximal muscles of lower extremity was found to be lower by ultrasound in patients with CS in our study supports the proximal myopathy feature of CS. Besides that, it was shown that the gastrocnemius lateralis and medialis thicknesses, which are the distal muscles of the lower extremity, were also shown to be lower in the Cushing group. On the other hand, CS might not affect the thickness of the lower extremity tendons. Moreover, the mechanism of the decrease in the level of myostatin, the negative regulator of muscle growth, in patients with needs to be elucidated with CS further studies. Presentation: Friday, June 16, 2023

Thigh ultrasound monitoring identifies muscle atrophy in mechanically ventilated pediatric patients.

Over the last decade, ultrasonography has taken on an increasingly important role in the daily management of critically patients and has recently been proposed as a means of measuring muscle volume and architecture. This study had two main aims: to monitor for the onset of muscle atrophy in mechanically ventilated pediatric patients during stays in a pediatric intensive care unit based on quadriceps femoris muscle thickness measurements and to study whether demographic and clinical variables have an impact on muscle loss in critically children. The study followed a prospective, observational, single-center design. The sample included all children admitted to our pediatric intensive care unit (PICU) who required mechanical ventilation for more than 48h. Two trained clinicians measured the thickness of the quadriceps using a 12-MHz linear ultrasound transducer within 24h of initiating invasive mechanical ventilation and again at 72h, 1week, and weekly thereafter until extubation. For the entire cohort, quadriceps femoris muscle thickness decreased by 4.67% on average (IQR = -13.4 to -0.59) between the first two assessments and 13% by the time of the final measurement (IQR = -24 to -0.5%) or 1.57%/day (p < 0.001). Approximately half of all the children (23/41; 56%) experienced muscle atrophy (defined a priori as a decrease in thickness of 10% or more). Bivariate analyses revealed that increasing age, being a child (vs. infant), cumulative energy and protein deficit, highest C-reactive protein value, exposure to neuromuscular blockers, and a longer stay in the PICU were all predictive of a greater decrease in thickness. In a multivariate model, exposure to neuromuscular blockers was linked with greater muscle loss. Conclusion: In mechanically ventilated children, point-of-care ultrasonography can identify skeletal muscle atrophy. Muscle atrophy of limbs is strongly associated with the use of neuromuscular blockers. Ultrasound-based monitoring of the quadriceps femoris is a clinically useful tool for assessing muscle mass that can provide information on nutritional status and guide rehabilitation. What is Known: • ICU-acquired muscle atrophy is common and has a deleterious effect on adult outcomes. The prevalence and severity of muscular atrophy in critically ill children, however, are poorly understood. • Point-of-care ultrasonography has been put forward as an accurate, reliable method for monitoring variations in muscle mass.. What is New: • The quadriceps femoris muscle tends to suffer an intense loss of thickness early on in most critically ill children. • Quadriceps femoris ultrasound monitoring is a helpful tool for measuring muscle thickness and could lead to the development of novel therapies for critically ill children.

Transversal psoas muscle thickness measurement is associated with response and survival in patients with HCC undergoing immunotherapy.

Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT) measurement in patients with HCC undergoing immunotherapy. HCC patients treated with programmed death ligand 1-based therapies between June 2016 and October 2022 at the Vienna General Hospital (n = 80) and the Hôpital Beaujon Clichy (n = 96) were included and followed until April 2023. TPMT at the level of the third lumbar vertebra was measured independently by 2 radiologists to evaluate interreader reliability. TPMT <12mm/m in men and <8mm/m in women indicated sarcopenia. Overall, 176 patients (age: 66.3±11.7y; male: n=143, 81%, Barcelona-Clinic Liver Cancer C: n=121, 69%) were included, of which 131 (74%) exhibited cirrhosis. Interreader agreement for the diagnosis of sarcopenia based on TPMT was 92.6%, and Cohen κ showed a "strong agreement" [κ = 0.84 (95% CI: 0.75-0.92)]. Sarcopenia, present in 58 patients (33%), was associated with shorter median overall survival [7.2 (95% CI: 5.0-9.5) vs. 22.6 (95% CI: 16.4-28.8 months); p < 0.001] and median progression-free survival [3.4 (95% CI: 0.2-6.8) vs. 7.9 (95% CI: 5.8-9.9 months), p = 0.001], and an independent predictor of overall [adjusted HR: 1.63 (95% CI: 1.07-2.48)] and progression-free mortality [adjusted HR: 1.54 (95% CI: 1.06-2.23)] in multivariable analyses. The objective response rate [evaluable in 162 subjects (92.0%)] per modified Response Evaluation Criteria In Solid Tumors (mRECIST) in patients with and without sarcopenia was 22% and 39%, respectively (p = 0.029). Survival and radiological responses were worse in patients with sarcopenia and systemic inflammation [median overall survival: 6.1 (95% CI: 3.6-8.6)mo; median progression-free survival: 2.8 (95% CI: 2.1-3.4)mo; objective response rate=16%; disease control rate=39%]. Evaluation of sarcopenia using TPMT measurement is reliable and identifies HCC patients with a dismal prognosis and response to immunotherapy.

Ultrasonographic reliability and repeatability of simultaneous bilateral assessment of diaphragm muscle thickness during normal breathing.

The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes. The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intra-session (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing. Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919-0.997; standard error of measurement =0.002-0.007 cm; minimum detectable change =0.006-0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614-0.984; standard error of measurement =0.006-0.028 cm; minimum detectable change =0.017-0.079 cm), although some systematic errors were presented (P<0.05). Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback.

Reproducibility of subscapularis muscle thickness measurement using ultrasound imaging. -Relationship between subscapularis muscle thickness and internal rotation torque of the shoulder joint-

BackgroundFew studies have reported on the morphometry of the subscapularis muscle using ultrasound imaging (USI); and their reproducibility has not been verified. ObjectivesThis study aimed to clarify the relative and absolute reproducibility of USI measurements of subscapularis muscle thickness at rest and during isometric contraction as well as the degree of change in muscle thickness caused by the amount of internal rotational torque in the shoulder joint. DesignTwo-group repeated-measures study. MethodsThe subjects were the inferior fibers of the subscapularis muscle of 40 healthy adult males. Muscle thickness was measured at rest and at 10%–30% of the maximum isometric internal rotation torque. Intraclass correlation coefficients (ICC) and Brand Altman analysis were used for reproducibility measurement. The degree of change in muscle thickness at each torque was also calculated. ResultsIntra- and inter-rater ICCs (ranged from 0.69 to 0.91) were good. A proportional error was observed in intra-rater measurements. Both minimal detectable change 95 (ranged from 2.33 to 6.47) were high. The subscapularis muscle thickness was significantly increased at 10% torque (25.49 ± 3.80 mm), 20% torque (26.07 ± 3.90 mm), and 30% torque (25.96 ± 3.82 mm) as compared to that in resting conditions (24.53 ± 4.46 mm) (p < 0.05). ConclusionThe reproducibility and error of the subscapularis muscle thickness measurement using USI used in this study were clarified when repeated measurements were made in the same limb position and under the same probe installation conditions, suggesting that the contraction of the subscapularis muscle can be estimated by muscle thickness measurement.

Longitudinal changes of grip strength and forearm muscle thickness in young children.

Grip strength is a marker of future health conditions and is mainly generated by the extrinsic flexor muscles of the fingers. Therefore, whether or not there is a relationship between grip strength and forearm muscle size is vital in considering strategies for grip strength development during growth. Thus, this study aimed to examine the association between changes in grip strength and forearm muscle thickness in young children. Two hundred eighteen young children (104 boys and 114 girls) performed maximum voluntary grip strength and ultrasound-measured muscle thickness measurements in the righthand. Two muscle thicknesses were measured as the perpendicular distance between the adipose tissue-muscle interface and muscle-bone interface of the radius (MT-radius) and ulna (MT-ulna). All participants completed the first measurement and underwent a second measurement one year after the first one. There were significant (P < 0.001) within-subject correlations between MT-ulna and grip strength [r = 0.50 (0.40, 0.60)] and MT-radius and grip strength [r = 0.59 (0.49, 0.67)]. There was no significant between-subject correlation between MT-ulna and grip strength [r = 0.07 (-0.05, 0.20)], but there was a statistically significant (P < 0.001) between-subject relationship between MT-radius and grip strength [r = 0.27 (0.14, 0.39)]. Although we cannot infer causation from the present study, our findings suggest that as muscle size increases within a child, so does muscle strength. Our between-subject analysis, however, suggests that those who observed the greatest change in muscle size did not necessarily get the strongest.

The relationship between quadriceps femoris thickness measured by US and femoral cartilage thickness in knee osteoarthritis, its effect on radiographic stage and clinical parameters: comparison with healthy young population.

In this study, we aimed to investigate the relationship between quadriceps muscle thickness and femoral cartilage thickness measured by ultrasonography (US) in knee osteoarthritis (OA), to correlate this relationship with radiographic stage and clinical parameters, and to compare these values with those in healthy young adults. A total of 71 patients with knee osteoarthritis and 31 healthy young adults were included in the study. Patients with knee osteoarthritis (Group 1) and healthy young adults (Group 2) were divided into two groups. Muscle thickness measurements of the quadriceps femoris muscle (M. vastus intermedius + M. rectus femoris) were performed by US. Bilateral quadriceps muscle thickness and bilateral femoral cartilage thickness values were significantly lower in Group 1 than in Group 2. The 10-metre walk test score and Time Up and Go (TUG) test score were significantly higher in Group 1 than in Group 2. A strong positive correlation was found between bilateral quadriceps (RF+VI) muscle thickness and bilateral femoral cartilage thickness (medial, intercondylar, lateral) in Group 1. This study showed a strong positive correlation between quadriceps thickness and femoral cartilage thickness. According to these results, we conclude that US may have a place in the diagnosis of knee osteoarthritis.

Muscle ultrasound: reliability across experience levels in critical care physiotherapists

Muscle ultrasound is a valid tool to monitor muscle mass loss in critically ill patients. The level of experience is essential to the accuracy of the measurements. To evaluate the interobserver reliability of experienced and novice raters measuring muscle thickness and echo intensity of the quadriceps and tibialis anterior. Cross-sectional observational study. Twenty-four critical care physiotherapists participated (5 experienced and 19 novice). Following a standardized ultrasound protocol, each rater measured the thickness (centimeters) of the quadriceps and tibialis anterior of 10 healthy and young models using linear and convex probes of portable devices. The Intraclass Correlation Coefficient and the Minimal Detectable Change (95% confidence interval) were calculated. Additionally, the novices scored the echo intensity of 19 muscle ultrasound images of critically ill patients using the Heckmatt score (qualitative assessment). The agreement with experienced raters was evaluated (Spearman Rho). 960 muscle thickness measurements were performed (experienced = 200 and novice = 760). The mean thickness of the quadriceps and tibialis anterior was 4.4 ± 0.77 and 2.4 ± 0.35 centimeters for the experienced and 4.2 ± 0.80 and 2.2 ± 0.39 centimeters for the novices, respectively. Quadriceps' and tibialis' anterior reliability were 0.82 and 0.86 for experienced and 0.76 and 0.41 for novices, respectively. The Minimal Detectable Change ranged from 0.14-0.33 centimeters. The mean Heckmatt score was 2.6 ± 0.83 points, with a reliability of 0.68 and an agreement with the experimenters of 0.78 [p < 0.001]. Interobserver reliability was excellent for experienced raters and moderate to good for novice raters. The level of experience could determine the reliability of the results.

Effects of progressive body-weight versus barbell back squat training on strength, hypertrophy and body fat among sedentary young women

The objective of this study was to compare the effects of progressive bodyweight training and barbell back squat on muscle strength, muscluar hypertrophy, and body fat percentage in sedentary young women. Thirteen sedentary young women (aged 19.77 ± 0.83 years, height 164.91 ± 6.01) were randomly assigned to either the progressive bodyweight group (n = 6, consisting of 10 levels of movements progressing from bilateral to unilateral) or the barbell squat group (n = 7, 60–80% 1RM). Both groups underwent two training sessions per week for 6 weeks. Measurements of muscle strength (isokinetic knee extensor and flexor muscle peak torque of each leg), muscle thickness (gluteus maximus, rectus femoris, and gastrocnemius muscles), and body fat percentage were taken at baseline and post-testing. Both groups showed a significant increase in isometric peak torque of the knee extensor and flexor (p < 0.05), but there were no significant between-group differences in isometric peak torque of the knee extensor and flexor (p > 0.05) or in the mean concentric peak torque of the knee H/Q ratio (p > 0.05). Both groups also showed significant increases in muscle thickness (p < 0.05), with no significant differences in Gastrocnemius, Rectus femoris and Gluteus maximus (p > 0.05). The percentage of body fat significantly decreased in the barbell group (pre: 28.66 ± 4.58% vs post: 24.96 ± 5.91%, p = 0.044), but not in the bodyweight group (pre: 24.18 ± 4.63% vs post: 24.02 ± 4.48%, p = 0.679). Our findings indicate that while both training methods increased maximum strength and muscle mass, barbell back squat training may be more effective in reducing body fat percentage.

Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations.

The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.

Sarcopenia, frailty, and elective surgery outcomes in the elderly: an observational study with 125 patients (the SAFESOE study).

Sarcopenia is a syndrome characterized by loss of muscle mass, strength and function. Frailty, a state of vulnerability with diminished reserves. The measurement of perioperative risk does not include the assessment of these variables, as little is known about how these conditions impact each other. Observational study with a cross-sectional and a prospective cohort component. Elderly people over 60 years of age, able to walk and to independently perform activities of daily living were consecutively recruited in the preoperative period of non-emergency surgical procedures. Frailty was measured by the modified frailty index (mFI-11). Sarcopenia was measured by: (1) thickness and echogenicity on ultrasound; (2) handgrip strength on dynamometry and (3) gait speed. Data obtained from eight muscle groups were submitted to Principal Component Analysis. Postoperative complications were measured using the Clavien-Dindo scale. Follow-up was performed for 1 year to record readmissions and deaths. Between February and May 2019, 125 elderly people were recruited, median age of 71 years (IQR 65-77), 12% of whom were frail. Frailty was associated with older age, use of multiple medicines, presence of multimorbidity and greater surgical risk according to the American Society of Anesthesiologists (ASA) scale, in addition to lower gait speeds and lower handgrip strength. Frailty was also independently associated with smaller measurements of muscle thickness but not with echogenicity, and with longer hospital and Intensive care unit (ICU) stays. Prevalence of sarcopenia was 14% when considering at least two criteria: low walking speed and low handgrip strength. For muscle thickness, lower values were associated with female gender, older age, frailty, lower gait speeds and lower muscle strength, higher proportion of postoperative complications and higher occurrence of death. For echogenicity, higher values were related to the same factors as those of lower muscle thickness, except for postoperative complications. Lower gait speeds and lower handgrip strength were both associated with higher proportions of postoperative complications, and longer hospital stays. A higher mortality rate was observed in those with lower gait speeds. Sarcopenia was associated with frailty in all its domains. Unfavorable surgical outcomes were also associated with these two conditions.

One-Year Handgrip Strength Change in Kindergarteners Depends upon Physical Activity Status.

Free play in kindergarten can be roughly divided into fine and gross motor activities, but the effects of these activities on improving handgrip strength are unknown. Therefore, we aimed to compare one-year changes in handgrip strength and forearm flexor muscle size in children separated by preferred play in a kindergarten. One hundred and eleven children were recruited from a local kindergarten. They underwent handgrip strength and forearm muscle thickness measurements, and 95 (49 boys and 46 girls) underwent a second measurement one year after the first measurement. Class teachers assessed the physical activity of everyone in their class after the second measurement. Using three evaluation scores by the class teachers, we divided children into three groups based on the children's preference to play in kindergarten (fine movement vs. gross motor movement). Handgrip strength did not change differently between groups across one year. However, children who liked active playing outside (i.e., gross motor activity) were stronger than others. Furthermore, children who like playing outside observed greater changes than the other groups in the ulna (right hand) and radius muscle thickness (left hand), suggesting that changes in forearm muscle size might be incongruent with changes in handgrip strength among the three activity groups.

Low back pain, ultrasonographic muscle thickness measurements and biopsychosocial factors at different trimesters of pregnancy

BackgroundPregnancy-related low back pain is a multifactorial problem and its assosiation with pain intensity and biopsycosocial factors can not be fully explained. This study aimed to determine the psychosocial as well as biological/physical risk factors associated with self-reported low back pain (LBP) intensity during different trimesters of pregnancy. MethodsThis cross-sectional study comprised 107 pregnant women. An introductory information form for physical and medical characteristics, Visual Analog Scale (VAS) for low back pain intensity and Oswestry Disability Index (ODI) for degree of loss of functionality, Short Form-36 (SF-36) for quality of life and Pregnancy Physical Activity Questionnaire (PPAQ) for physical activity were applied. Abdominal muscle thicknesses and diastasis recti were measured by ultrasonography. Univariate regression was used to analyse associations between each plausible independent variable and low back pain intensity. ResultsMean LBP intensity during 1st, 2nd ve 3rd trimesters were 26.8 ± 20.9, 27.3 ± 19.8, 21.6 ± 20.1 mm, respectively. ODI scores were associated with LBP intensity, explaining 11%, 13% and 26% of LBP severity during the 1st, 2nd ve 3rd trimesters, respectively. Other biological/physical variables like age, body mass index, muscle thickness and diastasis recti were not associated with pain intensity. SF-36 emotional role limitation (coef = −0.03, R2 = 0.20, p = 0.01) in the 3rd trimester and SF-36 pain score in the 1st (coef = −0.04, R2 = 0.12, p = 0.02) and 3rd (coef = −0.05, R2 = 0.26, p = 0.004) trimesters and PPAQ-sedentary was associated during the 2nd trimester (coef = 0.17, R2 = 0.17, p = 0.02) with pain intensity. ConclusionODI scores were associated with LBP intensity in all three trimesters, with SF-36 pain domain in the 1st and 3rd trimesters, with SF-36 emotional role limitation only in the 3rd trimester and with sedentary activity level only in the 2nd trimester. İncreased pain intensity was surprisingly associated with a small number of biopsychosocial factors in all the trimesters. There is need for further large-sample studies.

Effects of the Inclusion of Dietary Bitter Gourd (Momordica charantia) on the Performance and Carcass Characteristics of Pigs: Potential Application in the Feed Chain

The objective of this study was to determine the effect of bitter gourd (BG) leftovers (stems and leaves) as an alternative dietary ingredient on pig performance, carcass characteristics, serum parameters (urea, insulin, and leptin levels), and faecal consistency. Healthy Tempo × Great Yorkshire and Landrace pigs (N = 240; 120 gilts and 120 boars) weighing 25.8 kg (9–10 weeks of age) were randomly assigned to three treatments (eight pens per treatment; each pen with five gilts and five boars). The three treatments consisted of a non-supplemented commercial diet (control; CON) and a CON diet supplemented with 6.5 g/kg BG (BG1) or 13 g/kg BG (BG2). Pigs were fed the experimental diets until slaughter (120 kg body weight; BW). Feed intake was recorded daily and calculated for each experimental phase (i.e., days 0–36, days 36–66, days 66–98, and the overall experimental period). Average daily feed intake (ADFI), average daily gain (ADG), and feed conversion ratio (FCR) were calculated. The frequencies of visiting the feed station and of feeding were recorded daily. Faecal scores (FS) for consistency were measured per pen twice weekly. On the day of slaughter, two pigs per pen (one male and one female) were randomly selected for the measurement of muscle thickness and blood collection. At the slaughterhouse, carcass weight, dressing percentage, back fat thickness, muscle depth, and lean meat percentage were recorded. Data were analysed using ANOVA, with the pen as the experimental unit. Diets BG1 or BG2 did not affect the performance of the pigs, except for a significant decrease in the ADG of the pigs fed the BG2 diet in the feeding period of 50–80 kg. However, no differences in performance were observed in the overall experimental period. Faecal scores, carcass quality, and serum levels of urea, insulin, and leptin were also not affected by the diet. In summary, leftovers (stems and leaves) of BG can be successfully added to the diet of growing-finishing pigs without interfering with performance and carcass characteristics.

COMPARATIVE STUDY OF HISTOPATHOLOGICAL CHANGES BETWEEN NANO-BORON AND BORON IN SMALL INTESTINE OF LAYER CHICKENS

The aim of this study was to compare the effect of boron and nanoboron" on histomorphology of the small intestine in layer chickens. 210 day-old chicks were used and were randomly assigned to seven equal groups. The experiment, groups were exposed to both normal boron and nano-boron as follows:G1 received 15 mg/L of boron in their drinking water, G2 got 25 mg/L, G3 got 45 mg/L, while groups nano boron as following G4 got 15 mg/L, G5 got 25 mg/L, G6 got 45 mg/L of nano-boron, and G7 was not given any treatment. By using a light microscope, the histomorphology result of intestine was examine to determine the villi's height, thickness, crypt depth, and muscle thickness. The measurements of villi height, crypt depth, and muscle thickness showed a significant difference (P≤0.05) between all treated groups (nanoboron at G5,G6 than normal boron) in comparison with control group, with the highest mean in G6(NB) in all measures of intestine. The findings of this study concluded that the adding of "boron and nanoboron" to consumption water improved the structure of intestine, and this was particularly evident at high nanoboron concentrations.