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We investigated the effect of increasing the number of sets per week every fortnight versus performing a constant set volume on muscular adaptations over 12 weeks. Thirty females (RT experience 2.1 ± 1.0 years) were randomly assigned to a constant group (CG, n = 9) that performed 22 sets per week, a two-set progression group (2SG, n = 11), or a four-set progression group (4SG, n = 10). Forty-five degree leg press one-repetition maximum (1RM), vastus lateralis cross-sectional area (VL-CSA), and the sum of proximal, middle and distal lateral thigh muscle thickness (∑MT) were assessed at baseline and after the intervention. We observed that the 4SG and 2SG conditions showed greater improvements in 1RM than the CG (p < 0.001, p = 0.032, respectively), with no differences between 4SG and 2SG (p = 0.118). Regarding VL-CSA, the 4SG group showed greater increases than the CG (p = 0.029) but not than the 2SG (p = 0.263), whereas no differences between the 2SG and CG (p = 0.443) were observed. There were no differences between groups for ∑MT (p = 0.783). While all groups demonstrated improvements in the measured outcomes, our findings suggest that increasing weekly sets may offer additional benefits for 1RM and vastus lateralis cross-sectional area. However, no additional benefits were observed for ∑MT. [ABSTRACT FROM AUTHOR]

Background: Diabetic peripheral neuropathy is regarded as one of the most common microvascular sequalae of type 2 diabetes mellitus which leads to lower limb complications. Lately, the focus has shifted to early detection of diabetic neuropathy in the subclinical stage. While nerve conduction studies are considered non-invasive, sensitive and objective procedures for diagnosis of neuropathies, the missed diagnosis rate is high in early neuropathy. Recently, ultrasonography use has been regarded as an alternative method for detecting neuropathies, being an inexpensive and a more comfortable tool. The aim of this study was to define the pattern of affection of lower limb peripheral nerves in type 2 diabetic patients using neuromuscular ultrasound and to assess its utility in evaluation of diabetic peripheral neuropathy in asymptomatic diabetic patients. Methods: This cross-sectional study included 40 type 2 diabetic patients and 20 healthy age- and sex-matched controls. All patients were subjected to full history taking, clinical examination, electrodiagnostic studies and neuromuscular ultrasound. Neuromuscular ultrasound was performed for tibial, fibular and sural nerves bilaterally for all patients and controls. Nerve cross-sectional area was measured at multiple sites for each nerve. Results: Diabetic patients had statistically significant higher mean cross-sectional area values than controls in nearly all examined sites of all nerves. Furthermore, patients with electrophysiological diabetic peripheral neuropathy (EDPN) had higher statistically significant mean sural cross-sectional area values than patients without EDPN. There were no statistically significant differences in mean cross-sectional area values between symptomatic and asymptomatic patients with EDPN in all measured nerves. ROC analysis showed that sural nerve cross-sectional area cut off value of > 5 mm2 was predictive for diagnosis of EDPN. Conclusions: Diabetic cases, even asymptomatic ones, had statistically significant higher mean cross-sectional area values than controls on neuromuscular ultrasound. In addition, patients with EDPN showed higher cross-sectional area values of lower limbs peripheral nerves. Thus, neuromuscular ultrasound could be used as a screening tool for diabetic peripheral neuropathy using sural nerve cross-sectional area measurement at the ankle even in asymptomatic diabetic patients. [ABSTRACT FROM AUTHOR]

Objective Methods Results Clinical Significance To compare preoperative and postoperative cross‐sectional areas (CSAs) of the external nares and nasal vestibule on computed tomography (CT) transverse sections in brachycephalic dogs that underwent a vestibuloplasty in combination with either a Trader's technique or vertical wedge resection rhinoplasty.Medical records and corresponding preoperative and postoperative head computed tomographic images were reviewed to measure CSA at two defined points on transverse sections of the nasal cavities.Nine brachycephalic dogs were included for analysis. Trader's technique and vestibuloplasty were performed in five dogs. Vertical wedge resection and vestibuloplasty were performed in four dogs. CSAs were significantly increased in all rostral nasal cavities postoperatively in both combination of techniques. The mean difference in CSA of the right and left external nares were 37.12 mm2 (95% confidence interval [CI] 24.59, 49.66) and 64.3 mm2 (95% CI 28.78, 60. 04), respectively. The mean difference in CSA of the right and left nasal vestibules were 25.08 mm2 (95% CI 11.44, 38.73) and 28.73 mm2 (95% CI 11.83, 45.64), respectively.Vestibuloplasty in combination with either Trader's technique or vertical wedge resection significantly increased the CSA of the external nares and nasal vestibules. These techniques did not result in recurrent stenosis or collapse of the alar wings in all evaluated rostral nasal cavities in this case series. [ABSTRACT FROM AUTHOR]

Background/Objectives: Musculoskeletal aging can clinically hardly be distinguished from degenerative disease, especially if symptoms are nonspecific, like lower back pain and reduced physical resilience. However, age-related changes are considered to be physiological until they cause osteoporotic fractures or sarcopenia-related restrictions. This radio-anatomic investigation examines whether findings in lumbar magnetic resonance imaging (MRI) mirror age- and sex-related musculoskeletal differences that help to identify the onset of sarcopenia. Methods: Lumbar MRI investigations from 101 women and 101 men were retrospectively evaluated for vertebral and muscular cross-sectional diameter sizes and T2-signal intensities ("T2-brightness") in axial sections in the L5-level. The results were correlated with the individual's age to find specific alterations that were indicative of sarcopenia or attributable to the aging process. Results: In women (average age 62.6 (34–85) years), musculoskeletal cross-sectional area sizes and diameters were significantly smaller (p < 0.00001) compared to those in men (average age 57.0 (21–90) years). The most pronounced structural age-related change was the increasing mean posterior paravertebral muscle brightness (MPPVB), which exceeded the mean vertebral brightness (MVB) earlier and to a greater extent in women than in men (p < 0.00001). The brightness difference (∆MVB − MPPVB) was found to indicate (pre-)sarcopenia at values below 25. Conclusions: Significant age-related deterioration in muscle quantity and quality was more obvious in women, correlated with the onset of menopause, and progressed to lower levels during aging. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome. Design: The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal–Wallis test. Setting: Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment. Participants: The study included 80 patients with mild-to-moderate carpal tunnel syndrome. Interventions: The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26). Main Outcome Measures: The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale). Results: Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001). Conclusion: The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms. [ABSTRACT FROM AUTHOR]

Agnieszka Fry&zacute;lewicz,1 Gabriela Rusin,1 Wojciech Rudnicki,2 Marzena U&lstrok;amek-Kozio&lstrok;,3 Jakub Antczak4 1Department of Neurology, University Hospital in Krakow, Cracow, Poland; 2Department of Radiology, University Hospital in Krakow, Cracow, Poland; 3Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; 4Department of Neurology, Jagiellonian University Medical College, Krakow, PolandCorrespondence: Jakub Antczak, Department of Neurology, Jagiellonian University Medical College, ul. Jakubowskiego 2, Kraków, 30-688, Poland, Tel +48 12 400 25 50, Fax +48 12 400 25 67, Email jakub.antczak@uj.edu.plIntroduction: Ultrasonography is increasingly used to diagnose the carpal tunnel syndrome (CTS). Most frequently, the enlargement of the nerve cross-sectional area (CSA) at the tunnel inlet serves to confirm the diagnosis. Recent research has shown that the nerve diameter is decreased within the tunnel, when measured at the level of pisiforme or capitatum. The stenosis index (SI), which uses the ratio of the diameter of median nerve at the tunnel inlet to the diameter within the tunnel (SI diameter), was proposed as the diagnostic marker of CTS. In this study, we compared the diameter of the median nerve measured at the site of maximal stenosis (DMS) between patients with CTS and controls. Additionally, we investigated the diagnostic utility of the modified SI, which uses the ratio of CSA at the inlet to the diameter within the tunnel (SI CSA).Methods: Forty-eight patients (72 hands) with CTS and 18 asymptomatic controls (28 hands) underwent electrodiagnostic testing and ultrasonography.Results: CSA at the inlet was larger in patients, whereas DMS showed only trend towards being smaller in CTS. CTS was also associated with more distal localization of maximal stenosis. Both SI diameter and SI CSA were higher in patients, however the discriminative effect of SI CSA was stronger. SI diameter, SI CSA, CSA at the inlet and DMS correlated with the electrodiagnostic severity grade of CTS. The post-hoc analysis revealed that patients with moderate and severe electrodiagnostic grade of CTS have smaller DMS, whereas patients with mild CTS did not differ from controls.Conclusion: DMS seems to have only limited diagnostic potential in mild CTS, but it may be a marker of more advanced cases. CTS may be associated with the distal shift of DMS. SI CSA may have significant diagnostic potential in CTS.Plain Language Summary: Carpal tunnel syndrome is a frequent condition, where the median nerve is compressed within the wrist by surrounding anatomical structures. As a consequence, the pain and numbness of the wrist, hand and fingers (except the little finger) occur. Further symptoms include loss of grip strength and hand dexterity. Traditionally, diagnosis is supported by the nerve conduction study, a medical procedure which may be painful. A painless alternative is the ultrasonography, which usually visualizes the nerve enlargement close to the compression. Only recently, ultrasound equipment became advanced enough to visualize the compression itself (Anatomical structures surrounding the nerve within the tunnel make the transmission of the ultrasound-waves difficult). In consequence, a number of researchers attempted to measure the nerve at the compression site to improve the diagnosis. They used to measure the diameter of the compressed nerve at certain anatomical point (landmark), eg, the hamate bone. In this work, we investigated the diagnostic usefulness of the measurement of nerve diameter at the maximal compression. Obtained results revealed that measurement at this point may not be an efficient diagnostic method at least in the early stage of the disease. On the other hand, when we combined this measurement with traditional measurement of nerve enlargement close to compression, the diagnostic accuracy turned to be very efficient.Keywords: carpal tunnel syndrome, ultrasound, nerve stenosis, cross-sectional area, stenosis index

Abstract Purpose (1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes. Methods Data between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs. Results A total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P

Introduction: This study aimed to investigate differences in the three-dimensional (3D) upper airway dimensions in Vietnamese participants. Methods: This study included 341 Vietnamese participants grouped based on the vertical growth pattern (ANB angle) (skeletal Class I, 123; Class II, 124; Class III, 94). The patients were categorized into subgroups based on the horizontal growth pattern according to the Frankfort mandibular angle (hypodivergent, 35; normodivergent, 175; hyperdivergent, 131) to compare the frequency distribution of the three growth patterns in each skeletal class. The airway dimensions of the three skeletal classes were divided into four volumes using 3D virtual software (In VivoDental Software 6.0). The height, width, and cross-sectional area (CSA) of each part, as well as the total volume and minimum CSA, were measured and analyzed. Results: The airway space was reduced in hyperdivergent Class II individuals, underscoring an important connection between upper airway dimensions and vertical skeletal patterns, which suggests that vertical growth patterns contribute to pharyngeal narrowing and subsequent upper airway obstruction. Significant differences (p < 0.001) in the minimum CSAs and volumes of the middle and inferior pharyngeal airways were observed based on Angle's skeletal classification. Conclusions: Our insights are valuable for orthodontics, especially in diverse populations, such as the Vietnamese, due to differences in the influence of genetic and environmental factors on skeletal and airway characteristics. [ABSTRACT FROM AUTHOR]

This study aimed to assess variances in paravertebral muscle structure in individuals with idiopathic scoliosis (IS) through imaging techniques. A cohort of 112 patients diagnosed with IS and treated at our institution between January and December 2023 was included in the analysis. During the same period, 37 patients with secondary scoliosis (SS) were included as controls. Imaging data were used to measure the Cobb angle of the apical vertebrae in scoliosis patients, along with the area and fat infiltration of the paravertebral muscles on both sides. Finally, the cross-sectional area of the paravertebral muscles and the degree of fat infiltration were comparatively evaluated. In patients with IS, the paravertebral muscles on the concave side of the main curve were significantly larger than those on the convex side (P < 0.05). The concave/convex muscle area ratio in IS patients showed a positive correlation with the Cobb angle and scoliosis duration (both P < 0.05). There was no significant difference in the muscle area ratio between patients with IS and those with SS (P > 0.05). In IS, the paravertebral muscles on the concave side of the main curve exhibited more fat infiltration than those on the convex side, with this fat infiltration positively correlating with body mass index, Cobb angle, age, and scoliosis duration. Similarly, the degree of fat infiltration in the paravertebral muscles on the concave side of SS was more than that observed on the convex side. Furthermore, the degree of fat infiltration in the paravertebral muscles associated with SS was more pronounced compared to that seen in IS (P < 0.05). In IS patients, the paravertebral muscles on the concave side are more prominent and exhibit more fat infiltration compared to those on the convex side. This fat infiltration positively correlates with the Cobb angle, scoliosis duration, body mass index, and age, possibly indicating scoliosis progression. [ABSTRACT FROM AUTHOR]

Background and Purpose: Spinal cord (SC) cross‐sectional areas (CSAs) assessed with MRI have proven to be extremely valuable imaging markers in several diseases. Among the challenges is the delineation of vertebral levels to determine level‐dependent changes in cord atrophy. With this study, we aimed to (1) test the hypothesis that there is proportionality in the position of the first six intervertebral discs and the length of the upper portion of the SC and (2) show that a proportionality approach can simplify the CSA assessment across vertebrae offering good reliability. Methods: Forty‐six volunteers underwent standard T2‐weighted and T1‐weighted cervical SC MRI acquisitions. The distance between the obex and the intervertebral discs (from C2‐C3 to T1‐T2) was measured on the T2‐weighted acquisitions of the entire cohort. In a test‐retest experiment on 12 subjects, the % disc position values were used to define vertebral levels, and a comparison was performed with manual vertebrae assignment in terms of mean CSA and its coefficient of variation. Results: The mean upper cord length for the cohort was 144.0 ± 13.1 mm. The discs' level % position in the upper cord was found to be fairly consistent, with standard deviations of 0.8%‐1.7%. The mean vertebral CSA obtained with the proportionality method was substantially equivalent to the manual approach in terms of mean CSA values and test‐retest reliability. Conclusions: With this study, we propose a proportionality method for the assignment of cervical SC vertebral levels that can simplify the processing of MRI datasets in the context of CSA measurements. [ABSTRACT FROM AUTHOR]

Background and Purpose: Lateral elbow pain is quite common in everyday life. Lateral epicondylitis and radial tunnel syndrome are the most common causes of lateral elbow pain. The aim of this study was to evaluate the sensitivity and specificity of neuromuscular ultrasound examination in the diagnosis of lateral epicondylitis versus radial tunnel syndrome. Methods: This was a prospective double‐blinded pilot study of 68 elbows in 34 patients with lateral elbow pain. Patients underwent clinical examination and standardized neuromuscular ultrasound evaluation in the first 15 days after the initiation of symptoms. Statistical significance was set at p <.001. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Sixty‐eight radial nerves were examined in 34 healthy controls (16 males; mean age 48.1 ± 8.2 years). Pain with palpation over the radial tunnel was found in 25 of 48 elbows (52.1%) compared to the pain over the lateral epicondyle found in 10 of 48 elbows (20.8%). Τhe sensitivity of palpation in differentiating radial tunnel syndrome from lateral epicondylitis was 75.7%, while the specificity was 50% (PPV 71.4%, NPV 51.5%). The sensitivity of neuromuscular ultrasound in differentiating radial tunnel syndrome from lateral epicondylitis was 92.6%, while the specificity was 80% (PPV 92.6%, NPV 80.0%). In most of the patients (25/31), fibrous bands anterior to the radio‐capitellar joint were responsible for the nerve entrapment. Conclusions: The present study highlights the importance of the neuromuscular ultrasound's diagnostic role in differentiating radial tunnel syndrome from lateral epicondylitis in the clinical scenario of lateral elbow pain. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Nerve enlargement has been described in autoimmune nodopathy and chronic inflammatory demyelinating polyneuropathy (CIDP). However, comparisons of the distribution of enlargement between autoimmune nodopathy and CIDP have not been well characterized. To fill this gap, we explored differences in the ultrasonographic and electrophysiological features between autoimmune nodopathy and CIDP. Methods: Between March 2015 and June 2023, patients fulfilling diagnostic criteria for CIDP were enrolled; among them, those with positive antibodies against nodal–paranodal cell‐adhesion molecules were distinguished as autoimmune nodopathy. Nerve ultrasound and nerve conduction studies (NCS) were performed. Results: Overall, 114 CIDP patients and 13 patients with autoimmune nodopathy were recruited. Cross‐sectional areas (CSA) at all sites were larger in patients with CIDP and autoimmune nodopathy than in healthy controls. CSAs at the roots and trunks of the brachial plexus were significantly larger in patients with anti‐neurofascin‐155 (NF155), anti‐contactin‐1 (CNTN1), and anti‐contactin‐associated protein 1 (CASPR1) antibodies than in CIDP patients. The patients with anti‐NF186 antibody did not have enlargement in the brachial plexus. NCS showed more frequent probable conduction block at Erb's point in autoimmune nodopathy than in CIDP (61.9% vs. 36.6% for median nerve, 52.4% vs. 39.5% for ulnar nerve). Markedly prolonged distal motor latencies were also present in autoimmune nodopathy. Discussion: Patients with autoimmune nodopathies had distinct distributions of peripheral nerve enlargement revealed by ultrasound, as well as distinct NCS patterns, which were different from CIDP. This suggests the potential utility of nerve ultrasound and NCS to supplement clinical characteristics for distinguishing nodopathies from CIDP. [ABSTRACT FROM AUTHOR]

Background The rotator cuff (RC) plays a pivotal role in the performance and health of the shoulder and upper extremity. Blood flow restriction training (BFRT) is a modality to improve strength and muscle hypertrophy with even low-load training in healthy and injured individuals. There is minimal evidence examining its effect proximal to the occluded area, and particularly on the RC. Hypothesis & Purpose The purpose of this case series is to explore the effects of low-load BFRT on RC strength, hypertrophy, and tendon thickness in asymptomatic individuals. Study Design Case series. Methods Fourteen participants with asymptomatic, untrained shoulders were recruited to participate. They performed an eight-week low-load shoulder exercise regimen where BFR was applied to the dominant arm only during exercise. The dependent variables were maximal isometric strength of the shoulder external rotators(ER) and elevators (in the scapular plane in full can position) (FC) measured via handheld dynamometry, cross sectional area (CSA) of the supraspinatus and infraspinatus muscles, and supraspinatus tendon thickness measured via ultrasound imaging (US). Mean changes within and between arms were compared after training using paired t-tests. Cohen's d was used to determine effect sizes. Results All participants were able to complete the BFRT regimen without adverse effects. Mean strength and CSA increased for all variables in both arms, however this increase was only significant (p<0.01) for FC strength bilaterally and CSA for the supraspinatus and infraspinatus on the BFRT side. The effect sizes for increased supraspinatus and infraspinatus CSA on the BFRT side were 0.40 (9.8% increase) and 0.46 (11.7% increase) respectively. There were no significant differences when comparing the mean changes of the BFRT side to the non-BFRT side for strength or muscle CSA. There were no significant changes to supraspinatus tendon thickness. Conclusion These results suggest variability in response of the RC musculature to low-load BFRT in asymptomatic individuals. The potential for a confounding systemic response in the study design makes determining whether low-load BFRT is more beneficial than low-load non-BFRT difficult. The hypertrophy seen on the BFRT side warrants further study. Level of Evidence 4 [ABSTRACT FROM AUTHOR]

Human skeletal muscle fiber type composition varies greatly along the muscle, so one biopsy may not accurately represent the whole muscle. Recommendations on the number of biopsies and fiber counts using immunohistochemistry and whether these findings can be extrapolated to other muscles are lacking. We assessed fiber type composition in the vastus lateralis and gastrocnemius medialis muscles of 40 individuals. Per muscle, we took four biopsy samples from one incision, collecting two samples each from a proximally and distally directed needle. Based on another dataset involving 10 vastus lateralis biopsies per participant (n = 7), we calculated 95% limits of agreement for subsets of biopsies and fiber counts compared with the 10-biopsy average. Average absolute differences in type I fiber proportions between proximal and distal, and between within-needle samples were 6.9 and 4.5 percentage points in the vastus lateralis, and 5.5 and 4.4 percentage points in the gastrocnemius medialis, respectively. The 95% limits of agreement narrowed to ±10 percentage points when 200 fibers from at least three biopsies were analyzed, with minimal improvements with greater fiber counts. Type I fiber proportions in the vastus lateralis and gastrocnemius medialis showed a moderate positive association (r2 = 0.22; P = 0.006; at least 200 fibers in each of three to four samples per muscle). In conclusion, three biopsies with a minimum of 200 counted fibers are required to estimate the vastus lateralis fiber type composition within ±10 percentage points. Even when using these standards, researchers should be cautious when extrapolating muscle fiber type proportions from one muscle to another. NEW & NOTEWORTHY: Fiber type composition is equally variable in muscle biopsy samples taken from one incision as from multiple incisions. Hence, we propose two biopsies from a single incision—needles directed proximally and distally, and each rotated 180° for cutting a second sample—as a more feasible, less invasive alternative to three biopsies from as many incisions. In addition, we identified the gastrocnemius medialis as a slow-twitch muscle with an average of 64.7% slow fibers. [ABSTRACT FROM AUTHOR]

Purpose: (1) to investigate the consecutive changes in hip muscle volume in patients with femoroacetabular impingement syndrome (FAIS) during the initial postoperative period, and (2) to determine the potential effect of the early changes in hip muscle volume on clinical outcomes. Methods: Data between March 2021 and March 2022 was reviewed. Patients diagnosed with FAIS based on clinical symptoms and radiographic findings, and undergoing hip arthroscopic treatment were included. Exclusion criteria were incomplete MRI data, prior history of hip surgery, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). MRI was performed preoperatively and 3, 6, 12-month postoperatively. Cross-sectional area (CSA) of hip muscles including rectus femoris (RF), iliocapsularis (IC), iliopsoas (IP), gluteus medius/minimus complex (G-med/min), and gluteus maximus (G-max) were collected on MRI. The CSA was corrected by body surface area (BSA). Preoperative and a minimum of 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and international Hip Outcome Tool, 12-component form (iHOT-12) were collected. A multivariate linear regression model was built to determine the influence of the potential factors on postoperative PROs. Results: A total of 76 patients were included in the study. Compared to the preoperative level, decreased volume of RF and G-max, and increased IC/RF ratio were observed at postoperative 3 months (all with P <.05). Both G-med/min and G-max presented decreased volume at postoperative 6 months (all with P <.05). G-med/min presented decreased volume (P =.001) at postoperative 12 months. Changes in RF at postoperative 3 months and 12 months were positively related to improvement of iHOT-12 (Beta = 0.371, P =.012 and Beta = 0.330, P =.026, respectively). Changes in IC at postoperative 6-month was positively related to improvement of mHHS (Beta = 0.367, P =.027) and iHOT-12 (Beta = 0.315, P =.044). Conclusion: During the initial first year following arthroscopic treatment for FAIS, decreased volume of the RF and gluteal muscles was observed. Early changes in volume of RF and IC were positively correlated to the improvement of minimum 2-year PROs. Level of evidence: Level IV; case series. [ABSTRACT FROM AUTHOR]

Simple Summary: Numerous studies have examined the accessory ligament of the deep digital flexor tendon (AL-DDFT), focusing on both its normal and pathological anatomy. However, limited information is available regarding the precise relationship between the AL-DDFT and its surrounding structures. Clinically, this ligament is often implicated in desmitis and the formation of adhesions, yet the mechanisms driving these pathological changes are not fully understood. While previous investigations have suggested potential contributing factors, detailed descriptive studies are still necessary. In this study, macroscopic, microscopic, and morphometric analyses of the AL-DDFT were carried out. Through dissection and examination of E12 plastinated sections, we provide novel insights into the structural organization and interactions of the AL-DDFT with adjacent tissues. These findings enhance the current understanding of the anatomical and clinical aspects of the AL-DDFT, building upon and integrating previous research. The accessory ligament of the deep digital flexor tendon (AL-DDFT) plays a crucial role in the stay apparatus of the horse. This study aimed to investigate the anatomical relationship between the AL-DDFT, the superficial digital flexor tendon (SDFT), and other structures in the metacarpal region. Sixteen distal forelimbs from eight horses, aged 1 to 6 years, were evaluated through macroscopic, microscopic, and morphometric analyses, utilizing detailed dissection, E12 plastinated sections, and histological analysis. During lateral dissection, a connection was observed between the AL-DDFT and the SDFT. Histological evaluation revealed that this connection was a fibrous band (FB), extending the common synovial sheath (CSS) to the SDFT, along with associated collagen fibrils of the epiligament and peritenon. Additionally, two distinct forms of the AL-DDFT were identified, Type I and Type II, with Type II showing a greater cross-sectional area (CSA) than Type I. While numerous morphological and morphometric studies have explored the AL-DDFT and related structures, research incorporating plastination-based morphological and histological evaluations remains scarce. The findings provide valuable insights for both the morphological and clinical assessment of structures within the metacarpal region. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients. This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients. This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1. Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t -tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude. Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy. The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to examine the effects of 8-weeks (3 days/week) of linear periodization resistance exercise training (RET) on neuromuscular function in prepubescent youth. Methods: Twenty-five healthy prepubescent youth (11 males, 14 females, age = 9.1 ± 0.8 years) completed the RET (n = 17) or served as controls (CON, n = 8). Isometric maximal voluntary contractions (MVCs) and trapezoidal submaximal contractions at 35 and 60% MVC of the right leg extensors were performed with surface electromyography (EMG) recorded from the leg extensors [vastus lateralis (VL), rectus femoris, and vastus medialis] and flexors (biceps femoris and semitendinosus). EMG amplitude of the leg extensors and flexors were calculated during the MVCs. Motor unit (MU) action potential trains were decomposed from the surface EMG of the VL for the 35 and 60% MVCs. MU firing rates and action potential amplitudes were regressed against recruitment threshold with the y-intercepts and slopes calculated for each contraction. Total leg extensor muscle cross-sectional area (CSA) was collected using ultrasound images. ANOVA models were used to examine potential differences. Results: Isometric strength increased post-RET (P = 0.006) with no changes in leg extensor and flexor EMG amplitude. Furthermore, there were no changes in total CSA or the MU action potential amplitude vs. recruitment threshold relationships. However, there were increases in the firing rates of the higher-threshold MUs post-RET as indicated with greater y-intercepts (P = 0.003) from the 60% MVC and less negative slope (P = 0.004) of the firing rates vs. recruitment threshold relationships at 35% MVC. Conclusions: MU adaptations contribute to strength increases following RET in prepubescent youth. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the diagnostic accuracy of median nerve cross‐sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic‐based (EDX) classification systems. Methods: Retrospective analysis of cross‐sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX‐based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability. Results: Binary categorizations of CTS (ie, "Normal" vs "Absent") were statistically superior to consolidated categorizations of CTS severity (ie, "Normal," "Mild," "Moderate," or "Severe"). Binary categorizations established consistent CSA cutoff values across all EDX‐based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: <7 or <1 mm2 to rule out and >13 or >7 mm2 to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: ≤10 or ≤3 mm2 to rule out and ≥11 or ≥4 mm2 to rule in CTS, respectively. Conclusions: Using median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, binary categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX‐based classifications examined. [ABSTRACT FROM AUTHOR]

Among different mechanical properties, stiffness of natural fibers is one of the most important and challenging properties to measure due to their irregular cross section area. In this paper, a direct strain measurement method is presented and applied to Fique (Fucraea andina) fibers. The results are compared against the conventional indirect strain measurement method commonly used in fiber characterization. The latter requires considering the system compliance, being particularly challenging for natural fibers with a wide variability among them. One solution to address this issue can be using gauge lengths of around 100 to 200 mm, which are longer than the ones typically used for the characterization of single fibers. Each fiber’s cross section has been measured precisely, and the assumption that fibers have a circular cross section is studied. The Young’s modulus of the tested Fique fibers is measured to be 17 GPa using indirect strain measurement, and it is found to increase with gauge length using direct strain measurement to 18 GPa for 100 mm length, for either area calculation approach. Fibers’ area values show differences from assuming circularity to measure the cross-sectional area, but its impact on the Young’s modulus is not significant when enough number of fibers is tested.

Abstract Background This systematic review aimed to discern the relationships between muscle morphology, architecture, and quality with sprint cycling performance while considering the multifaceted nature of these relationships across diverse studies. Methods Employing the PRISMA guidelines, an exhaustive search was performed across four primary databases: MEDLINE/PubMed, Web of Science, CINAHL Complete, and SPORTDiscus. The Methodological Index For Non-Randomised Studies (MINORS) was used to assess the methodological quality of the included studies. Out of 3971 initially identified records, only 10 studies met the eligibility criteria. Results These investigations underscored the robust relationship of quadriceps muscle volume with peak power output (R2 from 0.65 to 0.82), suggesting its pivotal role in force production. In muscle architecture, the pennation angle and fascicle length showed varied associations with performance. Furthermore, muscle quality, as denoted by echo intensity, showed preliminary evidence of a potential inverse relationship with performance. The methodological quality assessment revealed varied scores, with the most consistent reporting on the aim, endpoints, and inclusion of consecutive patients. However, limitations were observed in the prospective calculation of study size and unbiased assessment of study endpoints. Conclusion Our findings indicate that muscle volume is a major determinant of sprint cycling performance. Muscle architecture and quality also impact performance, although in a more intricate way. The review calls for standardised methodologies in future research for a more comprehensive understanding and comparability of results. PROSPERO registration number CRD42023432824 ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=432824 ).

Purpose: To evaluate the clinical feasibility of atlantoaxial intra-articular cage (AIC) fusion via intermuscular approach for treating reducible atlantoaxial dislocation (AAD). Methods: An analysis was conducted on the data of 10 patients who underwent C1-C2 segmental fixation and AIC fusion for AAD by unilateral intermuscular approach and contralateral open approach. Outcome assessments included Japanese Orthopaedic Association score (JOA) and Visual Analog Scale Score for Neck Pain (VASSNP). The duration of surgical exposure, screw insertion and cage insertion, and postoperative drainage volume were also compared between two approaches. Bone fusion was evaluated through computed tomography (CT) reconstruction. Postoperative paravertebral tissue edema was evaluated by paravertebral tissue cross-sectional area (CSA) and signal intensity on T2 weighted sequence of magnetic resonance imaging (MRI) at 3 days postoperatively. Results: The intermuscular approach exhibited a longer exposure time but lower drainage postoperatively compared to the open approach (P < 0.05). After operation, JOA scores significant improved (P < 0.05), while VASSNP scores significantly decreased (P < 0.05). There was no significant difference in preoperative CSA between two approaches (P > 0.05). However, compared to the open approach, the intermuscular approach exhibited less CSA (P < 0.05) and lower T2 signal intensity on MRI postoperatively, indicating less invasive to the paravertebral tissues. Conclusions: AIC fusion by intermuscular approach is an effective and safe technique in the treatment of reducible AAD. Intermuscular approach could reduce the postoperative drainage volume and the extent of paravertebral tissue edema compared to open approach. [ABSTRACT FROM AUTHOR]

Background and purpose: Nerve cross‐sectional area (CSA) is not constant over the human lifespan. The relationship between an increasing CSA and age has been described as a linear positive correlation, but few studies have found a linear decrease in nerve size with older age. The aim of the present study was to analyze the development of nerve CSA in a healthy population from early childhood to old age using high‐resolution ultrasound. Methods: The median, ulnar, radial and sural nerves were examined bilaterally at 18 nerve sites in 110 healthy children, adolescents and adults aged between 2 and 98 years. The CSA of every nerve site was evaluated separately and in different age groups. The correlation of CSA with age, height and weight was analyzed in a linear, logarithmic and quadratic model and correlation coefficients were compared in a goodness‐of‐fit analysis. Models were then adjusted for weight and height. Results: Linear CSA–age correlations showed the lowest correlation coefficients for all nerve sites. An inverted parabolic curve suggesting a quadratic correlation of CSA and age was the best‐fitting model. Weight and height had a higher predictive value than age in adjusted models. Conclusions: There is an increase in nerve size during childhood and adolescence and a trend towards a decrease in old age, suggesting an inverted parabolic curve partly explained by age‐related changes in weight and height. Enlarged nerves in elderly individuals should not be attributed to age alone. [ABSTRACT FROM AUTHOR]

Background: This systematic review aimed to discern the relationships between muscle morphology, architecture, and quality with sprint cycling performance while considering the multifaceted nature of these relationships across diverse studies. Methods: Employing the PRISMA guidelines, an exhaustive search was performed across four primary databases: MEDLINE/PubMed, Web of Science, CINAHL Complete, and SPORTDiscus. The Methodological Index For Non-Randomised Studies (MINORS) was used to assess the methodological quality of the included studies. Out of 3971 initially identified records, only 10 studies met the eligibility criteria. Results: These investigations underscored the robust relationship of quadriceps muscle volume with peak power output (R2 from 0.65 to 0.82), suggesting its pivotal role in force production. In muscle architecture, the pennation angle and fascicle length showed varied associations with performance. Furthermore, muscle quality, as denoted by echo intensity, showed preliminary evidence of a potential inverse relationship with performance. The methodological quality assessment revealed varied scores, with the most consistent reporting on the aim, endpoints, and inclusion of consecutive patients. However, limitations were observed in the prospective calculation of study size and unbiased assessment of study endpoints. Conclusion: Our findings indicate that muscle volume is a major determinant of sprint cycling performance. Muscle architecture and quality also impact performance, although in a more intricate way. The review calls for standardised methodologies in future research for a more comprehensive understanding and comparability of results. PROSPERO registration number: CRD42023432824 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=432824). Key Points: • Muscle size matters: greater muscle volume and cross-sectional area correlate strongly with peak power output, emphasising the importance of muscle size in sprint cycling. • Pennation angle positively correlates with peak power output, but varied associations indicate the existence of other influencing factors, highlighting the complexity of muscle architecture in sprint performance. • Preliminary evidence suggests lower echo intensity, indicating higher muscle quality, may be linked to better sprint performance, urging further exploration of this relationship in athletes. [ABSTRACT FROM AUTHOR]

Background. Muscle hypertrophy is one of the main goals of resistance training and is frequently associated with an increase in muscle cross-sectional area (CSA). Imaging techniques are valid and reliable techniques for measuring CSA but are inaccessible to most professionals. Anthropometric-based multiple regression equations (i.e. using circumference and skinfolds outcomes) have been proposed to estimate muscle CSA describing a limited number of muscles. Purpose. The aim of this study was to develop anthropometric-based multiple regression equations using ultrasound images to estimate CSA of pectoralis major, biceps brachii, triceps brachii, rectus abdominis, rectus femoris, vastus lateralis, biceps femoris, gastrocnemius lateralis and medialis muscles at two distinct regions for each muscle assessed. Methods. Thirty trained women and men (mean ± SD; body mass = 69.6 ± 11.1 kg; stature = 168.5 ± 8.9 cm; and age = 25.7 ± 4. years) participated in the study. Circumference and skinfold measurements were taken at the same points where ultrasound images were acquired to evaluate the CSA of muscles analyzed. Muscle CSA area was assessed using panoramic-view ultrasound. Results. Seventeen multiple regression equations were developed using measures of circumference, skinfold, body weight, height and muscle CSA. Conclusions. Ten equations developed presented the relative errors between 7.2 and 19.9%. These values are comparable or less than those found in equations commonly used by sport and exercise professionals. Thus, these equations are recommended for single-time point estimation of muscle CSA. However, their usefulness for monitoring the CSA changes promoted by resistance training requires further research. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to examine the relationships between severity of stenosis, pain, functional limitation, disability, and quality of life in patients with cervical spondylotic radiculopathy. Materials and methods: Patients (45 female, 19 male) with radiculopathy due to spondylotic changes in the cervical spine were included in this study. Stenosis severity (thecal sac cross-sectional area (CSA)), numbness, neck and arm pain severity, functional limitation (Cervical Radiculopathy Impact Scale), disability, and quality of life (EQ-5D-3L General Quality of Life Scale) were evaluated. The study was registered at ClinicalTrials.gov as NCT06001359. Results: According to CSA values, 28 (43.75%) patients had severe stenosis and 36 (56.25%) had moderate stenosis, and the average CSA was 81.65 ± 10.08 mm². Positive correlations were found between both neck and arm pain and neck disability (r = 0.597, r = 0.359), and negative correlations were found for the General Quality of Life Scale index score and EQ-5D-3L visual analog scale (r = -0.787, r = -0.518). There were significant positive correlations between Cervical Radiculopathy Impact Scale subscales and severity of stenosis, neck and arm pain, numbness, and disability (p < 0.05 for all). A significant negative correlation was observed between Cervical Radiculopathy Impact Scale subscales and quality of life (p < 0.01). Stenosis severity was correlated with pain, neck disability, and quality of life (p < 0.01 for all). Conclusion: There are direct relationships between cervical spondylotic radiculopathy and neck and arm pain, numbness, disability, and quality of life. Additionally, an increase in the severity of cervical stenosis is associated with an increase in pain and disability. [ABSTRACT FROM AUTHOR]

We previously observed lifelong endurance exercise (LLE) influenced quadriceps whole‐muscle and myofiber size in a fiber‐type and sex‐specific manner. The current follow‐up exploratory investigation examined myofiber size regulators and myofiber size distribution in vastus lateralis biopsies from these same LLE men (n = 21, 74 ± 1 years) and women (n = 7, 72 ± 2 years) as well as old, healthy nonexercisers (OH; men: n = 10, 75 ± 1 years; women: n = 10, 75 ± 1 years) and young exercisers (YE; men: n = 10, 25 ± 1 years; women: n = 10, 25 ± 1 years). LLE exercised ~5 days/week, ~7 h/week for the previous 52 ± 1 years. Slow (myosin heavy chain (MHC) I) and fast (MHC IIa) myofiber nuclei/fiber, myonuclear domain, satellite cells/fiber, and satellite cell density were not influenced (p > 0.05) by LLE in men and women. The aging groups had ~50%–60% higher proportion of large (>7000 μm2) and small (<3000 μm2) myofibers (OH; men: 44%, women: 48%, LLE; men: 42%, women: 42%, YE; men: 27%, women: 29%). LLE men had triple the proportion of large slow fibers (LLE: 21%, YE: 7%, OH: 7%), while LLE women had more small slow fibers (LLE: 15%, YE: 8%, OH: 9%). LLE reduced by ~50% the proportion of small fast (MHC II containing) fibers in the aging men (OH: 14%, LLE: 7%) and women (OH: 35%, LLE: 18%). These data, coupled with previous findings, suggest that myonuclei and satellite cell content are uninfluenced by lifelong endurance exercise in men ~60–90 years, and this now also extends to septuagenarian lifelong endurance exercise women. Additionally, lifelong endurance exercise appears to influence the relative abundance of small and large myofibers (fast and slow) differently between men and women. [ABSTRACT FROM AUTHOR]

Background and Purpose: Uremic neuropathy (UN) is a disabling neuropathy in end‐stage kidney disease (ESKD) affecting the majority of patients receiving long‐term hemodialysis (HD). One previous nerve ultrasound study reported an increased cross‐sectional area (CSA) of the median nerve in moderate UN, while another study found enlarged sural nerves in small‐fiber polyneuropathy associated with ESKD. The present cohort study aims to analyze bilateral CSA of multiple nerves in UN. Methods: Ten nondiabetic ESKD patients with UN on HD for at least 2 years and 10 healthy age‐matched controls underwent bilateral ultrasound examinations with CSA measurements in 13 arm and leg nerve sites. Nerve conduction studies (NCS) and the total neuropathy score (TNS) were recorded. Pearson's coefficient and the Mann‐Whitney U‐test were used to analyze correlations and compare groups. Results: ESKD patients presented advanced neuropathic symptoms (mean TNS 15.9). NCS showed significantly reduced motor and sensory amplitudes in the UN group compared to the control group, and a slightly reduced nerve CSA was observed in 5 of 13 nerve sites (p <.05); the other nerve sites were not enlarged. Sural nerve CSA (p <.05) and sensory amplitude (p <.01) were negatively correlated with the TNS. Conclusions: Nerve enlargement was not observed in the present study in advanced UN. A reduced nerve CSA observed in the sural nerve suggests an axonal loss associated with long‐term HD in ESKD. During clinical workup of an acute disease of the peripheral nervous system in ESKD patients, nerve enlargement might be attributable to other causes than chronic UN. [ABSTRACT FROM AUTHOR]

Ramos-Campo, DJ, Benito-Peinado, PJ, Caravaca, LA, Rojo-Tirado, MA, and Rubio-Arias, JÁ. Efficacy of split versus full-body resistance training on strength and muscle growth: a systematic review with meta-analysis. J Strength Cond Res 38(7): 1330-1340, 2024-No previous study has systematically compared the effect of 2 resistance training routines commonly used to increase muscle mass and strength (i.e., split [Sp] and full-body [FB] routines). Our objective was to conduct a systematic review and meta-analysis following PRISMA guidelines to compare the effects on strength gains and muscle growth in healthy adults. 14 studies (392 subjects) that compared Sp and FB routines in terms of strength adaptations and muscle growth were included. Regarding the effects of the Sp or FB routine on both bench press and lower limbs strength, the magnitude of the change produced by both routines was similar (bench press: mean difference [MD] = 1.19; [-1.28, 3.65]; p = 0.34 k = 14 lower limb: MD = 2.47 [-2.11, 7.05]; p = 0.29 k = 14 . Concerning the effect of the Sp vs. FB routine on muscle growth, similar effects were observed after both routines in the cross-sectional area of the elbow extensors ( MD = 0.3 ; [-2.65, 3.24]; p = 0.84 k = 4 ), elbow flexors ( MD = 0.17 [-2.54, 2.88]; p = 0.91 k = 5 ), vastus lateralis ( MD = - 0.08 ; [-1.82, 1.66]; p = 0.93 k = 5), or lean body mass ( MD = - 0.07 ; [-1.59, 1.44]; p = 0.92 k = 6 ) . In conclusion, the present systematic review and meta-analysis provides solid evidence that the use of Sp or FB routines within a resistance training program does not significantly impact either strength gains or muscle hypertrophy when volume is equated. Consequently, individuals are free to confidently select a re- sistance training routine based on their personal preferences. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to provide data of nerve sizes and echogenicity reference values of the Lithuanian population. Methods: High-resolution ultrasound was bilaterally performed according to the Ultrasound Pattern Sum Score and Neuropathy ultrasound protocols for healthy Lithuanian adults. Cross-sectional area (CSA) measurement and echogenicity were used as the main parameters for investigation. Echogenicity was evaluated using ImageJ, and nerves were categorized in classes according to echogenicity. Results: Of 125 subjects enrolled, 63 were males (mean age 47.57 years, range 25–78 years) and 62 were females (mean age 50.50 years, range 25–80 years). Reference values of nerve sizes and values of echogenicity as a fraction of black in percentage of cervical roots, upper and middle trunks of the brachial plexus and the following nerves: vagal, median, ulnar, radial, superficial radial, tibial, fibular, and sural in standard regions were established. Mild to moderate correlations were found between nerves CSA, echogenicity values and anthropometric measurements with the differences according to sex. Inter-rater (ICC 0.93; 95% CI 0.92–0.94) and intra-rater (ICC 0.94; 95% CI 0.93–0.95) reliability was excellent. Conclusions: Reference values of nerve size and echogenicity of Lithuanians were presented for the first time as a novel such kind of publication from the Baltic countries. [ABSTRACT FROM AUTHOR]

Background: Clinicians and researchers are beginning to pay attention to the importance of the intrinsic foot muscles (IFMs). Among IFMs, the abductor hallucis (AbH) is associated with foot disorders. However, so far no method for assessing the strength of the AbH has been established. In addition, previous studies have shown increased IFM activity in the plantarflexed position of the ankle. Therefore, this study tests the hypothesis that a correlation will be found between the cross-sectional area (CSA) of the AbH and the flexion torque and that the first metatarsophalangeal (MTP) joint would be stronger in the plantarflexed (PF) position of the ankle joint than in the neutral (N) position. Methods: Eight male and 8 female patients (16 lower limbs) were included in this study to measure the CSA of IFM and the extrinsic foot muscles of the lower leg. Furthermore, the flexion torque of the first MTP joint was measured using a handheld dynamometer at the N and PF positions of the ankle joint. Correlation analysis was performed to examine the relationship between the CSA of each muscle and the flexion torque of the first MTP joint in the N and PF positions. Results: In the N position, a correlation was found between the flexion torque of the first MTP joint and the CSA of the AbH (r = 0.818), flexor hallucis brevis (r = 0.730), and flexor hallucis longus (r = 0.726). In the PF position, a correlation was found between the flexion torque of the first MTP joint and the CSA of the AbH (r = 0.863) and flexor hallucis brevis (r = 0.680). (P <.05) Conclusion: Overall, this study suggested that by measuring flexion torque of the first MTP joint in the PF position, AbH strength can be estimated without using any expensive equipment. Level of Evidence: Level V, mechanism-baced reasoning. [ABSTRACT FROM AUTHOR]

Objectives: This study examines the associations between the median nerve (MN) shear wave elastography (SWE), the MN cross‐sectional area (CSA), patient's symptoms, and the neurophysiological severity of carpal tunnel syndrome (CTS). The most appropriate site to perform SWE was also tested. Methods: This prospective study comprised 86 wrists of 47 consecutive patients who volunteered for MN ultrasound after an electrodiagnostic study. The neurophysiological severity of CTS was assessed according to the results of a nerve conduction study (NCS). The MN CSA was measured at the carpal tunnel inlet (wCSA) and the forearm (fCSA). SWE was performed on the MN in a longitudinal orientation at the wrist crease (wSWE), at the forearm (fSWE), and within the carpal tunnel (tSWE). Results: The wCSA and wSWE correlated positively with the neurophysiological severity of CTS (r =.619, P <.001; r =.582, P <.001, respectively). The optimal cut‐off values to discriminate the groups with normal NCS and with findings indicating CTS were 10.5 mm2 for the wCSA and 4.12 m/s for the wSWE. With these cut‐off values, wCSA had a sensitivity of 80% and specificity of 87% and wSWE a sensitivity of 88% and specificity of 76%. Neither tSWE nor fSWE correlated with the neurophysiological severity of CTS or differed between NCS negative and positive groups (P =.429, P =.736, respectively). Conclusion: Shear wave velocity in the MN at the carpal tunnel inlet increases in CTS and correlates to the neurophysiological CTS severity equivalently to CSA measured at the same site. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

The impact of ultimate limit state checks on the fire resistance of the cross-section (element) of softwood structural timber is analyzed in this study, which was found to depend on the cross-sectional area, strength class or material quality expressed through the actual price. The limit state method and the reduced cross-section method were used to obtain numerical results. The established practice suggests that, if the ultimate limit state is satisfied, the softwood structural timber will meet fire resistance according to the load-bearing criterion of 30 min (R30). This study shows that this is not entirely correct and is not always applicable. The main results of this study are precisely related to the above, and it will now be possible to provide much more precise answers to questions related to fire resistance according to the load-bearing criterion. Certainly, the price, which plays a significant role in achieving a certain or required fire resistance, should not be overlooked. This study provides the possibility of optimizing the choice of the cross-sectional area, fire resistance and price, depending on the state of stress to which the cross-section (element) is exposed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the utility of semitendinosus tendon (ST) and gracilis tendon (GT) cross‐sectional area (CSA) on magnetic resonance imaging (MRI) and anthropometric characteristics in preoperative estimation of graft diameter in patients undergoing anterior cruciate ligament reconstruction (ACLR) with four‐strand hamstring autografts. Methods: Three databases were searched on 29 August 2023. The authors adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) and R‐AMSTAR (Revised Assessment of Multiple Systematic Review) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, anthropometric characteristics, imaging techniques, tendon CSA, correlation coefficients, sensitivities, specificities, regression models and cutoffs for predicting intraoperative graft diameters above 8 mm were recorded. Results: Forty‐six studies comprising 4140 patients were included. Twelve of 19 (63.2%) studies reporting on ST + GT CSA found a moderate to very high correlation with intraoperative graft diameter. Five of 10 (50%) and one of seven (14.3%) studies reporting on ST CSA and GT CSA, respectively, found a moderate to high correlation with intraoperative graft diameter. Cutoffs of ST + GT CSA for predicting graft diameters above 8 mm ranged from 15.8 to 31.2 mm2. Nine of 35 (25.7%) studies that reported on height found a moderate to very high correlation with graft diameter. Seven of 33 (21.2%) studies reporting on weight found a moderate correlation with graft diameter. Conclusion: Of the MRI parameters assessed, ST + GT CSA was the most reliable predictor of graft diameter. However, cutoffs, sensitivities, and specificities for predicting diameters above 8 mm were highly variable. Anthropometric characteristics in general were less predictive of graft diameter than MRI parameters. This information can be used by clinicians to predict patients at risk for ACLR failure due to insufficient graft size. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Concentrated Photovoltaic Thermal systems, integrating both photovoltaic and thermal technologies, have gained significant attention as a sustainable and efficient means of harnessing solar energy. This research paper investigates the performance of CPV/T systems by analysing four different collectors under diverse operating conditions. The collectors under scrutiny include Rectangular Channels, Trapezoidal Channel, Hexagonal honeycomb, and Chevron Pattern absorbers, each subjected to distinct parameter variations to comprehensively evaluate their efficiency and potential for integration into renewable energy systems. The study systematically examines the collectors' performance under varying environmental conditions, including 6 kWh/m2 solar irradiance, 24 °C ambient temperature, and 3 m/s wind speed. The impact of changing parameters such as velocity and fluid flow rate ranges from 20 to 30 kg/h on the overall system efficiency is thoroughly analysed. Through numerical simulations and experimental validations, the paper aims to provide insights into the dynamic behaviour of each collector type and their suitability for different applications and geographical locations. The analytical result correlates with the numerical mathematical models to provide more convincing evidence that the acquired data is accurate. At a flow rate of 30 kg/h, the overall efficiency is determined to be 49.3 % for the rectangular channel absorber, outperforming hexagonal honeycomb (41.2 %), chevron pattern (41.1 %), and Trapezoidal channel (40.9 %) absorbers. The simplicity and cost-effectiveness of the fabrication process for rectangular channel absorbers, achievable through standard manufacturing techniques such as etching or pressing into materials like copper, aluminium, or stainless steel, emerge as primary advantages.

BACKGROUND: Diabetic polyneuropathy remains a significant and urgent problem in the context of diabetes mellitus, affecting more than a quarter of patients with type 2 diabetes mellitus. Currently, the method of peripheral nerve examination using ultrasound is gaining worldwide popularity. In the Russian Federation, however, it remains widely used only in some medical institutions. The ultrasound method employs the indicator “nerve cross-sectional area” to diagnose this complication, exhibiting a high degree of sensitivity (93%) in comparison to magnetic resonance imaging data (67%). Foreign and Russian studies [3, 4] confirm the observed increase in the cross-sectional area of the nerve in patients with diabetes mellitus. AIM: The study aimed to assess the diagnostic value of the ultrasound method of peripheral nerve examination in the detection of diabetic polyneuropathy in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: The Philips Epiq 7 ultrasonic diagnostic device (USA) with a linear transducer, operating at a frequency of 4–18 MHz, was used. The comparison group consisted of 30 volunteers. The main group comprised 25 patients with type 2 diabetes mellitus and confirmed diabetic polyneuropathy, as determined by electroneuromyography and physical examination methods. The median cross-sectional area of the sciatic and common peroneal nerves in patients with type 2 diabetes mellitus and healthy volunteers was calculated. The criterion for a difference in area values was calculated using the Mann-Whitney test. RESULTS: The cross-sectional area thresholds were determined based on the 95th percentile of a cohort of healthy volunteers. In patients with type 2 diabetes mellitus, the following median nerve cross-sectional area values were found: for the sciatic nerve, 0.579 cm2 (at the gluteal crease) and 0.553 cm2 (2 cm proximal to the bifurcation); for the common peroneal nerve, 0.11 cm2 (1 cm distal to the bifurcation of the sciatic nerve) and 0.08 cm2 (at the level of the head of the fibula). In healthy volunteers, the values were as follows: for the sciatic nerve, 0.46 cm2 (at the gluteal crease) and 0.37 cm2 (2 cm proximal to the bifurcation); for the common peroneal nerve, 0.08 cm2 (1 cm distal to the bifurcation of the sciatic nerve) and 0.06 cm2 (at the level of the head of the fibula). A significant difference was found between the control and target groups using the Mann-Whitney test (p 0.01). CONCLUSIONS: In patients with type 2 diabetes mellitus and diabetic polyneuropathy, a significant increase in the cross-sectional area of the nerves of the lower extremities (sciatic and peroneal nerves) was revealed, which allows for the use of ultrasound as an additional method for the instrumental diagnosis of diabetic polyneuropathy. However, due to the small sample size, further study is required to confirm these findings.

Jessica S Staempfli,1 Melanie Kistler-Fischbacher,2 Jan Gewiess,3 Johannes Dominik Bastian,3 Anna K Eggimann4 1Medical Faculty, University of Bern, Bern, Switzerland; 2Centre on Aging and Mobility, Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland; 3Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland; 4Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, 3010, SwitzerlandCorrespondence: Anna K Eggimann, Department of Geriatrics, Inselspital, Bern University Hospital University of Bern, Freiburgstrasse 40, Bern, CH-3010, Switzerland, Tel +41 31 632 54 89, Email anna.eggimann@insel.chPurpose: Muscle ultrasound has emerged as a promising method in the diagnostic work-up of sarcopenia. The objective of this scoping review was to explore the validity of muscle ultrasound against the latest sarcopenia definitions among older adults.Methods: We adhered to the PRISMA guidelines for scoping reviews. A systematic search of databases was performed by two independent reviewers. All articles comparing the performance of ultrasound to an internationally acknowledged sarcopenia definition among older adults (≥ 60 years) and published between 2019/01/01 (the year updated sarcopenia definitions were introduced) and 2023/11/15 were included. Data were extracted and collated by muscle and muscle parameters.Results: Out of 2290 articles screened, six studies comprising 24 validity tests among a total of 1619 older adults (mean age 74.1 years, 52.2% female) were included. The validity tests investigated the rectus femoris (n = 7), biceps brachii (n = 5), gastrocnemius medialis (n = 4), tibialis anterior (n = 4), soleus (n = 3), and rectus abdominis (n = 1). The parameter muscle thickness (MT) (n = 14) was most commonly measured. The latest European and Asian sarcopenia definitions (EWGSOP2, AWGS2) were applied as reference standards in four validity tests each. None of the studies used the Sarcopenia Definition and Outcome Consortium (SDOC) criteria. The highest area under the curve AUC (0.92, 95% confidence interval [CI] 0.89– 0.94) was found for the muscle thickness of the rectus femoris muscle. Due to substantial heterogeneity among the studies, pooling of data using a meta-analytic approach was not feasible.Conclusion: Limited number of studies have examined the validity of muscle ultrasound for diagnosing sarcopenia based on recent definitions among older adults. Thereby, muscle thickness of the rectus femoris showed promising results regarding validity. Further studies are needed to investigate the validity of key muscles and to validate muscle ultrasound among older hospitalized patients.Keywords: geriatric assessment, muscle thickness, cross-sectional area, rectus femoris, POCUS, SARCUS, EWGSOP, AWGS, SDOC

Abstract Changes in myonuclear architecture and positioning are associated with exercise adaptations and ageing. However, data on the positioning and number of myonuclei following exercise are inconsistent. Additionally, whether myonuclear domains (MNDs; i.e., the theoretical volume of cytoplasm within which a myonucleus is responsible for transcribing DNA) and myonuclear positioning are altered with age remains unclear. The aim of this investigation was to investigate relationships between age and activity status and myonuclear domains and positioning. Vastus lateralis muscle biopsies from younger endurance‐trained (YT) and older endurance‐trained (OT) individuals were compared with age‐matched untrained counterparts (YU and OU; OU samples were acquired during surgical operation). Serial, optical z‐slices were acquired throughout isolated muscle fibres and analysed to give three‐dimensional coordinates for myonuclei and muscle fibre dimensions. The mean cross‐sectional area (CSA) of muscle fibres from OU individuals was 33%–53% smaller compared with the other groups. The number of nuclei relative to fibre CSA was 90% greater in OU compared with YU muscle fibres. Additionally, scaling of MND volume with fibre size was altered in older untrained individuals. The myonuclear arrangement, in contrast, was similar across groups. Fibre CSA and most myonuclear parameters were significantly associated with age in untrained individuals, but not in trained individuals. These data indicate that regular endurance exercise throughout the lifespan might better preserve the size of muscle fibres in older age and maintain the relationship between fibre size and MND volumes. Inactivity, however, might result in reduced muscle fibre size and altered myonuclear parameters.

There is a great interest in replacing synthetics with natural materials to minimize global climate change and environmental pollution. This study presents a simple yet effective method to extract natural fibers such as banana, sisal, and false banana plant fibers and their mechanical properties. An effective mechanical and chemical fiber treatment to improve the mechanical behavior of the fibers is presented. The quality of the fibers and the cross-sectional area of each fiber were examined using FTIR and a Zeta 20 optical 3D microscope. Compared with the untreated fibers, the proposed treatment improved the banana, sisal, and false banana fibers by 34.78%, 22.68%, and 3.08%, respectively. The ultimate tensile strength of the treated false banana fibers was higher than those of sisal and banana fibers by 13.05% and 14.08%, respectively, and the failure strain was higher by 40% and 16.66%, respectively. On the other hand, the linear density and tenacity of false banana were slightly lower than sisal fiber but marginally higher than banana fiber. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Ulnar nerve instability (UNI) in the retroepicondylar groove is described as nerve subluxation or dislocation. In this study, considering that instability may cause chronic ulnar nerve damage by increasing the friction risk, we aimed to examine the effects of UNI on nerve morphology ultrasonographically. Methods: Asymptomatic patients with clinical suspicion of UNI were referred for further clinical and ultrasonographic examination. Based on ulnar nerve mobility on ultrasound, the patients were first divided into two groups: stable and unstable. The unstable group was further divided into two subgroups: subluxation and dislocation. The cross‐sectional area (CSA) of the nerve was measured in three regions relative to the medial epicondyle (ME). Results: In the ultrasonographic evaluation, UNI was identified in 59.1% (52) of the 88 elbows. UNI was bilateral in 50% (22) of the 44 patients. Mean CSA was not significantly different between groups. A statistically significant difference in ulnar nerve mobility was found between the group with CSA of <10 versus ≥10 mm2 (p =.027). Nerve instability was found in 85.7% of elbows with an ulnar nerve CSA value of ≥10 mm2 at the ME level. Discussion: The probability of developing neuropathy in patients with UNI may be higher than in those with normal nerve mobility. Further prospective studies are required to elucidate whether asymptomatic individuals with UNI and increased CSA may be at risk for developing symptomatic ulnar neuropathy at the elbow. [ABSTRACT FROM AUTHOR]

Background: The morphology and internal composition, particularly the nucleus-to-cross sectional area (NP-to-CSA) ratio of the lumbar intervertebral discs (IVDs), is important information for finite element models (FEMs) of spinal loadings and biomechanical behaviors, and, yet, this has not been well investigated and reported. Methods: Anonymized MRI scans were retrieved from a previously established database, including a total of 400 lumbar IVDs from 123 subjects (58 F and 65 M). Measurements were conducted manually by a spine surgeon and using two computer-assisted segmentation algorithms, i.e., fuzzy C-means (FCM) and region growing (RG). The respective results were compared. The influence of gender and spinal level was also investigated. Results: Ratios derived from manual measurements and the two computer-assisted algorithms (FCM and RG) were 46%, 39%, and 38%, respectively. Ratios derived manually were significantly larger. Conclusions: Computer-assisted methods provide reliable outcomes that are traditionally difficult for the manual measurement of internal composition. FEMs should consider the variability of NP-to-CSA ratios when studying the biomechanical behavior of the spine. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The main risk factor for pelvic floor disorders is vaginal delivery, which may cause levator ani muscle (LAM) injury and denervation. LAM includes pubovisceral muscle (PVM, pubococcygeus), puborectalis muscle (PRM), and iliococcygeus muscle. We hypothesize that primiparous women with low pelvic floor muscle contraction have a reduced PVM cross-sectional area (CSA) compared to nulliparous women. Methods (Sample Size and Statistical Approaches): This single-centre prospective observational study compared healthy nulliparous (n = 40) to primiparous (n = 40) women after vaginal delivery without LAM avulsion and Oxford score ≤ 3. Demographics, questionnaires (ICIQ-UI-SF, OAB-Q-SF, PISQ-12), POP-Q, Oxford score, ultrasound measurements (minimal anteroposterior and lateral diameters, hiatal area, PRM thickness, levator-urethra gap) and magnetic resonance imaging (MRI)—PVM CSA were evaluated. Normality was tested, and an appropriate test was used to compare the groups. Power calculation suggested 40 participants per group. Results: The primiparous group was older, had a higher BMI, and their hiatal area on ultrasound at contraction was larger compared to the nulliparous group. The CSA of the left-sided PVM (1.15 ± 0.50 cm2) was larger compared to the right side (1.03 ± 0.50 cm2), p = 0.02 in nulliparous women. The PVM CSA of primiparous women with low Oxford score was reduced compared to nulliparous (0.87 ± 0.30 versus 1.09 ± 0.50 cm2, p = 0.006). The intra-rater reliability for PVM CSA had an ICC of 0.90 and inter-rater ICC of 0.77. Conclusions: Primiparous women after vaginal delivery with low pelvic floor contraction force had reduced PVM CSA on MRI images compared to nulliparous women. [ABSTRACT FROM AUTHOR]

Chronic nonspecific low back pain (CNLBP) is a common disorder in people of active ages and significantly affects their quality of life. Different structures in the lumbar area can cause LBP. The lumbar muscle disorders, including the psoas major (PM) muscles, have an essential role in LBP. Magnetic Resonance Imaging (MRI) has been introduced as a safe and useful instrument for investigating the morphological properties of skeletal muscle. In general, PM morphology changes may be one reason for the pain and disability experienced in CNLBP patients. Thus, this study aimed to assess the relationship among the PM's Cross-sectional area (CSA), medial-lateral (ML), and anterior-posterior (AP) diameters, with disability index and pain score in patients with CNLBP. One hundred twenty patients with CNLBP (60 men and 60 women) participated in this cross-sectional study. Axial MRIs were obtained from L3/L4 and L4/L5 disc levels. Then, patients filled out Rolland Morris Disability Questionnaires, demographic data forms, and the Numeric Pain Rating Scale (NPRS). Image J software was used to analyze the images. Using Linear Regression and the Pearson test, the correlation between muscle CSA and diameters, as well as data obtained from questionnaires and NPRS, was analyzed. Results from the statistical analysis showed no statistically significant relationship among morphological characteristics of the psoas major muscle in L3/L4 and L4/L5 disc levels with disability index and pain score (p < 0.05). There is no significant relationship between the PM morphological characteristics and disability index and pain score. Therefore, muscle CSA and diameters are insufficient to determine the cause of CNLBP. [ABSTRACT FROM AUTHOR]

Changes in myonuclear architecture and positioning are associated with exercise adaptations and ageing. However, data on the positioning and number of myonuclei following exercise are inconsistent. Additionally, whether myonuclear domains (MNDs; i.e., the theoretical volume of cytoplasm within which a myonucleus is responsible for transcribing DNA) and myonuclear positioning are altered with age remains unclear. The aim of this investigation was to investigate relationships between age and activity status and myonuclear domains and positioning. Vastus lateralis muscle biopsies from younger endurance‐trained (YT) and older endurance‐trained (OT) individuals were compared with age‐matched untrained counterparts (YU and OU; OU samples were acquired during surgical operation). Serial, optical z‐slices were acquired throughout isolated muscle fibres and analysed to give three‐dimensional coordinates for myonuclei and muscle fibre dimensions. The mean cross‐sectional area (CSA) of muscle fibres from OU individuals was 33%–53% smaller compared with the other groups. The number of nuclei relative to fibre CSA was 90% greater in OU compared with YU muscle fibres. Additionally, scaling of MND volume with fibre size was altered in older untrained individuals. The myonuclear arrangement, in contrast, was similar across groups. Fibre CSA and most myonuclear parameters were significantly associated with age in untrained individuals, but not in trained individuals. These data indicate that regular endurance exercise throughout the lifespan might better preserve the size of muscle fibres in older age and maintain the relationship between fibre size and MND volumes. Inactivity, however, might result in reduced muscle fibre size and altered myonuclear parameters. What is the central question of the study?How do endurance exercise and the ageing process affect the positioning and number of myonuclei within muscle fibres?What are the main findings and their importance?There was reduced muscle fibre size, with smaller myonuclear domains and altered myonuclear domain scaling in older, untrained individuals. However, older trained individuals maintained similar muscle and myonuclear characteristics to younger trained individuals. This suggests that inactivity, rather than ageing, influences muscle fibre and myonuclear characteristics. These observations suggest that consistent endurance exercise over one's lifetime might help to preserve muscle fibre size and quality and myonuclear arrangement into old age. [ABSTRACT FROM AUTHOR]