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BackgroundParaspinal muscle fat infiltration is associated with spinal degeneration and low back pain, however, quantifying muscle fat using clinical magnetic resonance imaging (MRI) techniques continues to be a challenge. Advanced MRI techniques, including chemical-shift encoding (CSE) based water-fat MRI, enable accurate measurement of muscle fat, but such techniques are not widely available in routine clinical practice.MethodsTo facilitate assessment of paraspinal muscle fat using clinical imaging, we compared four thresholding approaches for estimating muscle fat fraction (FF) using T1- and T2-weighted images, with measurements from water-fat MRI as the ground truth: Gaussian thresholding, Otsu's method, K-mean clustering, and quadratic discriminant analysis. Pearson's correlation coefficients (r), mean absolute errors, and mean bias errors were calculated for FF estimates from T1- and T2-weighted MRI with water-fat MRI for the lumbar multifidus (MF), erector spinae (ES), quadratus lumborum (QL), and psoas (PS), and for all muscles combined.ResultsWe found that for all muscles combined, FF measurements from T1- and T2-weighted images were strongly positively correlated with measurements from the water-fat images for all thresholding techniques (r = 0.70-0.86, p

Purpose: This study aimed to investigate the relationship between physical activity (PA) levels and short-term changes in skeletal muscle characteristics in patients with subacute hemiparetic stroke. Materials and Methods: This prospective observational study included 76 patients with stroke who received inpatient care in a convalescent rehabilitation ward. The PA level was measured as the duration of daily total PA (≥ 1.5 metabolic equivalents) using a triaxial accelerometer for 7 days after admission. The outcomes were changes in the quadriceps muscle quality and quantity on the affected and unaffected sides, as assessed by ultrasonography at admission and 1 month after admission. Results: Multiple regression analysis indicated that the duration of total PA was significantly associated with a percentage change in quadriceps muscle quality (p = 0.011) and quantity (p = 0.012) on the affected side. However, no significant relationship was observed between the muscle quality and quantity on the unaffected side. Conclusions: The results revealed that PA was associated with changes in the quadriceps muscle quality and quantity on the affected side in patients with subacute hemiparetic stroke. These findings highlight the importance of promoting PA in stroke rehabilitation to improve muscle properties and functional outcomes. IMPLICATIONS FOR REHABILITATION: Improving skeletal muscle quality and quantity is an important goal in post-stroke rehabilitation. We investigated physical activity and post-stroke changes in muscle properties. Physical activity is related to changes in muscle quantity and quality on the affected side. Promoting physical activity is essential for improving muscle quantity and quality on the affected side. [ABSTRACT FROM AUTHOR]

Summary: Obesity is a major health burden worldwide. Although bariatric surgery (BS) is recognized as an effective strategy for weight loss and comorbidities improvement, its impact on muscle strength and quality is still unclear. We aimed to examine postoperative changes in muscle strength and quality and their relationship with body mass index (BMI) changes among adults undergoing BS. To this end, we systematically searched the WoS, PubMed, EBSCO, and Scopus databases. The meta‐analyses, which included 24 articles (666 participants), showed that BS reduces absolute lower‐limb isometric strength (ES = −0.599; 95% CI = ‐0.972, −0.226; p = 0.002). Subjects who experienced a more significant reduction in BMI after BS also suffered a higher loss of absolute muscle strength. Similarly, absolute handgrip strength showed a significant decrease (ES = −0.376; 95% CI = −0.630, −0.121; p = 0.004). We found insufficient studies investigating medium‐ and long‐term changes in muscle strength and/or quality after BS. This study provides moderate‐quality evidence that BS‐induced weight loss can reduce the strength of appendicular muscles in the short term, which should be addressed in management these subjects. More high‐quality studies are needed to evaluate the impact of BS on muscle strength and the different domains of muscle quality in the medium and long term (registered on PROSPERO CRD42022332581). [ABSTRACT FROM AUTHOR]

Muscle quality index (MQI) is a novel indicator reflecting the quality of skeletal muscles. The association between MQI and the development of advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is unknown. We investigated the association of low MQI with advanced fibrosis among adults with NAFLD using a nationally representative sample of the US population. Adults with NAFLD who participated in the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were included. Sex-specific standard was used to define low and extremely low MQI. Univariate and multivariate logistic regressions were used to assess the association between MQI level and advanced fibrosis. In the study, 3758 participants with NAFLD were included. The prevalence of low and extremely low MQI was 11.7% (95% CI 10.4–13.0%) and 2.2% (95% CI 1.6–2.8%), respectively. Among these participants, 96 were assessed to have advanced fibrosis. Individuals with low [(odds ratio (OR) 2.45, 95% confidence interval (CI) 1.22–4.91)] and extremely low MQI (OR 10.48, 95% CI 3.20–34.27) were associated with advanced fibrosis in multivariable analysis. A linear trend relationship was also observed between MQI level and the risk of advanced fibrosis (Ptrend = 0.001). Subgroup and sensitivity analyses yielded similar results to the main analyses. Decreased MQI is highly prevalent, and is associated with an increased risk of advanced fibrosis in adult US population with NAFLD. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has been proposed as a useful point-of-care diagnostic tool to assess muscle quality, but no validated cut-offs for sarcopenia have been reported. Using novel automated artificial intelligence (AI) software to interpret ultrasound images may assist in mitigating the operator-dependent nature of the modality. Our study aims to evaluate the fidelity of AI-aided ultrasound as a reliable and reproducible modality to assess muscle quality and diagnose sarcopenia in surgical patients. Methods: Thirty-six adult participants from an outpatient clinic were recruited for this prospective cohort study. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Ultrasonography of the rectus femoris muscle was performed, and images were analyzed by an AI software (MuscleSound® (Version 5.69.0)) to derive muscle parameters including intramuscular adipose tissue (IMAT) as a proxy of muscle quality. A receiver operative characteristic (ROC) curve was used to assess the predictive capability of IMAT and its derivatives, with area under the curve (AUC) as a measure of overall diagnostic accuracy. To evaluate consistency between ultrasound users of different experience, intra- and inter-rater reliability of muscle ultrasound parameters was analyzed in a separate cohort using intraclass correlation coefficients (ICC) and Bland–Altman plots. Results: The median age was 69.5 years (range: 26–87), and the prevalence of sarcopenia in the cohort was 30.6%. The ROC curve plotted with IMAT index (IMAT% divided by muscle area) yielded an AUC of 0.727 (95% CI: 0.551–0.904). An optimal cut-off point of 4.827%/cm2 for IMAT index was determined with a Youden's Index of 0.498. We also demonstrated that IMAT index has excellent intra-rater reliability (ICC = 0.938, CI: 0.905–0.961) and good inter-rater reliability (ICC = 0.776, CI: 0.627–0.866). In Bland–Altman plots, the limits of agreement were from −1.489 to 1.566 and −2.107 to 4.562, respectively. Discussion: IMAT index obtained via ultrasound has the potential to act as a point-of-care evaluation for sarcopenia screening and diagnosis, with good intra- and inter-rater reliability. The proposed IMAT index cut-off maximizes sensitivity for case finding, supporting its use as an easily implementable point-of-care test in the community for sarcopenia screening. Further research incorporating other ultrasound parameters of muscle quality may provide the basis for a more robust diagnostic tool to help predict surgical risk and outcomes. [ABSTRACT FROM AUTHOR]

Skeletal muscle is the largest organ system in the human body and plays critical roles in athletic performance, mobility, and disease pathogenesis. Despite growing recognition of its importance by major health organizations, significant knowledge gaps remain regarding skeletal muscle health and its crosstalk with nearly every physiological system. Relevant public health challenges like pain, injury, obesity, and sarcopenia underscore the need to accurately assess skeletal muscle health and function. Feasible, non-invasive techniques that reliably evaluate metrics including muscle pain, dynamic structure, contractility, circulatory function, body composition, and emerging biomarkers are imperative to unraveling the complexities of skeletal muscle. Our concise review highlights innovative or overlooked approaches for comprehensively assessing skeletal muscle in vivo. We summarize recent advances in leveraging dynamic ultrasound imaging, muscle echogenicity, tensiomyography, blood flow restriction protocols, molecular techniques, body composition, and pain assessments to gain novel insight into muscle physiology from cellular to whole-body perspectives. Continued development of precise, non-invasive tools to investigate skeletal muscle are critical in informing impactful discoveries in exercise and rehabilitation science. [ABSTRACT FROM AUTHOR]

Copyright of Acta Agriculturae Zhejiangensis is the property of Acta Agriculturae Zhejiangensis Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The mechanisms through which obesity impacts age-related muscle mass regulation are unclear. In the present study, rates of integrated myofibrillar protein synthesis (iMyoPS) were measured over 48-h prior-to and following a 45-min treadmill walk in 10 older-obese (O-OB, body fat[%]: 33 ± 3%), 10 older-non-obese (O-NO, 20 ± 3%), and 15 younger-non-obese (Y-NO, 13 ± 5%) individuals. Surface electromyography was used to determine thigh muscle "activation". Quadriceps cross-sectional area (CSA), volume, and intramuscular thigh fat fraction (ITFF) were measured by magnetic resonance imaging. Quadriceps maximal voluntary contraction (MVC) was measured by dynamometry. Quadriceps CSA and volume were greater (muscle volume, Y-NO: 1182 ± 232 cm3; O-NO: 869 ± 155 cm3; O-OB: 881 ± 212 cm3, P < 0.01) and ITFF significantly lower (m. vastus lateralis, Y-NO: 3.0 ± 1.0%; O-NO: 4.0 ± 0.9%; O-OB: 9.1 ± 2.6%, P ≤ 0.03) in Y-NO compared with O-NO and O-OB, with no difference between O-NO and O-OB in quadriceps CSA and volume. ITFF was significantly higher in O-OB compared with O-NO. Relative MVC was lower in O-OB compared with Y-NO and O-NO (Y-NO: 5.5 ± 1.6 n·m/kg−1; O-NO: 3.9 ± 1.0 n·m/kg−1; O-OB: 2.9 ± 1.1 n·m/kg−1, P < 0.0001). Thigh muscle "activation" during the treadmill walk was greater in O-OB compared with Y-NO and O-NO (Y-NO: 30.5 ± 13.5%; O-NO: 35.8 ± 19.7%; O-OB: 68.3 ± 32.3%, P < 0.01). Habitual iMyoPS did not differ between groups, whereas iMyoPS was significantly elevated over 48-h post-walk in O-OB (+ 38.6 ± 1.2%·day−1, P < 0.01) but not Y-NO or O-NO (+ 11.4 ± 1.1%·day−1 and + 17.1 ± 1.1%·day−1, respectively, both P > 0.271). Equivalent muscle mass in O-OB may be explained by the muscle anabolic response to weight-bearing activity, whereas the age-related decline in indices of muscle quality appears to be exacerbated in O-OB and warrants further exploration. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to understand the role of vitamin B12 supplementation in improving skeletal muscle function among the elderly. Methods: A literature review in the Medline database was conducted to understand the association between vitamin B12 and muscle function in Section A. In Section B, 28 healthy elderly participants aged ≥60 years were recruited in a cross‐sectional design for estimation of plasma vitamin B12 status and assessment of upper limb muscle strength Maximal voluntary contraction (MVC) and muscle quality (expressed as MVC/total muscle mass). Participants were grouped based on vitamin B12 status into vitamin B12‐depleted (<148 pmol/L) and replete (≥148 pmol/L) groups. In a quasi‐experimental study design, the vitamin B12‐depleted group (n = 14) received daily oral vitamin B12 supplementation of 100 μg for 3 months. All the study measures were repeated post‐supplementation. Results: Vitamin B12 deficiency was identified to contribute adversely to muscle strength, quality, and physical performance among older people in the extensive literature review. The pilot intervention study showed significant improvement in MVC and muscle quality (p < 0.050) post‐vitamin B12 supplementation, comparable to the vitamin B12‐replete group. Conclusions: Vitamin B12 may have a crucial role in the maintenance of muscle function. 3‐month oral vitamin B12 supplementation among subclinical vitamin B12 deficient elderly improved muscle strength and quality and reached levels similar to the vitamin B12 replete group. [ABSTRACT FROM AUTHOR]

Background: For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. Methods: A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. Results: Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. Conclusions: The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects. [ABSTRACT FROM AUTHOR]

Background: The aging process induces neural and morphological changes in the human musculoskeletal system, leading to a decline in muscle mass, strength and quality. These alterations, coupled with shifts in muscle metabolism, underscore the essential role of physical exercise in maintaining and improving muscle quality in older adults. Muscle quality's morphological domain encompasses direct assessments of muscle microscopic and macroscopic aspects of muscle architecture and composition. Various tools exist to estimate muscle quality, each with specific technical requirements. However, due to the heterogeneity in both the studied population and study methodologies, there is a gap in the establishment of reference standards to determine which are the non-invasive and direct tools to assess muscle quality after exercise interventions. Therefore, the purpose of this review is to obtain an overview of the non-invasive tools used to measure muscle quality directly after exercise interventions in healthy older adults, as well as to assess the effects of exercise on muscle quality. Main text: To address the imperative of understanding and optimizing muscle quality in aging individuals, this review provides an overview of non-invasive tools employed to measure muscle quality directly after exercise interventions in healthy older adults, along with an assessment of the effects of exercise on muscle quality. Results: Thirty four studies were included. Several methods of direct muscle quality assessment were identified. Notably, 2 studies harnessed CT, 20 utilized US, 9 employed MRI, 2 opted for TMG, 2 adopted myotonometry, and 1 incorporated BIA, with several studies employing multiple tests. Exploring interventions, 26 studies focus on resistance exercise, 4 on aerobic training, and 5 on concurrent training. Conclusions: There is significant diversity in the methods of direct assessment of muscle quality, mainly using ultrasound and magnetic resonance imaging; and a consistent positive trend in exercise interventions, indicating their efficacy in improving or preserving muscle quality. However, the lack of standardized assessment criteria poses a challenge given the diversity within the studied population and variations in methodologies.. These data emphasize the need to standardize assessment criteria and underscore the potential benefits of exercise interventions aimed at optimizing muscle quality. [ABSTRACT FROM AUTHOR]

Objectives:Methods:Results:Conclusion:Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses.Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent.Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0).Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill. [ABSTRACT FROM AUTHOR]

Purpose: Muscle quality is more important than muscle mass for assessing physical function. Computed tomography (CT) is used to evaluate intramuscular fatty infiltration. The mid-thigh quadriceps CT attenuation values (CTV) expressed in Hounsfield units (HU) negatively correlate with physical function. Patients with hip osteoarthritis (HOA) have lower extremity muscle atrophy, including decreased cross-sectional area (CSA), CTV, and muscle strength. Using preoperative CT images, we investigated the association between mid-thigh quadriceps CSA, CTV, and postoperative outcomes in patients with HOA. Methods: This study included 62 patients who had unilateral HOA (62 hips) and underwent total hip arthroplasty (THA). We investigated the association between preoperative and postoperative Japanese Orthopaedic Association (JOA) hip scores, 12-item Short Form survey (SF-12), mid-thigh quadriceps CSA, and CTV. Results: The mean age was 64.7 ± 10.1 years, with 15 men (24.2%), and the mean body mass index was 24.3 ± 4.3 kg/m2. Secondary HOA was present in 79.0% of patients. The mean CSA and CTV of the mid-thigh quadriceps on the operative side were 38.8 ± 9.8 cm2 and 40.3 ± 7.8 HU, respectively. Multiple regression analyses adjusted for age and sex showed that preoperative mid-thigh quadriceps CSA was not associated with preoperative and postoperative JOA hip scores or SF-12. The preoperative mid-thigh quadriceps CTV was associated with the postoperative JOA hip score in the gait ability domain and SF-12 in the physical component summary domain. Conclusion: Preoperative muscle quality is associated with postoperative outcomes in patients who have HOA regardless of age and sex. [ABSTRACT FROM AUTHOR]

Decreased muscle volume and increased muscle-associated adipose tissue (MAAT, sum of intra and inter-muscular adipose tissue) of the foot intrinsic muscle compartment are associated with deformity, decreased function, and increased risk of ulceration and amputation in those with diabetic peripheral neuropathy (DPN). What is the muscle quality (normal, abnormal muscle, and adipose volumes) of the DPN foot intrinsic compartment, how does it change over time, and is muscle quality related to gait and foot function? Computed tomography was performed on the intrinsic foot muscle compartment of 45 subjects with DPN (mean age: 67.2 ± 6.4 years) at baseline and 3.6 years. Images were processed to obtain volumes of MAAT, highly abnormal, mildly abnormal, and normal muscle. For each category, annual rates of change were calculated. Paired t-tests compared baseline and follow-up. Foot function during gait was assessed using 3D motion analysis and the Foot and Ankle Ability Measure. Correlations between muscle compartment and foot function during gait were analyzed using Pearson's correlations. Total muscle volume decreased, driven by a loss of normal muscle and mildly abnormal muscle (p<0.05). MAAT and the adipose-muscle ratio increased. At baseline, 51.5% of the compartment was abnormal muscle or MAAT, increasing to 55.0% at follow-up. Decreased total muscle volume correlated with greater midfoot collapse during gait (r = −0.40, p = 0.02). Greater volumes of highly abnormal muscle correlated with a lower FAAM score (r = −0.33, p = 0.03). Muscle volume loss may progress in parallel with MAAT accumulation, impacting contractile performance in individuals with DPN. Only 48.5% of the DPN intrinsic foot muscle compartment consists of normal muscle and greater abnormal muscle is associated with worse foot function. These changes identify an important target for rehabilitative intervention to slow or prevent muscle deterioration and poor foot outcomes. • CT imaging can be used to describe muscle quality of the intrinsic foot compartment. • Individuals with diabetic peripheral neuropathy demonstrate impaired muscle quality. • DPN muscle and presence of muscle-associated adipose tissue worsen over time. • Muscle quality, not adipose tissue, is related to foot function during gait. [ABSTRACT FROM AUTHOR]

Purpose: Many modern-day children are at risk of pediatric dynapenia (muscle weakness). We examined the effects of a 12-week resistance training (RT) program on neuromuscular function and body composition parameters in pubertal children with a risk of dynapenia. Methods: Twelve children (13.4 ± 0.9 y) with dynapenia performed a progressive RT program consisting of knee extension and flexion, bench press, abdominal crunch, back extension, lateral pull-down, elbow flexion, and upright row (1–2 sets of 10–15 repetitions/exercise) twice/week for 12 weeks. Outcome measures included one-repetition maximum (1-RM) strength, maximal voluntary isometric contraction (MVIC) torque, rate of torque development (RTD), electromyographic (EMG) activity, muscle thickness (MT), muscle quality (MQ) assessed by echo intensity (MQEI) of the knee extensors and specific tension of MVIC torque to thigh fat-free mass (MQST), and total and regional body and bone composition assessed by dual-energy X-ray absorptiometry. Changes in the measures before and after the 12-week RT and associations among the measures were analyzed by linear mixed models. Results: Significant (p < 0.05) increases in 1-RM (63.9 ± 4.5%), MVIC torque (16.3 ± 17.8%), MT (18.8 ± 5.5%) and MQ (MQEI: -25.9 ± 15.2%; MQST: 15.1 ± 18.8%;) were evident from pre- to post-training. Total fat-free mass (FFM) increased by 2.3 ± 3.2% from baseline (p = 0.01), but no changes (p > 0.05) in the other measures were observed. Significant (p < 0.05) associations between the changes in 1-RM and/or MVIC torque and the changes in quadriceps MT, MQEI, MQST and total body FFM were evident. Conclusions: The 12-week RT was effective for improving neuromuscular and body composition parameters, and thereby reversed the risk of pediatric dynapenia. [ABSTRACT FROM AUTHOR]

Although it is widely recognized that muscle quality significantly influences adverse outcomes in patients with cancer, the precise definition of muscle quality remains elusive. The muscle quality index (MQI), also known as muscle-specific strength, is a relatively recent functional concept of muscle quality. It is obtained through the ratio of muscle strength to muscle mass, but its predictive value in patients with cancer remains unknown. In this study, we explored the prognostic significance of MQI in patients with cancer. Furthermore, we introduce and assess the prognostic potential of a novel muscle quality metric: the strength-to-muscle-radiodensity index (SMRi). A secondary analysis was conducted on a prospective cohort study. CT scans were opportunistically used to assess body composition parameters, including skeletal muscle mass (SM in cm2) and muscle radiodensity (SMD in HU) at the third lumbar vertebra (L3). Handgrip strength (HGS) was measured. MQI CT was calculated using the ratio of HGS to SM (cm2). SMRi was calculated as the ratio of HGS to SMD (HU). For analysis purposes, low MQI CT and SMRi were defined using two approaches: statistical cutoffs associated with survival, and median-based distribution data. A total of 250 patients were included (52.8% females, 52% adults, 20–90 years). Gastrointestinal tumors and stage III-IV were the most frequent diagnosis and stages. SMRi and MQI CT were strongly positively correlated (ρ = 0.71 P < 0.001). Individual components of MQI CT and SMRi were also positively correlated. Patients with both low MQI CT and SMRi had shorter survival (log-rank P = 0.023 and P = 0.003, respectively). When applying median distribution cutoffs, SMRi emerged as the most accurate predictor of mortality (HR adjusted 3.18, 95% CI 1.50 to 6.75, C-index: 0.71), when compared to MQI CT (HR adjusted 1.49, 95% CI 0.77 to 2.87, C-index: 0.68). This study introduces the concept and potential prognostic significance of the SMRi. The physiological and clinical implications of this new index warrant further investigation across a spectrum of diseases, including cancer. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to develop a novel MRI-based paravertebral muscle quality (PVMQ) score for assessing muscle quality and to investigate its correlation with the degree of fat infiltration (DFF) and the vertebral bone quality (VBQ) score of paravertebral muscles. Additionally, the study compares the effectiveness of the PVMQ score and the VBQ score in assessing muscle quality and bone quality. Methods: PVMQ scores were derived from the ratio of paravertebral muscle signal intensity (SI) to L3 cerebrospinal fluid SI on T2-weighted MRI. Image J software assessed paravertebral muscle cross-sectional area (CSA) and DFF. Spearman rank correlation analyses explored associations between PVMQ, VBQ scores, DFF, and T-scores in both genders. Receiver operating characteristic (ROC) curves compared PVMQ and VBQ scores' effectiveness in distinguishing osteopenia/osteoporosis and high paraspinal muscle DFF. Results: In this study of 144 patients (94 females), PVMQ scores were significantly higher in osteoporosis and osteopenia groups compared to normals, with variations observed between genders (P < 0.05). PVMQ showed stronger positive correlation with VBQ scores and DFF in females than males (0.584 vs 0.445, 0.579 vs 0.528; P < 0.01). ROC analysis favored PVMQ over VBQ for low muscle mass in both genders (AUC = 0.767 vs 0.718, 0.793 vs 0.718). VBQ was better for bone mass in males (0.737/0.865 vs 0.691/0.858), whereas PVMQ excelled for females (0.808/0.764 vs 0.721/0.718). Conclusion: The novel PVMQ score provides a reliable assessment of paravertebral muscle quality and shows a strong correlation with VBQ scores and DFF, particularly in females. It outperforms VBQ scores in evaluating muscle mass and offers valuable insights for assessing bone mass in females. These findings underscore the potential of the PVMQ score as a dual-purpose tool for evaluating both muscle and bone health, informing future research and clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Objectives The objective of this study is to understand the role of vitamin B12 supplementation in improving skeletal muscle function among the elderly. Methods A literature review in the Medline database was conducted to understand the association between vitamin B12 and muscle function in Section A. In Section B, 28 healthy elderly participants aged ≥60 years were recruited in a cross‐sectional design for estimation of plasma vitamin B12 status and assessment of upper limb muscle strength Maximal voluntary contraction (MVC) and muscle quality (expressed as MVC/total muscle mass). Participants were grouped based on vitamin B12 status into vitamin B12‐depleted (

Abstract Muscle quality index (MQI) is a novel indicator reflecting the quality of skeletal muscles. The association between MQI and the development of advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is unknown. We investigated the association of low MQI with advanced fibrosis among adults with NAFLD using a nationally representative sample of the US population. Adults with NAFLD who participated in the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were included. Sex-specific standard was used to define low and extremely low MQI. Univariate and multivariate logistic regressions were used to assess the association between MQI level and advanced fibrosis. In the study, 3758 participants with NAFLD were included. The prevalence of low and extremely low MQI was 11.7% (95% CI 10.4–13.0%) and 2.2% (95% CI 1.6–2.8%), respectively. Among these participants, 96 were assessed to have advanced fibrosis. Individuals with low [(odds ratio (OR) 2.45, 95% confidence interval (CI) 1.22–4.91)] and extremely low MQI (OR 10.48, 95% CI 3.20–34.27) were associated with advanced fibrosis in multivariable analysis. A linear trend relationship was also observed between MQI level and the risk of advanced fibrosis (P trend = 0.001). Subgroup and sensitivity analyses yielded similar results to the main analyses. Decreased MQI is highly prevalent, and is associated with an increased risk of advanced fibrosis in adult US population with NAFLD.

Abstract Background The aging process induces neural and morphological changes in the human musculoskeletal system, leading to a decline in muscle mass, strength and quality. These alterations, coupled with shifts in muscle metabolism, underscore the essential role of physical exercise in maintaining and improving muscle quality in older adults. Muscle quality's morphological domain encompasses direct assessments of muscle microscopic and macroscopic aspects of muscle architecture and composition. Various tools exist to estimate muscle quality, each with specific technical requirements. However, due to the heterogeneity in both the studied population and study methodologies, there is a gap in the establishment of reference standards to determine which are the non-invasive and direct tools to assess muscle quality after exercise interventions. Therefore, the purpose of this review is to obtain an overview of the non-invasive tools used to measure muscle quality directly after exercise interventions in healthy older adults, as well as to assess the effects of exercise on muscle quality. Main text To address the imperative of understanding and optimizing muscle quality in aging individuals, this review provides an overview of non-invasive tools employed to measure muscle quality directly after exercise interventions in healthy older adults, along with an assessment of the effects of exercise on muscle quality. Results Thirty four studies were included. Several methods of direct muscle quality assessment were identified. Notably, 2 studies harnessed CT, 20 utilized US, 9 employed MRI, 2 opted for TMG, 2 adopted myotonometry, and 1 incorporated BIA, with several studies employing multiple tests. Exploring interventions, 26 studies focus on resistance exercise, 4 on aerobic training, and 5 on concurrent training. Conclusions There is significant diversity in the methods of direct assessment of muscle quality, mainly using ultrasound and magnetic resonance imaging; and a consistent positive trend in exercise interventions, indicating their efficacy in improving or preserving muscle quality. However, the lack of standardized assessment criteria poses a challenge given the diversity within the studied population and variations in methodologies.. These data emphasize the need to standardize assessment criteria and underscore the potential benefits of exercise interventions aimed at optimizing muscle quality.

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses.Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent.Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0).Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Functional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI. This is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54–69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01–0.84). Functional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI. [Display omitted] • Muscle quality is an independent predictor of mortality in patients post-AMI. • Isolated parameters of muscle quality had less predictive capacity. • Muscle quality index enhances the prognostic assessment of patients post-AMI. [ABSTRACT FROM AUTHOR]

Background : Muscle-liver crosstalk plays an important role in the development and progression of non-alcoholic fatty liver disease (NAFLD). The measurement of muscle echo-intensity during ultrasonography is a real-time, non-invasive method of assessing muscle quality. In this retrospective study, we investigated the significance of poor muscle quality (namely, a greater mass of non-contractile tissue, including intramuscular fat) as a risk factor for advanced liver fibrosis and considered whether it may represent a useful tool for the diagnosis of advanced liver fibrosis. Methods : We analyzed data from 307 patients with NAFLD (143 men and 164 women) who visited the University of Tsukuba Hospital between 2017 and 2022. The patients were stratified into the following tertiles of muscle quality according to their muscle echo-intensity on ultrasonography: modest (84.1 arbitrary units [A.U.]), intermediate (97.4 A.U.), and poor (113.6 A.U.). We then investigated the relationships between muscle quality and risk factors for advanced liver fibrosis and calculated appropriate cutoff values. Results : Patients with poor muscle quality showed a significant, 7.6-fold greater risk of liver fibrosis compared to those with modest muscle quality. Receiver operating characteristic curve analysis showed that muscle quality assessment was as accurate as the fibrosis-4 index and NAFLD fibrosis score in screening for liver fibrosis and superior to the assessment of muscle quantity and strength, respectively. Importantly, a muscle echo-intensity of ≥92.4 A.U. may represent a useful marker of advanced liver fibrosis. Conclusion : Muscle quality may represent a useful means of identifying advanced liver fibrosis, and its assessment may become a useful screening tool in daily practice.

Objectives: Muscle and bone tissue are interrelated throughout their developmental processes via paracrine and endocrine pathways. Osteosarcopenia has emerged with the growing data proving the high rate of simultaneous occurrence of sarcopenia and osteoporosis. We aimed to evaluate the relationship between osteoporosis, and muscle quality by grading the fatty infiltration in paraspinal muscles according to the Goutallier classification in magnetic resonance imaging (MRI). Methods: Data of postmenopausal patients who underwent MRI for low back pain were analyzed retrospectively. Lumbar spine and femoral neck bone mineral density (BMD) were measured by using dual energy X-ray absorptiometry (DXA). Grade of paraspinal muscle fatty infiltration for each level of lumbar vertebrae including L1-L2, L2-L3, L3-L4, was evaluated separately according to Goutallier classification system. Results: A total of 91 postmenopausal women were included in the study. The mean age of the study population was 60.5 ± 11. Lumbar vertebrae L1-L4 total T-scores and BMD g/cm2 were lower in patients with higher grades of Goutallier classification (P = 0.031 and P = 0.023, respectively). The distribution of the severity of fatty degeneration was significantly higher in the osteoporosis/osteopenia group at all 3 disc levels. No significant correlation was observed between femoral neck BMD and paraspinal muscle fat infiltration. Conclusions: There is a strong relationship between osteoporosis of the lumbar spine and paraspinal muscle quality, which can be considered as a reflection of osteosarcopenia. The Goutailler classification can be an effective and easy method in the evaluation of muscle quality with MRI.

Abstract Sarcopenia (low muscle mass, i.e., quantity) is associated with poor clinical outcomes in patients with acute-on-chronic liver failure (ACLF). In this study, we aimed to illustrate the clinical prognostic value of myosteatosis (muscle fat infiltration) for short-term mortality in patients with ACLF. We retrospectively enrolled consecutive patients with ACLF between January 2019 and January 2022. Computed tomography-based body composition analysis was performed at the third lumbar vertebral level to determine skeletal muscle radiation attenuation. Fine and Gray’s competing risk regression model, with liver transplantation as a competing risk, was used to assess the factors associated with 90-day mortality. A total of 431 patients with ACLF were included. Myosteatosis and sarcopenia were observed in 261 (60.6%) and 87 (20.2%) patients, respectively. Competitive risk regression showed that age (HR 1.021, 95% CI 1.000–1.043, P = 0.042), APASL ACLF Research Consortium (AARC) score (HR 1.498, 95% CI 1.312–1.710, P

This experiment aimed to evaluate the impact of dietary hydroxyproline (Hyp) supplementation on the muscle quality of juvenile Pacific white shrimp (Litopenaeus vannamei) fed a low fishmeal diet. Six formulated diets included one high fishmeal (HF; 25% fishmeal content) and five low fishmeal diets (10% fishmeal content) with 0%, 0.2%, 0.4%, 0.6% and 0.8% Hyp (LF0, LF2, LF4, LF6 and LF8, respectively). Each diet was assigned to four replicates, and 40 shrimp (0.32 ± 0.00 g) per replicate were fed four times a day for 8 weeks. Dietary Hyp supplementation had little effects on growth performance, but increased the contents of Hyp, prolyl 4-hydroxylases (P4Hs), and collagen. The meat yield, springiness, hardness, chewiness, and cohesiveness of muscle were the highest in the LF4 group among the low fishmeal groups (P < 0.05). Cooking loss and freezing loss of muscle were the lowest in the LF4 group (P

Abstract Background Sarcopenic obesity (SO) in nursing home residents is rarely studied. We aimed to evaluate and compare the prevalence and consistency of different SO diagnostic methods and to investigate which criterion demonstrated a stronger association with instrumental activities of daily living (IADL) disability. Methods We consecutively recruited older adults aged ≥ 60 years, residing in 15 nursing homes in Zigong City, China. Sarcopenia obesity was defined according to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity criteria (SOESPEN), recommending skeletal muscle mass (SMM) adjusted by body weight (SMM/W) to identify low muscle mass. Further, we adapted ESPEN criteria (SOESPEN−M) by employing SMM adjusted by body mass index (SMM/BMI). Results We included 832 participants (median age 73.0 years, 296 women). The prevalence of SOESPEN and SOESPEN−M was 43.5% and 45.3%, respectively. SOESPEN showed good consistency with SOESPEN−M (Cohen’s kappa = 0.759). More than one-third of participants in the normal weight group were diagnosed with SOESPEN or SOESPEN−M. Even within the underweight group, the prevalence of SOESPEN and SOESPEN−M was 8.9% and 22.2%, respectively. Participants with IADL disability had significantly lower SMM/W and SMM/BMI, but higher fat mass percentage of body weight (FM%) than participants without IADL disability. After full adjustment for potential confounders, SOESPEN−M (OR 1.68, 95% CI 1.21 to 2.32), but not SOESPEN (OR 1.28, 95% CI 0.93 to 1.75), remained significantly associated with IADL disability. Conclusions Both SOESPEN and SOESPEN−M showed a high prevalence among nursing home residents, even among individuals with underweight or normal weight. While SOESPEN had a good consistency with SOESPEN−M, only SOESPEN−M was independently associated with IADL disability. Screening and diagnosis of SO should be conducted in nursing home residents irrespective of BMI.

Hybrid F1 is a novel hybrid of Erythroculter ilishaeformis (♀) and Ancherythroculter nigrocauda (♂). Current studies have focused on the genetic features, evaluation of fillet quality, farming techniques, and so on. Meanwhile, few studies have addressed enhancing fillet quality. Traditional intensive pond aquaculture is the major culture method in China. A large amount of excreta and feed residuals remaining in the aquaculture water bodies restricts the critical nutrients, flesh texture, and taste of the fillet. In this study, juvenile hybrid F1 cultured in ponds was obtained from the seed farm (Wuhan Xianfeng Aquaculture Technology Company Limited, Wuhan, Hubei) as the study subject. The fish was treated with short-term micro-flow water (1.2 BL/s) to improve muscle quality. The effects of treatment time (0, 4, 8, and 12 d) on muscle quality in juvenile hybrid F1 flesh were investigated following short-term micro-flow water treatment by assessing the color, muscle fiber, texture, nutrient composition, and the contents of amino acid and fatty acid. The color of the samples was determined by a CR-400 automatic chromaticity meter (Konica Minolta, Japan), wherein the color was expressed by L, a*, and b*. The skin yellowness values were significantly higher at treated 8 d and 12 d, while the short-term micro-flow water treatment significantly influenced muscle redness (P < 0.05). The texture property of fish is one of the keys to its quality. The juvenile hybrid F1 flesh showed a significant improvement in fiber density, hardness, chewiness, and springiness by 70.96%, 92.04%, 198.99%, and 35.71% compared with the control group, respectively after 8 d treatment. Frozen fresh samples were lyophilized for the following analysis. Kjeldahl and Soxhlet-Henkel methods were used for the determination of total, crude protein (N=6.25) and fat content respectively. The protein and fat content significantly decreased in the flesh following the extension of micro-flow water treatment time, while the ash content did not significantly change (P > 0.05, the same below). The amino acid content presented the highest values of glutamic acid, followed by proline, and the lowest values in cystine among the 17 amino acids detected in the fillet of juvenile hybrid F1. The amino acid composition was assayed by a Hitachi L-8900 automatic amino acid analyzer. The amino acids EAA/TAA of all groups were about 40%, and the amino acids EAA/NEAA was over 60%, which were high-quality proteins complied with the Food and Agriculture Organization of the United Nations and the World Health Organization (FAO/WHO) standards. Umami flavors are closely related to the composition and ratio of umami amino acid. The content of total amino acids and essential amino acids showed a decreasing trend under the influence of micro-flow water. The total of delicious amino acid treated at 4 d were significantly higher than those of juvenile hybrid F1 treated at 8 d and 12 d. The TAA content and total EAA content did not dramatically change. The essential amino acid index (EAAI) is used to indicate how close the essential amino acid content is to the standard protein. EAAI were 77.33%, 74.91%, 76.56% and 76.75%, respectively. The fatty acid composition was assayed using gas chromatography (Agilent 7890A, USA). Nineteen kinds of fatty acids were detected in the muscle of juvenile hybrid F1, including 5 kinds of saturated fatty acids, 6 kinds of monounsaturated fatty acids, and 8 kinds of polyunsaturated fatty acids, respectively. The micro-flow water significantly affected the fatty acid content in muscle. The content of cis-15-tetracosenoic acid (6.85 mg/100 g), eicosatrienoic acid (41.05 mg/100 g), and arachidonate (53.84 mg/100 g) was significantly higher than that in the other groups after treatment for 8 d. Meanwhile, the content of α-linolenic acid (48.05 mg/100 g), monounsaturated fatty acid (MUFA) (1 336.43 mg/100 g), and n-6 polyunsaturated fatty acids (524.43 mg/100 g) were higher than that in the other groups at 4 d and 12 d. This study indicated that short-term micro-flow water treatment improves the color of skin and meat, and the meat texture at 8 d while ensuring the quality of the flesh. The short-term micro-flow water treatment can help to provide new ideas to improve the quality of aquatic products cultured in ponds.

Sarcopenia (low muscle mass, i.e., quantity) is associated with poor clinical outcomes in patients with acute-on-chronic liver failure (ACLF). In this study, we aimed to illustrate the clinical prognostic value of myosteatosis (muscle fat infiltration) for short-term mortality in patients with ACLF. We retrospectively enrolled consecutive patients with ACLF between January 2019 and January 2022. Computed tomography-based body composition analysis was performed at the third lumbar vertebral level to determine skeletal muscle radiation attenuation. Fine and Gray’s competing risk regression model, with liver transplantation as a competing risk, was used to assess the factors associated with 90-day mortality. A total of 431 patients with ACLF were included. Myosteatosis and sarcopenia were observed in 261 (60.6%) and 87 (20.2%) patients, respectively. Competitive risk regression showed that age (HR 1.021, 95% CI 1.000–1.043, P = 0.042), APASL ACLF Research Consortium (AARC) score (HR 1.498, 95% CI 1.312–1.710, P < 0.001), and sarcopenia (HR 1.802, 95% CI 1.062–3.060, P = 0.029) were independently associated with increased 90-day mortality. Subgroup analysis of male patients with HBV-ACLF revealed that myosteatosis (HR 2.119, 95% CI 1.101–4.078, P = 0.025) was promising prognostic factors for 90-day mortality after being adjusted for ascites, acute kidney injury, AARC score, and sarcopenia. Myosteatosis is predictive of short-term outcomes in male patients with HBV-ACLF. Our results emphasise the importance of focusing on muscle fat infiltration in patients with HBV-ACLF. Further studies are warranted to investigate the underlying mechanisms and potential therapies for myosteatosis. [ABSTRACT FROM AUTHOR]

Background: Recently, many studies have been devoted to discovering nutrients for exercise-like effects. Resistance exercise and the intake of essential amino acids (EAAs) are known to be factors that can affect muscle mass and strength improvement. The purpose of this study was to investigate changes in muscle quality, myokines, and inflammation in response to resistance exercise and EAA supplementation. Methods: Thirty-four males volunteered to participate in this study. They were assigned to four groups: (1) placebo (CO), (2) resistance exercise (RE), (3) EAA supplementation, and (4) RE + EAA supplementation. Body composition, muscle quality, myokines, and inflammation were measured at baseline and four weeks after treatment. Results: Lean body fat had decreased in both RE and RE + EAA groups. Lean body mass had increased in only the RE + EAA group. In all groups except for CO, irisin, myostatin A, and TNF-α levels had decreased. The grip strength of the right hand and trunk flexion peak torque increased in the RE group. The grip strength of the left hand, trunk flexion peak torque, and knee flexion peak torque of the left leg were increased in RE + EAA. Conclusions: RE, EAA, and RE + EAA could effectively improve the muscle quality, myokine, and inflammation factors of young adult males. This finding highlights the importance of resistance exercise and amino acid intake. [ABSTRACT FROM AUTHOR]

Ultrasonography has been extensively used to evaluate skeletal muscle morphology. The echo intensity, i.e., the mean pixel intensity of a specific region of interest in an ultrasound image, may vary among muscles and individuals with several intramuscular parameters presumed to influence it. The purpose of this study was to investigate the correlation between muscle echo intensity and muscle fiber type composition in humans. Thirteen female physical education students (age: 22.3 ± 5.4 years, height: 1.63 ± 0.06 m, body mass: 59.9 ± 7.4 kg) with no history of systematic athletic training participated in the study. Body composition with dual X-ray absorptiometry, leg-press maximum strength (1-RM), echo intensity, and the cross-sectional area (CSA) of the vastus lateralis (VL) muscle according to ultrasonography were measured. Muscle biopsies were harvested from the VL site where the echo intensity was measured. VL echo intensity was not significantly correlated with the percentage of type I muscle fibers or with the percentage area of type I muscle fibers. However, when VL echo intensity was corrected for the subcutaneous fat thickness at the site of the measurement, it was significantly correlated with the percentage of type I muscle fibers (r = 0.801, p < 0.01) and the percentage area of type I muscle fibers (r = 0.852, p < 0.01). These results suggest that the echo intensity of the vastus lateralis muscle corrected for the subcutaneous fat thickness at the measurement site may provide an estimate of the muscle fiber type composition, at least in young moderately trained females. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Henan Agricultural Sciences is the property of Editorial Board of Journal of Henan Agricultural Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Sarcopenic obesity (SO) in nursing home residents is rarely studied. We aimed to evaluate and compare the prevalence and consistency of different SO diagnostic methods and to investigate which criterion demonstrated a stronger association with instrumental activities of daily living (IADL) disability. Methods: We consecutively recruited older adults aged ≥ 60 years, residing in 15 nursing homes in Zigong City, China. Sarcopenia obesity was defined according to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity criteria (SOESPEN), recommending skeletal muscle mass (SMM) adjusted by body weight (SMM/W) to identify low muscle mass. Further, we adapted ESPEN criteria (SOESPEN−M) by employing SMM adjusted by body mass index (SMM/BMI). Results: We included 832 participants (median age 73.0 years, 296 women). The prevalence of SOESPEN and SOESPEN−M was 43.5% and 45.3%, respectively. SOESPEN showed good consistency with SOESPEN−M (Cohen's kappa = 0.759). More than one-third of participants in the normal weight group were diagnosed with SOESPEN or SOESPEN−M. Even within the underweight group, the prevalence of SOESPEN and SOESPEN−M was 8.9% and 22.2%, respectively. Participants with IADL disability had significantly lower SMM/W and SMM/BMI, but higher fat mass percentage of body weight (FM%) than participants without IADL disability. After full adjustment for potential confounders, SOESPEN−M (OR 1.68, 95% CI 1.21 to 2.32), but not SOESPEN (OR 1.28, 95% CI 0.93 to 1.75), remained significantly associated with IADL disability. Conclusions: Both SOESPEN and SOESPEN−M showed a high prevalence among nursing home residents, even among individuals with underweight or normal weight. While SOESPEN had a good consistency with SOESPEN−M, only SOESPEN−M was independently associated with IADL disability. Screening and diagnosis of SO should be conducted in nursing home residents irrespective of BMI. [ABSTRACT FROM AUTHOR]

The purpose of this experiment was to explore the effects of honeysuckle residue and jasmine residue on the growth performance and meat quality of Longlin black goats. Twenty 3-month-old (weaned) and healthy Longlin black goats were randomly divided into experimental group and control group, with 10 replicates in each group and one sheep in each replicate. The control group was fed with basic diet, while the experimental group was added with 5% honeysuckle residue and jasmine residue in the basic diet. The trial period was one year. The results showed that the carcass weight, net meat weight, bone weight, and average daily gain in spring, summer, and winter were significantly increased (P<0.05), while the body height, body length, chest circumference, final weight, slaughter rate, and net meat rate were increased (P>0.05). The muscle pH value, cooked meat percentage, polyunsaturated fatty acid, and n3 polyunsaturated fatty acid content increased (P<0.05), and the muscle conductivity and crude fat content decreased (P<0.05). The contentrations of crude protein, aspartate, threonine, lysine, and delicious amino acids in muscle of the experimental group were higher than those of the control group (P>0.05). The study indicates that adding honeysuckle residue and jasmine residue to feed can promote the growth and development of Longlin black goats and improve the meat quality. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the variations in nutrient levels of Pelodiscus sinensis across three distinct cultural regions, assess the nutritional make up of its muscle, and establish a theo‐ retical framework for assessing its nutritional significance. A total of thirty robust Pelodiscus sinensis sourced from various farms across three Guangxi regions, specifically Guiping, Nanning, and Yulin, were carefully chosen for the purpose of assessing and analyzing mineral elements, conventional nutrients, amino acids, and fatty acid levels. The results indicate that the Pelodiscus sinensis muscle from Nanning exhibited the highest concentration of water and crude protein in terms of conventional nutrition, while the Pelodiscus sinensis muscle from Yulin displayed a lower ash content but a significantly higher crude fat content compared to the Pelodiscus sinensis muscle from Guiping (P<0.05). In terms of minerals, the Pelodiscus sinensis muscle in Nanning exhibited the highest levels of magnesium and calcium, while the Pelodiscus sinensis muscle in Guiping displayed a relatively high concentration of calcium; among the trace elements, the muscle of the Pelodiscus sinensis in the three regions displayed relatively high iron and zinc content, whereas the muscle of the Pelodiscus sinensis in Yulin (excluding manganese and zinc) exhibited higher levels of trace elements compared to the Pelodiscus sinensis in Guiping and Nanning. Out of the 16 amino acids found in the turtle meat from the three regions, Glu was the most abundant, followed by Asp, with EAA/TAA and EAA/NEAA ratios ranging from 37.05% to 38.34% and 70.04% to 74.23%, re‐ spectively, which were in line with the WHO/FAO's recommended protein ratios of 40% and 60%, and FAA/TAA ratios ranging from 39.45% to 40.76%. The EAAI index varied between 65.14 and 81.42, with percentages ranging from 39.45% to 40.76%. Guiping Pelodiscus sinensis exhibited the highest concentra‐ tions of STAA, SEAA, SFAA, and EAAI in its muscles. In terms of the fatty acid composition, each of them contained over 20 species, and on the whole, the muscles of Pelodiscus sinensis in Guiping and Nan‐ ning exhibited elevated levels of EPA+DHA. The differences in different breeding areas in Guangxi, and the muscle nutrients between the cultured Pelodiscus sinensis have their own characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Neuromuscular deficits and atrophy after anterior cruciate ligament reconstruction (ACLR) may be accompanied by changes in muscle composition and poor quadriceps muscle quality (QMQ). Quadriceps atrophy occurs after ACLR but improves within the first three postoperative months, yet this hypertrophy could be attributable to increases in noncontractile tissue (i.e., poor QMQ). The purposes of this study were to evaluate changes in QMQ after ACLR and to determine if changes in QMQ and cross-sectional area (CSA) occur in parallel or independently. Methods: A longitudinal prospective cohort design was implemented to evaluate QMQ and CSA in 20 individuals with ACLR and 12 healthy controls. Participants completed three testing sessions (baseline/presurgery, 1 month, and 3 months) during which ultrasound images were obtained from the vastus lateralis (VL) and rectus femoris (RF). QMQ was calculated as the echo intensity (EI) of each image, with high EI representing poorer QMQ. Anatomical CSA was also obtained from each image. Results: RF and VL EI were greater at 1 and 3 months in the ACLR limb compared with baseline and the contralateral limb and did not change between 1 and 3 months. VL and RF CSA in the ACLR limb were smaller at 1 and 3 months compared with the contralateral limb and controls (VL only) but increased from 1 to 3 months. Changes in QMQ and CSA were not correlated. Conclusions: QMQ declines within the first month after ACLR and does not improve by 3 months although hypertrophy occurs, suggesting that these morphological characteristics change independently after ACLR. Poorer QMQ represents greater concentration of noncontractile tissues within the muscle and potentially contributes to chronic quadriceps dysfunction observed after ACLR. [ABSTRACT FROM AUTHOR]

• Association between PhA and postoperative outcomes was assessed in LSS patients. • PhA was associated with JOA score pre- and post-operatively. • PhA may be useful as a clinical indicator for patients undergoing LSS surgery. No reports of longitudinal studies on phase angle (PhA) in lumbar spinal stenosis (LSS) exist, and its association with postoperative clinical outcomes is unclear. We longitudinally investigated PhA in patients with LSS preoperatively to 12 months postoperatively and determined the association between PhA and the Japanese Orthopedic Association (JOA) score. This prospective observational study included patients who underwent consecutive surgical treatments for clinically and radiologically defined LSS. Outcome measures including walking speed, Timed Up and Go test (TUG), JOA score, and PhA based on bioelectrical impedance analysis were measured preoperatively and at 3, 6, and 12 months postoperatively. Correlations between PhA and the JOA score and motor function were analyzed. The effect of PhA on JOA scores was evaluated using mixed-effect models for repeated measurements (MMRM). Eighty-nine patients were included at baseline, and 85, 85, and 78 patients were analyzed at 3, 6, and 12 months postoperatively, respectively. PhA was 3.9 ± 0.8 (p = 0.086), 4.0 ± 0.8 (p = 0.644), and 4.1 ± 0.9 (p = 0.791) at 3, 6, and 12 months postoperatively and 4.2 ± 0.8 at baseline. PhA was significantly correlated with the JOA score (p < 0.01) and walking speed and TUG results (p < 0.01) at all assessment points. In the MMRM, PhA was associated with the JOA score at all assessment points. Changes in postoperative JOA scores after lumbar spine surgery are associated with PhA at each assessment time point. PhA may be a useful postoperative clinical indicator after surgery for LSS. [ABSTRACT FROM AUTHOR]

Introduction: Fatty infiltration (FI) of the rotator cuff has important clinical implications. Quantitatively estimating FI using ultrasound (US) has considerable benefits for assessing FI in a non‐invasive, accessible manner. This research investigated whether FI of the supraspinatus (SS) and infraspinatus (IS), estimated using US was related to intramuscular fat fractions measured from magnetic resonance images (MRI). Methods: Data from 12 healthy young adult participants were used for analysis. US images of the SS and IS were captured using multiple transducer placement techniques from which echogenicity of the muscle region was quantified. Shoulder MRI were captured from which SS and IS were manually segmented and intramuscular fat fractions calculated. Six upper limb strength exertions were performed, resisted by a hand dynamometer. Results: IS and SS echogenicity explained a significant amount of variance in MRI fat fractions for certain body positions and transducer techniques. Echogenicity agreement was higher for IS than SS. Significant relationships were identified between strength exertions and both echogenicity and MRI muscle volume, but not MRI fat fraction. Conclusions: This research provides preliminary evidence showing that quantitative‐based US methods can be used to estimate MRI calculated fat fractions for the rotator cuff. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the effects of silkworm excrement supplementation on growth performance, liver and intestine histomorphology, and muscle quality of grass carp (Ctenopharyngodon idellus). A total of 300 Cteno⁃ pharyngodon idellus with an initial weight of (932.34±36.9) g were randomly divided into 2 groups with 3 replicates each with 50 fish per replicate. Two isonitrogenous and isolipidic diets supplemented with 0 (as control) and 10% silkworm excrement were fed during the 93-d feeding trial. The results showed as follows: ① Compared with the control group, the feed coefficient rate in the 10% silkworm excrement group was significantly increased (P< 0.05). There were no significant difference in weight gain rate, specific growth rate, survival rate, viscerosomatic index, condition factor and hepatosomatic index among the groups (P>0.05). ② Compared with the control group, the height of intestinal villi in the 10% silkworm excrement group was significantly increased (P<0.05), while there were no significant difference in intestinal villi width and muscle thickness (P>0.05); the liver cells in the control group and the 10% silkworm excrement group of Cteno⁃pharyngodon idellus showed normal morphology, clear nuclear structure, and no cell vacuolization or nuclear deviation. ③ Compared with the control group, the contents of muscle methionine, histidine, arginine, and semi-essential amino acids were significantly increased (P<0.05), and the contents of protein, aspartic acid, glutamic acid, fresh amino acid, threonine, valine, isoleucine, leucine tyrosine, phenylalanine, lysine, proline, essential amino acid, and essential/non-essential amino acid were extremely significantly increased in 10% silkworm excrement group (P<0.01), while the moisture content was significantly decreased (P<0.05), and there were no significant difference in the content of fat, ash, glycine, alanine, serine, sweet amino acids, essential amino acids/total amino acids, and inosinic acid among each group (P>0.05). The muscle fiber diameter in the 10% silkworm excrement group was extremely significantly lower than that in the control group (P<0.01), and the muscle fiber density and hardness were significantly higher than those in the control group (P<0.05), and the cohesiveness, gumminess, and chewiness were extremely significantly higher than those in the control group (P<0.01). No significant differences were observed in springiness, resilience, and shear force among the groups (P>0.05). In summary, supplemented with 10% silkworm excrement has no significant effects on the growth performance and does not damage the tissue structure of the intestine and liver of grass carp. It can reduce the moisture content of muscles, significantly increase the protein, fresh amino acids, and essential amino acid content of muscles, improve muscle texture characteristics and improve the muscle quality of grass carp. [ABSTRACT FROM AUTHOR]

Due to the shortage and high prices of fish meal and soybean meal, there is an urgent need to explore alternative sources of high-quality protein. Yellow mealworms, being a high protein, easy to raise, and low-cost insect resource, have significant potential in replacing protein in aquatic animal feed. This article provides a comprehensive explanation of the value of yellow mealworms and its impact on fish growth performance, muscle quality, immune antioxidant capacity, and liver and intestinal health, in order to provide reference materials for the development of new types of aquatic animal feed. [ABSTRACT FROM AUTHOR]

This study scrutinized the nutritional quality and serum biochemical indices of grass carp (Ctenopharyngodon idellus) cultivated in traditional pond intercropping (TPI) and in-pond raceway system (IPRS) aquaculture setups. The findings showed that the TPI group exhibited a superior water-holding capacity, while the IPRS showcased heightened crude lipid content and levels of textural properties such as springiness. Moreover, significant differences emerged in the fatty acid profiles, with the TPI group manifesting higher total polyunsaturated fatty acids (ΣPUFAs), EPA, DHA, and Σn-3, while the IPRS group exhibited elevated total saturated fatty acids (ΣSFAs). In terms of amino acids, valine and histidine levels were notably higher in the IPRS group, whereas lysine levels were reduced. Volatile compound analysis revealed significant variations, with the IPRS group containing more volatile substances with a better aroma, resulting in a better odor. The IPRS group performed better in serum biochemistry analysis. Additionally, grass carp in the IPRS group displayed an improved structure and greater coverage area of the visceral peritoneum, appearing lighter in color compared to the TPI group. TPI mainly influences nutritional elements; IPRSs primarily affect muscle texture, serum biochemistry, and overall health. This study aims to fill the gap in quality comparison research and provide an important scientific basis. [ABSTRACT FROM AUTHOR]

In order to study the muscle quality of different crustaceans, we aim to provide a comprehensive assessment of their muscle quality characteristics as a theoretical reference. In this work, seven major species of farmed and consumer crustaceans were selected, including crayfish (Procambarus clarkii), freshwater prawns (Macrobrachium rosenbergii), pacific white shrimp (Litopenaeus vannamei), black tiger shrimp (Penaeus monodon), kuruma prawns (Penaeus japonicus), river prawns (Macrobranchium nipponense), and Chinese shrimp (Penaeus chinensis). Their morphometric parameters, nutritional composition, textural properties, and physical and chemical indexes were comparatively analyzed. The results showed that the meat content (MC, about 14.78%) of crayfish was significantly lower than that of the other six species. By contrast, pacific white shrimp had the highest MC, although the MCs of black tiger shrimp, kuruma prawns, and Chinese shrimp are greater than 40%. All seven crustacean species were high in protein and low in fat, while pacific white shrimp had the highest crude protein, crude lipid, and crude ash content compared to the other crustaceans. The content of threonine (Thr) was the highest in crayfish. The content of methionine (Met) and lysine (Lys) was the highest in freshwater prawns. The content of isoleucine (Ile), leucine (Leu), and non–essential amino acid (NEAA) was the highest in pacific white shrimp. C18:2n-6 (linoleic acid, LA) was the highest in freshwater prawns and pacific white shrimp; C18:3n-3 (linolenic acid, LNA), C20:4n-6 (arachidonic acid, AA), unsaturated fatty acids (UFA), and monounsaturated fatty acids (MUFA) were all the highest in crayfish; and polyunsaturated fatty acids (PUFA) was the highest in freshwater prawns, but the content was not significantly different from crayfish, pacific white shrimp, black tiger shrimp, and Chinese shrimp. Pacific white shrimp had the highest values for hardness, cohesiveness, gumminess, and chewiness. The redness values of crayfish, black tiger shrimp, and Chinese shrimp were significantly higher than those of the other three species except kuruma prawns. Compared to other crustaceans, river prawns had the highest drip loss and cooking loss. Black tiger shrimp and Chinese shrimp had the lowest cooking loss rates. The research shows that the tail muscle of the seven species of crustaceans is rich in protein, essential amino acids, unsaturated fatty acids and low in fat, representing a high-quality protein. Among these crustaceans, the main essential amino acids and essential fatty acids in the tail muscle of pacific white shrimp, freshwater prawns, and crayfish are higher in content and better in nutritional value. [ABSTRACT FROM AUTHOR]

Objective: To assess whether changes in MRI-based measures of thigh muscle quality associated with statin use in participants with and without/at-risk of knee osteoarthritis. Methods: This retrospective cohort study used data from the Osteoarthritis Initiative study. Statin users and non-users were matched for relevant covariates using 1:1 propensity-score matching. Participants were further stratified according to baseline radiographic knee osteoarthritis status. We used a validated deep-learning method for thigh muscle MRI segmentation and calculation of muscle quality biomarkers at baseline, 2nd, and 4th visits. Mean difference and 95% confidence intervals (CI) in longitudinal 4-year measurements of muscle quality biomarkers, including cross-sectional area, intramuscular adipose tissue, contractile percent, and knee extensors and flexors maximum and specific contractile force (force/muscle area) were the outcomes of interest. Results: After matching, 3772 thighs of 1910 participants were included (1886 thighs of statin-users: 1886 of non-users; age: 62 ± 9 years (average ± standard deviation), range: 45–79; female/male: 1). During 4 years, statin use was associated with a slight decrease in muscle quality, indicated by decreased knee extension maximum (mean-difference, 95% CI: − 1.85 N/year, − 3.23 to − 0.47) and specific contractile force (− 0.04 N/cm2/year, − 0.07 to − 0.01), decreased thigh muscle contractile percent (− 0.03%/year, − 0.06 to − 0.01), and increased thigh intramuscular adipose tissue (3.06 mm2/year, 0.53 to 5.59). Stratified analyses showed decreased muscle quality only in participants without/at-risk of knee osteoarthritis but not those with established knee osteoarthritis. Conclusions: Statin use is associated with a slight decrease in MRI-based measures of thigh muscle quality over 4 years. However, considering statins' substantial cardiovascular benefits, these slight muscle changes may be relatively less important in overall patient care. [ABSTRACT FROM AUTHOR]

[Objectives] This study was conducted to understand the biological characteristics of Duoluo goats. [Methods] With male and female Duoluo goats as the research object, related performance indexes were determined and analyzed after slaughter. [Results] The weights of one-year-old male and female Duoluo goats before slaughter were (25.68±2.37) and (24.51 ±1.97) kg, respectively; the dressing percentages were (43.55 ±3.24) % and (43.84 ±3.42) %, respec- tively; and the net meat percentages were (33.02 ±2.32) % and (34.19±2.46)%, respectively. (2) The cooked meat rates of male and female Duoluo goats were (65.49 ±1.42) % and (65.36±1.55) %, respectively; the shearing force was (5.48±1.24) and (5.65 ±1.02) N, respectively; and the loin-eye mus- cle areas were (8.95±1.72) and (8.82±1.15) cm², respectively. (3) The protein contents of male and female Duoluo goats were (20.07±0.42) and (19.47±1.22) g/100g, respectively; and the fat contents were (1.30 ±0.80) % and (2.92 ±0.55)%, respectively; and the cholesterol contents were (71.76±11.47) and (74.83±2.68) mg/100 g, respectively; (4) The Ca contents of male and female Duoluo goats were (69.53±10.89) and (63.00±4.56) mg/kg, respectively; the Fe contents were (16.73±1.83) and (14.77±0.58) mg/kg, respectively; and the Zn contents were (38.47 ±3.68) and (31.83 ±2.22) mg/kg, respectively. (5) In the muscles of male and female Duoluo goats, the contents of essential amino acids were (7.44±0.24) and (7.26±0.41) g/100 g, respectively; the contents of non-essential amino acids were (11.81 ±0.33) and (11.42 ±0.67) g/100 g, respectively; and the contents of flavor amino acids were (8.79±0.27) and (8.42 ±0.57) g/100 g, respectively. [Conclusions] This study lays a foundation for the excavation and utilization of the resource, Duoluo goats. [ABSTRACT FROM AUTHOR]

To investigate the modification of muscle quality of farmed tilapia through dietary fatty acid strategies, two diets were formulated. Diet SO, using soybean oil as the lipid source, and diet BO, using blended soybean and linseed oils, each including 0.58% and 1.35% α-linolenic acid (ALA), respectively, were formulated to feed juvenile tilapia for 10 weeks. The muscular nutrition composition, positional distribution of fatty acid in triglycerides (TAGs) and phospholipids (PLs), volatile flavor, lipid mobilization and oxidation were then analyzed. The results showed that there was no distinct difference between the SO and BO groups in terms of the nutrition composition, including crude protein, crude lipid, TAGs, PLs, and amino acid. Although the fatty acid distribution characteristics in ATGs and PLs showed a similar trend in the two groups, a higher level of n-3 PUFA (polyunsaturated fatty acid) and n-3 LC-PUFA (long-chain polyunsaturated fatty acid) bound to the glycerol backbone of TAGs and PLs was detected in the BO group than the SO group, whereas the opposite was true for n-6 PUFA. Additionally, the muscular volatile aldehyde and alcohol levels were higher in the BO group. Moreover, the expression of enzymatic genes and protein activities related to lipid mobilization (LPL, LPCAT, DGAT) and oxidation (LOX and GPX) was higher in the BO group. The results demonstrate that high-ALA diets may improve the fatty acid bioavailability and volatile flavor of tilapia by improving the lipid mobilization and oxidation, which provides new ideas for the improvement of muscle quality in farmed fish. [ABSTRACT FROM AUTHOR]

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Rosemary extract (RE) had strong antioxidant activity which was used as an ideal substitute for antibiotic. However, few studies were explored its effects on fish species. Therefore, present study was conducted to determine the effects of RE on disease-resistance and nutrient metabolism in largemouth bass. Fish with initial body weight 9.07 g ± 0.01 g were fed with diets supplemented with gradient RE levels (0 %, 0.3 %, 0.6 % and 0.9 %) for 8 weeks. Following 8 weeks trial, Edwardsiella tarda challenge test were conducted to explore the ability of disease-resistance. Data on Edwardsiella tarda challenge test showed that all experimental groups exhibited higher survival rate than control group. RE supplementation significantly decreased the Ca2+ concentration and apoptosis rate and increased the mitochondrial membrane potential in blood cells. Meanwhile, the plasma biochemical indexes of antioxidant, immune response and key regulators in antioxidant, immune response presented an increasing pattern after RE supplementation. The growth trial results showed that visceral adipose index (VAI) and abdominal fat weight (AFW) showed a decreasing trend with the increase of RE addition levels, which further decreased growth performance. Further analyzed the lipid metabolism, we found that dietary RE addition markedly inhibited growth hormone-insulin like growth factor (GH-IGF), target of rapamycin (TOR) signalings and activated amino acid response (AAR) signaling to enhance lipid catabolism. Beyond that, the increased antioxidant capacity in turn reduces muscle cooking loss, hardness and increased muscle cohesiveness, springiness, chewiness. In conclusion, based on immunity, antioxidant capacity, disease-resistance and muscle quality, dietary 0.3–0.6 % RE addition was suggested in aquafeeds.

Protein demand from aquaculture exacerbates environmental pressures. Zig-zag eel (Mastacembelus armatus, MA) is a new aquaculture species in southern China and has great potential for future promotion. In this study, we used Spirulina platensis powder (SPP) to replace 0–20 % of fishmeal in the feed, respectively. A 10-week aquaculture experiment was conducted on 600 MAs with five groups of F0 (0 %), F1 (5 %), F2 (10 %), F3 (15 %), and F4 (20 %) set up with equal nitrogen (approximately 50.00 % crude protein) and equal fat (about 5.50 % crude fat) feeds. The experimental results showed that replacing fishmeal with different proportions of SPP significantly reduced FCR (p < 0.05), increased WGR and SGR (p < 0.05), and reduced the feeding cost, with the best performance in F2. Polynomial analysis combining WGR and SGR showed that the optimum percentage of substitution was 10.93 % and 11.09 % in MA diets, respectively. The addition of SPP significantly reduced the levels of EPA and DHA content (p < 0.05), significantly increased the proportion of C14:0, C16:1, C20:5n3, and C22:6n3 (p < 0.05), and a high proportion of SPP addition significantly decreased saturated fatty acid content (p < 0.05). The length of intestinal villi and the secretion levels of Chymotrypsin and Pepsin were significantly increased (p < 0.05), and the secretion level of Lipase was significantly decreased (p < 0.05) in the experimental group. A low percentage of SPP increased microbial diversity in MA’s gut. Functional pathways related to metabolic functions were the most obvious broad groups with the most significant changes in relative abundance in the experimental group, and Plesiomonas and Aeromonas may be the key microorganisms involved in regulating the digestion and metabolism of SPP in the gut of MA.