Superficial Muscles Research Articles

The influence of testing positions and resistance locations on muscle activities during shoulder internal rotation strength measurements in young healthy adults

BackgroundAlthough some tests of shoulder internal rotator strength including subscapularis are commonly used in clinical practice, the differences in shoulder muscle activities other than subscapularis muscle among those tests are not well understood. The purpose of this study was to examine the activities of the superficial shoulder muscles in addition to internal rotation strength during two belly-press and three lift-off test positions. MethodsThirteen healthy young adult men (age 29.5 ± 5.4 years) were recruited for the present study. They performed isometric shoulder internal rotation against manual resistance during the belly-press test positions with two different resistance locations and the lift-off test with three different arm positions. The surface electromyographic activities of the superficial shoulder muscles, including the deltoid (anterior, middle, posterior), pectoralis major, long head of triceps and latissimus dorsi muscle, were collected and compared between the two belly-press tests, and among the three lift-off test positions (P < 0.05). ResultsThe belly-press test position with resistance to elbow showed significantly greater activities of the anterior and middle deltoid muscle than the original belly-press test; but showed significantly smaller activities of pectoralis major, triceps and latissimus dorsi muscle than the original belly-press test. Among the three lift-off tests, all muscle activities, except for the pectoralis major, were greater in the lift-off at L4/5 than in the lift-off at buttock and thigh. Lift-off at thigh showed significantly smaller activity of pectoralis major than the lift-off at L4/5 and buttock. ConclusionsThe findings of the present study suggest that clinician should give attention to compensatory motions by excessive shoulder extensor and adductor muscle activities for the original belly press test, by excessive deltoid muscle activities for the modified belly-press, and by excessive shoulder extensor muscle activities for the lift off test in the inferior arm positions.

Role of caveolin-1 in chronic postsurgical pain in rats.

Chronic postsurgical pain (CPSP) has a high incidence, but the underlying mechanisms remain elusive. Previous studies have indicated that caveolin-1 (Cav-1) plays a notable role in pain modulation. To study the role of Cav-1 in CPSP in the present study, a rat model of skin/muscle incision and retraction (SMIR) was established. Under anesthesia, skin and superficial muscle of the medial thigh were incised and a small pair of retractors inserted. It was revealed that SMIR increased the expression of Cav-1 in the dorsal root ganglion (DRG) and the injured tissue around the incision. Furthermore, the infiltration of endothelial cells and macrophages in the injured tissue around the incision increased constantly, and the vascular permeability increased due to the destruction of the vascular endothelial barrier function around the injured tissue. Cav-1 was mainly expressed by CD68-positive macrophages and CD34-positive endothelial cells in the injured tissues around the incision, while it was also primarily localized in the medium and large neurofilament 200-positive neurons and a small number of calcitonin gene-related peptide- and isolectin B4-positive small and medium-sized neurons in the DRG. The results demonstrated that the sustained high expression levels of Cav-1 in the injured tissue around the incision could lead to the dysfunction of the vascular endothelial barrier and, thus, could induce the inflammatory response through the lipoprotein transport of endothelial cells, thereby resulting in peripheral sensitization. In addition, the sustained high expression levels of Cav-1 in the DRG could sensitize large-sized neurons and change the transmission mode of noxious stimuli. The findings of the present study indicated that a Cav-1-mediated process could participate in neuronal transmission pathways associated with pain modulation.

Malocclusion with posterior unilateral crossbite affects superficial masseter and anterior temporal muscle activity during mastication

Background: Mastication patterns due to malocclusion with unilateral posterior crossbite may permanently change. Purpose: This study aimed to examine the effect of malocclusion with unilateral posterior crossbite of the superficial masseter and anterior temporal muscles on the crossbite and non-crossbite sides during mastication. Methods: Thirty subjects (8 males and 22 females) between the ages of 17 and 30 years who were students of the 2017–2019 Dentistry and Dental Hygiene Study Program, Faculty of Dentistry, UGM and who had at least two posterior teeth with unilateral posterior crossbite were divided into 10 subjects with Angle’s class I, 10 subjects with class II and 10 subjects with class III malocclusions. The amplitude of the superficial masseter and temporal anterior muscles was performed during mastication using surface electromyography (sEMG). The mean difference between the groups of malocclusion on the crossbite and non-crossbite sides of the superficial masseter and temporal anterior was analysed by a two-way analysis of variance (ANOVA). Results: The results indicated a difference in amplitude mean between the malocclusion types on the crossbite sides and non-crossbite sides of the superficial masseter and temporal anterior muscles (p&lt;0.05). This study confirmed there was a decrease in superficial masseter and anterior temporal muscle activity on the crossbite side rather than in the non-crossbite side in Angle’s class I and class II. However, there was an increase in activity of the superficial masseter and anterior temporal muscles on the crossbite side for class III. Conclusion: Malocclusion with unilateral posterior crossbite affects masticatory activity of the superficial masseter and temporal anterior muscles on the crossbite side.

Morphological and molecular identification of Cryptocotyle lingua metacercariae isolated from Atlantic cod (Gadus morhua) from Danish seas and whiting (Merlangius merlangus) from the English Channel

Trematode larvae (metacercariae) causing black spot disease occur frequently in gills, fins, skin and the superficial muscle layers of marine fish. Species within the genus Cryptocotyle Lühe, 1899 are frequently associated with this disease. Descriptions of the metacercarial stage are relatively limited and none has hitherto been reported from fish from the English Channel. The present study reports the morphological and molecular identifications of encysted black spot-inducing parasites from whiting (Merlangius merlangus) and Atlantic cod (Gadus morhua) caught respectively from the north coast of France (English Channel) and from Danish sea waters. Metacercariae were characterised morphologically based on microscopic observations and molecularly using Sanger sequencing of fragments of the mitochondrial cox1 gene and rDNA ITS region. Morphological data were compared with available data in the literature. Phylogenetic trees including reference sequences were built to confirm morphological and molecular identifications. This survey constitutes the first description of C. lingua metacercariae in the English Channel ecosystems.

Epidemiology of Blackleg Disease in Ethiopia

Blackleg is an infectious bacterial disease of cattle and rarely of other ruminants. This bacteria is caused by Clostridium chauvoei which is an anaerobic, gram positive, motile, rod-shaped bacillus bacterium and persists in the soil as resistant spores. Blackleg is an acute or subacute but chronic disease may occur. It occurs most frequently in animals 6-24 months of age and the disease mainly affects none vaccinated as well as animals in good nutritional condition. It produces persistent spores when conditions are not ideal and spores are highly resistant to environmental factors and disinfectants. Infected ruminants do not directly transmit the disease to other animals. The bacteria enter the body through the alimentary mucosa after ingestion of contaminated feed. Secretion of cytolytic toxins that cause necrosis of vascular endothelia .The toxins are absorbed into the animal’s bloodstream which makes the animal acutely sick and causes rapid death. Economic importance due to blackleg is loss of animals, milk production and draft oxen, and cost for treatment and vaccination. Fatality rate of blackleg in fully susceptible populations approaches 100%. Clinical Signs include lethargy anorexia, reluctance to move lameness and recumbence. When superficial muscles are affected, swelling and crepitus are evident. Cattle found dead of blackleg are lying on the side with the affected hind limb stands out stiffly, bloating and putrefaction occur quickly and bloodstained from exudates, nostrils and anus. The disease can be diagnosed using laboratory diagnosis, Immune Fluorescent, Cell Culture and PCR. Control and prevention relies mainly on vaccination.

Anatomy of Cowper\u2019s gland in humans suggesting a secretion and emission mechanism facilitated by cooperation of striated and smooth muscles

This study presents the detailed anatomy of the Cowper’s gland in humans. Elucidating the mechanism of secretion and emission of the Cowper’s gland requires analysis of the muscles around the Cowper’s gland. We hypothesized that the Cowper’s gland involves not only smooth muscle but also the striated muscles of the pelvic floor. Here, we provide comprehensive and three-dimensional anatomy of the Cowper’s gland and its surrounding structures, which overcomes the current local and planar understanding. In this study, seven male corpses of body donors were used to conduct macroscopic anatomy, histology, and three-dimensional reconstruction. The Cowper’s gland was surrounded laterally and posterosuperiorly by striated and smooth muscles, respectively. The striated muscle bundle was connected from the superficial transverse perineal muscle, levator ani, and external anal sphincter to the external urethral sphincter (rhabdosphincter). The smooth muscle was part of the deep transverse perineal muscle and entered between the bilateral Cowper’s glands and lobules. Our findings indicate that the secretion and emission of the Cowper’s gland in humans are carried out through the cooperation of striated and smooth muscles.

Multi-muscle deep learning segmentation to automate the quantification of muscle fat infiltration in cervical spine conditions

Muscle fat infiltration (MFI) has been widely reported across cervical spine disorders. The quantification of MFI requires time-consuming and rater-dependent manual segmentation techniques. A convolutional neural network (CNN) model was trained to segment seven cervical spine muscle groups (left and right muscles segmented separately, 14 muscles total) from Dixon MRI scans (n = 17, 17 scans < 2 weeks post motor vehicle collision (MVC), and 17 scans 12 months post MVC). The CNN MFI measures demonstrated high test reliability and accuracy in an independent testing dataset (n = 18, 9 scans < 2 weeks post MVC, and 9 scans 12 months post MVC). Using the CNN in 84 participants with scans < 2 weeks post MVC (61 females, 23 males, age = 34.2 ± 10.7 years) differences in MFI between the muscle groups and relationships between MFI and sex, age, and body mass index (BMI) were explored. Averaging across all muscles, females had significantly higher MFI than males (p = 0.026). The deep cervical muscles demonstrated significantly greater MFI than the more superficial muscles (p < 0.001), and only MFI within the deep cervical muscles was moderately correlated to age (r > 0.300, p ≤ 0.001). CNN’s allow for the accurate and rapid, quantitative assessment of the composition of the architecturally complex muscles traversing the cervical spine. Acknowledging the wider reports of MFI in cervical spine disorders and the time required to manually segment the individual muscles, this CNN may have diagnostic, prognostic, and predictive value in disorders of the cervical spine.

Comparative biomechanics of the Pan and Macaca mandibles during mastication: finite element modelling of loading, deformation and strain regimes.

The mechanical behaviour of the mandibles of Pan and Macaca during mastication was compared using finite element modelling. Muscle forces were calculated using species-specific measures of physiological cross-sectional area and scaled using electromyographic estimates of muscle recruitment in Macaca. Loading regimes were compared using moments acting on the mandible and strain regimes were qualitatively compared using maps of principal, shear and axial strains. The enlarged and more vertically oriented temporalis and superficial masseter muscles of Pan result in larger sagittal and transverse bending moments on both working and balancing sides, and larger anteroposterior twisting moments on the working side. The mandible of Pan experiences higher principal strain magnitudes in the ramus and mandibular prominence, higher transverse shear strains in the top of the symphyseal region and working-side corpus, and a predominance of sagittal bending-related strains in the balancing-side mandible. This study lays the foundation for a broader comparative study of Hominidae mandibular mechanics in extant and fossil hominids using finite element modelling. Pan's larger and more vertical masseter and temporalis may make it a more suitable model for hominid mandibular biomechanics than Macaca.

Vocal Creativity in Elephant Sound Production.

Simple SummaryElephants are known for their complex vocalization system and for being able to imitate sounds. Here, we show that African elephants apply unusual and individualistic sound production mechanisms to generate idiosyncratic sounds. These sounds are produced by manipulating non-phonatory structures, e.g., applying an ingressive airflow at the trunk tip to emit extraordinarily high-frequency sounds or repeatedly contract superficial muscles at the trunk base to generate lower-frequency pulsated sounds. Intriguingly, each individual establishes its own distinctive sound-producing strategy (e.g., contracting different muscle bundles). The production of these sounds on cue is encouraged via positive reinforcement training. This suggests that social feedback and reinforcement can facilitate vocal creativity and learning behavior in elephants. Social interactions and positive feedback are also crucial for early speech learning in human infants. Increasing knowledge on sound production plasticity in elephants—long-living, highly social mammals—is crucial in the effort to better understand their communicative and vocal learning ability and its function in wild elephant populations.How do elephants achieve their enormous vocal flexibility when communicating, imitating or creating idiosyncratic sounds? The mechanisms that underpin this trait combine motoric abilities with vocal learning processes. We demonstrate the unusual production techniques used by five African savanna elephants to create idiosyncratic sounds, which they learn to produce on cue by positive reinforcement training. The elephants generate these sounds by applying nasal tissue vibration via an ingressive airflow at the trunk tip, or by contracting defined superficial muscles at the trunk base. While the production mechanisms of the individuals performing the same sound categories are similar, they do vary in fine-tuning, revealing that each individual has its own specific sound-producing strategy. This plasticity reflects the creative and cognitive abilities associated with ‘vocal’ learning processes. The fact that these sounds were reinforced and cue-stimulated suggests that social feedback and positive reinforcement can facilitate vocal creativity and vocal learning behavior in elephants. Revealing the mechanism and the capacity for vocal learning and sound creativity is fundamental to understanding the eloquence within the elephants’ communication system. This also helps to understand the evolution of human language and of open-ended vocal systems, which build upon similar cognitive processes.

The Influence Of Hydration Status And Segmental Water Content On Echo Intensity In Older Men

Echo intensity (EI) has gained popularity as a method for quantifying ultrasound-derived muscle quality in older adults, which may reflect non-contractile tissue accumulation. However, since water is hypo-echoic, previous authors have suggested that alterations in hydration status and/or intracellular water content (ICW) may influence EI. PURPOSE: To assess the influence of hydration status and segmental ICW on EI in older men. METHODS: Twenty normal weight, healthy, older men (mean ± SD age: 69.5 ± 2.0 yrs; body mass index: 23.6 ± 1.2 kg/m2) refrained from vigorous exercise for 48 hours and fasted for a minimum of eight hours prior to visiting the laboratory on one occasion. A clinical handheld refractometer was used to assess hydration status via urine specific gravity (USG). Panoramic brightness mode ultrasound imaging was used to determine anatomical cross-sectional area (CSA) and EI. Following a 20-minute lying rest period, one scan of each superficial quadricep muscle (vastus lateralis, rectus femoris, vastus medialis) was taken of the right thigh at 50% femur length with the leg propped and supported at 50 degrees of flexion. Cross-sectional area was summed and EI was averaged across all three muscles. Segmental bioelectrical impedance spectroscopy was used to measure ICW and extracellular water content (ECW) of the right thigh. Total body water (TBW) of the segment was determined from the sum of ICW and ECW. The ICW values were normalized to TBW prior to analyses. Pearson’s product-moment correlation coefficients were used to assess the association between EI and USG and ICW/TBW. Given previous authors have suggested ICW reflects the amount of contractile tissue, a partial correlation was used to assess the association between EI and ICW/TBW while controlling for CSA. RESULTS: Echo intensity (96.9 ± 12.6 a.u.) was not associated with USG (1.016 ± 0.01) (P = 0.865). Poorer EI (higher value) was negatively associated (r = -0.527, P = 0.02) with lower ICW/TBW (0.50 ± 0.04) prior to and after accounting for CSA (29.8 ± 4.7 cm2) (r = -0.518, P = 0.02). CONCLUSIONS: Hydration status did not influence EI in a group of largely euhydrated (70%) older adults. Thigh specific segmental ICW content influences EI values in older adults. Future studies are needed to determine how ICW content influences age-related differences in EI.

B-PO03-087 ATRIAL UNIPOLAR VOLTAGE MAPPING FOR DETECTION OF INTRAMURAL ABLATION GAPS

Endocardial bipolar voltage is primarily influenced by superficial muscle layers. Thus, endocardial scar with surviving intramural/epicardial layers may exhibit low bipolar voltage. Alternatively, intramural/epicardial scar with preserved endocardium may exhibit normal voltage. To examine the value of unipolar voltage for assessing atrial tissue. In a chronic swine model of transcaval ablation line with intentional gap (7.9-14.8mm), the RA was mapped after a survival period of 6 weeks using a multielectrode catheter (Pentaray, Biosense Webster). Unipolar and bipolar voltage maps were compared with histopathology. In 10 swine, the transcaval ablation line was transmural in 4 and non-transmural in 6. Four gaps exhibited endocardial scar with preserved mid-myocardial and epicardial layers; 1 gap showed preserved endocardium with mid-myocardial scar, and 1 gap showed a fully preserved atrial wall. Bipolar voltage (using a 0.50mV cutoff) performed well for detecting all endocardial gaps (0.64mV, IQR: 0.36-1.52, PPV=100%) but failed to detect intramural gaps (0.28mV, IQR:0.13-0.52, p=0.004; PPV=0%;). Lowering the bipolar voltage cutoff to 0.2mV did not significantly improve its sensitivity to detect intramural gaps (PPV=25%). In contrast, unipolar voltage was higher in sites of intramural gaps (1.37mV, IQR:1.12-1.93) compared to regions of transmural scar (0.74mV, IQR:0.58-0.94, p<0.001; PPV=100%) without false positive gap detection (NPV=100%); Figure. Unipolar voltage mapping may be useful for detecting intramural surviving muscle. The clinical utility and specific cutoff values require further investigation.

The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up.

Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.

E-Res U-Net: An improved U-Net model for segmentation of muscle images

In this paper, we propose a new semantic segmentation network called ’E-Res U-Net’, to achieve better segmentation results of deep and superficial muscles in ultrasonic muscle images. This model is based on U-Net, and its structure has been modified to improve the performance of the algorithm. There are three aspects of improvement based on U-Net, including E-Res layer, dilated convolution module, and E-Res path. Additional experiments demonstrate that each designed module in our proposed network is effective, can improve the accuracy compared to the original U-Net. When compared with other algorithms which are state-of-the-art, the experimental result under the overall network structure is even more excellent.

Rehabilitation Exercises for Dysfunction of the Scapula: Exploration of Muscle Activity Using Fine-Wire EMG

Background: Scapular muscle activity during shoulder exercises has been explored with surface electromyography (EMG). However, knowledge about the activity of deeper-layer scapular muscles is still limited. Purpose: To investigate EMG activation of the deeper-layer scapular stabilizers (levator scapulae [LS], rhomboid major [RM], pectoralis minor [Pm] muscles) together with superficial muscle activity (upper [UT], middle [MT], and lower trapezius [LT] and serratus anterior [SA]) during 4 exercises often used for training scapular function. Based on the amplitude EMG of the deeper-layer muscles, scapular muscle activation ratios for the 4 exercises were calculated, hereby providing knowledge of the optimal muscle balance. Study Design: Descriptive laboratory study. Methods: A total of 26 healthy participants performed 4 shoulder exercises (side-lying external rotation [ER], side-lying forward flexion, prone horizontal abduction with ER, and prone extension) while simultaneously measuring scapular muscle activity. Intramuscular electrodes were used for the deeper layer, in contrast to surface electrodes for the superficial muscles. All data were normalized to percentage of maximal voluntary isometric contraction (%MVIC), and the activation ratios (the muscle activity of the deeper layer relative to the other muscles) were calculated. A 1-way analysis of variance with Bonferroni correction was applied for statistical analysis. Results: Moderate activity was found in all exercises for the LS and RM (25%-45% MVIC). The Pm resulted in low activity during both side-lying exercises (13%-18% MVIC). Ratios involving LS or RM showed values >1 for all exercises (1.28-12.41) except for LS/MT, LS/LT, and LS/RM (0.85-0.98) during side-lying ER, and LS/MT, RM/MT and RM/LS (0.85-0.99) during side-lying forward flexion. Likewise, values <1 were found when MT (0.85) and LS (0.99) were involved with RM in the numerator during side-lying forward flexion. Ratios with Pm in the numerator showed values <1, apart from the ratios with UT and SA in the denominator. Conclusion: The study provides extended knowledge about the deeper-layer scapular muscle activity and related ratios during the 4 shoulder exercises mentioned here. Putting theory into practice, based on our results, we advise both side-lying exercises to be performed to strengthen LT and MT, even in case of hyperactivity of the Pm. However, the 4 exercises should be given carefully to patients with hyperactivity in the LS and/or RM. Clinical Relevance: The findings of this study may assist clinical decision making in exercise selection for restoring scapular function.

The accuracy of needle electrode placement by trainees in selected forearm muscles using verification by neuromuscular ultrasound

IntroductionAnatomic landmarks alone may not always be sufficient to accurately guide electromyography (EMG) electrode needle placement. MethodsSenior residents and fellows (n = 11) targeted 4 forearm muscles with anatomic landmarks alone versus with audiovisual EMG feedback. Accuracy of EMG needle placement was verified using neuromuscular ultrasound imaging. ResultsWhile relatively large and superficial FCR muscle was sampled at a rate of 100% with and without audiovisual EMG feedback, accuracy of deeper and/or smaller forearm muscles (FPL, EIP, and SUP) diminished significantly without audiovisual EMG feedback. DiscussionOur study suggests that in clinical scenarios in which an electrodiagnostician relies on anatomic landmarks alone to target small and deep muscles, the risk of misplacement of needle electrode is increased. Consideration for neuromuscular ultrasound to augment training and/or real time guidance in EMG practice may be appropriate.

Upper Quadrant Pain and Disability Associated with a Cross-Sectional Area of Deep and Superficial Neck Muscles: A Computed Tomography Study.

An analytical cross-sectional computed tomography (CT) study. To investigate the association of the cross-sectional area (CSA) and density of neck muscles (sternocleidomastoid, upper trapezius, levator scapulae, anterior scalene, longus coli, longus capitis) with upper quadrant pain and disability. Neck pain, a common condition, causes substantial disability to individuals. The deep cervical flexor muscles are impaired in persons with neck pain. These muscles play a greater role in maintaining stable head postures, whereas, superficial muscles are responsible for peak exertions and reinforcing spinal stability at terminal head postures. Two hundred thirty consecutive individuals suffering from neck pain were referred to CT scans; 124/230 complied with the inclusion and exclusion criteria. Subjects were interviewed and the measurements of the CSA and muscle density were extracted from the scans. Muscles associated with quick disability of the arms, shoulders, and hand questionnaire (QDASH) were the lateral posterior group (LPG) CSA C3-C4 on the right side (beta = -0.31, P = 0.029); the sternocleidomastoid (SCM) CSA C3-C4 on the left side (beta = 0.29, P = 0.031); the LPG CSA C3-C4 on the left side (beta = -0.49, P = 0.000); the LCM CSA C5-C6 on the right side (beta = -0.19, P = 0.049); the LPG CSA C5-C6 on the right side (beta = -0.36, P = 0.012); and the LPG CSA C5-C6 on the left side (beta = -0.42, P = 0.002). Further analyses with radiculopathy acting as an augmenting/enhancing variable (moderator), showed an increase in the model strength (r2 = 0.25) with a stronger prediction of pain and disability. Muscle measurements did not predict neck disability index (NDI) scores. By using an accurate measuring tool, we found an association of the deep and superficial neck muscles' CSA with upper extremities' pain and disability. When performing manual work, a special load is placed on the shoulders and neck muscles. Future research should focus on examining the effectiveness of exercise-type intervention programs to strengthen the deep neck and upper extremities' muscles in order to prevent muscle fatigue.Level of Evidence: 2.

Sarcocystis rileyi (Apicomplexa) in Anas platyrhynchos in Europe with a potential for spread.

Four specimens of mallard (Anas platyrhynchos) shot by local hunters (December 2020 to January 2021 along the eastern coastline of the island of Bornholm in the Baltic Sea) were diagnosed with a heavy load of sarcocysts in the musculature. Morphometric and molecular diagnosis based on rDNA (18 S, ITS1, 28 S) of parasites recovered from two of the birds revealed the causative pathogen to be Sarcocystis rileyi. We further present novel sequences for the entire 5.8 S and ITS2 for this species. Elongate cysts (mean length 5.25 (SD 0.6) mm, width 1.37 (SD 0.2) mm) were recorded in all parts of the striated skeletal musculature of the birds. The main part (72%) of the 2585 cysts in one female mallard was located in the outer superficial pectoral musculature, with 11% in the inner pectoral musculature. Minor but significant parts were found in the dorsal, ventral abdominal, neck and head, legs, hand and arm (wing) musculature. No cysts were found in the smooth musculature. Each cyst contained a median of 3.2 mio bradyzoites indicating that more than 8 billion bradyzoites are available for infection of one or more predators/scavengers ingesting the bird. Bradyzoites (median length 13.5 μm (range 12.1–14.5) and median width 2.66 μm (range 2.1–3.3)) were highly resistant to proteinase treatment, which secures the passage through the stomach of the predator to its intestine where wall penetration takes place. One of the birds was ringed (tagged) in Sweden Island Øland in the Baltic Sea two years before being shot. This is documenting immigration of mallards from northern locations. The parasite species was originally described in North America in 1893 and was commonly reported in this region during the 20th century but not in Europe. Recent cases from Norway, Finland, Lithuania, Poland, UK and Hungary suggest that the species may be spreading geographically. Experienced duck hunters with a 40 years record of hunting on the island reported that this type of infection unprecedented. The final host is reported to be canines (fox, raccoon dog), skunk and mustelids, including ermines and American mink. Presence of these hosts in Europe may allow establishment of the life cycle and further colonization of the local duck populations which calls for implementation of a survey program in Europe.

Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study.

Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity. To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain. An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1-5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics. Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions. Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.

Eyelid Lymphatics: An Anatomical Study by Microdissection.

To obtain further understanding of the eyelid lymphatic anatomy. Thirty-two halves of eyelids from 16 fresh fetus cadavers were studied by microdissection using a mixture of 3% Prussian blue and chloroform to visualize the lymphatic vessels. Three layers of lymphatic plexuses were demonstrated in the eyelids: a superficial or preorbicularis muscle plexus; a pretarsal or postorbicular muscle plexus; and a deep or posttarsal plexus. Furthermore, communicating branches among these plexuses were also spotted. The study results demonstrated the topographic distribution of the eyelid lymphatic vessels and confirmed the existence of communicating branches. This discovery will be conducive to understanding the route and mechanism by which inflammation of the eyelid spreads and cancer disseminates. It also provides anatomical insights to apply during eyelid surgery with regard to the prevention of possible eyelid lymphatic injury.

Palliative surgery for thumb involvement in ulnar paralysis

Ulnar paralysis has multiple clinical presentations, which are due to partial recovery or to anatomical variations between the ulnar and median nerves. The main sequelae of ulnar nerve paralysis are the loss of hand strength with impairment of all intrinsic functions of the fingers and some of the thumb’s functions. Weakness of the adductor pollicis and flexor pollicis brevis muscles may manifest as weak key pinch with automatic flexion of the thumb interphalangeal joint when gripping. Indications for palliative surgery have decreased due to advances in peripheral nerve surgery. However, palliative surgery still has a significant role to play when nerve repair techniques are not indicated or do not provide satisfactory results. The principle is to reinforce metacarpophalangeal flexion while stabilizing the thumb’s interphalangeal joint, thus supplementing the action of the flexor pollicis brevis. This is generally done by transferring the flexor digitorum superficialis tendon of the fourth finger to the distal insertion of the superficial thenar muscles and the extensor pollicis longus. Restoration of the first dorsal interosseous is more rarely indicated.