Muscle Thickness Research Articles

Minimum Intensity of Daily Six Eccentric Contractions to Increase Muscle Strength and Size.

Our previous study showed that daily six maximal eccentric contractions that were performed 5 days a week for 4 weeks increased maximal voluntary isometric (MVC-ISO), concentric (MVC-CON), and eccentric contraction (MVC-ECC) strength of the elbow flexors and muscle thickness of biceps brachii and brachialis (MT) by 8.3 ± 4.9%, 11.1 ± 7.4%, 13.5 ± 11.5%, and 10.6 ± 5.1%, respectively. In the present study, we tested the hypothesis that the muscle strength and MT would still increase when the training intensity was reduced to 2/3 or 1/3 of the peak MVC-ECC torque. Thirty-six healthy young (19-24 years) adults who had not performed resistance training were placed to three groups (n = 12/group): 2/3MVC or 1/3MVC that performed six eccentric contractions with 2/3 or 1/3 MVC-ECC load using a dumbbell 5 days a week for 4 weeks or control group that did not perform any training. Changes in the MVC-ISO, MVC-CON, MVC-ECC torque, and MT before and after the 4-week period were compared among the groups and with the group of the previous study in which six maximal eccentric contractions were performed 5 days a week for 4 weeks (MVC group; n = 12). The control and 1/3MVC groups showed no significant changes in any measures. Significant (p < 0.05) increases in MVC-ISO (10.3 ± 11.4%), MVC-CON (10.9 ± 9.5%), and MVC-ECC (9.3 ± 8.8%) torque and MT (10.1 ± 9.2%) were observed for the 2/3MVC group. These changes were not significantly different from those of the MVC group. These results suggest that the 2/3-intensity eccentric contractions with a dumbbell are as effective as maximal-intensity isokinetic eccentric contractions to induce muscle adaptations.

Mobile health–supported comprehensive intervention model (CIMmH) improved physical fitness of patients with esophageal cancer after esophagectomy: Prospective randomized controlled trial.

1634 Background: Esophageal cancer (EC) significantly impacts patients’ quality of life (QOL) post-esophagectomy, with malnutrition, reduced physical activity, and psychological distress being common. Our preliminary study indicated that a Mobile Health-Supported Comprehensive Intervention Model (CIMmH) is safe, feasible, and efficacious in improving QOL and physical fitness for EC patients. This randomized controlled trial (RCT) evaluates the effectiveness of CIMmH in promoting post-surgery recovery for EC patients. Methods: EC patients undergoing modified McKeown esophagectomy were randomly allocated to either the intervention group, receiving the CIMmH protocol (nutrition, exercise, psychological support), or the control group, receiving standard postoperative care. Outcomes were assessed at baseline, 1 month, and 3 months post-surgery. Key metrics included sarcopenia (assessed via skeletal muscle index and psoas muscle thickness on CT scans), quality of survival (EORTC-QLQ-C30 and EORTC-QLQ-QES-18), physical fitness (six-minute walk distance, SMWD), and nutritional status (body weight). Results: Of 111 screened patients, 80 were enrolled (40 per group). Follow-up assessments were completed by 76 patients at 1 month and 69 at 3 months. At 1 month, the intervention group showed a significant improvement in SMWD compared to the control group ( P=0.020), though no difference was observed at 3 months ( P=0.835). The intervention group also demonstrated a significant increase in the skeletal muscle index at 3 months ( P=0.039), alongside notable improvements in the 30-second arm curl test and cough symptom relief ( P=0.027 and P=0.045, respectively). No significant differences in QOL scores or body weight were observed between groups at any time point. Conclusions: CIMmH significantly enhances short-term physical fitness in EC patients post-esophagectomy. These findings suggest the need for further refinement and optimization of the intervention to maximize its long-term effectiveness and impact on QOL. Clinical trial information: ChiCTR2000041007 .

Development and Validation of an Ultrasonography-Based Machine Learning Model for Predicting Outcomes of Bruxism Treatments.

We aimed to develop a predictive model for the outcome of bruxism treatments using ultrasonography (USG)-based machine learning (ML) techniques. This study is a quantitative research study (predictive modeling study) in which different treatment methods applied to bruxism patients are evaluated through artificial intelligence. The study population comprised 102 participants with bruxism in three treatment groups: Manual therapy, Manual therapy and Kinesio Tape or Botulinum Toxin-A injection. USG imaging was performed on the masseter muscle to calculate muscle thickness, and pain thresholds were evaluated using an algometer. A radiomics platform was utilized to handle imaging and clinical data, as well as to perform a subsequent radiomics statistical analysis. The area under the curve (AUC) values of all machine learning methods ranged from 0.772 to 0.986 for the training data and from 0.394 to 0.848 for the test data. The Support Vector Machine (SVM) led to excellent discrimination between bruxism and normal patients from USG images. Radiomics characteristics in pre-treatment ultrasound scans of patients, showing coarse and nonuniform muscles, were associated with a greater chance of less effective pain reduction outcomes. This study has introduced a machine learning model using SVM analysis on ultrasound (USG) images for bruxism patients, which can detect masseter muscle changes on USG. Support Vector Machine regression analysis showed the combined ML models can also predict the outcome of the pain reduction.

Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial.

Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients. A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX ModuleTM. The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7. From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119. Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh KN, Pachisia AV, et al. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024;28(6):587-594.

Differences in ankle and knee muscle architecture and plantar pressure distribution among women with knee osteoarthritis.

The aim of this study was to compare the plantar pressure distribution and knee and ankle muscle architecture in women with and without knee osteoarthritis (OA). Fifty women with knee OA (mean age=52.11±4.96years, mean Body mass index (BMI)=30.94±4.23kg/m2) and 50 healthy women as a control group (mean age=50.93±3.78years, mean BMI=29.06±4.82kg/m2) were included in the study. Ultrasonography was used to evaluate knee and ankle muscles architecture and femoral cartilage thickness. The plantar pressure distribution was evaluated using the Digital Biometry Scanning System and Milleri software (DIASU, Italy). Static foot posture was evaluated using the Foot Posture Index (FPI), and pain severity was assessed using the Visual Analog Scale. The OA group exhibited lower muscle thickness in Rectus Femoris (RF) (p=0.003), Vastus Medialis (VM) (p=0.004), Vastus Lateralis (p=0.023), and Peroneus Longus (p=0.002), as well as lower Medial Gastrocnemius pennation angle (p=0.049) and higher Fat thickness (FT) in RF (p=0.033) and VM (p=0.037) compared to the control group. The OA group showed thinner femoral cartilage thickness (p=0.001) and higher pain severity (p=0.001) than the control groups. FPI scores were higher (p=0.001) in OA group compared to the control group. The plantar pressure distribution results indicated an increase in total surface (p=0.027), total load (p=0.002), medial load (p=0.005), and lateral load (p=0.002) on dominant side in OA group compared to the control group. Knee and ankle muscle architecture, knee extensor muscle FT, and plantar pressure distribution in the dominant foot differed in individuals with knee OA compared to the control group.

Autoregulation Does Not Provide Additional Benefits to a Mixed Session Periodized Resistance Training Program in Trained Men.

Bartolomei, S, Francesco, L, Latini, D, and Hoffman, JR. Autoregulation does not provide additional benefits to a mixed session periodized resistance training program in trained men. J Strength Cond Res 38(9): 1535-1542, 2024-The aim of this investigation was to study how autoregulation impacted training volume, performance, and muscle size on a 10-week mixed session periodized (MSP) resistance training program, characterized by the inclusion of different training foci in each session. Twenty-four resistance trained men were assigned to an autoregulated mixed session periodized (AMSP group; n = 13; age = 26.2 ± 4.9 y; body mass = 82.0 ± 8.7 kg; height = 176.8 ± 6.0 cm) or into an MSP ( n = 11; age = 24.0 ± 2.6; body mass = 81.3 ± 10.5 kg; height = 174.0 ± 5.4 cm) group. Subjects in both groups trained 5 days per week for 10 weeks and performed the same exercises. The difference between the groups consisted in the use of a perceived recovery-based scale to adjust the individual training volume in the AMSP program. Maximal strength (bench press and squat 1 repetition maximum), power (bench press throw and countermovement jump), and muscle architecture (muscle thickness [MT] of biceps brachii, trapezius, vastus lateralis and vastus medialis) were collected before and after the 10-week training period. In addition, training volume and session load were calculated for each training session. A higher total training volume ( p < 0.001) was seen in AMSP program compared with MSP program, but no differences ( p > 0.05) were noted in the average session load. No significant differences between the groups were detected for MT of both upper-body and lower-body muscles ( p's > 0.05) and lean body mass ( p = 0.681). No significant differences between the groups were detected for any strength or power measurements. Results of this study indicate that a perceived recovery-based AMSP training program was not more effective than an MSP training program for increasing muscle size and performance in resistance trained men.

EFFECTS OF GRADED LEVELS OF CORN AND COB MEAL ON CARCASS PARAMETERS, ORGAN WEIGHT, VILLI MORPHOMETRIC, AND SENSORY PROPERTIES OF TOPIGS NORSVIN TN70 WEANED PIGS

Thirty-two (32) TN70 (Topigs Norsvin) weaned pigs, aged 7 weeks, having an average weight of 10.5±0.5 kg were used to evaluate the effect of corn and cob meal (CCM) on the carcass parameters, organ weight, villi morphometric, and organoleptic properties of the pigs. CCM was produced by grinding the grain and the cob together. The pigs were acclimatized for seven days before they were randomly allotted to four (4) dietary treatments with eight (8) pigs per replicate in a completely randomized design. The experiment lasted for seven weeks. The feed had 0%, 10%, 20%, and 30% corn and cob meal (CCM) in the diets tagged as D1, D2, D3, and D4 respectively. All the data were analyzed using SPSS version 16 and the means were compared using one-way analysis of variance (ANOVA). Except for the eviscerated weight, back fat, and loin, all the carcass parameters were significantly influenced (P&lt;0.05). The weight of the visceral organs was significantly influenced (P&lt;0.05) except for the weight of the lungs. All the villi morphometric parameters differed significantly (P&lt;0.05) except the crypt width. CCM influenced (P&lt;0.05) the colour, tenderness, juiciness, and overall acceptability of the meat. The use of 30% CCM stimulated pancreas hypertrophy, increased carcass weight, belly, ham, picnic shoulder, villi height, muscle thickness, and improved organoleptic properties.

Fishmeal substitution by zooplankton or Daphnia magna biomass meals in the diet of Nile tilapia: Effectson growth, gut histological changes, bacterial abundanceand stress tolerance.

Fishmeal substitution with sustainable feed sources is highly essential towards sustainable production. This study aimed to investigate the effects of substituting fishmeal (FM) with Daphnia magna biomass meal (DBM) or zooplankton biomass meal (ZBM) on growth performance, liverand intestinal histology, gut bacterial abundanceand stress tolerance of Nile tilapia, Oreochromis niloticus, fry. Nile tilapia fry (0.23 ± 0.04 g) were randomly assigned to five groups of three replicates. The control diet comprised 300 g/kg FM, and the FM was substituted with DBM or ZBM at levels of 25% and 50% (DBM-25, DBM-50, ZBM-25and ZBM-50respectively) in the other experimental diets. The experiment lasted 56 days in 1.5 m3 concrete tanks. The results revealed that weight gain andfeed conversion ratio(FCR) significantly (p ≤ 0.035 and 0.025respectively) improved with a polynomial response with a peak at 25% ZBM and a linear increase with DBM up to 50% of FM. Histometric indices of the distal intestine showed improvements (p ≤ 0.001) in villus height, villus width, crypt depthand muscle thickness of fish fed DBM or ZBM compared to the control. In the meantime, there were no histological abnormalities in the liver sections. The replacement of FM with DBM or ZBM could modulated gut bacterial abundance, including total bacterial count, Escherichia coli, Bacillus subtilis, and Lactobacillus sp. The fish-fed DBM or ZBM-containing diets had higher (p ≤ 0.05) tolerances to salinity stress than the control group. In conclusion, DBM or ZBM could replace FM up to 50% and 25%, respectivelywith improved fish growth performance, FCR, gut histologyand tolerance to salinity stress.

Evaluating the between-day reliability and likelihood of change of a test battery incorporating vastus lateralis muscle thickness, ankle-brachial pressure index, maximal voluntary torque, and six-minute walk test in patients with claudication.

The study aims to evaluate the between-day reliability of a proposed test battery for patients with claudication that can be used for monitoring the effectiveness of exercise interventions and other therapeutic strategies tailored to this patient population. Twenty-five men with claudication were recruited. The test battery consisted of the Vastus Lateralis muscle thickness (VL-MT), ankle-brachial pressure index (ABI), unilateral isometric knee extension maximal voluntary torque (MVT) and 6-minute walk test (6MWT). A single investigator conducted the tests for each patient on two separate testing sessions (T1 and T2) 5-7days apart. Good to excellent reliability was observed for VL-MT (ICC = 0.95, 95% LOA = ±3.10mm, SEM = 0.81mm), ABI (ICC = 0.97, 95% LOA = ±0.10, SEM = 0.02), MVT (ICC = 0.97, 95% LOA = ±24.0N·m, SEM = 6.31N·m), 6MWT distance (ICC = 0.99, 95% LOA = ±39.6m, SEM = 11.0m), 6MWT time to claudication (ICC = 0.99, 95% LOA = ±30.8s, SEM = 7.8s), and 6MWT ratings of pain (ICC = 0.87, 95% LOA = ±2.4 CR-10+, SEM = 0.7 CR-10+ ). Analysis derived from reliability data indicates a change of 1.4mm for VL-MT, 0.14 for ABI, 12N·m for MVT, 25m for 6MWT distance, 15s for 6MWT time to claudication and 1 CR-10+ for 6MWT ratings of pain is required to be interpreted as the minimum 'likely' change (76% chance). The test battery provides a reliable assessment of patients with claudication and can be widely used to evaluate the effects of exercise programmes and other therapeutic interventions. For the individual, changes in VL-MT, ABI, MVT, and 6MWT greater than the minimum likely change as a result of an exercise programme or an intervention are likely changes and less influenced by error associated with the test.

Understanding tightened muscle in knee osteoarthritis and the impacts of Fu's subcutaneous needling: A pilot trial with shear-wave elastography and near-infrared spectroscopy.

Given the scarce reports on the interplay between Fu's subcutaneous needling (FSN), tightened muscle, and therapeutic effects, we developed a clinical research protocol to synchronously collect data on clinical efficacy and muscle characteristics in patients with knee osteoarthritis, exploring the mechanism of FSN action. The primary aim was to assess the feasibility and safety of this protocol, guiding future trials and their sample size calculations. In this prospective, single-blind, self-controlled study, 19 patients with early to mid-stage unilateral knee osteoarthritis underwent FSN therapy on both knees over 1 week (4 sessions, every other day). We measured local elastic modulus, muscle thickness, blood flow volume, and oxygen consumption rate of bilateral vastus lateralis muscles using shear-wave elastography and near-infrared spectroscopy (NIRS) before and after the first and fourth treatments. Additionally, real-time NIRS indicators (oxygenated hemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [THb], and tissue saturation index [TSI]) were recorded during these treatments. Pain intensity (visual analogue scale [VAS]), functional status (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and active range of motion were evaluated before these treatments. All 19 participants completed the trial without serious adverse events. After 3 FSN treatments, significant changes were observed in VAS and WOMAC scores (VAS: P < .001; WOMAC: P < .001), and knee flexion (P < .001) and external rotation (P = .02), except for internal rotation. No meaningful significant differences were observed in muscle characteristics at baseline or between pre- and post-treatment periods. NIRS results during treatments indicated significant increases in local O2Hb and THb post-FSN therapy (First treatment: O2Hb: P = .005; THb: P = .006. Fourth treatment: O2Hb: P = .002; THb: P = .004); however, no significant increases were observed for HHb (First treatment: P = .06; Fourth treatment: P = .28). No linear correlation was found between therapeutic effects and changes in tightened muscle indices. FSN reduces pain and improves joint function in knee osteoarthritis, while also enhancing blood flow and oxygenation in the vastus lateralis muscle of the affected side. Further revisions of this protocol are warranted based on our insights.

Effects of effortful swallowing against kinesiology taping resistance on the swallowing function in patients with poststroke dysphagia: A randomized controlled trial.

A dysphagia rehabilitation method using kinesiology taping (KT) was recently introduced, and its potential for clinical efficacy was demonstrated by evaluating muscle activity and thickness. However, its effect on the swallowing function in patients with dysphagia remains unclear. This study aimed to investigate the effects of effortful swallowing against KT resistance on the swallowing function in patients with post stroke dysphagia. Thirty patients with poststroke dysphagia were recruited and randomly assigned to the experimental and placebo groups. In the experimental group, the KT was attached to the front of the neck (the hyoid bone between the sternum) with a tension of approximately 70% to 80%, and effortful swallowing was performed against the KT tension. In contrast, the placebo group performed effortful swallowing with KT applied at the same location without tension. The intervention was performed 30 times/day, 5 days/week for 6 weeks. The videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study were used to analyze oropharyngeal swallowing function. The experimental group showed statistically significant improvements in the oral and pharyngeal phases of the VDS (P = .029 and .007, respectively) and PAS (P = .034) compared with the placebo group. Effect sizes were observed for the oral (0.3) and pharyngeal phases (0.5) of the VDS and PAS (1.1). This study demonstrated that effortful swallowing against resistance to KT is an effective therapeutic exercise for improving the swallowing function in patients with poststroke dysphagia.

#360 Short-term treatment with medium cut-off dialyzers increases muscle mass with preserved fat tissue in maintenance HD patients

Abstract Background and Aims Protein-energy wasting is a significant complication of maintenance hemodialysis (HD) patients characterized by reduced fat or muscle mass and strength. The combination of non-modifiable general and disease-related factors, such as uremic toxin accumulation and systemic inflammation, is responsible for this condition. Medium cut-off (MCO) membranes are designed to provide clearance of large-middle molecular weight uremic toxins and inflammatory cytokines without causing loss of albumin. This study aimed to investigate the short-term effect of MCO dialyzers on fat tissues and muscle mass. Method We conducted a prospective, single-center cross-over study on maintenance HD patients treated with regular low-flux (LF) dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters from six different muscle groups were evaluated with ultrasound. The baseline (control) parameters were measured under LF dialyzers, and the measurements were repeated two weeks after switching to MCO dialyzers for the patients ordered by their clinicians according to the clinical indications. Results The median age was 69.5 (50.3,78.8) years, and 60% of the patients were female. Two weeks after switching to MCO, the Kt/Vs, urea reduction ratios, mean serum albumin, dry weight, and body mass index scores were similar. Mean skinfold thickness and mid-upper arm circumference were 15 mm (11,17) and 28mm (27,30) under LF and 16mm (14,19) and 28mm (27,30) under MCO dialyzers (p=0.82 and p=0.27). Rectus abdominis and external oblique muscle groups remained similar. Internal and external oblique muscle thickness were significantly increased (p=0.002 and p=0.001). Mean rectus femoris and gastrocnemius medialis (GKM) thicknesses were 1.19cm (0.99,1.33) and 1.16cm (0.9,1.4) under LF and 1.31cm (1.20, 1.40) and 1.24cm (0.95,1.40) under MCO dialyzers (p=0.002 and p=0.02). Mean GKM fibrile length and pennation angles were 2.4cm (2.2,2.8) and 20o (18,23) under LF and 2.7cm (2.4, 2.9) and 22o (19,24) under MCO dialyzers (p=0.007 and p=0.001). Conclusion Our study showed that MCO dialyzers increase muscle mass with preserved fat tissues in HD patients, short-term follow-up. This favorable effect might be due to the clearance of uremic toxins, which cannot be removed with conventional methods. If long-term studies support our findings, MCO dialyzers would be a milestone for the treatment of sarcopenia in HD patients.

Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study

BackgroundFrailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty.MethodsThis study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30).ResultsBy CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66–0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an ‘add-on’ test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3–304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined ‘add-on’ test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81–0.95) may also be superior to either CFS or gait speed test alone.ConclusionsPreoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery.Trial registrationThe study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.

#2831 A randomised controlled study of a Combined Home-based ExERcISe and Nutritional ApproacH to improve frailty in kidney transplant recipients (CHERISH)

Abstract Background and Aims Post-transplantation frailty is common, with a prevalence of up to 52% in kidney transplant recipients (KTRs), and is associated with increased mortality, recurrent hospitalisation and inferior quality of life (QoL). Resistance exercise training (RET) was found to improve frailty in this patient group. Both high and low protein intakes were associated with potential risk of graft failure. To date, no studies have evaluated the safety and efficacy of RET combined with protein supplementation (RETPS) in KTRs. The objectives of this study were to investigate the effect of RETPS on kidney function and frailty status in KTRs, and assess its impact on QoL. Method Forty clinically stable KTRs ≥1 year post-transplantation [mean age = 54 ± 14 years; 50% male, median time post-transplantation = 7 years] were enrolled and randomised to either RET (n = 20) or RETPS (n = 20). All participants completed a 30-minute home-based progressive RET regimen 2-3 times weekly for 12 weeks, guided by an exercise worksheet and a study-specific video link. Participants received weekly telephone call to ensure safety and compliance of the interventions. The RETPS group received additional body-weight adjusted whey protein supplementation 1-hour post exercise. Total daily dietary protein intake did not exceed 1.40 g/kg/day to confine to a safe level of protein consumption in KTRs. Kidney function was measured by estimated glomerular filtration rate (eGFR), creatinine, and albumin-creatinine ratio (ACR). Frailty was evaluated using Fried Frailty Phenotype (FFP), Short Performance Physical Battery (SPPB), 60-second Sit-to-Stand test (60s-STST), handgrip- (HG) and back-leg-chest- (BLC) derived muscle strength, bioimpedance-derived lean tissue index (LTI), and ultrasound-derived thigh muscle thickness (TMT). QoL was assessed using Short Form (SF) -36 questionnaire. All measurements were performed at baseline and at week 12. Results Kidney function did not differ significantly between baseline and week 12 in both RET [eGFR: 62.1 vs 59.7 ml/min; creatinine: 107.3 vs 111.5 μmol/L; ACR: 12.8 vs 10.4 mg/mmol] and RETPS [eGFR: 61.2 vs 60.7 ml/min; creatinine: 101.1 vs 102.2 μmol/L; ACR: 17.6 vs 20.9 mg/mmol] groups. Frailty status assessed by FFP and SPPB improved in both RET [FFP: 2.5 vs 1.3, P &amp;lt; .001; SPPB: 7.2 vs 11.6, P &amp;lt; .001] and RETPS [FFP: 2.8 vs 1.1, P &amp;lt; .001; SPPB: 6.4 vs 10.9, P &amp;lt; .001] groups, but the improvements did not differ significantly between groups (P &amp;gt; 0.23). Improvements in 60s-STST, HG-derived muscle strength, BLC-derived muscle strength, and ultrasound-derived TMT were observed in both RET [60s-STST: 23 vs 27, P &amp;lt; .001; HG-derived muscle strength: 24 vs 30 kg, P &amp;lt; .001; BLC-derived muscle strength: 62 vs 71 kg, P &amp;lt; .001; ultrasound-derived TMT: 15 vs 19 mm, P &amp;lt; .001] and RETPS [60s-STST: 20 vs 29, P &amp;lt; .001; HG-derived muscle strength: 24 vs 32 kg, P &amp;lt; .001; BLC-derived muscle strength: 57 vs 80 kg, P &amp;lt; .001; ultrasound-derived TMT: 14 vs 21 mm, P &amp;lt; .001] groups, with greater improvements in RETPS group for 60s-STST (P &amp;lt; .01), HG-derived muscle strength (P &amp;lt; .05), BLC-derived muscle strength (P &amp;lt; .05), and ultrasound-derived TMT (P &amp;lt; .001). For bioimpedance-derived LTI, improvement was observed only in RETPS group [12.8 vs 14.8 kg/m2, P &amp;lt; .05]. SF-36-derived overall-, physical- and mental- related QoL improved in both groups (P &amp;lt; .05 for all), with RETPS group reporting a greater improvement in physical-related QoL (P &amp;lt; .05). Conclusion This represents the first study demonstrating RET combined with protein supplementation is safe and effective in improving frailty and QoL in KTRs. Protein supplementation augments increased muscle mass and strength beyond RET effect, further enhancing improvement in physical-related QoL.

Reliability and reference values for diaphragmatic excursion, thickness, and thickening fraction and quadriceps femoris muscle thickness in full-term newborns evaluated by ultrasound.

To determine the diaphragm thickness, thickening fraction, and excursion and thickness of the quadriceps femoris muscle in full-term newborns and to evaluate the intra- and interrater reliability of these measurements.This was a prospective, observational clinical study including full-term newborns born within the first 48h after birth. Serial measurements of the thickness, thickening fraction, and mobility of the diaphragm muscles and the thickness of the quadriceps muscle were obtained using ultrasound images. A total of 69 newborns with a mean gestational age of 39 weeks were included. The following measurements were obtained and are expressed as the mean (standard deviation): inspiratory diaphragm thickness, 0.19cm (0.04); expiratory diaphragm thickness, 0.16cm (0.04); diaphragm thickness fraction, 16.70cm (10.27); diaphragmatic excursion, 0.68cm (0.22); and quadriceps thickness, 0.99cm (0.14). Intrarater reliability was assessed using intraclass correlation coefficients (ICCs). Excellent intrarater agreement was observed for the two groups of operators (ICC > 0.86,p < 0.001) for all measurements except for the diaphragm thickening fraction, which showed good agreement for both operator groups (ICC = 0.70,p < 0.001). Regarding interrater reliability, moderate agreement between the raters was observed in the means of all measures (ICC > 0.49,p < 0.001), except for the diaphragm thickening fraction, which showed poor agreement. Conclusion: Good intrarater and moderate interrater reliability were achieved in ultrasound evaluations of the thickness and mobility of the diaphragm and quadriceps femoris muscles in full-term newborns, demonstrating the feasibility of this technique for clinical use. This pioneering study offers reference values for these muscles in a single study, allowing comparisons between different clinical conditions. What is Known: •Ultrasound is a highly reliable tool for muscle assessment that can be used to assess muscular atrophy in critically ill patients. • Muscle atrophy worsens the patient's condition and has been associated with worse outcomes. What is New: • To our knowledge, this is the first study to jointly evaluate the diaphragm and quadriceps muscle thickness and evaluate the reliability of all measurements. • Our study presents reference values for both muscles, enabling comparisons between different clinical conditions.

Uncovering sarcopenia and frailty in older adults by using muscle ultrasound-A narrative review.

Muscle ultrasound is a valuable non-invasive and cost-effective method in assessing muscle mass and structure, both of which are significant indicators for the development of sarcopenia and frailty in elderly individuals. Sarcopenia refers to the loss of muscle mass and strength that occurs with age, whereas frailty is a complex geriatric syndrome characterized by reduced physical function and an increased susceptibility to negative health outcomes. Both conditions are prevalent in older adults and are associated with higher risks of falls, disability, and mortality. By measuring muscle size and structure and several other ultrasound parameters, including muscle thickness, cross-sectional area, echogenicity (brightness in the ultrasound image), pennation angle, and fascicle length ultrasound can assist in identifying sarcopenia and frailty in older adults. In addition, ultrasound can be used to evaluate muscle function such as muscle contraction and stiffness, which may also be affected in sarcopenia and frailty. Therefore, muscle ultrasound could lead to better identification and tracking of sarcopenia and frailty. Such advancements could result in the implementation of earlier interventions to prevent or treat these conditions, resulting in an overall improvement in the health and quality of life of the elderly population. This narrative review describes the benefits and challenges when using ultra-sound for the evaluation of frailty and sarcopenia.

Evaluation of Neuromuscular Morphometry of the Vaginal Wall Using Protein Gene Product 9.5 (Pgp 9.5) and Smooth Muscle α-Actin (Sma) in Patients with Posterior Vaginal Wall Prolapse.

Background and Objectives: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in women without prolapse, to determine the difference, and to demonstrate the role of neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In this prospective study, women aged between 40 and 75 years who had not undergone any vaginal surgery and had not undergone any abdominal prolapse surgery were included. Thirty-one women diagnosed with rectocele on examination were included in the study group. Thirty-one patients who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse were included in the control group. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical stainings were compared between the two groups. The collected data were analyzed using the SPSS 23 package program. p values less than 0.05 were considered statistically significant. Results: In the control group, muscle thickness and the number of nerves per mm2 of fascia were statistically significantly higher than in the study group (p < 0.05). Conclusions: We found that smooth muscle tissue and the number of nerves per mm2 of fascia were decreased in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by parity, number of live births, and number of vaginal deliveries.

Clinical and radiologic features in patients with the WHO grade I and II meningiomas

Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior. Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema. Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032). Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results.

New Perspectives for Low Muscle Mass Quantity/Quality Assessment in Probable Sarcopenic Older Adults: An Exploratory Analysis Study.

Low muscle mass quantity/quality is needed to confirm sarcopenia diagnosis; however, no validated cut-off points exist. This study aimed to determine the diagnostic accuracy of sarcopenia through muscle mass quantity/quality parameters, using the bioimpedance analysis (BIA), isokinetic, and ultrasound tools in probable sarcopenic community-dwelling older adults (≥60 years). Also, it aimed to suggest possible new cut-off points to confirm sarcopenia diagnosis. A cross-sectional exploratory analysis study was performed with probable sarcopenic and non-sarcopenic older adults. BIA, isokinetic, and ultrasound parameters were evaluated. The protocol was registered on ClinicalTrials.gov (NCT05485402). A total of 50 individuals were included, 38 with probable sarcopenia (69.63 ± 4.14 years; 7 men and 31 women) and 12 non-sarcopenic (67.58 ± 4.54 years; 7 men and 5 women). The phase angle (cut-off: 5.10° men, p = 0.003; 4.95° women, p < 0.001), peak torque (cut-off: 66.75 Newtons-meters (N-m) men, p < 0.001; 48.35 N-m women, p < 0.001), total work (cut-off: 64.00 Joules (J) men, p = 0.007; 54.70 J women, p = 0.001), and mean power (cut-off: 87.8 Watts (W) men, p = 0.003; 48.95 W women, p = 0.008) in leg extension, as well as the the forearm muscle thickness (cut-off: 1.41 cm (cm) men, p = 0.017; 0.94 cm women, p = 0.041), had great diagnostic accuracy in both sexes. The phase angle, peak torque, total work, and mean power in leg extension, as well as forearm muscle thickness, had great diagnostic accuracy in regard to sarcopenia, and the suggested cut-off points could lead to the confirmation of sarcopenia diagnosis, but more studies are needed to confirm this.

Morphological Changes of the Temporomandibular Joint and Masseter Muscle After Mandibular Angle Osteotomy.

Mandibular angle osteotomy with outer cortex grinding is an effective cosmetic procedure for correcting square faces. However, morphological changes in the mandible may also cause temporomandibular joint (TMJ) disorders. This retrospective study aimed to investigate the morphological stabilization of the TMJ and changes in masseter muscle thickness after mandibular angle osteotomy to evaluate the safety of the procedure. Data from patients who underwent mandibular angle osteotomy with outer cortex grinding between January 2016 and January 2019 were retrospectively reviewed. Preoperative and long-term follow-up (~1 y) computed tomography data were collected from these patients, and morphological changes in the TMJ and masseter muscle were analyzed. The results from the computed tomography data showed that the condylar length and condylar height were significantly reduced 1 year after the operation ( P < 0.05). In addition, the morphology of the TMJ was stable, and the distance between the mandibular condyle and the glenoid fossa did not change significantly. No significant difference was observed in masseter muscle thickness before and after the operation. After mandibular angle osteotomy with outer cortex grinding, the length and height of the mandibular condyle were functionally restored without any disorders of the TMJ. Moreover, the masseter muscle exhibited stable function. In conclusion, the procedure is safe for occlusal function and suitable for popularization.