Significant Difference In Cross-sectional Area Research Articles

Long-Term Effects and Impressions of Minimal Footwear in Older Adults

Introduction: Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults. Methods: Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants’ impressions of the footwear, the progressive wear schedule, the footwear’s effects on orthopedic-related pain, balance, and foot awareness/sensation. Results: Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed. Conclusion: Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

Effect of transnasal humidified rapid insufflation ventilatory exchange on cerebral oxygen saturation during induction of general anesthesia in patients undergoing traumatic brain injury emergency surgery

To evaluate the effect of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) on regional cerebral oxygen saturation (rScO2) during induction of general anesthesia in patients undergoing traumatic brain injury (TBI) emergency surgery. A prospective randomized controlled trial was conducted. The TBI emergency general anesthesia patients who underwent intracranial hematoma removal surgery at the Northern Jiangsu People's Hospital from January to July in 2023 were enrolled. The patients were divided into a conventional mask ventilation group and a THRIVE group using a random number table method. The patients in the conventional mask ventilation group were anesthetized and induced to pre oxygenate without positive pressure ventilation in the front mask for 10 minutes, with an oxygen flow rate of 8 L/min and an fraction of inspired oxygen (FiO2) of 1.00. After anesthesia induction for about 90 s, tracheal intubation was performed after the muscle relaxant took effect (patient's jaw muscle was relaxed). The patients in the THRIVE group were pre oxygenated with THRIVE for 10 minutes, with an oxygen flow rate of 30 L/min and a FiO2 of 1.00. During anesthesia induction, the oxygen flow rate was increased to 50 L/min, and anesthesia induction medication was used. The lower jaw of patient was supported with both hands to maintain airway patency, and the patient's mouth was kept closed throughout the process. After the muscle relaxant took effect (the patient's jaw muscle was relaxed), tracheal intubation was performed. At the time of patient entering the operating room, 10 minutes of pre oxygenation, and immediately after successful intubation, rScO2 was measured on the surgical and non-surgical sides. At the same time, ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and arterial blood gas analysis was performed. The partial pressure of end-tidal carbon dioxide (PETCO2) during the first mechanical ventilation after successful tracheal intubation, the incidence of hypoxemia [pulse oxygen saturation (SpO2) < 0.95] during tracheal intubation, as well as prognostic indicators such as the length of intensive care unit (ICU) stay, total length of hospital stay, and Glasgow outcome scale (GOS) score at discharge were recorded. During the study period, a total of 70 TBI patients underwent emergency general anesthesia surgery, of which 2 patients died postoperatively, 2 patients were unable to cooperate with closed mouth breathing, and 3 patients had poor ultrasound image acquisition in the gastric antrum, all of whom were excluded. A total of 63 patients were ultimately enrolled, including 32 in the conventional mask ventilation group and 31 in the THRIVE group. There were no statistically significant differences in gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Glasgow coma scale (GCS) score, optic nerve sheath diameter (ONSD), baseline vital signs, fasting situation, anesthesia time, surgical time, and intraoperative blood loss between the patients in the two groups, indicating comparability. When entering the operating room, there was no statistically significant difference in rScO2 on the surgical and non-surgical sides, and blood gas analysis indexes arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) between the patients in the two groups. When pre oxygenated for 10 minutes, both the surgical and non-surgical sides rScO2 levels in the THRIVE group were significantly higher than those in the conventional mask ventilation group (surgical side: 0.709±0.036 vs. 0.636±0.028, non-surgical side: 0.791±0.016 vs. 0.712±0.027, both P < 0.01), and the PaO2 was significantly increased [mmHg (1 mmHg ≈ 0.133 kPa): 450.23±60.99 vs. 264.88±49.33, P < 0.01], PaCO2 was significantly reduced (mmHg: 37.81±3.65 vs. 43.59±3.76, P < 0.01), and the advantage continues tilled immediately after successful intubation. There was no statistically significant difference in CSA at each time point of ultrasound examination between the two groups. Compared with the conventional mask ventilation group, the patients in the THRIVE group showed a significant decrease in PETCO2 during the first mechanical ventilation after successful tracheal intubation (mmHg: 43.10±2.66 vs. 49.22±3.31, P < 0.01), and the incidence of hypoxemia during tracheal intubation was also significantly reduced [0% (0/31) vs. 28.12% (9/32), P < 0.01]. In terms of prognostic indicators, there was no statistically significant difference in the length of ICU stay and total length of hospital stay between the patients in the conventional mask ventilation group and the THRIVE group [length of ICU stay (days): 10 (9, 10) vs. 10 (9, 11), total length of hospital stay (days): 28.00 (26.00, 28.75) vs. 28.00 (27.00, 29.00), both P > 0.05]. However, the proportion of patients in the THRIVE group with a good prognosis at discharge (GOS score > 3) was significantly higher than that in the conventional mask ventilation group [35.5% (11/31) vs. 12.5% (4/32), P < 0.05]. THRIVE can significantly increase rScO2 during anesthesia induction in TBI emergency surgery patients and improve their neurological function prognosis.

Sarcopenia in long-term survivors of cancer in childhood and adolescence: A cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle-bone unit.

Sarcopenia, a loss of systemic skeletal muscle mass (SMM), is prevalent in childhood cancer survivors and often accompanied by increased fat mass (sarcopenic obesity [SO]). We examined whether calf muscle cross-sectional area (CSA), measured by peripheral quantitative computed tomography (pQCT), can identify sarcopenia and SO in long-term survivors of pediatric acute lymphoblastic leukemia (ALL), and explored its relationship with adjacent bone geometry. Calf muscle CSA and CSA Z scores at the 38% tibia in 70 subjects (median survival 15years) were compared between sexes and ALL risk group, and their association with sarcopenia and SO evaluated. Relationships between bone strength and muscle mass were assessed further using linear regression and methods described by Schoenau etal. for evaluation of a functional muscle-bone unit. A calf muscle CSA Z score of less than or equal to zero is 73.81% sensitive and 84.62% specific for detecting sarcopenia defined by height-adjusted appendicular lean mass measured by dual-energy x-ray absorptiometry. No significant difference in CSA Z scores was noted between sexes or ALL risk groups; however, Z scores were markedly higher in those without SO (adjusted odds ratio 0.529, 95% confidence interval [CI]: 0.340-0.824). Ratios of calf muscle mass to height and total bone mineral content at the 38% tibia are "sufficient" and consistent with estimated reference ranges for a healthy population. CSA Z scores may represent a useful clinical measure of SMM and are predictive of SO in this population. Our results are supportive of a functional muscle-bone unit in long-term survivors of pediatric ALL.

Paper 31: Quantitative MRI of the Hamstring Muscles Ten Years After Autograft Hamstring ACLR

Paper 31: Quantitative MRI of the Hamstring Muscles Ten Years After Autograft Hamstring ACLR

The effect of anthropometric characteristics and electronic device use on median nerve cross-sectional area: A cross-sectional study

IntroductionThis study aimed to identify the relationship between age, body mass index (BMI), weight, height, and wrist circumference and median nerve cross-sectional area (CSA). The study also aimed to examine the difference between CSA in individuals reporting a high amount (>4 hours per day) of electronic device use compared to those reporting a low amount (≤4 hours per day). Materials/MethodsOne hundred twelve healthy individuals volunteered to participate in the study. Anthropometric, demographic, and self-reported electronic device usage data were collected. A transverse image of the median nerve was captured using ultrasonography from the dominant wrist at the carpal tunnel inlet . A Spearman's rho correlation coefficient was used to examine correlations between participant characteristics (age, BMI, weight, height, and wrist circumference) and CSA. Separate Mann-Whitney U tests were used to examine differences in CSA in those younger and older than age 40, in those with BMI <25 kg/m2 and BMI ≥25 kg/m2, and in high and low-frequency device users. ResultsBMI, weight, and wrist circumference showed fair correlations with CSA. There were significant differences in CSA between individuals younger than 40 and those older than 40 and between individuals with BMI <25kg/m2 and those with BMI ≥25kg/m2. There were no statistically significant differences in CSA in the low- and high-use electronic device groups. DiscussionAnthropometric and demographic characteristics including age and BMI or weight should be considered when examining the CSA of the median nerve, especially when determining cut-off points for establishing a diagnosis of carpal tunnel syndrome.

To Study Utility and Practicality of High-Frequency Ultrasonography to Demonstrate Nerve Involvement in Leprosy

ABSTRACT Background: Nerve examination in leprosy is subjective. There is a paucity of literature on objective methods to evaluate nerve involvement in Leprosy. Aims and Objectives: (1) To measure cross-sectional area (CSA) of nerves and identify echotexural changes in nerves in patients of leprosy by high-frequency ultrasonography (HFUS). (2) To compare HFUS findings in CSA and echotexture of nerves at baseline and after treatment. (3) To compare clinical grading and HFUS grading of nerves before and after treatment. Methods: Both newly diagnosed and treated patients of leprosy were included in the study. Nerve examination was done clinically and clinical grading of nerve thickening was done. Then, thickened nerves were subjected to HUFS to examine CSA (CSA) and echotextural changes. Nerves were also graded by HFUS grading. Parameters such as CSA, echotextural changes, and clinical and HFUS grading were compared before and after completion of treatment. Observations: Sixty-four leprosy patients were studied. Most of the patients in our study were in the third and fourth decade with a male preponderance and the mean age of presentation is 35.75 years. A total of 154 peripheral nerves were studied in 64 leprosy patients. Borderline tuberculoid leprosy (BTH) was the most common type of leprosy. The ulnar nerve was the most commonly imaged nerve followed by the greater auricular nerve. There was a statistically significant difference in CSA of nerves before and after treatment. Only 7 of 23 patients, who were found to have features of neuritis on USG, were clinically symptomatic. Three patients were diagnosed to have nerve abscesses. Conclusion: HFUS appears to be an objective, simple method to evaluate nerve involvement in leprosy. It is also useful to diagnose silent neuritis and nerve abscess. Limitations: All the peripheral nerves were not examined in healthy controls and leprosy patients.

Differences in the cross-sectional area along the ankle tendons with both age and sex.

Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross-sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n=20; mean ± SD age=22.5 ± 4.5 years), middle-age (n=20; age=40.6 ± 8. 0 years), or old (n=20; age=69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1-weighted 1.5T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle-age group than both young and old participants (p < 0.01) and large effect sizes were observed for these differences (Cohen's d> 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region-specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle-age to young and old (p < 0.05). In conclusion, (1) great magnitude of morpho-structural differences was discovered in the AT; (2) there are region-specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes.

Diagnosis and Severity Evaluation of Ulnar Neuropathy at the Elbow by Ultrasonography: A Case-Control Study.

Traditional diagnostic techniques such as clinical examination and electrodiagnosis are less sensitive in diagnosing ulnar neuropathy at the elbow (UNE). Ultrasonography (USG) is increasingly being used to diagnose UNE. However, clinical applicability is limited by the lack of uniformity in the previous studies. Therefore, we aimed to study in the Indian patients the diagnostic utility of the ulnar nerve cross-sectional area (CSA) and a novel parameter-entrapment index (EI) in UNE measured by USG and to find if both these parameters correlate with the electrodiagnostic severity. This retrospective casecontrol study included 28 patients (36 nerves) of UNE and 12 (24 nerves) age- and gender-matched healthy controls. Electrodiagnostic severity was graded using the Padua classification. USG was performed in both groups, and CSA was measured at the medial epicondyle (ME) and 5 cm proximally and distally. EI was calculated by multiplying the ratio of CSA above ME over CSA at ME by 100. Best cutoffs were derived by the receiver operating characteristic curve analysis. UNE group had significantly higher CSA at all three locations and lower EI than the control group. CSA at ME ≥9.7 mm2 and EI ≤61.5 has sensitivity and specificity of 88.9%/87.5% and 72.2%/79.2%, respectively. There was no significant difference in CSA and EI between nonsevere and severe UNE groups. CSA at ME and EI have good sensitivity and specificity in diagnosing UNE. However, they cannot differentiate nonsevere from severe UNE.

Validity and reliability of masseter muscles segmentation from the transverse sections of Cone-Beam CT scans compared with MRI scans.

To evaluate the validity and reliability of cone-beam computed tomography (CBCT) masseter muscle segmentation by comparing with the magnetic resonance imaging (MRI) masseter muscle segmentation of the same patients. Seventeen volunteers were included in this study. CBCT and MRI scans of the volunteers were taken, respectively, within one month. The masseter muscles in the CBCT scans were segmented by a generative adversarial network (GAN)-based framework combined with manual check. The masseter muscles in the MRI scans were segmented manually. The segmentations were repeated by the first examiner and a second examiner. For cross-sectional area (CSA), paired t-test, intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were calculated to evaluate the validity and reliability of the segmentations. The validity and reliability were also calculated by Dice similarity coefficient (DSC) and average Hausdorff distance (aHD) between different segmentations. Seventeen volunteers were included in this study. CBCT and MRI scans of the volunteers were taken, respectively, within one month. The masseter muscles in the CBCT scans were segmented by a generative adversarial network (GAN)-based framework combined with manual check. The masseter muscles in the MRI scans were segmented manually. The segmentations were repeated by the first examiner and a second examiner. For cross-sectional area (CSA), paired t-test, intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were calculated to evaluate the validity and reliability of the segmentations. The validity and reliability were also calculated by Dice similarity coefficient (DSC) and average Hausdorff distance (aHD) between different segmentations. Paired t-test showed that there was no significant difference in CSA between CBCT and MRI masseter segmentations. The ICCs were all larger than 0.95 and the SEM was less than 4.85 mm2 for CSA. The DSC was all larger than 0.95 showing over 95% of similarity between CBCT and MRI masseter segmentations. The aHD was all smaller than 0.09mm showing great consistency of the contour of CBCT and MRI segmentations. Masseter muscle segmentation from CBCT scans was not significantly different from the segmentation from MRI scans. CBCT muscle segmentation showed great validity compared with MRI scans, and great reliability in retests.

Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

BackgroundPreoperative identification and visualization of tumor infiltration of the recurrent laryngeal nerve (RLN) in patients with thyroid cancer is important. The purpose of our study was to evaluate the reliability and feasibility of preoperative assessment by ultrasound and to identify ultrasound imaging features potentially associated with tumor infiltration of the RLN.MethodsIn this prospective study, patients undergoing thyroid cancer surgery at our institution between August 2020 and January 2021 were included, and preoperative ultrasound visualization of the RLN and thyroid lesions was performed. RLN infiltration was also confirmed surgically in all cases. Five patients with enlarged lymph nodes were selected to undergo injection of carbon nanoparticles to confirm the correctness of RLN identification by preoperative ultrasound. The repeatability of RLN assessment by ultrasound was evaluated by comparing the correlation between pre- and intraoperative, intra- and inter-group assessments. Parameters of normal RLNs according to age, sex, and body mass index were established. Finally, ultrasound imaging features of patients with RLN tumor infiltration were analyzed to identify potential risk predictors.ResultsAccording to the ultrasonic assessment, RLNs of 70 patients appeared normal, while 14 of those patients appeared to be infiltrated by tumors. During surgery, the 70 cases of normal RLNs were confirmed, but only 8 of the 14 suspected cases of infiltration were confirmed. In all five patients injected with carbon nanoparticles, the location of RLNs adjacent to the marked lymph nodes observed by surgeons corresponded to the RLN location identified by preoperative ultrasound. The repeatability of RLN estimation varied from moderate to excellent. There were no significant differences in cross-sectional area, width, or thickness of normal RLNs according to age, sex, or body mass index. Indistinct margin with tumor, incontinuous shape as ultrasound features by the analysis of patients with surgically confirmed RLN infiltration were associated with tumor invasion.ConclusionWe show that preoperative ultrasound can be applied to visualize the RLN and may help predict tumor infiltration of the RLN.

Effects of combined the trendelenburg and passive leg raising positions on the cross-sectional area of the right internal jugular vein.

The primary aim of this study was to assess the effects of a combination of the passive leg raising (PLR) and Trendelenburg positions on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) using ultrasound measurement in awake patients. This prospective observational cross-over study measured the CSA of RIJV in patients in supine (Supine-I), Trendelenburg, Trendelenburg with passive leg raising (T + PLR position), and repeated supine position (Supine-II). The CSA and vertical and horizontal diameters of the RIJVs were compared before and after each position. A total of 120 adult patients were enrolled in the study. The mean CSA of the RIJV significantly increased from 91.2 ± 31.7 mm2 to 110.4 ± 38.2 mm2 in the Trendelenburg position compared to the supine position (P < 0.05). However, there were no statistically significant differences in CSA were observed between the Trendelenburg and Trendelenburg + PLR positions. Although the PLR + Trendelenburg position increased the jugular vein diameter relative to the supine position, its clinical usefulness is limited as this increase was still lower than that achieved with the Trendelenburg position alone.

The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial.

Epidural fentanyl doses above 100 μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women. To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography. A double-blinded randomised controlled study. A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020. Eighty labouring women with cervical dilation 5 cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus. Women randomised to high (>100 μg) or low (<100 μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2 h thereafter (T2 h). The primary outcome was CSA at T2 h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2 h. Sub-group analysis compared stomach content at T2 h according to baseline stomach content, empty (CSA <381 mm2) or full (CSA ≥381 mm2), and high-dose versus low-dose fentanyl. Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no significant difference in CSA at T2 h between high-dose, mean 335 ± SD 133 mm2, versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2 h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically significant differences in CSA at T2 h. The CSA at T2 h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort. Clinicaltrials.gov number: NCT04202887.

'Stop sign' position for subclavian ultrasound: a single-blinded observational study of subclavian vein dimensions.

Right subclavian vein (SCV) dimensions were evaluated on ultrasound and whether these change when the right upper limb is in a neutral position compared with the 'stop sign' position (shoulder abducted and externally rotated to 90°, elbow flexed to 90°), and when patients were positioned 30° head-up compared with lying supine. Images of transverse and longitudinal views of the right SCV in patients ≥18 years, presenting with a range of conditions to a Regional Hospital Emergency Department, were recorded by two physicians in a randomly assigned, nonsequential order and measured blinded. Data were analysed with paired Student's t tests. N = 62. Primary outcome: cross-sectional area (CSA) of the right SCV in transverse images. depth of SCV to skin and diameter of SCV on longitudinal images. There was no significant difference in CSA of the SCV in supine patients when the arm was in the stop sign position compared with neutral (mean CSA: 1.20 ± 0.42 and 1.15 ± 0.39 cm, respectively; P = 0.3). In patients positioned 30° head-up, the stop sign position significantly increased CSA from 0.65 ± 0.33 to 1.00 ± 0.38 cm (P < 0.0001). Utilizing the stop sign position does not change SVC dimensions when patients are supine, however, may improve dimensions when lying supine is contraindicated.

Ciliary muscle morphology and accommodative lag in hyperopic anisometropic children.

To investigate the cross-sectional area (CSA) and thickness of the ciliary muscle and their correlation with accommodative lag in hyperopic anisometropic children. Forty children aged between 6 and 10years with hyperopic anisometropia were recruited. The more hyperopic eye (mean refractive power of 3.51 ± 1.70 D) was compared with the less hyperopic eye (mean refractive power of 0.78 ± 1.41 D). The thickness and CSA of the ciliary muscle were measured with anterior segment optical coherence tomography (OCT) images at four meridians. The differences between the eyes and the correlations between CSA, thickness, axial length and accommodative lag were accessed. There was no statistically significant difference in CSA between the two groups at any meridian, except at the inferior meridian (P < 0.05). There was no statistically significant difference in ciliary muscle thickness between eyes at any meridian, except on the temporal and the nasal meridians (P < 0.05). There was a significant difference in the ratio of CSA to axial length at all meridians between the two groups (all P < 0.05). Accommodative lag was 1.65 ± 0.55 D and 0.93 ± 0.45 D in the more and less hyperopic eyes, respectively, which was a statistically significant difference (P < 0.05). There was no significant correlation between the CSA with the axial length and the accommodative lag. This study demonstrated a greater degree of accommodative lag in the more hyperopic eye of anisometropic children. There was no correlation among accommodative lag, axial length and CSA of the ciliary muscle with the degree of hyperopia.

Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration

BackgroundPrevious studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI).MethodsTwenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4–5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups.ResultsThere were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05).ConclusionsThere was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine.Trial registration numberClinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.

Do FCU and ECU muscle architecture in children with hemiparetic cerebral palsy affect wrist functionality?

In individuals with cerebral palsy (CP), wrist flexor and extensor muscles can have impaired tonus, strength, posture, and range of motion. Muscle force and movement generating capacity are related to muscle architecture. The purpose of the study was to measure muscle morphology of the flexor (FCU) and extensor carpi ulnaris (ECU) muscles and compare it with strength and passive stiffness in affected and unaffected forearms of children with hemiparetic CP. Nine children (MACS levels 1 and 2) were analyzed. Ultrasound was used to measure the maximal cross-sectional area, muscle thickness, and muscle perimeter of FCU and ECU. The strength of the wrist flexors and extensors muscles was measured using a manual dynamometer. Wrist flexion passive stiffness was evaluated using isokinetic dynamometry in passive mode. No significant differences in cross-sectional area, anteroposterior distance, and perimeter between unaffected and affected forearm were observed. Flexion and extension isometric torques were reduced in the affected forearm compared with the unaffected, except the passive stiffness, which was increased. A correlation matrix analysis presented some significant correlations between morphological and functional outcomes. Wrist flexion and extension torques are reduced in the affected side of children with hemiparetic CP, and passive stiffness is increased, even without changes in FCU and ECU morphological parameters.

Sexual dimorphism of foramen magnum: a NCCT based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Radiological determination of gender relies predominantly on the skeletal radiology and assumes importance in mass natural disasters, bomb explosions, exhumations and warfare where skeletal fragmentation is common. Varied literature is present regarding the role of foramen magnum in establishing gender identification.&lt;strong&gt; &lt;/strong&gt;The objective of the study was&lt;strong&gt; &lt;/strong&gt;to establish normative values of cross-sectional area of foramen magnum in both genders using NCCT and try to ascertain any significant difference in cross-sectional area in the two genders which may help in gender identification.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; NCCT head images of 378 subjects were analysed in individuals beyond the age of skeletal immaturity. Free ROI technique using electronic calliper tool was used. The cross-sectional area of foramen magnum was automatically obtained after tracing its whole inner circumference.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean cross-sectional area of foramen magnum in females was 806.79±106.58 mm&lt;sup&gt;2 &lt;/sup&gt;and was 878.33±98.42 mm&lt;sup&gt;2&lt;/sup&gt; in males. Although the cross-sectional area in males was greater than females no statistically significant difference was found. The correlation coefficient was found to be weaker (R=0.0413).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;No statistically significant difference was found between the two genders. The correlation coefficient was also weak to draw any inference about the gender of the skull on CT imaging. Further studies are needed to include other parameters like the sagittal and transverse diameters of foramen magnum in a larger sample to show importance of foramen magnum, if any, in helping gender identification of skeletal remains.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy.

ObjectiveIn this study we investigated the potential value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in characterizing changes in the cervical spinal cord and peripheral nerve roots in vivo in patients with spinal muscular atrophy (SMA).MethodsWe developed an MRI protocol with 4 sequences to investigate the cervical spinal cord and nerve roots on a 3 Tesla MRI system. We used 2 anatomical MRI sequences to investigate cross-sectional area (CSA) at each spinal segment and the diameter of ventral and dorsal nerve roots, and two diffusion tensor imaging (DTI) techniques to estimate the fractional anisotropy (FA), mean (MD), axial (AD) and radial diffusivity (RD) in 10 SMA patients and 20 healthy controls.ResultsThere were no significant differences in CSA (p > .1), although an 8.5% reduction of CSA in patients compared to healthy controls was apparent at segment C7. DTI data showed a higher AD in grey matter of patients compared to healthy controls (p = .033). Significantly lower MD, AD and RD values were found in rostral nerve roots (C3-C5) in patients (p < .045).ConclusionsWe showed feasibility of an advanced 3 T MRI protocol that allowed differences to be determined between patients and healthy controls, confirming the potential of this technique to assess pathological mechanisms in SMA. After further development and confirmation of findings in a larger sample, these techniques may be used to study disease course of SMA in vivo and evaluate response to survival motor neuron (SMN) augmenting therapy.

DEVELOPMENT OF FIBER TYPE AREAS FROM CHILDHOOD TO ADULTHOOD IN VASTUS LATERALIS

It is well known that cross‐sectional areas (CSA) of various skeletal muscle fiber types differ between genders in adults. Generally, CSA of muscle fiber areas is larger in men compared to women. Moreover, CSA of type IIA fibers is the largest in men whereas CSA of type I fibers are the largest in women (Glenmark et al. Acta Physiol Scand. 1992; 146:251–9, Simoneau et al. Am J Physiol. 1989; 25:567–72). To our knowledge, a gender‐related analysis in this respect has not been performed in biopsy samples from children of both sexes. Thus, the aim was to compare CSA of the various fiber types in children of both sexes with corresponding CSAs in adults of both sexes. 27 healthy children (9.0–12.8 years) and 29 young adults (18.0–24.5 years) were studied. Half of the children had 2–3 weeks before the study started professional dance training (“dancers”). All children in the present study had been active in various sports for 1–6 years, 2h/week. Three of the children had also been dancing 1–2 times/week. Half of the adults had completed a 9 years professional dance education (“dancers”) and rest of them had been physically active around 45 min/week (“non‐dancers”). All women had normal menstrual periods and all girls were premenarche. All subjects and the parents of the children were fully informed verbally and in writing before consenting to participate in the study and approved by the Ethics Committees of the Karolinska Institutet. Muscle biopsies were obtained from vastus lateralis and were taken from “dancers” (children and adults) and adult “non‐dancers” under local anaesthesia of the skin and from non‐dancer children during general anaesthesia when undergoing minor surgery. The biopsies were frozen in isopentane precooled with liquid nitrogen and analyzed histochemically for different fiber types (I, IIA, IIB and IIC) with ATPase stains and were examined morphologically for CSA by planimetry (type I, IIA and IIB) from a NADH‐dehydrogenase stain. Our results show that there were no significant differences in CSA of the various fiber types comparing dancers and non‐ dancers in either children or in young adults. Thus, this statistical outcome allowed us to pool dancers and non‐dancers in further statistical analysis. In children, there were no significant differences in CSA either between genders or between fiber types, with a mean and range of 1923 (750–3018) μm2 independent of fiber type and gender. Comparing children and adults, an interaction was found between age and gender for each fiber type (P &lt; 0.003 – P &lt; 0.001). CSA of the various fiber types in the adult group showed larger CSA in men compared to women, especially for type IIA and IIB as expected: Mean and SD for type I, IIA and IIB was for men 4140 (963), 5130 (980) and 4370 (1100) μm2 and for women 3220 (550) and 3040 (750) and 2310 (600) μm2, respectively. In conclusion, the gender specific pattern, in CSA area of the various fiber types in adults was demonstrated to develops during the transition from childhood to adulthood and that this transition in current study was independent of the various training background.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Fibrillar architecture at three different sites of the bovine superficial digital flexor tendon.

Superficial digital flexor tendon (SDFT) of the bovine hindlimb originates from the caudolateral aspect of the distal femur and finally inserts onto the plantar aspect of the middle phalanges. In the present study, morphology and morphometry of the bovine SDFT at the muscle-tendon junction (MTJ), middle metatarsus (mM) and tendon-bone interface (TBI) were investigated. Cross-sectional morphology at the three regions of SDFT were oval, semioval and ring-formed, respectively. Significant difference in cross-sectional area was found only between MTJ-mM and mM-TBI (P<0.05). Functional compression and friction from the adjacent structures could be the most potential interactions affecting such appearances. Morphometric data of tenocyte number, water content, and glycosaminoglycan (GAG) length and angle were found increasing in the proximodistal direction, except the fibril diameter and collagen fibril index (CFI). Statistical analyzes could reveal significant differences in average number of tenocytes (P<0.0001), CFI (between MTJ-mM and MTJ-TBI, P<0.05), water content (between MTJ-TBI, P<0.05), length of GAG chains (between MTJ-TBI, P<0.05), and angle of GAG chains (P<0.0001), respectively. The fibrillar characteristics at the three different areas, including fibril diameter distribution and interfibrillar distance, existed in conforming to the tensional axes in situ. In addition, length and angle of GAG chains were relevant to moving directions of the collagen fibrils.