Significant Increase In Cross-sectional Area Research Articles

Acute Effects of Selective Strength Exercise on the Peroneus Longus and Brevis.

The peroneus muscles are muscles that mainly act in ankle eversion and can be divided into PL and PB, which have different but important roles in foot and ankle functions. Therefore, PL and PB dysfunction can lead to foot and ankle issues, making. selective strength exercise necessary. This study aimed to identify the effect of two different exercise techniques on PL and PB morphologies. Two interventions were performed on separate days: the PL intervention, in which a Thera-Band® was placed on the ball of the foot and pushed out from the contact point, and the PB intervention, in which the Thera-Band® was pulled from the base of the fifth metatarsal. Cross-sectional area (CSA) and thickness of the peroneus muscles at 25% (showing the PL morphology) and 75% (showing the PB morphology) proximal to the line connecting the fibular head and lateral malleolus, as well as ankle strength was measured before and immediately after the interventions and at 10, 20, and 30 min later. A repeated-measures two-way analysis of variance was conducted to identify differences in the effects of the interventions on the PL and PB. Main and interaction effects on CSA, thickness, and ankle strength, with a significant increase in CSA and thickness in the proximal 25% in the PL intervention and the distal 75% in the PB intervention immediately after implementation, were observed (p < 0.05). The transient increase in muscle volume due to edema immediately after exercise indicates the acute effect of exercise. The CSA and thickness of the proximal 25% in the PL intervention and the distal 75% in the PB intervention increased immediately after the intervention, indicating that these interventions can be used to selectively exercise the PL and PB.

Augmentation of peripheral venous diameter for ultrasound-guided peripheral intravenous line insertion

ObjectivesUltrasound-guided intravenous line placement is utilized often in the emergency department for venous access in patients whose veins are difficult to cannulate by traditional methods. This study aims to identify specific interventions that will augment venous cross-sectional area. MethodsResidents and medical students volunteers each had their basilic vein identified using the linear array probe on an ultrasound. The area of the vein was measured with no intervention with the arm positioned parallel to the floor as well as approximately 45 degrees below the level of the bed. These two positions were repeated with the following interventions: one standard rubber tourniquet applied proximal to the vein measurement, an additional rubber tourniquet applied proximal to first tourniquet, blood pressure cuff inflated to between 160 and 200 mmHg applied proximal to the vein, CAT battle tourniquet application proximal to measurement site, and soaked warm towel applied to brachium for up to one minute. The primary outcome was to evaluate the increase in venous cross-sectional area from the baseline measurement after the interventions. ResultsWe had 41 participants in this study. All interventions were statistically significant in increasing venous cross-sectional area as compared to no intervention, with the most significant augmentation being from the CAT battle tourniquet (mean change +7.32 mm2, 95% CI, 5.73–8.91 mm2) . The change in position of the arm, was not statistically significant for any intervention except for the CAT tourniquet (mean change −1.74 mm2, 95% CI, −0.54 to −2.93 mm2). There was no significant difference between two tourniquets and blood pressure cuff (mean change +0.58 mm2, 95% CI, −1.13 to +2.29 mm2), but there was a significant increase in cross-sectional area with CAT tourniquet use compared to blood pressure cuff (mean change +1.62 mm2, 95% CI, 0.29–2.95 mm2). Lastly, two tourniquets increased cross- sectional area compared to one tourniquet (mean change +2.20 mm2, 95% CI, 1.14 − +3.26 mm2). ConclusionsThis study identified several potential interventions for maximizing venous cross-sectional area on ultrasound. All the tested interventions resulted in statistically significant increases in cross-sectional area. Arm positioning did not show significant changes in most interventions, with the exception of the CAT tourniquet. Further studies should be performed on how these maneuvers affect success in ultrasound-guided intravenous line placement.

Effect of water change on quality deterioration of Pacific white shrimp (Litopenaeus vannamei) during partial freezing storage

The correlation between water changes and quality deterioration of Litopenaeus vannamei during partial freezing storage was evaluated in this study. Significant increases in cross-sectional area and equivalent diameter are detected, but the roundness and longiness of the ice crystals show irregular growth. Within the extension of storage, the bound water (T2b) and immobilized water (T21) decreased significantly. However, the free water (T22) increased significantly. Quality determination showed significant decrease in total sulfhydryl and Ca2+-ATPase, but significant increase in disulfide bonds during storage. Correlation analysis revealed that cross-sectional area showed significant negative correlation with total sulfhydryl and Ca2+-ATPase, while significant positive correlation with disulfide bonds, respectively. The correlation between water distribution index and Ca2+-ATPase, disulfide bonds was significant, respectively. Predicted models for the growth of ice crystals with respect to cross-sectional area and equivalent diameter size have been developed with the help of the Arrhenius model.

Acute Effects of Selective Strength Exercise on the Peroneus Longus and Brevis

The peroneus muscles are muscles that mainly act in ankle eversion and can be divided into PL and PB, which have different but important roles in foot and ankle functions. Therefore, PL and PB dysfunction can lead to foot and ankle issues, making. selective strength exercise necessary. This study aimed to identify the effect of two different exercise techniques on PL and PB morphologies. Two interventions were performed on separate days: the PL intervention, in which a Thera-Band® was placed on the ball of the foot and pushed out from the contact point, and the PB intervention, in which the Thera-Band® was pulled from the base of the fifth metatarsal. Cross-sectional area (CSA) and thickness of the peroneus muscles at 25% (showing the PL morphology) and 75% (showing the PB morphology) proximal to the line connecting the fibular head and lateral malleolus, as well as ankle strength was measured before and immediately after the interventions and at 10, 20, and 30 min later. A repeated-measures two-way analysis of variance was conducted to identify differences in the effects of the interventions on the PL and PB. Main and interaction effects on CSA, thickness, and ankle strength, with a significant increase in CSA and thickness in the proximal 25% in the PL intervention and the distal 75% in the PB intervention immediately after implementation, were observed (p &lt; 0.05). The transient increase in muscle volume due to edema immediately after exercise indicates the acute effect of exercise. The CSA and thickness of the proximal 25% in the PL intervention and the distal 75% in the PB intervention increased immediately after the intervention, indicating that these interventions can be used to selectively exercise the PL and PB.

Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. Retrospective study. Tertiary level craniofacial hospital. 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.

Specific Adaptations to 0%, 15%, 25%, and 50% Velocity-Loss Thresholds During Bench Press Training.

To compare the effect of 4 velocity-loss (VL) thresholds-0% (VL0), 15% (VL15), 25% (VL25), and 50% (VL50)-on strength gains, neuromuscular adaptations, and muscle hypertrophy during the bench press (BP) exercise using intensities ranging from 55% to 70% of 1-repetition maximum (1RM). Fifty resistance-trained men were randomly assigned to 4 groups that followed an 8-week (16 sessions) BP training program at 55% to 70% 1RM but differed in the VL allowed in each set (VL0, VL15, VL25, and VL50). Assessments performed before (pre) and after (post) the training program included (1)cross-sectional area of pectoralis major muscle, (2)maximal isometric test, (3)progressive loading test, and (4)fatigue test in the BP exercise. A significant group × time interaction was found for 1RM (P = .01), where all groups except VL0 showed significant gains in 1RM strength (P < .001). The VL25 group attained the greatest gains in 1RM strength and most load-velocity relationship parameters analyzed. A significant group × time interaction was observed for EMG root mean square in pectoralis major (P = .03) where only the VL25 group showed significant increases (P = .02). VL50 showed decreased EMG root mean square in triceps brachii (P = .006). Only the VL50 group showed significant increases in cross-sectional area (P < .001). These findings indicate that a VL threshold of about 25% with intensities from 55% to 70% 1RM in BP provides an optimal training stimulus to maximize dynamic strength performance and neuromuscular adaptations, while higher VL thresholds promote higher muscle hypertrophy.

Functional improvements to 6months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals.

Older adults are encouraged to engage in multicomponent physical activity, which includes aerobic and muscle-strengthening activities. The current work is an extension of the Vitality, Independence, and Vigor in the Elderly 2 (VIVE2) study - a 6-month multicenter, randomized, placebo-controlled trial of physical activity and nutritional supplementation in community dwelling 70-year-old seniors. Here, we examined whether the magnitude of changes in muscle size and quality differed between major lower-extremity muscle groups and related these changes to functional outcomes. We also examined whether daily vitamin-D-enriched protein supplementation could augment the response to structured physical activity. Forty-nine men and women (77±5yrs) performed brisk walking, muscle-strengthening exercises for the lower limbs, and balance training 3 times weekly for 6months. Participants were randomized to daily intake of a nutritional supplement (20g whey protein+800IU vitamin D), or a placebo. Muscle cross-sectional area (CSA) and radiological attenuation (RA) were assessed in 8 different muscle groups using single-slice CT scans of the hip, thigh, and calf at baseline and after the intervention. Walking speed and performance in the Short Physical Performance Battery (SPPB) were also measured. For both CSA and RA, there were muscle group × time interactions (P<0.01). Significant increases in CSA were observed in 2 of the 8 muscles studied, namely the knee extensors (1.9%) and the hip adductors (2.8%). For RA, increases were observed in 4 of 8 muscle groups, namely the hip flexors (1.1HU), hip adductors (0.9HU), knee extensors (1.2HU), and ankle dorsiflexors (0.8HU). No additive effect of nutritional supplementation was observed. While walking speed (13%) and SPPB performance (38%) improved markedly, multivariate analysis showed that these changes were not associated with the changes in muscle CSA and RA after the intervention. We conclude that this type of multicomponent physical activity program results in significant improvements in physical function despite relatively small changes in muscle size and quality of some, but not all, of the measured lower extremity muscles involved in locomotion.

Rotator cuff strength is not augmented by blood flow restriction training

ObjectiveBlood flow restriction (BFR) training utilizes a tourniquet applied to the upper or lower extremities (UE or LE) to occlude blood flow while exercising. BFR training may help augment strength in muscles that are proximal to BFR cuff application. However, prior studies have failed to demonstrate augmented strength gains in the rotator cuff when the tourniquet is applied to the UE. The purpose of this study was to evaluate if a protocol consisting of LE exercises, performed with BFR, followed by rotator cuff exercises was superior in augmenting strength, and cross-sectional area (CSA) of the rectus femoris, in untrained subjects when compared to a non-BFR training group. DesignRandomized controlled trial. SettingUniversity. ParticipantsThirty-five subjects (mean age 25.8 ± 1.6 y) randomized to a BFR or non-BFR group. Main outcome measuresMuscular strength measured via hand held dynamometer and the CSA of the dominant rectus femoris was measured by diagnostic ultrasound. ResultsBoth groups experienced significant gains in LE and rotator cuff strength. Strength increased in the BFR group by 11.6% for the supraspinatus, 34.1% for shoulder ER, 23.4% for the quadriceps, and 17.1% for the hamstrings. Strength increased in the non-BFR group by 7.3% for the supraspinatus, 20% for shoulder ER, 12.8% for the quadriceps, and 10.7% for the hamstrings. However, there were no differences in strength gains between groups. Neither group experienced a significant increase in CSA for the rectus femoris. ConclusionThe BFR protocol used in this study did not augment strength for the rotator cuff in subjects who also performed LE exercises under occlusion.

Lean Body Mass and Muscle Cross-Sectional Area Adaptations Among College Age Males with Different Strength Levels across 11 Weeks of Block Periodized Programmed Resistance Training.

The block periodization training paradigm has been shown to produce enhanced gains in strength and power. The purpose of this study is to assess resistance training induced alterations in lean body mass and cross-sectional area using a block periodization training model among individuals (n = 15) of three differing strength levels (high, moderate and low) based on one repetition maximum back squat relative to body weight. A 3 × 5 mixed-design ANOVA was used to examine within-and between-subject changes in cross-sectional area (CSA), lean body mass (LBM), lean body mass adjusted (LBMadjusted) and total body water (TBW) over an 11-week resistance training program. LBMadjusted is total body water subtracted from lean body mass. The ANOVA revealed no statistically significant between-group differences in any independent variable (p > 0.05). Within-group effects showed statistically significant increases in cross-sectional area (p < 0.001), lean body mass (p < 0.001), lean body mass adjusted (p ˂ 0.001) and total body water (p < 0.001) from baseline to post intervention: CSA: 32.7 cm2 ± 8.6; 36.3 cm2 ± 7.2, LBM: 68.0 kg ± 9.5; 70.6 kg ± 9.4, LBMadjusted: 20.4 kg ± 3.1; 21.0 kg ± 3.3 and TBW: 49.8 kg ± 6.9; 51.7 kg ± 6.9. In conclusion, the results of this study suggest subjects experienced an increase in both lean body mass and total body water, regardless of strength level, over the course of the 11-week block periodized program. Gains in lean body mass and cross-sectional area may be due to edema at the early onset of training.

Effects of exercise on cervical muscle strength and cross-sectional area in patients with thoracic hyperkyphosis and chronic cervical pain

There is a lack of studies comparing the effects of different exercise types in patients with thoracic hyperkyphosis. Twenty-four subjects were divided into three groups: corrective exercise, resistance exercise, and physical therapy. The groups performed their respective interventions, two times per week for three months. Clinical outcomes, including the value of Cobb’s angle, cervical muscle strength and endurance, and the cross-sectional area of the cervical deep muscles were measured pre- and post-intervention. There was a significant difference in the changes in the thoracic Cobb’s angle between the groups (P < 0.001). The corrective exercise group revealed a significantly superior increase in muscle strength and endurance between pre- and post-intervention (P < 0.012). There was a significant difference in the cross-sectional area of the cervical deep muscles included longus capitis and multifidus between the groups (P < 0.036 and 0.007, respectively). The corrective exercise group showed the most significant increase in cross-sectional area between pre- and post-intervention (P < 0.012). A corrective exercise program is a more effective intervention than traditional resistance exercise and physical therapy for improving the thoracic Cobb’s angle, cervical muscle strength and endurance, and the cross-sectional area of the deep muscles in patients with thoracic hyperkyphosis.Trial registration: KCT0005292.

Oral fucoidan improves muscle size and strength in mice.

Fucoidan is a sulfated polysaccharide found in a range of brown algae species. Growing evidence supports the long‐term supplementation of fucoidan as an ergogenic aid to improve skeletal muscle performance. The aim of this study was to investigate the effect of fucoidan on the skeletal muscle of mice. Male BL/6 mice (N = 8–10) were administered a novel fucoidan blend (FUC, 400 mg/kg/day) or vehicle (CON) for 4 weeks. Treatment and control experimental groups were further separated into exercise (CON+EX, FUC+EX) or no‐exercise (CON, FUC) groups, where exercised groups performed 30 min of treadmill training three times per week. At the completion of the 4‐week treatment period, there was a significant increase in cross‐sectional area (CSA) of muscle fibers in fucoidan‐treated extensor digitorum longus (EDL) and soleus fibers, which was accompanied by a significant increase in tibialis anterior (TA) muscle force production in fucoidan‐treated groups. There were no significant changes in grip strength or treadmill time to fatigue, nor was there an effect of fucoidan or exercise on mass of TA, EDL, or soleus muscles. In gastrocnemius muscles, there was no change in mRNA expression of mitochondrial biogenesis markers PGC‐1α and Nrf‐2 in any experimental groups; however, there was a significant effect of fucoidan supplementation on myosin heavy chain (MHC)‐2x, but not MHC‐2a, mRNA expression. Overall, fucoidan increased muscle size and strength after 4 weeks of supplementation in both exercised and no‐exercised mice suggesting an important influence of fucoidan on skeletal muscle physiology.

Comparison of Blood Flow Restriction Training versus Non-Occlusive Training in Patients with Anterior Cruciate Ligament Reconstruction or Knee Osteoarthritis: A Systematic Review.

Patients undergoing anterior cruciate ligament (ACL) reconstruction and patients suffering from knee osteoarthritis (KOA) have been shown to have quadriceps muscle weakness and/or atrophy in common. The physiological mechanisms of blood flow restriction (BFR) training could facilitate muscle hypertrophy. The purpose of this systematic review is to investigate the effects of BFR training on quadriceps cross-sectional area (CSA), pain perception, function and quality of life on these patients compared to a non-BFR training. A literature research was performed using Web of Science, PEDro, Scopus, MEDLINE, Dialnet, CINAHL and The Cochrane Library databases. The main inclusion criteria were that papers were English or Spanish language reports of randomized controlled trials involving patients with ACL reconstruction or suffering from KOA. The initial research identified 159 publications from all databases; 10 articles were finally included. The search was conducted from April to June 2020. Four of these studies found a significant improvement in strength. A significant increase in CSA was found in two studies. Pain significantly improved in four studies and only one study showed a significant improvement in functionality/quality of life. Low-load training with BFR may be an effective option treatment for increasing quadriceps strength and CSA, but more research is needed.

Drug-induced Sleep Endoscopy (DISE) with Simulation Bite to Predict the Success of Oral Appliance Therapy in Treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)

Study objectivesOral appliances have gained their place in the treatment of obstructive sleep apnea (OSA) where custom-made titratable mandibular advancement devices (MAD) have become the oral appliance of choice. This study aimed to asses the value of the drug-induced sleep endoscopy (DISE) using a MAD in the prediction of treatment outcome for OSAHSMethodsThis is a prospective, single-center cohort study that enrolled sixty-six consecutive patients with diagnosed OSA (5 events/h < apnea-hypopnea index (AHI) < 50 events/h) to be treated with a custom-made titratable MAD. The patients were evaluated polysomnographically with the MAD in situ after the adaptation and titration period of 3 months. The associations between findings during DISE and treatment outcome were assessedResultsThe subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07. The simulation bite was associated with a significant increase in cross-sectional area at level of the velopharynx, tongue base and epiglottis. MAD treatment response in the studied population was 91%, with a mean AHI improving from 43.10 to 12.93.ConclusionsDrug-induced sleep endoscopy with simulation bite is an acceptably reproducible technique for determining the sites of obstruction in OSAHS subjects; it thus offers possibilities as a prognostic indicator for treatment with MAD

Effect of Previous Strength Training Episodes and Retraining on Cross-Sectional Area and Protein Contents of Rat Soleus Muscle

PURPOSE: This study tested the hypothesis that previous strength training episodes favorably contribute to muscular hypertrophic adaptations in rat soleus muscle after long-term detraining and retraining in rats.METHODS: Female Sprague-Dawley rats (n=24) aged 8 weeks were randomly assigned to four groups: control (CON), detraining (DT), strength training (ST), and retraining (RT). The strength training was a regular bout of ladder climbing exercise that consisted of three sets of five repetitions and three days per week for eight weeks. A cylinder containing weights was loaded to the bottom of each rat’s tail. The weights carried during each training session were initially 50% of body weight and progressively increased by 10% per session. Rats in the DT underwent twenty weeks of detraining periods immediately after eight weeks of strength training. Rats in the ST were aged matched to the RT group and underwent eight weeks of strength training at the same duration with the RT group. Rats in the RT were conducted to the resistance training for eight weeks following the detraining period. Soleus muscles were collected at the end of the training episodes to examine alterations in cross-sectional area and protein contents.RESULTS: ST showed a significant increase in cross-sectional area of the rat soleus muscle, compared with CON. It was interestingly demonstrated that RT markedly elicited hypertrophy of soleus muscle, compared with all other groups. It was supported that RTinduced hypertrophy was related to increased myofibrillar protein contents of the soleus muscle.CONCLUSIONS: These results suggest that although prolonged training cessation occurs previous strength training episodes have a positive impact on restoring muscular contractile properties and hypertrophy after retraining.

English

BACKGROUND Central Venous Cannulation is a very important technique needed intra operatively and in critical care setting. Most commonly accessed is the right internal jugular vein due to lesser incidence of complications and easy accessibility. Ultrasound guidance improves the successful insertion rate than blind technique. Increasing the cross-sectional area (CSA) of IJV improves the success rate and decreases complications. Several manoeuvres such as Trendelenburg’s position, Valsalva’s manoeuvre, hepatic compression and positive end-expiratory pressure have been used to increase the diameter of the IJV. Application of PEEP of 10–12 cm H2O in supine position has been found to increase the CSA of right IJV in various studies. The aim of the study is to determine the optimal PEEP which increases size of IJV without complications. METHODS This is an observational study conducted in the Government Medical College, Thrissur. The groups were chosen from instances where three different levels of PEEP were used. A total of 90 ASA PS 1 &amp; 2 patients who received general anaesthesia for elective surgeries where assigned to three groups - P0, P5 and P10 with different values of PEEP- 0, 5, and 10 cm of H2O respectively. Patients with obesity, raised intracranial pressure, previous neck surgery were excluded from the study. After application of PEEP for 2 minutes, the diameter of Right Internal Jugular was sonologically measured. The increase in cross sectional area of IJV in each group was analysed. Application of PEEP affects heart rate and mean arterial pressure in patients. So, the heart rate and mean arterial pressure readings were taken at the time of measurement of IJV. These were also analysed statistically. RESULTS The three groups P0, P5 and P10 were comparable in demographic parameters like age and weight. Cross-sectional area of three groups was compared. The mean CSA in P0 was 1.3345, P5 was 1.399 and P10 was 1.443 cm2. (p .001). There was a statistically significant increase in cross-sectional area of IJV when PEEP was applied. Increase in CSA was significantly higher with higher PEEP (p .001). CONCLUSIONS The application of PEEP of 5 to 10 cm of H2O is a safe method to increase the area of IJV for successful cannulation. This value of PEEP did not cause clinically significant haemodynamic effects. KEYWORDS PEEP, Cross-Sectional Area of IJV, Sonoanatomy, IJV Cannulation

Effect of Bilateral Versus Unilateral Use of Smartphone on Cross Sectional Area of Median Nerve

AbstractBackground: The use of smartphones and mobile devices has become widespread, particularly among youth, and the possible impacts on hand function and structures have not been clarified during bilateral and unilateral use of smartphone.Aim of Study: This study was conducted to compare between bilateral and unilateral hand use of smartphone on cross sectional area of median nerve.Subjects and Methods: Fifty-six students aged 18-25 years old were recruited from Faculty of Physical Therapy Kafr El-Sheikh University. By using noninvasive ultrasonography, Cross Sectional Area (CSA) of median nerve was measured while subjects typed specific text on smartphone using bilateral hands then unilateral hand.Results: The results revealed that the paired t-test show significant increase in CSA of median nerve in unilateral than bilateral hands use of smartphone as t-value was 55,000 and p-value was p<.001.Conclusion: Unilateral hand use of smartphone has higher risk on CSA of median nerve so bilateral hands use of smart-phone is recommended than unilateral hand use to reduce risk of Carpal tunnel syndrome.

Effect of Positive End-Expiratory Pressure on Overlap Between Internal Jugular Vein and Carotid Artery in Mechanically Ventilated Patients with Laryngeal Mask Airway (LMA) Insertion - A Prospective Randomized Trial.

BackgroundIn the present study, we aimed to determine the effect of different positive end-expiratory pressure (PEEP) levels on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) and the overlap index between the RIJV and the right common carotid artery (RCCA) in mechanically ventilated patients with laryngeal mask airway (LMA) insertion.Material/MethodsA total of 60 patients who were scheduled for elective surgery under general anesthesia with LMA insertion were enrolled. After LMA insertion, the image of RIJV and RCCA were taken after applying 4 different PEEPs in a random order: 0 (P0), 5 (P5), 10 (P10), and 15 (P15) cm H2O. The CSA, transverse and anteroposterior (AP) diameters of the RIJV, and the overlap index were measured.ResultsCompared to group P0, the overlap indexes of P10 (P=0.0032) and P15 (P<0.001) were significantly increased, but without a significant trend toward further increases in group P15. PEEP at 10 and 15 cm H2O increased CSA, transverse and AP diameter of the RIJV in comparison to group P0 (all P<0.001). There was a statistically significant increase in CSA of the RIJV in P15 compared with P10 by 12.2% (P<0.001), but did not reach the relevant cut-off value (ΔCSA ≥15%).ConclusionsThe application of PEEP at 10 cm and 15 cm H2O in patients receiving mechanical ventilation with LMA insertion significantly increases the size of the RIJV. However, the overlap index between the RIJV and the RCCA increased as well.

Ulnar nerve instability in the cubital tunnel of asymptomatic volunteers.

Ulnar nerve instability (UNI) in the cubital tunnel is defined as ulnar nerve subluxation or dislocation. It is a common disorder that may be noted in patients with neuropathy or in the asymptomatic. Our prospective, single-site study utilized high-resolution ultrasonography (US) to evaluate the ulnar nerve for cross-sectional area (CSA) and measures of shear-wave elastography (SWE). Mechanical algometry was obtained from the ulnar nerve in the cubital tunnel to assess pressure pain threshold (PPT). Forty-two asymptomatic subjects (n = 84 elbows) (25 males, 17 females) aged 22-40 were evaluated. Two chiropractic radiologists, both with 4years of ultrasound experience performed the evaluation. Ulnar nerves in the cubital tunnel were sampled bilaterally in three different elbow positions utilizing US, SWE, and algometry. Descriptive statistics, two-way ANOVA, and rater reliability were utilized for data analysis with p ≤ 0.05. Fifty-six percent of our subjects demonstrated UNI. There was a significant increase in CSA in subjects with UNI (subluxation: 0.066mm2 ± 0.024, p = 0.027; dislocation: 0.067mm2 ± 0.024, p = 0.003) compared to controls (0.057mm2 ± 0.017) in all three elbow positions. There were no significant group differences in SWE or algometry. Inter- and intra-observer agreements for CSA of the ulnar nerves within the cubital tunnel were assessed using intraclass correlation coefficient (ICC) and demonstrated moderate (ICC 0.54) and excellent (ICC 0.94) reliability. Most of the asymptomatic volunteers demonstrated UNI. There was a significant increase in CSA associated with UNI implicating it as a risk factor for ulnar neuropathy in the cubital tunnel. There were no significant changes in ulnar nerve SWE and PPT. Intra-rater agreement was excellent for the CSA assessment of the ulnar nerve in the cubital tunnel. High-resolution US could be utilized to assess UNI and monitor for progression to ulnar neuropathy.

Preoperative assessment of gastric contents and volume using bedside ultrasound in adult patients: A prospective, observational, correlation study.

Background and Aims:Pulmonary aspiration of gastric contents is a serious complication of anaesthesia. The aim of this study was to determine, with the help of ultrasound, the gastric volume and content in fasted patients presenting for elective surgeries and correlate the results with fasting times and co-morbidities of the patients.Methods:The study was conducted in 100 adult patients presenting for elective surgery. A preoperative bedside gastric ultrasound scan was done in supine and right lateral position. Gastric contents were noted, and gastric volume was calculated at the level of the gastric antrum. Gastric volume was estimated by measuring antral cross-sectional area (CSA) and using a mathematical model. Gastric volume in the right lateral decubitus (RLD) position was taken as the final reading. Analysis of variance and Student's t-test were done for statistical significance and P < 0.05 was considered statistically significant.Results:Six out of 100 patients had solid gastric contents and 16 had >1.5 ml/kg clear liquids, although they had been fasting between 10 and 15 hours. Patients suffering from diabetes and chronic kidney disease had statistically significant increase in CSA in both supine and RLD. We also found increase in estimated gastric volume as the BMI of the patients increased.Conclusion:Our study showed that fasting for more than 6–10 hours does not guarantee an empty stomach. Those with co-morbidities like diabetes mellitus, obesity and chronic kidney disease (CKD) appear more prone to have unsafe gastric contents.

Effects of varying entry points and trendelenburg positioning degrees in internal jugular vein area measurements of newborns.

Recent guidelines from the National Institute for Clinical Excellence recommend the use of ultrasonography in the central venous catheterization of children. In this study, we aimed to compare area measurements using ultrasonography and efficiency of varying Trendelenburg degrees on the area measurements, for two different entry points used as internal jugular vein (IJV) cannulation points in newborns. Fifty-eight healthy newborns, weighing between 3000 and 3500 g, were recruited for this prospective study. Right IJV (RIJV) consecutive measurements were performed in three different Trendelenburg positions at 0°, 15°, and 30°, at two different entry points: The superior approach and an inferior approach. The landmark used in the superior approach was the top of the triangle formed by the two heads of the sternocleidomastoid muscle with the clavicle; while in the inferior approach, it was taken as the midpoint of the clavicle, as measured from the upper edge of the clavicle. The cross-sectional area (CSA) of the RIJV was significantly increased when using the inferior approach, compared to that in the superior approach, in all Trendelenburg degrees, including the neutral position. Both 15° and 30° Trendelenburg positioning resulted in a significant increase in CSA, both in superior and inferior approaches, when compared to neutral positioning. The use of 15° Trendelenburg positioning may have significant advantage for increasing the CSA when used with the inferior approach.