Muscle Wall Thickness Research Articles

Effects of protein diet on expression of Anoctamin1 of Cajal cell in the nervous plexus of the stomach in male mice.

To determine the association between a protein-rich diet and the expression of anoctamin 1 in Interstitial cells of Cajal within the muscle layer of the stomach wall in male mice. The experimental study was conducted at the Anatomy Department of the College of Medicine, Al- Nahrain University, Iraq, from November 2020 to April 2021, and comprised male adult healthy male mice. They were divided randomly into two equal groups. Group A was fed a high protein diet, while control group B was fed a standard pellet diet. The tissue samples were harvested at day 30 post-surgery. The stomach samplings were placed in 10% neutral formalin for 24 hours to obtain paraffin sections for routine histological and immunohistochemical staining. The protein expression in stomach smooth muscle of each group was detected by immunohistochemical staining. Data was analysed using SPSS 24. Of the 20 mice, 10(50%) were in each of the two groups. Group A exhibited significant weight-gain compared to group B (p≤ 0.05). There was significant elevation in muscle wall thickness in group A, compared to group B (p≤0.05). Tunica muscularis of the stomach in group A significantly thickened compared to group B (p≤0.05). The expression of anoctamin 1 was significantly more intense in group A compared to group B (p≤0.01). Unbalanced food had a significant impact on the stomach, affecting the thickness of the muscularis layer and the expression of anoctamin 1 in cajal cells in the muscularis externa.

Morphological alterations of the abdominal wall after open incisional hernia repair with endoscopic anterior and open posterior component separation.

Effects of component separation (CS) on abdominal wall morphology have only been investigated in smaller case series or cadavers. This study aimed to compare abdominal wall alterations following endoscopic anterior CS (EACS) or open transverse abdominis release (TAR). Computed tomography scans were evaluated in patients who had undergone open incisional hernia repair with EACS or TAR. Abdominal wall circumference, lateral abdominal wall muscle thickness, and displacement were compared with (1) preoperative images after bilateral CS and (2) the undivided side postoperatively after unilateral CS. In total, 105 patients were included. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74cm (95% CI 2.29-3.19cm, P < 0.001) and 0.82cm (0.07-1.57cm, P = 0.032) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% (5.8-15.6%, P < 0.001)) and insignificantly decreased after TAR (mean decrease 2.6% (-4.8 to 9.5%, P = 0.50)). The abdominal wall circumference was unchanged after bilateral (mean reduction 0.90cm (-0.77 to 2.58cm), P = 0.29) and unilateral CS (mean increase 0.03cm (-1.01 to 1.08cm), P = 0.95). Postoperative changes in the lateral abdominal wall musculature were different following EACS and open TAR. Either technique seems not to compromise the overall integrity of the lateral abdominal wall.

Chest wall muscle mass depletion is related to certain pulmonary functions and diseases in patients with bronchiectasis.

Background and objectiveMany bronchiectasis patients suffer dyspnea, decreased exercise tolerance, and low body mass index. Chest wall muscles play a special role in respiratory movement and make up parts of skeletal muscles. This study aimed to examine the chest wall muscle thickness and their relationship with disease severity in bronchiectasis.MethodsWe retrospectively included 166 patients with bronchiectasis and 62 patients with pneumonia as comparators. The thickness of chest wall muscle as determined in chest CT, pulmonary function, and Bronchiectasis Severity Index (BSI) score were recorded. We compared the thickness of the chest wall muscle in two groups and assessed the relationships among chest wall muscle thickness, pulmonary function, and BSI score.ResultsChest wall muscle thickness of the anterior midclavicular line and posterior exterior scapula were thinner in bronchiectasis patients than comparators both above the aortic arch level and at the aortic arch window level. Muscle thickness of the posterior interior scapula above the aortic arch level was significantly thinner in bronchiectasis patients. Chest wall muscle thickness at the anterior midclavicular line both the above aortic arch level and at the level of the aortic arch window were related to diffuse capacity in bronchiectasis patients. Anterior chest wall muscle thickness above the aortic arch was found to be a risk factor of disease severity.ConclusionAnterior chest wall muscles in the upper and middle chest were thinner in bronchiectasis patients than in comparators, and had relationship with spirometry and diffuse compacity factors. We provide another method to conveniently assess bronchiectasis severity.

Rumen Development of Artificially-Reared Lambs Exposed to Three Different Rearing Regimens.

Simple SummaryYoung ruminants possess an undeveloped rumen when first born. Encouraging good rumen development in early life is vital for young ruminants as they transition to a solid feed diet, to ensure optimum growth post-weaning. This study aimed to investigate the effect of three different rearing regimens on rumen development in lambs reared artificially. Weaning of lambs at 42 d of age improved rumen fluid n-butyric content and also resulted in a thicker rumen dorsal wall. Feeding lambs pellets with low fibre and weaning them early increased rumen fluid n-valeric content. Papillae width, density, and rumen wall muscle thickness were affected by rearing treatment. Empty rumen weight, rumen volume, papillae development, and rumen fluid iso-butyric and iso-valeric content had positive associations with dry matter intake and nutrient intakes from solid feed. The majority of volatile fatty acids in the rumen fluid had a positive association with papillae height on the rumen dorsal wall. These results suggest that lamb diet and age at weaning influenced rumen function and physical development. Further studies examining how rumen microbial composition and rumen gene expression are influenced by rearing regimens are required.The objective of this study was to examine the effect of three different rearing regimens on rumen development in lambs reared artificially. Romney ram lambs were randomly allocated to one of three treatments: commercial milk replacer fed to 57 d of age and high fibre concentrate pellets (HFP57); commercial milk replacer, high fibre concentrate pellets, and early weaning from milk replacer at 42 d of age (HFP42); high protein milk replacer from 2–16 d of age followed by commercial milk replacer, low fibre concentrate pellets, and early weaning from milk replacer at 42 d of age (LFP42). Lambs were slaughtered at 57 d of age. Volatile fatty acid content in rumen fluid at slaughter was analysed and rumen tissue samples were collected for histological examination. The rumen n-butyric content was greater (p < 0.05) in both LFP42 and HFP42 treatment lambs compared to HFP57 lambs. The n-valeric content was greater (p < 0.05) in LFP42 lambs compared to both HFP57 and HFP42 treatment lambs. Thickness of the rumen dorsal wall determined by ultrasound scanning at 49 d was greater (p < 0.05) in both HFP42 and LFP42 lambs compared to HFP57 lambs. There was an interaction (p < 0.05) between treatment and site of rumen tissue sampling on papillae width, density, and rumen muscular layer thickness. Collectively, early weaning and the provision of a low fibre pellet leads to improved rumen function and physical development.

O50 ALTERATIONS IN THE ABDOMINAL WALL MUSCULATURE AFTER ENDOSCOPIC ANTERIOR AND OPEN POSTERIOR COMPONENT SEPARATION

Abstract Aim Effects of component separation (CS) on abdominal wall musculature have only been investigated in smaller case series. The study aimed to compare abdominal wall alterations following endoscopic anterior component separation (EACS) or transverse abdominis release (TAR). Material and Methods Computed tomography scans were evaluated in patients who underwent open ventral hernia repair with TAR or EACS. Lateral abdominal wall muscle thickness and displacement were compared with preoperative images after bilateral CS and the undivided side postoperatively after unilateral CS. Results In total, 105 patients were included. The mean defect width was 12.2 cm. Fifty-five (52%) and 15 (14%) underwent bilateral and unilateral EACS, respectively. Five (5%) and 14 (13%) underwent bilateral and unilateral TAR, respectively. Sixteen (15%) underwent unilateral EACS and contralateral TAR. Complete fascial closure was achieved in 103 (98%) patients. The external oblique and transverse abdominis muscles were significantly laterally displaced with a mean of 2.74 cm (95% CI 2.29-3.19 cm) and 0.82 cm (0.07-1.57 cm) after EACS and TAR, respectively. The combined thickness of the lateral muscles was significantly decreased after EACS (mean decrease 10.5% [5.8-15.6%]) and insignificantly decreased after TAR (mean decrease 2.6% [-4.8-9.5%]), mean reduction difference EACS versus TAR 0.22 cm (-0.01-0.46 cm). One (1%) patient developed an iatrogenic linea semilunaris hernia after EACS. The recurrence rate was 19% after mean 1.7 years follow-up. Conclusions The divided muscle was significantly more laterally displaced after EACS compared with TAR. The thickness of the lateral muscles was slightly decreased after EACS and unchanged after TAR.

Intestinal smooth muscle aberrations in pancreatic cancer patients with sarcopenia

AbstractBackgroundCancer cachexia is characterized by impaired function of skeletal and cardiac muscle. Smooth muscle is abundantly present in the body and critical for the function of the gastrointestinal tract. Given the frequently reported gastrointestinal symptoms in cancer patients, we hypothesized that the smooth musculature could be compromised in cancer patients with sarcopenia.MethodsFull‐thickness jejunal tissue sections from 57 pancreatic cancer patients were analysed by picrosirius red stains and immunohistochemistry for α‐smooth muscle actin (α‐SMA), smoothelin, and CD117 (c‐kit). Muscle wall thickness, contractile marker expression, and collagen deposition were quantified. Patients were assigned to a sarcopenia or non‐sarcopenia group based on their skeletal muscle index.ResultsIntestinal smooth muscle wall thickness did not differ between the sarcopenia and non‐sarcopenia group (1,661 ± 125.0 vs. 1,439 ± 93.5 μm, P = 0.41). Whereas α‐SMA staining intensity was similar in both groups, staining intensity of smoothelin, a key marker of the contractile smooth muscle cell phenotype, was reduced (143.0 ± 22.6 vs. 125.4 ± 29.3 arbitrary units, P = 0.02) in sarcopenic patients. The distribution of CD117+ interstitial cells of Cajal was similar in both groups, but pronounced collagen deposition around the myenteric plexus was more often observed in patients with sarcopenia (P = 0.04).ConclusionsThese data suggest that cancer cachexia is not only associated with skeletal and cardiac muscle wasting, but also affects the intestinal smooth musculature. Reduced contractile smooth muscle marker expression and fibrosis around the myenteric plexus suggest that both contractile function of smooth muscle cells and regulation of their contractile functionality could be compromised.

Ultrasonographic Evaluation in Early Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants. This study was conducted to identify the accuracy of ultrasonography in the diagnosis of infantile Hypertrophic pyloric Stenosis.&#x0D; Methods: This cross-sectional descriptive. Study was conducted in Department of radiology and imaging, institute of child and mother health during two year period from 16th September 2016 to 16th September 2018. Fifty patients &lt;8 weeks of age who presented with complaints of non-bilious vomiting were included in the study. Abdominal ultrasound was performed in all the cases. On ultrasonography pyloric canal length, diameter and pyloric muscle wall thickness was measured. Open surgery was performed as per indications and after informed consent. The pre-operative findings were compared with ultrasongraphic findings. Study variable were male to female ratio, percentage of cases in which pyloric mass was palpable. We also compare the duration of onset of symptoms with pyloric canal length, diameter and muscle thickness.&#x0D; Results: In this study, out of 50 patients, 46 (92%) were male and 4 (8%) were females. Gastric peristalsis was visible in 100% patients and mass was palpable in 14 (28%) patients. Pyloric canal length was more than standard in 98% cases; canal diameter was more than the standard in 87% cases and pyloric muscle thickness in 60% of cases. Ultrasonographic findings remained 98% accurate in this study.&#x0D; Conclusion: Ultrasonography is an investigation of choice for early diagnosis of IHPS before significant fluid and electrolyte imbalance occur. It is cost effective, harmless, freely available and easier to perform.&#x0D; J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 208-211

Ağır Skarlı Böbreklerin Üreter Alt Uç Patolojik Özellikleri Az Skarlı Tarafla Karşılaştırıldığında Belirgin Farklılık Göstermektedir

Objective: This study aims to describe the pathological features of the distal end of ureters and their correlation with scar formation patterns in the kidney. Methods: The study includes 83 children (49 male, 34 female), who underwent ureteroneocystostomy (UNC) operations from 2008-2010. The distal end of ureters (approximately 3-4 mm) were resected and 110 ureter specimens from 83 patients were available for pathological examination. The presentation age, clinical presentation pattern, reflux grade and scar patterns on dimercaptosuccinic acid (DMSA) scan were obtained from record and correlation with histopathological findings were investigated. Scar patterns were defined as presence of no scar (NS), diffuse scar (DS) or focal cortical scars (FS). General structural changes were also investigated histopathologically including inflammatory changes graded for intensity (G1-G3), extracellular matrix and smooth muscle content, ureteric diameter and wall thickness. Results: Histological examination of the ureterorenal units showed that there were 35/110 (33%), 30/110 (27%) and 45/110 (40%) in the NS, DS and FS groups, respectively. When scar rates were investigated by grade of reflux (G1-2 low grade vs. G3-5 high grade reflux) the scar rates were 39.5%and 90.3% respectively. High grade inflammation (G3) was found in 66%, 28.9% and 36.4% in kidneys in the DS, FS and NS scar groups respectively (p&amp;lt;0.05). Conclusion: This investigation shows that there are significant differences of histologic structure of the distal end of the ureters when they are classified by kidney scarring. There is more intense inflammation, more collagen deposition, less ssmooth muscle content and increased ureteric wall thickness in the ureters of the kidneys with diffuse scar when compared to others with less or no scar.

Comparison of the Abdominal Wall Muscle Thickness in Female Rugby Players Versus Non-Athletic Women: A Cross-Sectional Study

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.

Are we performing ultrasound measurements of the wall thickness in hypertrophic pyloric stenosis studies the same way?

To retrospectively review imaging planes, number of visible pyloric layers and location of measurements, in infants with suspected (HPS). 103 pyloric ultrasound studies for suspected HPS were included. For each study, we recorded whether longitudinal or transverse views were performed, the layers visualized (a schematic was developed for two pediatric radiologists to categorize the interfaces of the anatomic layers a-e) and position of the internal measurement cursor. Categories for the anterior (superficial wall) layers were from external to internal: (a) internal aspect of the muscularis propria; (b) external aspect of the muscularis mucosa; (c) internal aspect of the muscularis mucosa; (d) internal aspect of the mucosa interfacing with a mucosal fold (e) deep aspect of the mucosal fold. Median differences between HPS groups were calculated and inter-reader agreement (kappa score) was performed between both readers. In 100 studies (97 patients), longitudinal (99%) and transverse (69%) views of the pylorus were recorded. For longitudinal views, measurements included muscle thickness (95%), length (97%) and no pyloric diameter. For the transverse view, measurements included muscle thickness (16%) and the diameter (3%). Pyloric layer interfaces were visible: (a) in 64% (b) in 64% (c) in 66% (d) in 30% and (e) in 26%. The internal reference point of cursor placement for measuring the muscle wall thickness in the longitudinal view for one reader was as follows: (a) 46% (b) 27% (c) 30% (d) 1% and (e) 2% of studies. Surgically proven HPS group had a median thickness measurement 0.17mm greater than the non-HPS studies (CI 95% 0.12-0.21, p < 0.05), and inter-reader agreement was considered as moderate (Kappa 0.5). We found a variety of thickness measurements performed predominantly in the longitudinal view and a largely abandoned diameter measurement. The latter might offer a solution as it is not defined by any internal interfaces.

Transplantation, gene therapy and intestinal pathology in MNGIE patients and mice

BackgroundGastrointestinal complications are the main cause of death in patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Available treatments often restore biochemical homeostasis, but fail to cure gastrointestinal symptoms.MethodsWe evaluated the small intestine neuromuscular pathology of an untreated MNGIE patient and two recipients of hematopoietic stem cells, focusing on enteric neurons and glia. Additionally, we evaluated the intestinal neuromuscular pathology in a mouse model of MNGIE treated with hematopoietic stem cell gene therapy. Quantification of muscle wall thickness and ganglion cell density was performed blind to the genotype with ImageJ. Significance of differences between groups was determined by two-tailed Mann-Whitney U test (P < 0.05).ResultsOur data confirm that MNGIE presents with muscle atrophy and loss of Cajal cells and CD117/c-kit immunoreactivity in the small intestine. We also show that hematopoietic stem cell transplantation does not benefit human intestinal pathology at least on short-term.ConclusionsWe suggest that hematopoietic stem cell transplantation may be insufficient to restore intestinal neuropathology, especially at later stages of MNGIE. As interstitial Cajal cells and their networks play a key role in development of gastrointestinal dysmotility, alternative therapeutic approaches taking absence of these cells into account could be required.

Effect of cottonseed oil and ferrous sulfate in broiler diets on intestinal morphometry at 42 days of age

ABSTRACT The aim of the study was to evaluate the intestinal morphometry of broilers at 42 days of age fed diets containing different levels of cottonseed oil, with and without addition of ferrous sulfate. A total of 560 male Ross chickens were used in a completely randomized design with a 4×2 factorial arrangement and five replications with 14 birds. The cottonseed oil levels tested were 0%, 2%, 4%, and 6%. At 42 days of age, one bird per replicate was collected for morphometric. Analyzed variables were villus height, crypt length and muscle wall thickness. The statistical analysis was performed using SAS, P=0.05. In the duodenum and ileum, there was no significant effect of interaction between the treatments. In the jejunum, only the length of the crypt, the treatment with cottonseed oil 2%, more ferrous sulfate resulted in lower values; however, the same oil content without ferrous sulfate led to a greater length, which was also observed in the treatment with 4% oil plus ferrous sulfate. Inclusion of cottonseed oil in broiler diets at 42 days of age does not impair their intestinal morphology. Supplementation with ferrous sulfate at these levels is unnecessary, since no improvement was observed in the intestinal morphometric.

Rehabilitative Ultrasound Imaging Features of the Abdominal Wall Muscles in Elite and Amateur Basketball Players

The aim of the present study was to evaluate and compare with rehabilitative ultrasound imaging (RUSI) abdominal wall muscle thickness and interrecti distance (IRD) between elite and amateur basketball players. A sample of 32 basketball players (age: 23.0 ± 8.5; height: 1.89 ± 14.25 m; weight: 86.6 ± 15.5 kg; body mass index: 22.8 ± 2.6 kg/m2) was divided in two groups: professional elite and amateur players. A diagnostic ultrasound tool with a 7–14 MHz range linear transducer was used for B mode ultrasound imaging. Ultrasound images of the external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and rectus anterior (RA) muscles as well as IRD were measured and analyzed by ImageJ software. Statistically significant differences (p &lt; 0.05) with greater height, weight, and Nijmegen scores were shown in favor of the elite basketball players compared to the amateur basketball players. Ultrasound measurements of the abdominal wall muscles showed statistically significant differences (p &lt; 0.05) for increased IRD and left TrAb thickness and decreased right and left EO thickness in favor of the elite versus amateur basketball players. The rest of the measurements did not show any statistically significant differences (p &gt; 0.05). Increased IRD and TrAb thickness and reduced EO thickness may be shown in elite versus amateur basketball players.

Exogenous GDF11 induces cardiac and skeletal muscle dysfunction and wasting.

Growth differentiation factor 11 (GDF11), a TGF-beta superfamily member, is highly homologous to myostatin and essential for embryonic patterning and organogenesis. Reports of GDF11 effects on adult tissues are conflicting, with some describing anti-aging and pro-regenerative activities on the heart and skeletal muscle while others opposite or no effects. Herein, we sought to determine the in vivo cardiac and skeletal muscle effects of excess GDF11. Mice were injected with GDF11 secreting cells, an identical model to that used to initially identify the in vivo effects of myostatin. GDF11 exposure in mice induced whole body wasting and profound loss of function in cardiac and skeletal muscle over a 14-day period. Loss of cardiac mass preceded skeletal muscle loss. Cardiac histologic and echocardiographic evaluation demonstrated loss of ventricular muscle wall thickness, decreased cardiomyocyte size, and decreased cardiac function 10days following initiation of GDF11 exposure. Changes in skeletal muscle after GDF11 exposure were manifest at day 13 and wereassociated with wasting, decreased fiber size, and reduced strength. Changes in cardiomyocytes and skeletal muscle fibers were associated with activation of SMAD2, the ubiquitin-proteasome pathway and autophagy. Thus,GDF11 over administration in vivo results in cardiac and skeletal muscle loss, dysfunction, and death. Here, serum levels of GDF11 by Western blotting were 1.5-fold increased over controls. Although GDF11 effects in vivo are likely dose, route, and duration dependent, its physiologic changes are similar to myostatin and other Activin receptors ligands. These data support that GDF11, like its other closely related TGF-beta family members, induces loss of cardiac and skeletal muscle mass and function.

Effects of dietary Moringa oleifera leaf meal supplementation on chicken intestinal structure and growth performance

Abstract Introduction: This study examined the effect of dietary Moringa oleifera leaf meal (MoLM) supplementation on intestinal structure vis-à-vis body weight gain in chickens. Materials and Methods: A total of 120-day-old Arbor Acres broiler chicks were randomly assigned to four groups, each with three replicates, 10 birds per replicate. Broiler feed supplemented with different quantities of MoLM, viz.: group T1 (control) - 0%, T2- 7.5%, T3- 15% and T4- 30%, was fed to the birds for 38 days, after which six birds/group were randomly selected and euthanized for histological work. Results: Normal histology was evident in the various intestinal components except the lamina propria and crypts in T4 and villus muscle strands in T3 and T4 where degenerative changes were observed. Villus height, crypt depth, muscle wall thickness and villus area in T1 (controls) were 935.6 pm, 173.8 pm, 192.5 pm and 0.19 mm-2, respectively. Relative to the controls, an increase in the afore mentioned measurements was noted in T2 (6.4%, 8.4%, 10.6% and 10.5%, respectively) while a reduction was recorded in T3 (16.1°%, 10.8°%, 14.8°% and 15.8°%, respectively) and T4 (20.1°%, 14.7°%, 18.3°% and 21.1°%, respectively). Body weight gain within the feeding period increased 31.2, 37.6, 23.9 and 10.9-fold in T1, T2, T3 and T4, respectively. Notably though, feed intake and villus height/ crypt depth ratio were not significantly different (p &lt; 0.05) between dietary treatments. Conclusion: Inclusion of M. oleifera in the diet should be done in moderation as quantities ≥ 15% interfere with intestinal structure and consequently body weight gain.

Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A.

The operative management of complex ventral hernia poses a formidable challenge, despite recent advances in surgical techniques. Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt. This study examines the effect of pre-operative abdominal wall chemical component relaxation using Botulinum Toxin A (BTA) to induce temporary flaccid paralysis in order to facilitate laparoscopic repair of large complex ventral hernia. This is a prospective evaluation of 27 patients from January 2013 to August 2015 who underwent ultrasound guided BTA injections to the lateral abdominal wall muscles prior to elective complex ventral hernia repair. Non-contrast serial CT imaging was obtained pre- and post-BTA injection to measure change in fascial defect size and abdominal wall muscle thickness and length. Fascial defects were closed and hernias repaired using laparoscopic or laparoscopic-assisted intra-peritoneal onlay mesh (IPOM) techniques. 27 patients received pre-operative BTA injections which were well tolerated with no complications. Comparison of pre-BTA and post-BTA CT imaging demonstrated a significant increase in mean length of the lateral abdominal wall from 15.7cm pre-BTA to 19.9cm post-BTA (p<0.0001), with mean unstretched length gain of 4.2cm/side (range 0-11.7cm/side). All hernias were surgically reduced and repaired with mesh, with no early recurrences. Pre-operative administration of BTA is a safe and effective technique in the pre-operative preparation of patients undergoing elective complex ventral hernia repair. This technique lengthens and relaxes the laterally retracted abdominal muscles and enables laparoscopic closure of large complex ventral hernia.

Assessment of myocardial changes in athletes with native T1 mapping and cardiac functional evaluation using 3T MRI.

Intensive physical exercise leads to increases in left ventricular muscle mass and wall thickness. Cardiac magnetic resonance imaging allows the assessment of functional and morphological changes in an athlete's heart. In addition, a native T1 mapping technique has been suggested as a non-contrast method to detect myocardial fibrosis. The aim of this study was to show the correlation between athletes' cardiac modifications and myocardial fibrosis with a native T1 mapping technique. A total of 41 healthy non-athletic control subjects and 46 athletes underwent CMR imaging. After the functional and morphological assessments, native T1 mapping was performed in all subjects using 3.0T magnetic resonance imaging. Most of the CMR findings were significantly higher in athletes who had ≥5years of sports activity when compared with non-athletic controls and athletes who had <5years of sports activity. Significantly higher results were shown in native T1 values in athletes who had <5years of sports activity, but there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-diastolic mass, or interventricular septal wall thickness between non-athletic controls and athletes who had <5years of sports activity. The native T1 mapping technique has the potential to discriminate myocardial fibrotic changes in athletes when compared to a normal myocardium. The T1 mapping method might be a feasible technique to evaluate athletes because it does not involve contrast, is non-invasive and allows for easy evaluation of myocardial remodeling.

Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair.

Surgical repair of recurrent abdominal incisional hernia(s) can be challenging due to complex operative conditions, intense post-operative pain, potential respiratory compromise and lateral muscle traction predisposing to early recurrence. We report our preliminary results with botulinum toxin A (BTA) injection causing flaccid paralysis (relaxation) of the lateral abdominal wall muscles prior to surgery. A prospective pilot study measured the effect of preoperative BTA prior to elective repair of recurrent abdominal hernias. Under ultrasound control, 2 weeks prior to surgery, 50 units of BTA was injected into the external oblique, internal oblique and transversus abdominis muscles at three sites on each side of the lateral abdominal wall (total dose 300 units). Pre- and post-BTA abdominal computed tomography measured changes in abdominal wall muscle thickness and length. All hernias were repaired with laparoscopic or laparoscopic-assisted mesh techniques in a single or two-staged procedure. Eight patients received BTA injections which were tolerated with no complications. Post-BTA preoperative computed tomography showed a significant increase in mean length of lateral abdominal wall from 18.5 cm pre-BTA to 21.3 cm post-BTA (P = 0.017) with a mean unstretched length gain of 2.8 cm per side (range 0.8-6.0 cm). All hernias were surgically reduced with mesh with no early recurrence. Preoperative BTA injection prior to complex abdominal hernia repair is a safe procedure that causes flaccid relaxation, elongation and thinning of the lateral abdominal muscles and decrease in hernia defect. Although further evaluation is required, BTA injections may be a useful adjunct to surgical repair of complex incisional hernias.

Effect of Genistein Diet on Jejunum Contractility, Motility and Morphology in a Mouse Model of Diabetic Obesity

We aimed to characterize jejunal function (contractility, motility and morphology), to better understand the intestinal dysfunction seen in the clinically relevant ob/ob mouse model of diabetes and obesity. We examined the effects of a 4-week genistein-containing diet (600 mg genistein/kg food) in female ob/ob and lean mice. Contractility (tension), of jejunum in response to incrementally increased concentrations of KCl was examined. There was no effect of genistein-diet on tension in ob/ob mice. There were no changes in jejunum total smooth muscle wall thickness, depth of inner circular smooth muscle, nor depth of outer longitudinal smooth muscle in ob/ob or lean mice fed genistein. Given the importance of the enteric nervous system in the control of local gastrointestinal functions, we evaluated total number clusters of acetylcholine receptors, AChR, via binding of α-bungarotoxin conjugated to tetramethyl-rhodamine to AChR. AChR were significantly decreased in ob/ob mice (41%, n=9, P<0.05) compared to leans (n=10), and genistein-diet reversed this. Utilizing a gastrointestinal motility monitoring system, we determined that the distance between consecutive contractile events was significantly increased by 50% in ob/ob mice (n=4, P<0.05) compared to leans (n=5), and genistein-diet reverses this. These data suggest that slowed GI transit in ob/ob mice is associated with decreased AChR, decreased contractile events/unit time, and genistein-diet ameliorates these dysfunctions. This work was supported by DAREF, SHRP, and MWU intramural funds (to L.A.)

Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers.

The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.