Visible Muscle Research Articles

Four weeks of electrical stimulation improves glucose tolerance in a sedentary overweight or obese Hispanic population.

Introduction/purposeMost US adults (54%) do not meet the minimum exercise recommendations by the American College of Sports Medicine. Neuromuscular electrical stimulation (NMES) is a novel alternate strategy to induce muscle contraction. However, the effectiveness of NMES to improve insulin sensitivity and energy expenditure is unclear. The purpose of this study was to investigate the effects of 4 weeks of NMES on glucose tolerance in a sedentary overweight or obese population.MethodsParticipants (n = 10; age: 36.8 ± 3.8 years; BMI = 32 ± 1.3 kg/m2) were randomized into either control or NMES group. All participants received bilateral quadriceps stimulation (12 sessions; 30 min/session; three times/week at 50 Hz and 300 µs pulse width) altering pulse amplitude to either provide low-intensity sensory level (control; tingling sensation) or at high-intensity neuromuscular level (NMES; maximum tolerable levels with visible muscle contraction). Glucose tolerance was assessed by a 3-h oral glucose tolerance test (OGTT), and substrate utilization was measured by indirect calorimetry and body composition via dual X-ray absorptiometry at baseline and after 4 weeks of NMES intervention.ResultsControl and NMES groups had comparable fasting blood glucose, glucose tolerance, substrate utilization, and muscle mass at baseline. Four weeks of NMES resulted in a significant improvement in glucose tolerance measured by OGTT, whereas no change was observed in the control group. There was no change in substrate utilization and muscle mass in both control and NMES groups.ConclusionNMES is a novel and effective strategy to improve glucose tolerance in an at-risk overweight or obese sedentary population.

Principles of Abdominal Muscles Training Aimed at their Visualization

Abdominal muscles have many vital anatomical and physiological functions, inclu­ding supporting the trunk and spine, allowing body movement and holding organs in place by regulating internal abdominal pressure. They can be divided into two groups: anterolateral, which include flat and vertical muscles, and posterior abdominal walls muscles. Due to the growing interest in physical activity, many people are looking for a recipe for strong and visible abdominal muscles. To achieve this, a combination of cardiorespiratory, strength, high intensity interval training (HIIT) and strict abdominal muscle exercises, with proper diet and lifestyle is required. The percentage of whole body fat and the level of visceral fat also play an important role in the process of visualization. Exercises for abdominal muscles should be diversified, based on various types of movement and engaging all major muscles. It is recommended to perform training regularly and modify it frequently, taking into account progression and increase in the difficulty level. The purpose of this review is to present the current state of knowledge on this topic in a clear and accessible manner, primarily addressed to those professionally involved in or interested in bodybuilding.

Trends in food sensory science

Trends in food sensory science

Physiologic signaling and viability of the muscle cuff regenerative peripheral nerve interface (MC-RPNI) for intact peripheral nerves

Background. Robotic exoskeleton devices have become a promising modality for restoration of extremity function in individuals with limb loss or functional weakness. However, there exists no consistent or reliable way to record efferent motor action potentials from intact peripheral nerves to control device movement. Peripheral nerve motor action potentials are similar in amplitude to that of background noise, producing an unfavorable signal-to-noise ratio (SNR) that makes these signals difficult to detect and interpret. To address this issue, we have developed the muscle cuff regenerative peripheral nerve interface (MC-RPNI), a construct consisting of a free skeletal muscle graft wrapped circumferentially around an intact peripheral nerve. Over time, the muscle graft regenerates, and the intact nerve undergoes collateral axonal sprouting to reinnervate the muscle. The MC-RPNI amplifies efferent motor action potentials by several magnitudes, thereby increasing the SNR, allowing for higher fidelity signaling and detection of motor intention. The goal of this study was to characterize the signaling capabilities and viability of the MC-RPNI over time. Methods. Thirty-seven rats were randomly assigned to one of five experimental groups (Groups A–E). For MC-RPNI animals, their contralateral extensor digitorum longus (EDL) muscle was harvested and trimmed to either 8 mm (Group A) or 13 mm (Group B) in length, wrapped circumferentially around the intact ipsilateral common peroneal (CP) nerve, secured, and allowed to heal for 3 months. Additionally, one 8 mm (Group C) and one 13 mm (Group D) length group had an epineurial window created in the CP nerve immediately preceding MC-RPNI creation. Group E consisted of sham surgery animals. At 3 months, electrophysiologic analyses were conducted to determine the signaling capabilities of the MC-RPNI. Additionally, electromyography and isometric force analyses were performed on the CP-innervated EDL to determine the effects of the MC-RPNI on end organ function. Following evaluation, the CP nerve, MC-RPNI, and ipsilateral EDL muscle were harvested for histomorphometric analysis. Results. Study endpoint analysis was performed at 3 months post-surgery. All rats displayed visible muscle contractions in both the MC-RPNI and EDL following proximal CP nerve stimulation. Compound muscle action potentials were recorded from the MC-RPNI following proximal CP nerve stimulation and ranged from 3.67 ± 0.58 mV to 6.04 ± 1.01 mV, providing efferent motor action potential amplification of 10–20 times that of a normal physiologic nerve action potential. Maximum tetanic isometric force (F o) testing of the distally-innervated EDL muscle in MC-RPNI groups produced F o (2341 ± 114 mN–2832 ± 102 mN) similar to controls (2497 ± 122 mN), thus demonstrating that creation of MC-RPNIs did not adversely impact the function of the distally-innervated EDL muscle. Overall, comparison between all MC-RPNI sub-groups did not reveal any statistically significant differences in signaling capabilities or negative effects on distal-innervated muscle function as compared to the control group. Conclusions. MC-RPNIs have the capability to provide efferent motor action potential amplification from intact nerves without adversely impacting distal muscle function. Neither the size of the muscle graft nor the presence of an epineurial window in the nerve had any significant impact on the ability of the MC-RPNI to amplify efferent motor action potentials from intact nerves. These results support the potential for the MC-RPNI to serve as a biologic nerve interface to control advanced exoskeleton devices.

Familial Partial Lipodystrophy: A Case Study and Review of Recent Literature

Introduction: Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by loss of subcutaneous adipose tissue, mainly from the extremities and gluteal region. FPLD is associated with a variety of metabolic abnormalities including severe hypertriglyceridemia (HTG), insulin resistance (IR), and hepatic steatosis. We present a case of FPLD and summarize recent literature on the metabolic features and their management in patients with this rare disease. Case: A 44 year old female with medical history of Type 2 DM, hypertension, hypothyroidism and recurrent pancreatitis from severe HTG was referred to our clinic. She was diagnosed with Type 2 DM in her 30s. Over the ensuing years she had significant IR requiring increasing doses of concentrated insulin (up to 250 units/day). She reported progressive loss of subcutaneous fat from extremities in the preceding 2–3 years. She had recurrent pancreatitis, including a recent hospitalization with TG>8000 mg/dL. On examination, she had typical features of FPLD including loss of subcutaneous adipose tissue from upper and lower extremities including gluteal region, visible skeletal muscles and veins in the extremities, and neck and truncal obesity (Fig. 1). Family history was significant for similar physical and metabolic manifestations in her father and brother. For HTG, she is treated with fibrates and high intensity statin. We avoided the use of fish oil in the patient, because she did not feel well when she was previously on this. Results of the genetic testing are pending. Discussion: FPLD is rare, predominantly autosomal dominant, disorder characterized phenotypically by variable loss of subcutaneous fat and metabolically by severe HTG and insulin resistance. The severity of metabolic derangements is proportional to the degree of the lipodystrophy. The proposed mechanism is limited capacity of adipose tissue to store fat leading to ectopic fat deposition, lipotoxicity and vascular inflammation. Diagnosis is often clinical, especially the loss of subcutaneous fat in the extremities and signs of IR, and is confirmed by genetic testing. Dunnigan syndrome is the most common type of FPLD, which occurs from an autosomal dominant missense mutation in lamin A/C (LMNA). Gene mutations encoding for PPAR-gamma, Akt2, CIDEC, perilipin and the ZMPSTE 24 enzyme are much less common. Treatment of FPLD is challenging, and mostly focuses on managing the metabolic abnormalities. Recent evidence suggests that fish oil may in fact worsen HTG when the main defect driving increased TG is impaired chylomicron clearance, which our patient had on lipid NMR profile. Metreleptin, a human leptin analog, has recently been approved for the management of FPLD with evidence of improved metabolic abnormalities. Recent data also suggests that GLP1 agonists and SGLT2 inhibitors improved glycemic control and reduced daily insulin requirements.

Comparison of Different Intensity Modes of Neuromuscular Electrical Stimulation in the Rehabilitation of Elderly Patients with Decompensated Chronic Heart Failure.

Aim To compare effects of neuromuscular electrostimulation (NMES) with various intensity of induced muscle contractions on its tolerance and effect on physical work ability in elderly patients admitted for chronic heart failure (CHF).Material and methods The study included 22 patients older than 60 years admitted for decompensated CHF. NMES was performed from the 2nd or 3d day of stay in the hospital to the discharge from the hospital. Patients choose the stimulation regimen themselves based on the result of the first session: the high intensity to achieve maximum tolerable muscle contractions (group 1) or the lower intensity to achieve visible/ palpable muscle contractions (group 2). Prior to the onset and after the completion of the training, the 6-min walk test (6MWT) was performed and the general condition of the patient was assessed with a visual analogue scale (VAS).Results More patients, mostly women, chose the less intensive NMES (14 vs. 8). The groups did not differ in age, comorbidity, and functional condition. Both groups achieved considerable increases in the 6MWT distance (7.3 [5.6; 176] and 9.8 [7.0; 9.9] %, respectively, p>0.05) and VAS scores without a significant difference between the groups. Among the patients who were compliant with continuing NMES after the discharge from the hospital, 69% were patients of the group of the less intensive stimulation.Conclusion The less intensive NMES (with achieving visible muscle contractions) was characterized by better tolerance and better compliance in elderly patients with decompensated CHF compared to the more intensive NMES (with achieving maximum contractions), but the less intensive NMES was not inferior to the more intensive NMES in effectiveness.

The muscle twitch profile assessed with motor unit magnetic resonance imaging

Localised signal voids in diffusion‐weighted (DW) images of skeletal muscle have been postulated to occur as a result of muscle fibre contraction and relaxation. We investigated the contrast mechanism of these signal voids using a combination of modelling and experimental measurements by employing DW and phase contrast (PC) imaging sequences. The DW signal and PC signal were simulated for each time point of a theoretical muscle twitch. The model incorporated compaction (simulating actively contracting muscle fibres) and translation (simulating passively moving surrounding fibres). The model suggested that the DW signal depended on contraction time and compaction whereas the PC signal depended on contraction time, compaction and translation. In a retrospective study, we tested this model with subgroup analyses on 10 healthy participants. Electrical nerve stimulation was used to generate muscle twitches in lower leg muscles; the resulting force was measured using an MR‐compatible force transducer. At current levels causing a visible muscle twitch (~13 mA), the width of the first signal drop in the DW signal (mean ± SD: 103 ± 20 ms) was comparable with the force contraction time (93 ± 34 ms; intraclass correlation coefficient [ICC] = 0.717, P = .010). At current levels activating single motor units (~9 mA), the contraction time determined from the DW signal was 75 ± 13 ms and comparable with the PC contraction time (81 ± 15 ms; ICC = 0.925, P = .001). The maximum positive velocity was 0.55 ± 0.26 cm/s and the displacement was 0.20 ± 0.10 mm. Voxel‐wise analysis revealed localised DW changes occurring together with more widespread phase changes. In conclusion, local signal attenuations in DW images following muscle fibre activation are primarily caused by compaction. The PC sequence also detects translating muscle tissue being passively pulled. The magnitude of the changes in DW and PC images depends on the twitch's contractile properties and percentage contraction. DW imaging and PC imaging can therefore measure twitch profiles of skeletal muscle fibres.

A Randomised Clinical Trial to Compare the Efficacy of Tramadol and Nalbuphine for Treatment of Shivering after Spinal Anaesthesia in Patients Posted for Lower Limb Orthopaedic Surgery

Introduction: Nalbuphine and tramadol are opioids which have been used to control post-anaesthetic shivering. Aim: To compare the efficacy of nalbuphine and tramadol in the treatment of post-spinal anaesthesia shivering. Materials and Methods: This was a randomised clinical trial conducted on 60 patients of either gender (20-60 years age group) from January 2019 to June 2020, American Society of Anaesthesiologists (ASA) Grade I or II, having post-spinal anaesthesia shivering. The total sample was divided into two groups of 30 patients each. Group T received injection (Inj) tramadol 1 mg/kg intravenously (iv) and Group N received Inj. nalbuphine 0.1 mg/kg iv. Grade of shivering was assessed with a five point scale as Grade 0- no shivering; Grade 1; No visible muscle activity, but one or more of piloerection, peripheral vasoconstriction or peripheral cyanosis Grade 2; Muscular activity in only one muscle group; Grade 3: Moderate muscular activity in more than one muscle group, but not generalised shaking; Grade 4: Violent muscular activity that involves the entire body. The time taken for disappearance of shivering, assessment of improvement of shivering (complete- if grade of shivering becomes 0, partial- if grade of shivering deceased but not zero), recurrence rate and side-effects such as nausea, vomiting, deep sedation were noted. Independent t-test and Chi-square test were used to analyse the data. A p-value <0.05 were considered statistically significant. Results: The time taken for disappearance of shivering was shorter in group N than T (3.20±0.96 minutes and 6.43±0.97 minutes respectively, p=0.001). Significantly better sedation (p-value 0.04) was seen in nalbuphine group as grade 3 sedation were seen in 15 patients of nalbuphine group as compared to none in tramadol group. All the patients in group N had complete improvement of shivering and there was no recurrence, while in group T six patients had partial improvement in shivering and four (13%) had recurrence. Complications such as nausea (three patients) and vomiting (one patient) were seen in Group T while none were seen in Group N. Conclusion: The efficacy of nalbuphine is greater than tramadol in controlling post-spinal anaesthesia shivering, with minimal side-effects.

WITHDRAWN: Beef tenderness evaluation using early post-mortem muscle nanostructure.

Ahead of Print article withdrawn by publisher.

ADAPTIVE CAPACITY OF STUD RAMS OF ASKANIAN MEAT AND WOOL BREED AND PARAMETERS OF SELECTION OF ZAKARPATTJA-TYPE PRECOCE BREED EWES FOR INTER-BREEDING

The rams of the Askanian meat-wool breed, grown and kept in the conditions of the steppe zone of the south of Ukraine, were investigated for their adaptive capacity and adaptation to the conditions of the lowland regions of Zakarpattja.
 It was found that the physiological response of the rams to the maximum air temperature was characterized by a slight increase in body temperature and pulse, and a significant increase in respiratory rate per 1 minute. The good adaptive properties of the Askanian meat and wool breed rams are indicated by the high breeding capacity of ewes, at 97%, in both farms. The ewes of the breed prekos with a live weight of 55.9–58.9 kg were involved in the breeding process, and the Askanian rams with a live weight of 93.3–95.1 kg. It was studied the influence of crossbred crossing of crossbred Askanian sheep of meat and wool breed on the development of productive and reproductive features of Zakarpattja sheep ewes of the breed prekos with the purpose of obtaining mixed breeds with improved economic performance. It is proven by theory and practice that one of the main criteria for the rational management of sheep breeding in modern conditions is the study of individual features of growth and development of young sheep. In a market economy, increasing the meat productivity of sheep is an important factor that determines the level of economic efficiency of the industry. Obtained progeny at the age of 4–8 months had a higher intensity of growth. Thus, the average daily weight gain of lambs in the control group was 234 g, and experimental — 265 g, which is 11.3% more than in the control. The average daily weight gain of the bright control group was 205 g, and the experimental one — 244 g, which is 11.9% more than in the control group. At the age of 8 months, the fat mass of slaughtered animals ranged from 32–36 kg and the carcass weight was 15–18 kg with good fat irrigation.
 The classification of sheep carcasses by fat irrigation according to the EUROP system corresponded to the average level of coverage of carcasses with fat, that is, the whole carcass was covered with a thin layer of fat, at the base of the tail — small accumulations of fat, the kidneys partially or completely covered with a thin layer of fat, with a slight fatty water between visible intercostal muscles .The balanced feeding of experimental animals had a positive effect on the increase in live birth weight and their viability. The minimum selection parameters of breeding sheep ewes, which are involved in the breeding process, are also set for obtaining animals with high multi-farrowing and combined productivity.

Prediction of dry-cured ham weight loss and prospects of use in a pig breeding program

Large ham weight losses (WL) in dry-curing are undesired as they lead to a loss of marketable product and penalise the quality of the dry-cured ham. The availability of early predictions of WL may ease the adaptation of the dry-curing process to the characteristics of the thighs and increase the effectiveness of selective breeding in enhancing WL. Aims of this study were (i) to develop Bayesian and Random Forests (RFs) regression models for the prediction of ham WL during dry-curing using on-site infrared spectra of raw ham subcutaneous fat, carcass and raw ham traits as predictors and (ii) to estimate genetic parameters for WL and their predictions (P-WL). Visible-near infrared spectra were collected on the transversal section of the subcutaneous fat of raw hams. Carcass traits were carcass weight, carcass backfat depth, lean meat content and weight of raw hams. Raw ham traits included measures of ham subcutaneous fat depth and linear scores for round shape, subcutaneous fat thickness and marbling of the visible muscles of the thigh. Measures of WL were available for 1672 hams. The best prediction accuracies were those of a Bayesian regression model including the average spectrum, carcass and raw ham traits, with R2 values in validation of 0.46, 0.55 and 0.62, for WL at end of salting (23 days), resting (90 days) and curing (12 months), respectively. When WL at salting was used as an additional predictor of total WL, the R2 in validation was 0.67. Bayesian regressions were more accurate than RFs models in predicting all the investigated traits. Restricted maximum likelihood (REML) estimates of genetic parameters for WL and P-WL at the end of curing were estimated through a bivariate animal model including 1672 measures of WL and 8819 P-WL records. Results evidenced that the traits are heritable (h2 ± SE was 0.27 ± 0.04 for WL and 0.39 ± 0.04 for P-WL), and the additive genetic correlation is positive and high (ra = 0.88 ± 0.03). Prediction accuracy of ham WL is high enough to envisage a future use of prediction models in identifying batches of hams requiring an adaptation of the processing conditions to optimise results of the manufacturing process. The positive and high genetic correlation detected between WL and P-WL at the end of dry-curing, as well as the estimated heritability for P-WL, suggests that P-WL can be successfully used as an indicator trait of the measured WL in pig breeding programs.

EP.19Anti-HMGCR positive necrotizing myopathy presenting in childhood

A 12-year-old girl, previously healthy, was hospitalized because of progressive proximal weakness for a few months. CK was 17000U/L. There were only minor skin changes, but an initial muscle biopsy was reported to have changes possibly compatible with dermatomyositis. Treatment was started with prednisolone and methotrexate, without adequate improvement. A biopsy two years later did not exclude the diagnosis of a muscular dystrophy. The fast development of weakness did not however really fit clinically. A neuromuscular gene panel analysis (328 genes) did not reveal the etiology, and ANA- and ANCA tests were negative. She gradually became weaker. At the age of 15,5y, she could not walk any longer, her upper extremities were weak, and she could not shift position in bed. She also had pain in her legs, and breathing and swallowing were affected. She was still on prednisolone, but methotrexate had been stopped. A new biopsy showed more extensive, chronic myopathic changes and acute changes, with fibers in different stages of necrosis. CK was 2600 U/L. MRI of total body disclosed generalized edema and patchy infiltration of fat in all visible muscles, combined with muscle atrophy. It was then suggested to test for HMGCR antibodies which were positive. The patient was started on IVIG infusions in addition to previous therapy and restarted methotrexate. She improved gradually. After one year she could walk with assistance, swallowing was normal, and respiration was much improved. HMGCR associated necrotizing autoimmune myopathy (NAM) may well occur without statin exposure. However, the disease is rare in childhood. A muscle biopsy with scattered necrotic fibers without inflammatory infiltrate should raise the suspicion of the disease. Because it is treatment responsive, HMGCR associated NAM is an important differential diagnosis also in children when the clinical picture, imaging and laboratory findings are in the borderline between a myositis and a muscular dystrophy.

Correlation between sarcopenia and osteoporosis in patients with post-poliomyelitis syndrome

Muscle mass, -strength and -density, sarcopenia, exercise and physical activity are correlated with bone mass, bone density and osteoporotic fractures. Bone and muscle decay and dysfunction are seen in ageing, but in neurological disorders with muscular atrophy, bone loss can be seen also at younger ages. Femoral neck and lumbar spine bone mineral density (BMD) is measured using dual X-ray absorptiometry in 30 patients with post-poliomyelitis syndrome, 18 women and 12 men, with a mean age of 56.3 years (ranging from 37 till 70). Eight women were postmenopausal. Mean femoral neck BMD was −22.76% or −1.86 SD and mean lumbar BMD was −13.21% or −1.25 SD. Low femoral bone mass was found in 80% of the patients (12 men and 12 women, of whom 5 were post-menopausal) and low lumbar bone mass was seen in 63% (9 men and 10 women, of whom 8 were post-menopausal). Six patients (all women) had normal femoral BMD and 11 normal lumbar BMD, whereas 6 (3 male and 3 female) had osteoporotic femoral BMD-scores (< −2.5 SD) and 3 (1 man and 2 women) had osteoporotic lumbar BMD. The remaining patients had osteopenia: 18 showed femoral osteopenia (< −1 SD) and 16 lumbar osteopenia. A significant difference in femoral (cortical) BMD between men and women was found: −27.72% or −2.24 SD in men and −19.46% or −1.62 SD in women. Only small sex differences were seen in lumbar (trabecular) BMD: −13.85% or −1.37 SD in men and −12.78% or −1.17 SD in women. The lowest BMD scores were present in patients with visible and clear lower limb muscle atrophy. A correlation is shown between low muscle mass and low cortical BMD can be explained by neurogenic bone loss, both due to muscle atrophy and disturbed regulation of bone by the central nervous system.

Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine

BackgroundMagnetic Resonance Imaging (MRI) is commonly used to assess the health of the lumbar spine and supporting structures. Studies have suggested that fatty infiltration of the posterior lumbar muscles is important in predicting responses to treatment for low back pain. However, methodological differences exist in defining the region of interest (ROI) of a muscle, which limits the ability to compare data between studies. The purpose of this study was to determine reliability and systematic differences within and between two commonly utilized methodologies for ROI definitions of lumbar paraspinal muscle.MethodsT2-weighted MRIs of the mid-L4 vertebrae from 37 patients with low back pain who were scheduled for lumbar spine surgery were included from a hospital database. Fatty infiltration for these patients ranged from low to high, based on Kjaer criteria. Two methods were used to define ROI: 1) segmentation of the multifidus and erector spinae based on fascial planes including epimuscular fat, and 2) segmentation of the multifidus and erector spinae based on visible muscle boundaries, which did not include epimuscular fat. Total cross sectional area (tCSA), fat signal fraction (FSF), muscle cross sectional area, and fat cross sectional area were measured. Degree of agreement between raters for each parameter was assessed using intra-class correlation coefficients (ICC) and area fraction of overlapping voxels.ResultsExcellent inter-rater agreement (ICC > 0.75) was observed for all measures for both methods. There was no significant difference between area fraction overlap of ROIs between methods. Method 1 demonstrated a greater tCSA for both the erector spinae (14–15%, p < 0.001) and multifidus (4%, p < 0.016) but a greater FSF only for the erector spinae (11–13%, p < 0.001).ConclusionThe two methods of defining lumbar spine muscle ROIs demonstrated excellent inter-rater reliability, although significant differences exist as method 1 showed larger CSA and FSF values compared to method 2. The results of this study confirm the validity of using either method to measure lumbar paraspinal musculature, and that method should be selected based on the primary outcome variables of interest.

Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy.

Sleeve gastrectomy (SG) has become the primary procedure for many bariatric teams and staple-line leak represents its most feared complication. Sarcopenic obesity combines the risks of obesity and depleted lean mass leading possibly to an inferior surgical outcome after abdominal surgery. The aim of this study was to evaluate the existence of a potential link between radiologically determined sarcopenic obesity and staple-line leak risk after SG. A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG as primary procedure. Total psoas muscles (TPA) and total visible muscles (TMA) areas were measured on a preoperative computed tomography (CT). Sarcopenia was defined as lowest tertile of skeletal muscular mass indexes (muscular areas over square of height) in each gender (using TPA or TMA). Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. During the study period, 205 patients were included in the analysis. Median BMI was 40.8kg/m2 (34.2-49.6), and 9 patients (4.4%) presented a gastric leak. The sex-specific cut-offs for skeletal muscular mass index according to TPA were 8.2cm2/m2 for men and 6.08cm2/m2 for women. After multivariate analysis, preoperative weight (OR = 1043) and sarcopenia (TPA) (OR = 5204) were independent predictive factors for gastric leak. The present series suggests that CT scan-determined sarcopenic obesity is associated with increased risk of gastric leak after SG. This preoperatively radiological examination would be a useful clinical tool to tailor patient management according to gastric leak risk.

Short pulse width in subthalamic stimulation in Parkinson's disease: a randomized, double-blind study.

We investigated the acute effect of short pulse widths on the therapeutic window in subthalamic nucleus deep brain stimulation in Parkinson's disease. We assessed 10 PD patients with STN-DBS at a 60-µs pulse width. We randomly and double-blindedly applied 10- to 50-µs pulse widths. The principal outcome was the therapeutic window (difference between the amplitude thresholds for visible muscle contraction and for best rigidity control). The secondary outcome was the charge per pulse (which reflects the efficiency of the stimulation) needed to control rigidity. Two-way analysis of variance and pairwise t tests were applied. The therapeutic window widened when the pulse width shortened (r = -0.45; P < 0.001), and charge per pulse was reduced (P < 0.05). This randomized, double-blind study showed that shorter pulse widths widen the therapeutic window of STN-DBS in PD without increasing the electrical charge required to obtain the same acute clinical benefit. © 2017 International Parkinson and Movement Disorder Society.

Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice.

Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice.

Effective management of spasticity and impacts on weight change and resting energy expenditure in a female with spinal cord injury: a case report

The impact of muscle spasticity on weight change and energy expenditure after spinal cord injury (SCI) is not well understood. This case study reports changes to body weight and resting energy expenditure (REE) in a 36-year-old female (T3 AIS A SCI; 80 kg; body mass index=28 kg m-2 at injury) requiring escalating therapies to manage severe spasticity. Body weight, spasticity medications and fasted REE (measured using indirect calorimetry, canopy hood) were recorded at 4, 16, 17, 20 and 44 months post injury. Spasticity was assessed at each time point using the Modified Ashworth Scale (MAS). At 4 months post injury, REE was high (1710 kcal per day) corresponding with severe spasticity in the lower limbs (4 on the MAS). Over the following 12 months, the patient experienced an 8 kg weight loss, visible lower limb muscle wasting and a 30% reduction in REE while requiring increasing drug therapies for spasticity. With insertion of an intrathecal Baclofen pump at 17 months and cessation of other medications, spasticity improved markedly and weight increased by 6 kg in 27 months without any significant change to REE (mean=1260 kcal±2%). Effective management of spasticity with intrathecal Baclofen appears to be associated with weight gain but not REE. Without body composition and activity energy expenditure data, this observation is difficult to explain. Regardless, routine weight monitoring with appropriate dietary counselling should be considered in this patient group to help prevent unintentional weight gain.

Characterization of Volitional Electromyographic Signals in the Lower Extremity After Motor Complete Spinal Cord Injury

Background. Previous studies have demonstrated the presence of intact axons across a spinal cord lesion, even in those clinically diagnosed with complete spinal cord injury (SCI). These axons may allow volitional motor signals to be transmitted through the injury, even in the absence of visible muscle contraction. Objective. To demonstrate the presence of volitional electromyographic (EMG) activity below the lesion in motor complete SCI and to characterize this activity to determine its value for potential use as a neuroprosthetic command source. Methods. Twenty-four subjects with complete (AIS A or B), chronic, cervical SCI were tested for the presence of volitional below-injury EMG activity. Surface electrodes recorded from 8 to 12 locations of each lower limb, while participants were asked to attempt specific movements of the lower extremity in response to visual and audio cues. EMG trials were ranked through visual inspection, and were scored using an amplitude threshold algorithm to identify channels of interest with volitional motor unit activity. Results. Significant below-injury muscle activity was identified through visual inspection in 16 of 24 participants, and visual inspection rankings were well correlated to the algorithm scoring. Conclusions. The surface EMG protocol utilized here is relatively simple and noninvasive, ideal for a clinical screening tool. The majority of subjects tested were able to produce a volitional EMG signal below their injury level, and the algorithm developed allows automatic identification of signals of interest. The presence of this volitional activity in the lower extremity could provide an innovative new command signal source for implanted neuroprostheses or other assistive technology.

Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

BackgroundFunctional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well.ObjectivesThe aim was to investigate the effectiveness of a “shoulder pacemaker” device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability.Patients and methodsThree patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off.ResultsNo changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed.ConclusionThe electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application. Video onlineThe online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: “The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern”. Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universitätsmedizin Berlin 2017, all rights reserved