Musculoskeletal Structures Research Articles

Biological sex-related differences in whole-body coordination during standing turns in healthy young adults

Biological sexes (male and female) have been reported to influence postural control and balance due to differences in musculoskeletal structures, hormonal factors, and neuromuscular control. These factors can contribute to the turning performance, potentially leading to an increased incidence of falls, particularly during turning. Therefore, this study aimed to explore the whole-body coordination and stepping characteristics and during standing turns in healthy adults to determine the effects of biological sex and turn speed. Fifty participants (25 males and 25 females) completed 180° standing turns on level ground. Inertial Measurement Units (XSENS) were used to measure whole-body movement turning kinematics and stepping characteristics. Moreover, clinical outcome of dynamic balance was measured by the Timed Up and Go (TUG). Participants were randomly tasked to turn at three speeds; fast, moderate, or slow to the left and right sides. Mann–Whitney U tests were used to compare the independent variables between male and females, and Friedman tests with Dunn’s tests for pairwise comparisons were used to compare between the three turning speeds within the two groups. The results demonstrated that significant differences were seen between males and females during fast turning for the leading foot onset (p = 0.048) and in the slow speed for the total step (p = 0.033), showing that these were greater in female with an increase in turn speed. In addition, significant differences were seen only in the males when comparing different speeds in the trailing foot onset latency (p = 0.035), step size (p = 0.009), and total number of steps (p = 0.002), while in the females a significant difference was found in peak head yaw velocity between fast and slow turn speeds, and moderate and slow turn speeds. Finally, there was no significant difference in TUG between groups. Therefore, these findings show differences between biological sexes in the response to whole-body coordination and step characteristics, indicating that females tend to have more changes in stepping characteristics compared to males due to differences in turning speed. This can affect their balance and stability. However, the differences in biological sex did not impact the dynamic balance and fall risk due to the lack of a significant difference shown by TUG between males and females.

Morphological description of spontaneous pelvic fin loss in a neotropical cichlid fish.

Pelvic finsare a characteristic structure of the vertebrate Bauplan. Yet, pelvic fin loss has occurred repeatedly across a wide diversity of other lineages of tetrapods and at least 48 times in teleost fishes. This pelvic finless condition is often associated with other morphological features such as body elongation, loss of additional structures, and bilateral asymmetry. However, despite the remarkable diversity in the several thousand cichlid fish species, none of them are characterized by the complete absence of pelvic fins. Here, we examined the musculoskeletal structure and associated bilateral asymmetry in Midas cichlids (Amphilophus cf. citrinellus) that lost their pelvic fins spontaneously in the laboratory. Due to this apparent mutational loss of the pelvic girdle and fins, the external and internal anatomy are described in a series of "normal" Midas individuals and their pelvic finless sibling tankmates. First, other traits associated with teleost pelvic fin loss, the genetic basis of pelvic fin loss, and the potential for pleiotropic effects of these genes on other traits in teleosts were all reviewed. Using these traits as a guide, we investigated whether other morphological differences were associated with the pelvic girdle/fin loss. The mean values of the masses of muscle of the pectoral fin, fin ray numbers in the unpaired fins, and oral jaw tooth numbers did not differ between the two pelvic fin morphotypes. However, significant differences in meristic values of the paired traits assessed were observed for the same side of the body between morphotypes. Notably, bilateral asymmetry was found exclusively for the posterior lateral line scales. Finally, we found limited evidence of pleiotropic effects, such as lateral line scale numbers and fluctuating asymmetry between the Midas pelvic fin morphotypes. The fast and relatively isolated changes in the Midas cichlids suggest minor but interesting pleiotropic effects could accompany loss of cichlid pelvic fins.

Diacutaneous Fibrolysis: An Update on Research into Musculoskeletal and Neural Clinical Entities.

Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as "a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin's integrity". The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF.

Minimizing Maladaptations Derived From Tennis Serve Training and Competition Loads

ABSTRACT Junior tennis players perform many high-intensity serves during practice and competition. These demands can potentially put specific musculoskeletal structures at risk of developing negative adaptations that can increase the likelihood of injury. In addition, serve velocity enhancement sessions commonly include motion-specific resistance training approaches that can increase the load on these already at-risk muscles and joints. Therefore, it is essential to address holistically the optimization of serve training. To minimize harmful musculoskeletal adaptations and maximize performance, a multiperspective approach is advised when designing a serve training program for junior tennis players. This paper will propose methodological recommendations that can be included in these programs. Examples and suggestions include the benefits of incorporating general strength training tasks to minimize asymmetries and build robustness. Furthermore, on-court injury prevention protocols are proposed to target specific altered body structures and overall serving loads. Finally, load management strategies should ensure that training is controlled and organized appropriately.

Anatomic Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Infratemporal Fossa Approach to the Jugular Foramen.

The infratemporal fossa (ITF) is a complex region bounded by the temporal bone, maxilla, sphenoid, pterygoid plates, and mandibular ramus. Containing a high density of neurovascular and musculoskeletal structures, the ITF can house a number of pathologies, and access is challenging. The ITF approach and its variations can be challenging due to complex anatomy and unfamiliarity by many surgeons. The objective of this study was to present a step-by-step 3-dimensional anatomic dissection for the classic Fisch Type A and modified ITF approach from the surgeon's perspective. Six sides of 3 formalin-fixed latex-injected specimens were dissected under microscopic magnification (JRD and AMN). Standard Fisch Type A and modified ITF approaches were performed on contralateral sides of each specimen. Representative high-quality 3-dimensional photography was performed for each key step. The ITF approach affords excellent access to the posterior ITF and jugular foramen. Modifications to this approach include preservation of the ear canal and limiting facial nerve transposition, thus limiting morbidity while generally still providing sufficient access to key anatomic structures. The ITF approach provides access to the lateral skull base for jugular foramen paraganglioma and other lesions. Modifications of the classic Fisch Type A technique can be used to access pathologies in this region without sacrificing conductive hearing or facial nerve function. Three dimensional operatively oriented neuroanatomy dissections provide surgeons with a valuable resource for learning this complex surgical approach.

Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients.

Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population. We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed. Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction. Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.

Autumn abstracts

Aims To analyse the C-spine position of consultant and trainee hand surgeons during standardised hand surgeries. Surgeons often perform procedures that require maintenance of sustained postures for prolonged periods of time. Hand surgeons may be at increased risk of sustained end of range postures, particularly cervical spine flexion. This can lead to strain on the musculoskeletal structures of the neck. Recent evidence suggests a higher incidence of neck dysfunction in hand surgeons, leading to an associated morbidity. We aimed to quantify the nature of cervical spine positioning among hand surgeons. Methods We examined 20 hand surgeons of all experience levels during a standardised carpal tunnel decompression procedure. We used real-time dynamic goniometric measurements of neck flexion using the ‘UPRIGHT GO 2’ device and accompanying smartphone app. Neck flexion >40% was used as a cut-off point for an acceptable neck position. Results Hand surgeons of all levels adopt maladaptive positions during hand surgery. Junior surgeons tended to adopt similar maladaptive positions (71% of the procedure time) versus 60% for consultant surgeons. This may contribute to C-spine dysfunction in hand surgeons and presents an opportunity to intervene at an early career stage to attenuate what could become irreversible dysfunction.

Decomposition and Reconstruction of Human Palm Movements.

The human hand is known to have excellent manipulation ability compared to other primate hands. Without the palm movements, the human hand would lose more than 40% of its functions. However, uncovering the constitution of palm movements is still a challenging problem involving kinesiology, physiology, and engineering science. By recording the palm joint angles during common grasping, gesturing, and manipulation tasks, we built a palm kinematic dataset. Then, a method for extracting the eigen-movements to characterize the common motion correlation relationships of palm joints was proposed to explore the palm movement constitution. This study revealed a palm kinematic characteristic that we named the joint motion grouping coupling characteristic. During natural palm movements, there are several joint groups with a high degree of motor independence, while the movements of joints within each joint group are interdependent. Based on these characteristics, the palm movements can be decomposed into seven eigen-movements. The linear combinations of these eigen-movements can reconstruct more than 90% of palm movement ability. Moreover, combined with the palm musculoskeletal structures, we found that the revealed eigen-movements are associated with joint groups that are defined by muscular functions, which provided a meaningful context for palm movement decomposition. This paper suggests that some invariable characteristics underlie the variable palm motor behaviors and can be used to simplify palm movement generation. This paper provides important insights into palm kinematics, and helps facilitate motor function assessment and the development of better artificial hands.

Simulations suggest walking with reduced propulsive force would not mitigate the energetic consequences of lower tendon stiffness.

Aging elicits numerous effects that impact both musculoskeletal structure and walking function. Tendon stiffness (kT) and push-off propulsive force (FP) both impact the metabolic cost of walking and are diminished by age, yet their interaction has not been studied. We combined experimental and computational approaches to investigate whether age-related changes in function (adopting smaller FP) may be adopted to mitigate the metabolic consequences arising from changes in structure (reduced kT). We recruited 12 young adults and asked them to walk on a force-sensing treadmill while prompting them to change FP (±20% & ±40% of typical) using targeted biofeedback. In models driven by experimental data from each of those conditions, we altered the kT of personalized musculoskeletal models across a physiological range (2-8% strain) and simulated individual-muscle metabolic costs for each kT and FP combination. We found that kT and FP independently affect walking metabolic cost, increasing with higher kT or as participants deviated from their typical FP. Our results show no evidence for an interaction between kT and FP in younger adults walking at fixed speeds. We also reveal complex individual muscle responses to the kT and FP landscape. For example, although total metabolic cost increased by 5% on average with combined reductions in kT and FP, the triceps surae muscles experienced a 7% local cost reduction on average. Our simulations suggest that reducing FP during walking would not mitigate the metabolic consequences of lower kT. Wearable devices and rehabilitative strategies can focus on either kT or FP to reduce age-related increases in walking metabolic cost.

A longer Achilles tendon moment arm length is not associated with superior hopping performance.

Variability in musculoskeletal and lower leg structure has the potential to influence hopping height. Achilles tendon moment arm length and plantarflexor muscle strength can influence ankle joint torque development and, consequently, hopping performance. While most studies have examined the connection of the Achilles tendon moment arm with hopping performance including the resting length, in this study we attempted to explore how the changes in Achilles tendon moment arm are related to hopping performance. Therefore, the purpose of this study was to test for correlations between foot and lower leg muscle structure parameters (i.e., muscle mass, volume, cross-sectional area and Achilles tendon moment arm length) and hopping height performance in relation to changes in Achilles tendon moment arm length. Eighteen participants (10 males 8 female) performed repetitive bilateral hopping on a force platform while sagittal plane kinematics of the lower leg were recorded. Additionally, maximal isometric plantarflexion was measured. To obtain structural parameters of the lower leg, the right lower leg of each participant was scanned with magnetic resonance imaging. The cross-sectional areas of the Achilles tendon, soleus, lateral and medial gastrocnemius were measured, while muscle volumes, muscle mass, and Achilles tendon moment arm length were calculated. Contrary to our initial assumption, longer Achilles tendon moment arm did not result in superior hopping performance. Interestingly, neither maximal isometric plantarflexion force nor muscle size correlated with repetitive bilateral hopping performance. We can assume that the mechanical characteristics of the tendon and the effective utilization of the stored strain energy in the tendon may play a more important role in repetitive hopping than the structural parameters of the lower leg.

Laporan Kasus Karsinoma Sel Skuamosa Nasofaring

Nasopharyngeal cancer is a cancer that occurs in the nasopharyngeal mucosa which shows squamous cell differentiation. The nasopharynx is a musculoskeletal and cuboid-shaped tube structure behind the nasal cavity. The cause of nasopharyngeal carcinoma is infection with the Epstein-Barr virus (EBV) and / or Human Papilloma Virus (HPV), with risk factors for smoking, consuming alcohol, genetics, exposure to radiation rays, and decreased body resistance Early detection in KNF cases, with physical examination and support, is expected to provide fast, appropriate and effective treatment as soon as possible, so as to improve cancer survival. A patient Mr.M, a 23-year-old male ca The lump is accompanied by pain and the color of the lump is not reddish. Complaints of swallowing pain and difficulty breathing are denied. Diagnosis of KNF is carried out by anamnesis of clinical symptoms and signs, physical examination, and supporting examinations. Endoscopy can assess abnormalities of the nasopharyngeal mucosa and support biopsy. A biopsy is the definitive way to establish the diagnosis of KNF. Imaging modalities, such as MRI and CT scans, look for tumors that are not visible to the endoscopy and assess tumor extension.

A smart walker based on a hybrid motion model and machine learning method

Due to the degeneration of musculoskeletal structure and strength, the elderly population is facing significant mobility challenges. Walkers are widely used for mobility-impaired people. In this research, a smart walker has been developed by using a hybrid motion model (HMM) and a machine learning model based on the vertical interaction force to match the velocity between the walker and its user, which can reduce the horizontal interaction force thus to help lower the operational effort. It is equipped with only force sensors on the handlebars as a human-robot interface. The human motion is modeled by using the HMM in which an inverted pendulum model is used in the single support phase and a constant velocity model is used in the double support phase. A novel gait phase detector is built based on a machine learning method to correlate the force information and the walking gait phases. Experiments with three subjects are carried out to verify the effectiveness of the gait phase detection method and the hybrid motion model. The results demonstrate that the walker can accurately identify gait phases with more than 90 % accuracy and the horizontal interaction force is reduced to around 50 % of that under the constant velocity model and power-off condition when using the HMM during walking.

The use of technology in the assessment and monitorization of a season in a professional padel player: A case study

Training process in elite padel players is influenced by travels and competitions density. The irregularity in the workloads, as well as demands of the season, could affect the musculoskeletal structures. Strength training has a protective role against the injury incidence, but the competitive context does not always allow adequate periodization of training and thus achieve adaptations. The aim of this study is to analyze, using technological tools, if improvements in player’s fitness are accompanied by improvements in sport performance through a case study. An elite padel player was analyzed during the 2021 season. Physical fitness was evaluated using different technological tools. Athlete monitoring was carried out using self-reported forms and sport performance was assessed through the results obtained in the World Padel Tour ranking at the end of the season. During the training process, multidimensional training was carried out in order to achieve the maximum availability of specific loads through coadjuvant training. Results of the assessment show slight improvements in all fitness tests. Assessment of sport performance reports an increased number of victories and a better position in the professional ranking. Musculoskeletal improvements helped the athlete’s workload tolerance, allowing overall improvement in padel performance. The training approach from this study has shown to be effective in maintaining or even improving force-producing capacity in lower and upper limbs, force-velocity relationship, agility and sport performance, despite the high competitive density. This work provides coaches with a practical approach to assess, monitor and design a competitive season for an elite padel player.

The impact of the 2023 Kahramanmaras (Turkey) earthquake on clubfoot management: A retrospective, observational study

Background/Aim: Clubfoot is the most common congenital foot deformity. Although the etiology and pathoanatomy of clubfoot are not fully understood, dysplasia is present in all musculoskeletal structures below the knee at varying rates. The aim of any treatment regimen is to obtain a pain-free, properly positioned foot that has functional use. The objective of this investigation was to evaluate difficulties in the follow-up and treatment of patients with clubfoot treated in our clinic after the 2023 Kahramanmaras earthquake. Methods: Data from patients with clubfoot treated with the Ponseti method at the Orthopedics and Traumatology Outpatient Clinic of Gaziantep Metropolitan Municipality Inayet Topcuoglu Hospital in Turkey between December 2022 and July 2023 were obtained from the hospital's electronic registry system. Patient demographics, the number of plaster casts made before the earthquake, the total number of plaster casts made, time delays in treatment due to the earthquake, and costs were all analyzed. The Dimeglio score was used for the morphological classification of clubfoot. We analyzed patient data from three time periods: the time of the initial treatment, the period before the earthquake, and the period after the earthquake. Results: The study included 31 feet (16 left and 15 right) of 20 patients (11 males, 9 females). The mean age of the cohort was 3.5 months (standard deviation: 1.6 months). The median and minimum/maximum Dimeglio scores were 11 (9, 13), 6 (4, 8), and 9 (7, 11) at first admission, before the earthquake, and after the earthquake, respectively (P<0.001). The number of casts before the earthquake was 4.32 (0.32), and the total number of casts was 9.39 (1.38). The average time delay until retreatment after the earthquake was 12 weeks (range: 8–15 weeks). There was a significant positive correlation between the duration of the delay and the Dimeglio score measured after the earthquake (r=0.392, P=0.029). The additional cost per patient due to the delay was calculated to be 8290.8 ± 5033.761 TRY (308.78 ± 187.43 USD). Conclusion: The 2023 Kahramanmaras earthquake had a significant impact on the management of clubfoot and other elective procedures. Dealing with the consequences of an unprecedented natural disaster is certainly challenging. However, by adopting carefully designed protocols and therapeutic approaches that are based on the unique characteristics of an illness, we can successfully alleviate the repercussions of such events.

Photogrammetric Quantification Analysis of Forward Head Posture among Healthy Participants and Subjects with Neck and Shoulder Pain – A Strobe Cross Sectional Study

Background:Musculoskeletal structures can change into an incorrect shape due to a reduction in physical activity and inappropriate posture habits in daily living. Aim of the study: To study and investigate the forward head posture which is related to shoulder and neck pain. Materials and Method: The design of this study was observational cross-sectional study and conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology Statement (STROBE). The study was conducted between January 2023 and March 2023. A total of 65 participants (42 males,23 females) aged 18- 35 years. Neck pain was measured using Neck Disability Index (NDI), shoulder pain was measured using DASH questionnaire, Forward Head Posture (FHP) was measured using CVA angle by photogrammetry. Theresults were compared and correlated using appropriate statistical tools.For data analysis, the computer program Statistical Social Science Package (SPSS) (19 windows version) has been used. The p value was considered < 0.01 considered quite significant. Conclusion: Cervical and shoulder pain, which is the causative factor to increase forward head posture and significant discomfort in all the participants.

Using represented bodies in Renaissance artworks to teach musculoskeletal and surface anatomy.

Surface anatomy is an important skill for students in preparation for patient care, and peer examination is often used to teach musculoskeletal and surface anatomy. An alternative pedagogical approach is to use bodies represented in artworks. Represented bodies display fictive anatomy, providing students with the opportunity to apply their musculoskeletal knowledge and to think critically when evaluating the anatomical fidelity of a represented body. An elective course at the University of Michigan enabled undergraduate students to analyze the musculoskeletal and surface anatomy depicted in Renaissance artworks. Students traveled to Italy in 2018 (n = 14) and 2022 (n = 15) to analyze the fictive anatomy portrayed in artistic sculptures and musculoskeletal structures depicted in wax anatomy models and sculpted skeletons. In assignments, students were asked to identify musculoskeletal structures as portrayed in the context of represented anatomy created by Italian Renaissance artists and to assess the fidelity of the depicted anatomy. The students also applied their knowledge of musculoskeletal anatomy to describe body position and evaluate muscle function in their assessments of the accuracy or inaccuracy of the fictive anatomy. The students reported that evaluating the anatomical fidelity of represented bodies in artworks supported their learning of musculoskeletal and surface anatomy, and that their critical thinking skills improved in the course. Evaluation of the anatomical fidelity of represented bodies in artworks is an effective pedagogical approach that can be implemented in art museums as an adjunctive learning experience to deepen students' musculoskeletal and surface anatomy knowledge and further develop their critical thinking skills.

Sarcopenia in Men With Bone-Predominant Metastatic Castration-Resistant Prostate Cancer Undergoing Ra-223 Therapy.

Osteosarcopenia is the progressive loss of musculoskeletal structure and functionality, contributing to disability and mortality. Despite complex interactions between bone and muscle, osteosarcopenia prevention and treatment in men with metastatic castration-resistant prostate cancer (mCRPC) focuses predominantly on bone health. It is unknown whether Radium-223 (Ra-223) therapy affects sarcopenia. We identified 52 patients with mCRPC who had received Ra-223 and had a baseline plus ≥1 follow-up abdominopelvic CT scan. The total contour area (TCA) and averaged Hounsfield units (HU) of the left and right psoas muscles were obtained at the inferior L3 endplate, and the psoas muscle index (PMI) was calculated therefrom. Intrapatient musculoskeletal changes were analyzed across various time points. TCA and PMI gradually declined over the study period (P = .002, P = .003, respectively), but Ra-223 therapy did not accelerate sarcopenia, nor the decline of HU compared to the pre-Ra-223 period. The median overall survival of patients with baseline sarcopenia was numerically worse (14.93 vs. 23.23 months, HR 0.612, P = .198). Ra-223 does not accelerate sarcopenia. Thus, worsening muscle parameters in men with mCRPC undergoing Ra-223 therapy are attributable to other factors. Further research is needed to determine whether baseline sarcopenia predicts poor overall survival in such patients.

Variable end-point viscoelasticity control for a musculoskeletal redundant arm

This paper presents a novel approach for controlling variable end-point viscoelasticity in musculoskeletal robots to reduce contact forces during contact tasks. This is achieved by adjusting the desired end-point viscoelasticity in response to environmental contact, and by controlling the end-point viscoelasticity in muscle space. The musculoskeletal system of living bodies can adapt to the mechanical impedance of joints via the nonlinear properties of muscles, which are a significant factor in enhancing flexibility and safety during contact tasks. To take advantage of the characteristics of the musculoskeletal structure, we introduce nonlinear viscous properties into muscles and control the end-point viscosity by modulating the internal force. Numerical simulations are conducted to evaluate the proposed method, which demonstrates that the method successfully reduces contact forces during the crank-turning task while maintaining tracking performance. Overall, the proposed approach promises to achieve safer and more flexible interactions between robots and their environment.

Association between abdominal muscle stiffness, diaphragm thickness and peak expiratory flow in younger versus older adults.

The present study aimed to evaluate forced expiration based on transverse abdominis (TrA) stiffness by identifying the relationship between TrA stiffness and peak expiratory flow (PEF) in both younger and older adults. We also assessed the relationship between diaphragm thickness and PEF. A total of 31 younger (21.24 ± 2.73 years) and 34 older (71.35 ± 5.26 years) adults were included in the present study. TrA muscle stiffness was measured at rest and during abdominal bracing using shear wave elastography. Diaphragm thickness was measured during deep inspiration and expiration using B-mode ultrasound, and respiratory function was assessed by measuring PEF using a spirometer. We found that TrA stiffness during bracing was significantly lower in older than younger adults (p < 0.05). Similarly, the difference in absolute stiffness of the TrA when bracing versus at rest was significantly lower in older than younger adults (p < 0.05). Additionally, TrA stiffness during bracing was positively associated with PEF in the younger group (r = 0.483), while a very weak correlation was found in the older group (r = 0.172). Similarly, PEF was moderately correlated with diaphragm thickness during expiration as well as during changes between inspiration and expiration in the younger group (r = 0.405 and r = 0.403); however, no significant correlation was found in the older group. These findings of the present study indicate that the variations in PEF between younger and older adults may be due to age-associated changes in the musculoskeletal structure and muscle fibre type.

Further assessment of the clinical relevance of anatomical structures through PubMed and other measures.

A previous paper has demonstrated a statistically significant moderate correlation between the number of citations obtained from PubMed and a Delphi study for 251 anatomical structures of the Head and Neck region, suggesting that clinical significance is a major driver of research involving anatomical structures. This raises the possibility that these ranks could be an objective measure of clinical relevance of individual anatomical structures. In the present study, we revisited the rankings of the PubMed results from the previous paper and compared it with a Delphi study for 450 musculoskeletal structures. PubMed ranks were derived using different search parameters; a PubMed search with quotations yielded a moderate, statistically significant correlation coefficient of 0.639 with the musculoskeletal dataset. Additionally, we developed a Python tool, PDF Term Search, to calculate the frequency of anatomical terms in four authoritative textbooks, and these frequencies exhibited moderate significant correlations ranging (0.549-0.646) with our PubMed-derived ranks. We further explored strategies to improve the accuracy of our PubMed results by addressing limitations identified in the previous paper. We refined the syntax of search queries for 500 anatomical structures, resulting in marked improvement in the correlation coefficients with the musculoskeletal dataset, demonstrating clear avenues for future iterations of PubMed-derived ranks. We also created a spreadsheet of 2181 anatomical structures ranked using PubMed, published Delphi studies, and authoritative texts, providing a resource for anatomical educators who are adjusting their curricula to better train future healthcare practitioners.