Limb muscle quality and quantity in elderly adults with dynapenia but not sarcopenia: An ultrasound imaging study

Establishment and Validation of a Predictive Model for Sarcopenia Based on 2-D Ultrasound and Shear Wave Elastography in the Medial Gastrocnemius Muscle

OBJECTIVE

To develop and validate a predictive model for sarcopenia.

METHODS

A total of 240 subjects who visited our hospital between August 2021 and May 2023 were randomly divided by time of entry into a training set containing 2/3 of patients and a validation set containing 1/3 of patients. The muscle thickness (MT), echo intensity (EI), and shear wave velocity (SWV) of the medial gastrocnemius muscle were measured. Indicators that were meaningful in the univariate analysis in the training set were included in a binary logistic regression to derive a regression model, and the model was evaluated using a consistency index, calibration plot, and clinical validity curve. Diagnostic efficacy and clinical applicability were compared between the model and unifactorial indicators.

RESULTS

Four meaningful variables, age, body mass index (BMI), MT, and SWV, were screened into the predictive model. The model was Logit Y = 21.292 + 0.065 × Age - 0.411 × BMI - 0.524 × MT - 3.072 × SWV. The model was well differentiated with an internally validated C-index of 0.924 and an external validation C-index of 0.914. The calibration plot predicted probabilities against actual probabilities showed excellent agreement. The specificity, sensitivity, and Youden's index of the model were 73.80%, 97.40%, and 71.20%, respectively, when using the diagnostic cut-off value of >0.279 for sarcopenia. The logistic model had higher diagnostic efficacy (p < 0.001) and higher net clinical benefit (p < 0.001) over the same threshold range compared to indicators.

CONCLUSION

The logistic model of sarcopenia has been justified to have good discriminatory, calibrated, and clinical validity, and has higher diagnostic value than indicators.

Effects of 12 weeks of inspiratory muscle training and whole body vibration on the inflammatory profile, BDNF and muscular system in pre-frail elderly women: A randomized controlled trial

AIM

to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women.

METHODS

this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS).

RESULTS

after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups.

CONCLUSIONS

IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.

The feasibility of visualizing and quantifying muscle changes in postoperative oral cancer patients using Quantitative Muscle Ultrasound (QMUS)

PURPOSE

Quantitative muscle ultrasound (QMUS) is a patient friendly tool for examining orofacial muscles. Resection of tissue can have an effect on the architecture and function of these muscles. The aim of this study is to investigate the feasibility of visualizing and quantifying muscle changes in postoperative oral cancer patients and to relate the findings to tumor and patient characteristics.

METHODS

Adult patients with a resected first primary pT1 or T2 oral squamous cell carcinoma, at least one year post operatively, where included. Ultrasound data were collected of the geniohyoid muscle, digastric muscles, masseter muscle, transverse muscle and genioglossus muscle. Ultrasound images were labeled as clearly visible, questionable or unclear. Of the clear muscles, echogenicity and muscle thickness were measured.

RESULTS

37 patients were included. The masseter muscle was clearly visible in all ultrasound images, both intrinsic tongue muscles had the lowest visibility (45.9%). There was a significant correlation between visibility and tumor localization for the genioglossus (p = 0.029). Age correlated with the visibility of the genioglossus muscle, BMI with the genioglossus and transverse muscles. Echogenicity and muscle thickness of the clearly identified muscles did not differ from normative values.

CONCLUSION

QMUS of orofacial muscles is feasible in postoperative oral cancer patients with relatively small tumor sizes. Tongue resections negatively affected the visibility of the two intrinsic tongue muscles. These preliminary results for particular muscles indicate that the use of ultrasound might be promising in oral cancer patients to help determine targeted goals in post-operative rehabilitation.

Exploring the associations between skeletal muscle echogenicity and physical function in aging adults: A systematic review with meta-analyses

BACKGROUND

Assessment and quantification of skeletal muscle within the aging population is vital for diagnosis, treatment, and injury/disease prevention. The clinical availability of assessing muscle quality through diagnostic ultrasound presents an opportunity to be utilized as a screening tool for function-limiting diseases. However, relationships between muscle echogenicity and clinical functional assessments require authoritative analysis. Thus, we aimed to (a) synthesize the literature to assess the relationships between skeletal muscle echogenicity and physical function in older adults (≥60 years), (b) perform pooled analyses of relationships between skeletal muscle echogenicity and physical function, and (c) perform sub-analyses to determine between-muscle relationships.

METHODS

CINAHL, Embase, MEDLINE, PubMed, and Web of Science databases were systematically searched to identify articles relating skeletal muscle echogenicity to physical function in older adults. Risk-of-bias assessments were conducted along with funnel plot examination. Meta-analyses with and without sub-analyses for individual muscles were performed utilizing Fisher's Z transformation for the most common measures of physical function. Fisher's Z was back-transformed to Pearson's r for interpretation.

RESULTS

Fifty-one articles (n = 5095, female = ∼2759, male = ∼2301, 72.5 ± 5.8 years, mean ± SD (1 study did not provide sex descriptors)) were extracted for review, with previously unpublished data obtained from the authors of 13 studies. The rectus femoris (n = 34) and isometric knee extension strength (n = 22) were the most accessed muscle and physical qualities, respectively. The relationship between quadriceps echogenicity and knee extensor strength was moderate (n = 2924, r = -0.36 (95% confidence interval: -0.38 to -0.32), p < 0.001), with all other meta-analyses (grip strength, walking speed, sit-to-stand, timed up-and-go) resulting in slightly weaker correlations (r:  -0.34 to -0.23, all p < 0.001). Sub-analyses determined minimal differences in predictive ability between muscle groups, although combining muscles (e.g., rectus femoris + vastus lateralis) often resulted in stronger correlations with maximal strength.

CONCLUSION

While correlations were modest, the affordable, portable, and noninvasive ultrasonic assessment of muscle quality was a consistent predictor of physical function in older adults. Minimal between-muscle differences suggest that echogenicity estimates of muscle quality are systemic. Therefore, practitioners may be able to scan a single muscle to estimate full-body skeletal muscle quality/composition, while researchers should consider combining multiple muscles to strengthen the model.

A new possible marker: can pennation angle defined by ultrasound predict the frailty?

BACKGROUND

Frailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated.

AIMS

The aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM).

METHODS

This cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis.

RESULTS

Of all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness (p = 0.002), CSA (p = 0.009), and fascicle length (p = 0.043) of RFM compared to robust. PA was significantly lowest in frails (p < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70-0.97, p = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p < 0.001).

DISCUSSION

Thickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation.

CONCLUSIONS

Ultrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.

Concordance between muscle mass assessed by bioelectrical impedance analysis and by muscle ultrasound: a cross-sectional study in a cohort of patients on chronic hemodialysis

BACKGROUND

Sarcopenia is a common problem in hemodialysis (HD) patients, and it is diagnosed by low muscle mass, strength and/or low physical performance. Muscle ultrasound (US) is a non-invasive portable tool that might be used for assessment of muscle mass. The aim of the current study was to investigate the concordance between muscle US and bioelectrical impedance analysis (BIA) in diagnosis of sarcopenia in HD patients.

METHODS

This cross-sectional study included 41 HD patients. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP). The skeletal mass index was measured by BIA and the muscle strength was measured by handgrip strength. Muscle US was used to measure cross-sectional area (CSA) and thickness of quadriceps and biceps muscles.

RESULTS

The current study included 41 patients on HD (25 males), with a mean (SD) age of 44.18 (13.11) years and a median HD duration of 48 months. Sarcopenia was diagnosed in 58.5% of the patients. Patients with sarcopenia had significantly lower quadriceps muscle CSA than those without sarcopenia. The optimal cut-offs of quadriceps muscle CSA for both males and females for the diagnosis of sarcopenia were 2.96 and 2.92 cm2, respectively.

CONCLUSION

Sarcopenia is prevalent among Egyptian HD patients. US on quadriceps muscle CSA could be used for diagnosis of sarcopenia in these patients.

Muscle ultrasound to diagnose sarcopenia in chronic kidney disease: a systematic review and bayesian bivariate meta-analysis

OBJECTIVE

The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for sarcopenia among chronic kidney disease (CKD) populations.

BACKGROUND

Sarcopenia has become a worldwide health issue, especially for CKD patients. Conventional techniques of muscle mass assessment often prove limited, thus prompts increasing interest in ultrasound suitability.

METHODS

We searched the Cochrane Library, PubMed and Embase for literature published up to June 2023. Ultrasound diagnosis of sarcopenia in CKD patients was included. Two independent investigators used the Quality Assessment Tool for Diagnosis Accuracy Studies (QUADAS-2) to assess the quality. We extracted valuable information from eligible studies. Using a Bayesian bivariate model, we pooled sensitivity and specificity values and summary receiver operating characteristic (SROC) curves.

RESULTS

Five articles, involving 428 participants at various stages of CKD were included. Three studies diagnosed by the cross-sectional area (CSA) of the rectus femoris, while two others by muscle thickness (MT) and shear wave elastography (SWE) from the same muscle, separately. Overall, CSA or SWE had a pooled sensitivity of 0.95 (95% CrI, 0.80, 1.00), and the specificity was 0.73 (95% CrI, 0.55, 0.88) for diagnosing sarcopenia in CKD patients.

CONCLUSIONS

Ultrasound measurements of CSA and SWE were more sensitive for diagnosing sarcopenia in the CKD population than in the general population. Ultrasound assessment from a single peripheral skeletal muscle site may serve as a rapid screening tool for identifying sarcopenic individuals within the CKD population, if a specific cut-off value could be determined.

Sonographic methods to predict type 2 diabetes patients with sarcopenia: B mode ultrasound and shear wave elastography

BACKGROUND

Type 2 diabetes accelerates the loss of muscle mass and strength. Sarcopenia is also one of the chronic complications of diabetes.

OBJECTIVE

To investigate the clinical value of B mode ultrasound (BMUS) and shear wave elastography (SWE) for predicting type 2 diabetic sarcopenia.

METHODS

We recorded Skeletal Muscle Mass Index (ASMI), grip strength, muscle thickness (MT), pinna angle (PA), fascicle length (FL), and the difference of Young's modulus in the relaxed states and tense states (ΔSWE). The correlations between clinical indicators and ultrasound characteristics were compared. A diagnostic model of sarcopenia was developed to assess the independent correlates and evaluate the diagnostic efficacy of sarcopenia.

RESULTS

ASMI was significantly and positively correlated with MT and ΔSWE (r = 0.826, 0.765, P < 0.01), and grip strength was significantly and positively correlated with MT and ΔSWE (r = 0.797, 0.818, P < 0.01). MT was the most significant predictor of sarcopenia (OR = 4.576, P < 0.001), and the cut-off value of MT was 11.4 mm (AUC: 0.952).

CONCLUSION

BMUS and SWE can quantitatively assess muscle mass and strength, and are effective methods to predict the occurrence of sarcopenia in elderly patients with type 2 diabetes.

Usefulness of muscle echo intensity for evaluating functional performance in the older population: A scoping review

Muscle echo intensity, as measured by ultrasonography, could be used as a new marker of functional performance in older populations. This scoping review aimed to present evidence on the utility of muscle echo intensity as determined by ultrasonography for assessing functional performance in older adults. The eligibility criterion included observational studies that investigated the associations between muscle echo intensity and functional performance in older adults. Terms, such as "echo intensity" and "older adults", were searched for in databases, such as PubMed, Web of Science, the Cochrane database of systematic reviews, and the Cumulative Index of Nursing and Allied Health Literature, in April 2021. Two independent reviewers screened and extracted the data; 46 papers, of which almost one-third were Japanese, were subsequently identified for inclusion. The representative functional performances included in this review were muscle strength, gait speed, sit-to-stand test results, and timed up-and-go test results. Poor to moderate associations were found between muscle echo intensity and functional performance; however, heterogeneities were observed in the characteristics of study participants. Moreover, the accurate effect size and causal inferences between muscle echo intensity and functional performance remained unclear. Further longitudinal studies are needed to determine these causal inferences.

Assessing thickness and stiffness of superficial/deep masticatory muscles in orofacial pain: an ultrasound and shear wave elastography study

INTRODUCTION

Sonoelastography has been increasingly used for non-invasive evaluation of the mechanical features of human tissues. The interplay between orofacial pain and regional muscle activity appears clinically paramount, although only few imaging studies have investigated this association. Using shear wave sonoelastography (SWS), this study ascertained whether orofacial pain induced alterations in the stiffness of superficial and deep masticatory muscles.

METHODS

All participants were systematically evaluated for oral/facial-related conditions, including the area and intensity of pain. SWS was applied to measure the stiffness of the bilateral masseter, temporalis, and lateral pterygoid muscles. The association between orofacial pain and muscle stiffness/thickness was investigated using a generalized estimating equation for adjusting the influence of age, sex, laterality, and body mass index on muscle thickness/stiffness.

RESULTS

A total of 98 participants were included in the present study: 48 asymptomatic controls, 13 patients with unilateral pain, and 37 patients with bilateral orofacial pain. The reliability, quantified by the intraclass correlation coefficient for muscle stiffness measurement, ranged from 0.745 to 0.893. Orofacial pain at the individual muscle level was significantly associated with masseter muscle stiffness. A trend of increased stiffness (p = 0.06) was also observed in relation to the painful side of the temporalis muscle. No significant correlation was identified between the numeric rating scales for pain and stiffness measurements.

CONCLUSIONS

SWS provides reliable stiffness measurements for the superficial and deep masticatory muscles. The ipsilateral masseter and temporalis muscles might be stiffer than those on the side without orofacial pain. Future studies using the present sonoelasotography protocol can be designed to investigate the stiffness changes in the target muscles after interventions.

Intraoperative ultrasound-assisted surgery in orbital apex tumours: technical note

BACKGROUND

Since the introduction of ultrasonography (US) in the operating theatre in the early 1970s, intraoperative ultrasound (IOUS) has become a very useful tool for real-time neurosurgical procedures. The main limitation of US is its innately reduced capacity to penetrate the intact skull. This is the reason why most IOUS-assisted procedures are usually performed via transfontanellar or after a craniotomy or laminotomy is done.

OBJECTIVE

We present a 54-year-old woman with a right optic nerve sheath meningioma, who was operated on by a right cranio-orbital approach and IOUS-assisted tumour removal.

METHODS

Data concerning the anamnesis and complementary studies were obtained from the clinical history. Surgical images were obtained in the operating room during surgery. Images obtained by US were compared with the preoperative and postoperative imaging scans. IOUS imaging was also compared with the intraoperative findings.

RESULTS

The correlation between US and both preoperative and postoperative studies was very high. During surgery, both transpalpebral and transperiorbital IOUS facilitated the resection with no specific technical difficulties or significant time consumption.

CONCLUSION

Recent improvements in the image quality of IOUS devices offer several attractive options for real-time neuronavigation. We describe our initial experience with the IOUS-assisted technique for orbital apex tumours. In our patient transpalpebral and transperiorbital IOUS provided an excellent source of control over location and over the extent of tumour resection. We hope that this description of how we usually perform this procedure may be useful for some selected cases and contribute to the further enhancement and improvement of the technique.

Muscle Ultrasound Changes Correlate With Functional Impairment in Spinal Muscular Atrophy

OBJECTIVE

We investigated ultrasound patterns of muscle involvement in different types of spinal muscular atrophy (SMA) and their correlation with functional status to determine the pattern of muscle compromise in patients with SMA and the potential role of ultrasound to evaluate disease progression.

METHODS

We examined muscles (biceps brachii, rectus femoris, diaphragm, intercostals and thoracic multifidus) of 41 patients with SMA (types 1 to 4) and 46 healthy age- and sex-matched control individuals using B-mode ultrasound for gray-scale analysis (GSA), area (biceps brachii and rectus femoris) and diaphragm thickening ratio. Functional scales were applied to patients only. We analyzed ultrasound abnormalities in specific clinical subtypes and correlated findings with functional status.

RESULTS

Compared with controls, patients had reduced muscle area and increased mean GSA for all muscles (p < 0.001), with an established correlation between the increase in GSA and the severity of SMA for biceps brachii, rectus femoris and intercostals (p = 0.03, 0.01 and 0.004 respectively) when using the Hammersmith Functional Motor Scale Expanded. Diaphragm thickening ratio was normal in the majority of patients, and intercostal muscles had higher GSA than diaphragm in relation to the controls.

CONCLUSION

Ultrasound is useful for quantifying muscular changes in SMA and correlates with functional status. Diaphragm thickening ratio can be normal even with severe compromise of respiratory muscles in quantitative analysis, and intercostal muscles were more affected than diaphragm.

Role of Muscle Ultrasound for the Study of Frailty in Elderly Patients with Diabetes: A Pilot Study

BACKGROUND

Sarcopenia and diabetes contribute to the development of frailty. Therefore, accessible methods, such as muscle ultrasounds (MUSs), to screen for sarcopenia should be implemented in clinical practice.

METHODS

We conducted a cross-sectional pilot study including 47 patients with diabetes (mean age: 77.72 ± 5.08 years, mean weight: 75.8 kg ± 15.89 kg, and body mass index: 31.19 ± 6.65 kg/m²) categorized as frail by the FRAIL Scale or Clinical Frailty Scale and confirmed by Fried's Frailty Phenotype or Rockwood's 36-item Frailty Index. We used the SARC-F questionnaire to identify sarcopenia. The Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) tests were used to assess physical performance and the risk of falls, respectively. In addition, other variables were measured: fat-free mass (FFM) and Sarcopenia Risk Index (SRI) with the bioimpedance analysis (BIA); thigh muscle thickness (TMT) of the quadriceps with MUS; and hand-grip strength with dynamometry.

RESULTS

We observed correlations between the SARC-F and FFM (R = -0.4; p < 0.002) and hand-grip strength (R = -0.5; p < 0.0002), as well as between the TMT and FFM of the right leg (R = 0.4; p < 0.02) and the SRI (R = 0.6; p < 0.0001). We could predict sarcopenia using a logistic regression model with a ROC curve (AUC = 0.78) including FFM, handgrip strength, and TMT. The optimal cut-off point for maximum efficiency was 1.58 cm for TMT (sensitivity = 71.4% and specificity = 51.5%). However, we did not observe differences in the TMT among groups of greater/less frailty based on the SARC-F, SPPB, and TUG (p > 0.05).

CONCLUSIONS

MUSs, which correlated with the BIA (R = 0.4; p < 0.02), complemented the diagnosis, identifying regional sarcopenia of the quadriceps in frail patients with diabetes and improving the ROC curve to AUC = 0.78. In addition, a TMT cut-off point for the diagnosis of sarcopenia of 1.58 cm was obtained. Larger studies to validate the MUS technique as a screening strategy are warranted.

A clustering-based method for estimating pennation angle from B-mode ultrasound images

B-mode ultrasound (US) is often used to noninvasively measure skeletal muscle architecture, which contains human intent information. Extracted features from B-mode images can help improve closed-loop human-robotic interaction control when using rehabilitation/assistive devices. The traditional manual approach to inferring the muscle structural features from US images is laborious, time-consuming, and subjective among different investigators. This paper proposes a clustering-based detection method that can mimic a well-trained human expert in identifying fascicle and aponeurosis and, therefore, compute the pennation angle. The clustering-based architecture assumes that muscle fibers have tubular characteristics. It is robust for low-frequency image streams. We compared the proposed algorithm to two mature benchmark techniques: UltraTrack and ImageJ. The performance of the proposed approach showed higher accuracy in our dataset (frame frequency is 20 Hz), that is, similar to the human expert. The proposed method shows promising potential in automatic muscle fascicle orientation detection to facilitate implementations in biomechanics modeling, rehabilitation robot control design, and neuromuscular disease diagnosis with low-frequency data stream.

Surgery-Related Muscle Loss after Pancreatic Resection and Its Association with Postoperative Nutritional Intake

To study the occurrence of surgery-related muscle loss (SRML) and its association with in-hospital nutritional intake, we conducted a prospective observational cohort study including patients who underwent pancreatic surgery because of (suspected) malignant diseases. Muscle diameter was measured by using bedside ultrasound 1 day prior to surgery and 7 days postoperatively. Clinically relevant SRML was defined as ≥10% muscle diameter loss in minimally one arm and leg muscle within 1 week after surgery. Protein and caloric intake was measured by nutritional diaries. The primary endpoint included the number of patients with SRML. Secondary endpoints included the association between SRML and postoperative nutritional intake. Of the 63 included patients (60.3% men; age 67.1 ± 10.2 years), a total of 24 patients (38.1%) showed SRML. No differences were observed in severe complication rate or length of hospital stay between patients with and without SRML. During the first postoperative week, patients with clinically relevant SRML experienced more days without any nutritional intake compared with the non-SRML group (1 [0-4] versus 0 [0-1] days, p = 0.007). Significantly lower nutritional intake was found in the SRML group at postoperative days 2, 3 and 5 (p < 0.05). Since this study shows that SRML occurred in 38.1% of the patients and most of the patients failed to reach internationally set nutritional goals, it is suggested that more awareness concerning direct postoperative nutritional intake is needed in our surgical community.

Effect of Yijinjing combined with elastic band exercise on muscle mass and function in middle-aged and elderly patients with prediabetes: A randomized controlled trial

Introduction

This study investigated the effect of Yijinjing combined with elastic band exercise on muscle mass and muscle function in patients with prediabetes.

Methods

This study was a randomized controlled trial designed in parallel (Chinese Clinical Trial Registry: ChiCTR2000039049). Participants with prediabetes (n = 47) were randomly divided into control (n = 21, 63.5 ± 4.7 years,16 females) and exercise (n = 26, 62.0 ± 5.0 years, 20 females) groups. The former maintained their original lifestyle, and the latter received Yijinjing combined with elastic band exercise five times a week for 6 months. All the outcome measures were assessed immediately at baseline, after 3- and 6-month intervention.

Results

After 6-month of the exercise, the body weight, body mass index, leg fat mass, gynoid fat mass, and total body fat mass in exercise group were significantly decreased compared with those at baseline (p < 0.05). Compared with those at baseline, total lean mass decreased at 3 and 6 months in both groups. The total muscle mass loss in the exercise group was always less than that in control group at all time periods, but the difference was not statistically significant. Handgrip strength, gait speed, reaction time, leg power, eye-closed and single-legged standing, and sit-and-reach were significantly improved for the exercise group at 3 and 6 months (p < 0.05). Gait speed and reaction time between both groups at 3 and 6 months were significant different (p < 0.05), and leg power at 6 months (p < 0.05). Compared with baseline, the reaction time of control group at six months was significantly improved (p < 0.05), and no other significant changes were observed. Compared with those at baseline, fasting plasma glucose, 2-h post-meal plasma glucose, fasting insulin, total cholesterol, and insulin resistance index in exercise group gradually decreased, and growth hormone was gradually increased with significance at 6 months (p < 0.05). 25-hydroxyvitamin D gradually and significantly increased in both groups at 3 and 6 months (p < 0.05). But two groups’ testosterone levels weren’t significant change.

Conclusion

Yijinjing combined with elastic band exercise can substantially reduce the body weight and body fat content of middle-aged and elderly patients with Prediabetes, improve muscle function and growth hormone secretion, and delay muscle mass reduction and diabetes development.

Clinical trial registration

[http://www.chictr.org.cn/showproj.aspx?proj=62753], identifier [ChiCTR2000039049].

Ultrasonographic assessment of skeletal muscles after experimentally induced neurogenic inflammation (facet injury) in rats

This study set out to examine ultrasonographic attributes of non-neurosegmentally (pectoral-forelimb) and neurosegmentally linked (hindlimb) myotomes in an experimental model that leads to neurogenic inflammation in segmentally linked myotomes, and to evaluate quantitative correlations among ultrasonographic attributes of the muscles, relative content of various inflammatory mediators, and nociceptive thresholds (hot and mechanical) in rats. Twelve male Wistar Kyoto rats were randomly divided into two equinumerous groups: surgery group, in which the left lumbar (L4-L6) facet joints were compressed for 3 min with modified Kelly forceps under general anesthesia, and sham-operated rats. All ultrasonograms were obtained with the Vevo 2100 Visual Sonic scanner connected to a 24-MHz transducer at four different time points: pre-surgery and 7, 14, and 21 days after surgical procedures. Digital ultrasonographic images of quadriceps femoris, hamstring, and pectoral-brachial muscle groups were analyzed using a polygonal meter region of interest placed on the largest cross-sectional area of the muscles displayed in Image ProPlus^® analytical software to compute numerical pixel values and pixel heterogeneity (standard deviation of mean pixel values). On day 21, pain behavior tests (hot plate and von Frey) were performed and then all animals were euthanized. Protein expression of inflammatory mediators in biceps brachii and rectus femoris muscles was measured by Western blot. The most prominent differences in muscle echotextural attributes between the two subsets of rats occurred 14 days post-surgery in pectoral-brachial and quadriceps femoris muscles. The expression of calcitonin-gene-related peptide was directly related to both echotextural variables only in biceps brachii (pixel intensity: r = 0.65, P = 0.02; and heterogeneity: r = 0.66, P = 0.02, respectively). Our findings have revealed the occurrence of echotextural changes in skeletal muscles of rats during myositis; however, the accumulation of inflammatory mediators and the outcomes of sensory tests did not relate to the changes in first-order echotextural characteristics of affected hindlimb muscles.

Influence of Subcutaneous Adipose Tissue and Skeletal Muscle Thickness on Rectus Femoris Echo Intensity in Younger and Older Males and Females

OBJECTIVES

Ultrasound measurements of muscle echo intensity are commonly used surrogates of muscle composition (eg, intramuscular adipose tissue). However, given that soundwaves are increasingly attenuated with tissue depth, the interpretation of echo intensity may be confounded by adipose and skeletal muscle thickness. Our objectives are to compare the associations between adipose or muscle tissue thickness and rectus femoris echo intensity in younger and older males and females.

METHODS

Participants included in this analysis were derived from 3 previously published cohorts of younger (<45 years) and older (≥60 years) males and females. Ultrasound images of the rectus femoris were evaluated for muscle thickness, echo intensity, and subcutaneous adipose tissue thickness.

RESULTS

Older adults (n: 49 males, 19 females) had a higher body mass index (P = .001) compared with younger adults (n: 37 males, 49 females). Muscle thickness was negatively associated with echo intensity in older males (r = -0.59) and females (r = -0.53), whereas no associations were observed in younger males (r = 0.00) or females (r = -0.11). Subcutaneous adipose tissue thickness displayed no associations with echo intensity in any group.

CONCLUSIONS

Despite the known influence of subcutaneous adipose tissue thickness on beam attenuation, we observed no association with muscle echo intensity, indicating that adipose tissue correction may be required to better understand muscle echo intensity across differences in adiposity. The negative associations between muscle thickness and echo intensity in older, but not younger adults, suggests these associations may be related to the co-occurrence of skeletal muscle atrophy and intramuscular adipose tissue infiltration with advancing age.

The Validity of Ultrasonographic Measurements of the Rectus Femoris Muscle in Older Adults with Sarcopenia in Thai Population

Purpose

This study aimed to determine the validity of ultrasonographic measurement of the rectus femoris muscle (RFM) thickness as a screening tool for low appendicular muscle mass (ASM) to diagnose sarcopenia and to determine the cut-off point of RFM thickness in the Thai population.

Patients and methods

We enrolled 857 community-dwelling adults aged 60 years and older who were diagnosed with sarcopenia using the Asian Working Group for Sarcopenia-2019 algorithm. The RFM thickness was measured using ultrasonography and compared with bioelectrical impedance analysis (BIA) data. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated, and the area under the receiver operating curve (AUROC) was used to determine the accuracy of the test.

Results

A total of 857 participants were included in the study. Overall, when the cut-off values of RFM thickness of ≤1.1 cm were used for male and ≤1 cm for female, the highest sensitivity for sarcopenia diagnosis was 90.9% and specificity was 92.2%. The PPV was 76.6, and the NPV was the highest at 97.3. The highest sensitivity for the diagnosis of severe sarcopenia was 92.5% and specificity was 97.4%. The AUROC of the cut-off point of RFM thickness for the diagnosis of sarcopenia was 0.92 (95% confidence interval [CI], 0.89−0.94); for severe sarcopenia, it was 0.95 (95% CI, 0.92−0.98).

Conclusion

Measuring RFM thickness using ultrasonography is a feasible and reliable screening test for sarcopenia, and the cut-off values of ≤1.1 cm for male and ≤1 cm for female showed the highest accuracy for confirming low ASM in the Thai population.

Prediction of probable sarcopenia with an alternative method: plantar flexion strength

OBJECTIVE

Sarcopenia is a geriatric syndrome characterized by age-related reduction in muscle mass and strength. Assessment of handgrip strength (HGS) is an essential measurement for the diagnosis of sarcopenia; however, disorders affecting upper limb muscles and joints may pose challenges in assessing handgrip strength. Therefore, the present study aimed to show the validity of plantar flexion strength (PFS) in diagnosing probable sarcopenia and investigating the relations between comprehensive geriatric assessment (CGA) and PFS while determining appropriate cutoff values for PFS.

METHODS

A total of 304 older participans who underwent CGA were included. The revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) were used to determine PFS cutoff values for gender groups. Associations between probable sarcopenia and CGA parameters were investigated using PFS cutoffs.

RESULTS

The mean age was 74.50 ± 7.10, and 170 of the participants (55.9%) were women. The mean HGS was 14.40 ± 5.63 kg in women and 25.08 ± 8.07 kg in men. The mean PFS were 13.17 ± 3.62 and 14.92 ± 3.86 kg respectively. In females, PFS cutoff with sensitivity/specificity; 0.81/0.60 was set at 14.95 kg (AUC 0.69, 95%CI: 0.611-0.772, p < 0.001). In males, PFS cutoff with sensitivity/specificity; 0.80/0.55 was set at 16.80 kg (AUC 0.68, 95%CI: 0.593-0.772, p < 0.001). Probable sarcopenia identified by GMS was associated with basic living activities, mobility, and frailty after adjusting for age and sex (p < 0.001, p = 0.021, and p = 0.011 respectively).

CONCLUSIONS

Probable sarcopenia identified by PFS could be associated with CGA. PFS may be useful for evaluating probable sarcopenia in older adults whose HGS cannot be estimated accurately.

Association of strength, power, and function with muscle thickness, echo intensity, and lean tissue in older males

Dual-energy X-ray absorptiometry (DXA) appendicular lean tissue is used to screen older adults for sarcopenia. However, emerging data indicates that ageing-related muscle atrophy largely occurs within specific muscles, which may be masked using appendicular lean tissue. Comparisons between appendicular lean tissue and site-specific measures of muscle in relation to strength and physical function are needed to advance our understanding of these features in the context of poor muscle function in aged adults. Our primary objective was to compare correlations between lean tissue and site-specific muscle characteristics in relation to strength and physical function in older males. Older males (≥65 years) were evaluated for muscle strength, physical function (6-minute walk and 30-second sit-to-stand), and muscle size (appendicular and site-specific) and composition (echo intensity) using DXA and ultrasound. Of the 32 older males (75.4 ± 7.9 years), 12 had low appendicular lean tissue. All DXA and ultrasound muscle characteristics were associated (r = 0.39 to 0.83, p < 0.05) with torque or power producing capabilities. Except for the knee flexors, no differences in correlation coefficients were observed between muscle thickness or regional lean tissue in relation to muscle strength. Neither DXA nor ultrasound muscle characteristics were associated with physical function. In older males, ultrasound-based muscle thickness and DXA lean tissue provided similar associations with strength. Novelty: Lean tissue and muscle thickness provide similar associations with strength. Muscle thickness can distinguish low and normal appendicular lean tissue in older adults.

Body Composition Characteristics of Community-Dwelling Older Adults With Dynapenia or Sarcopenia

This study aimed to determine the differences in muscle and fat masses of the arm and leg between older adults with dynapenia, sarcopenia, or presarcopenia and normal individuals. The percent body fat, lean body mass, and skeletal mass index were measured with bioelectrical impedance analysis. Muscle function was evaluated using grip strength and walking speed. Participants were classified into four categories. Dynapenia was defined as low muscle function with normal muscle mass. Sarcopenia was defined as the presence of both low muscle mass and low muscle function. Presarcopenia was defined as low muscle mass with normal muscle function. Control was defined as normal muscle mass and function. Multivariate analyses of variance were performed separately for women and men to test the main effect of sarcopenia category on body composition. Among the 356 enrolled participants, 270 were women, and 86 were men. In older women, the dynapenia and sarcopenia groups had significantly less muscle mass in the leg than the control group. In older men, the dynapenia group demonstrated a higher body fat mass in the leg than the control group. These results suggest that different strategies are necessary to prevent dynapenia in women and men.

Gait analysis under the lens of statistical physics

Human gait is a fundamental activity, essential for the survival of the individual, and an emergent property of the interactions between complex physical and cognitive processes. Gait is altered in many situations, due both to external constraints, as e.g. paced walk, and to physical and neurological pathologies. Its study is therefore important as a way of improving the quality of life of patients, but also as a door to understanding the inner working of the human nervous system. In this review we explore how four statistical physics concepts have been used to characterise normal and pathological gait: entropy, maximum Lyapunov exponent, multi-fractal analysis and irreversibility. Beyond some basic definitions, we present the main results that have been obtained in this field, as well as a discussion of the main limitations researchers have dealt and will have to deal with. We finally conclude with some biomedical considerations and avenues for further development.

Ultrasound Imaging for the Diagnosis and Evaluation of Sarcopenia: An Umbrella Review

There is an increasing number of reviews investigating the value of ultrasound (US) in the assessment of aging-related muscle loss. The present umbrella review aimed to systematically investigate the evidence of US imaging in the diagnosis and evaluation of sarcopenia. PubMed, Medline, Embase and Web of Science were searched from their inceptions to 31 October 2021. Systematic reviews and reviews using a systematic strategy for literature search were enrolled. The extracted data were narrated at the level of systematic reviews and meta-analyses. This umbrella review included four articles pertaining to 125 original studies and yielded several important findings. First, US is a reliable and valid imaging tool for the assessment of skeletal muscle mass. Second, among all the US parameters in B-mode, muscle thickness is the most commonly used one, which has good correlation with other standard measurements. Third, although sonoelastography and contrast-enhanced US are promising imaging modalities, their clinical utility is still limited at the current stage. Finally, a future systematic review is warranted to analyze how different ultrasonographic diagnostic criteria influence the prevalence of sarcopenia as well as its adverse health outcomes.

Diagnostic performance of magnetic resonance imaging and ultrasonography on the detection of cesarean scar pregnancy: A meta-analysis

BACKGROUND

: There is still a debate on which imaging method is the best to diagnose cesarean scar pregnancy (CSP). Accordingly, this study aimed to analyze the diagnostic performance of magnetic resonance imaging (MRI) and ultrasonography (US) on the detection of CSP based on current evidence in the literature.

METHODS

PubMed, Embase, Cochrane, Chinese Biomedical Documentation Service System, WanFang, and China National Knowledge Infrastructure databases were searched up to June 2020. The included studies were all comparisons of MRI and US in the diagnosis of CSP that adopted postoperative histological examination as the reference standard. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating characteristic curve (AUC) were calculated for MRI and US.

RESULTS

Thirteen studies were included, with a total sample size of 948 patients. The pooled sensitivity, specificity, PLR, NLR, and AUC of MRI in diagnosing CSP were 0.93 (95% CI, 0.91-0.95), 0.83 (95% CI, 0.75-0.89), 5.46 (95% CI, 3.70-8.05), 0.08 (95% CI, 0.06-0.11), and 0.96 (95% CI, 0.93-0.97), respectively; for US they were 0.84 (95% CI, 0.79-0.88), 0.73 (95% CI, 0.62-0.81), 3.06 (95% CI, 2.22-4.21), 0.23 (95% CI, 0.18-0.28), and 0.86 (95% CI, 0.83-0.89), respectively.

CONCLUSION

We found that both MRI and US effectively diagnosed CSP; however, MRI had a higher diagnostic performance in detecting CSP than US.

Evaluation of rehabilitation exercise effects by using gradation-based skeletal muscle echo intensity in older individuals: a one-group before-and-after trial study

Background

Higher muscle echo intensity (EI) reflects higher content of fat and/or connective tissue within skeletal muscle, eventually inducing lower muscle strength, physical dysfunction, and metabolic impairment. Continuous exercise decreases muscle EI in older individuals; however, it is not well understood how several months’ rehabilitation exercise affects gradation-based EI. The purpose of this study was to investigate the effects of 6 months of rehabilitation exercise on gradation-based higher and lower EI in older men and women.

Methods

Twenty-seven men and women (7 men, 20 women; age, 75.6 ± 6.4 years; height, 154.3 ± 8.5 cm; weight, 55.8 ± 9.7 kg) participated in this study. This study was a one-group before-and-after trial. They needed long-term care for activities of daily living. They performed rehabilitation exercises consisting of resistance exercises using a hydraulic resistance machine, stretching, and aerobic exercises using a recumbent bicycle once or twice a week for 6 months. B-mode ultrasonographic transverse image was taken from thigh muscles, e.g., rectus femoris, vastus lateralis, and biceps femoris. We calculated gradation-based cross-sectional area (CSA) from thigh muscles by dividing 256 greyscale level to 10 different components levels (e.g., 0–24, 25–49, 50–74, …, 200–224 and 225–249 a.u.).

Results

Lowest EI (e.g., 0–24 a.u.) CSA of thigh muscle was significantly increased after the exercise (0.3 ± 0.3 to 1.0 ± 0.8 cm²; P < 0.05). Middle to higher EI (e.g., 50–74, 75–99, 100–124, 125–149, 150–174, 175–199 and 200–224 a.u.) CSAs were significantly decreased from 23.0 to 68.7% after the exercise (P < 0.05).

Conclusions

Several months’ rehabilitation exercise affected both lower and higher EI in older men and women. This result suggests that rehabilitation exercise changes muscle composition by increasing contractile muscle tissue and decreasing fat and connective tissues.

Older males exhibit reduced anterior upper leg and anterior abdominal muscle thickness compared to younger males when matched for relative appendicular lean tissue

Background Ageing-related muscle atrophy does not occur uniformly across the body; rather, atrophy occurs to a greater extent in specific muscle groups compared to others. However, site-specific comparisons of muscle mass between older and younger adults typically do not account for relative muscle mass (i.e., matched for age- and sex-specific percentiles), which may confound site-specific differences. Furthermore, the uniformity of ageing-related differences in muscle composition (e.g., intramuscular adipose tissue) across the body are not well characterized. Purpose To examine site-specific muscle mass and composition differences between younger and older males matched for relative muscle mass. Methods Younger (18-44 years old, n = 19) and older (≥65 years old, n = 19) males were matched for relative appendicular lean tissue index (NHANES age- and sex-specific Z-scores) measured using dual-energy x-ray absorptiometry. Site-specific differences in skeletal muscle size (thickness) and composition (echo-intensity) were evaluated using ultrasound for 8 distinct landmarks across the body. Results Relative appendicular lean tissue mass was well matched between younger and older males (Z-score difference: -0.02, p = 0.927). Compared with younger males, older males had smaller muscle thickness for the anterior upper leg (difference: -1.08 cm, p < 0.001) and anterior abdomen (difference: -0.53 cm, p < 0.001). However, older adults displayed higher echo intensity across all muscles (p < 0.05), except for the posterior upper arm (p = 0.377), in comparison to the younger males. Conclusions When matched for relative appendicular lean tissue, muscle thickness differences between younger and older males are not-uniform across the body, whereas echo intensity was more uniformly higher in the older males.

The treatment effect of intramuscular stimulation on carpal tunnel syndrome: A blinded randomized trial on 75 patients

BACKGROUND

Carpal tunnel syndrome (CTS) is a disorder with a prevalence of about 5.8% for females and 0.6% for males. This study aims to determine whether intramuscular stimulation (IMS) to the pronator teres muscle subsequently reduces the severity of clinical parameters and the diameter of the median nerve.

METHODS

Seventy-five individuals with a cross-sectional diameter of the median nerve of more than 2 mm were included in this randomized clinical trial. Thirty-seven individuals received IMS to the pronator teres muscle with a depth of up to 45-50 mm. The 38 individuals in the control group received an acupuncture needle at Li11 with a depth of 4-5 mm. Both groups had 7 treatments within 7 weeks. The primary outcome was the cross-section of the median nerve in the carpal tunnel. Additionally, Phalen's test, Tinel's sign, VAS for pain intensity, and pincer grip strength were measured.

RESULTS

Both IMS subjects and controls showed significant reductions in the cross-section of the median nerve from baseline to follow-up (p < 0.001 and p = 0.002 respectively). The IMS group had the largest change, but the difference in change between the groups was not significant (p = 0.39). On all clinical tests, IMS subjects showed significant improvement from baseline compared with the control group (largest p = 0.002).

CONCLUSION

In this study we found that IMS to the pronator teres muscle significantly improved all clinical variables measured, compared with the group receiving acupuncture. Furthermore, the cross-section of the median nerve reduced over time for both groups. IMS may be a low-risk alternative while patients are waiting for surgery.

TRIAL REGISTRATION

Clinicaltrials. gov Identifier: NCT01102868. Retrospectively registered: March 29th^, 2010.

Does skeletal muscle morphology or functional performance better explain variance in fast gait speed in older adults?

BACKGROUND

Fast gait speed is being increasingly recognized as an important clinical tool in older adults. However, the underlying muscular and functional contributors to fast gait speed performance remain poorly understood.

AIM

We sought to determine predictors of fast gait speed in older adults. We hypothesized that lower-extremity skeletal muscle size and quality would be strong predictors.

METHODS

Ninety community-dwelling older adults (33 men, 57 women; mean ± SD age = 74 ± 6 years) participated. B-mode ultrasonography was used to capture images of the vastus lateralis, rectus femoris, and gastrocnemius in the transverse plane. Each participant performed 30-second chair stand, heel-rise, functional reach, and grip strength tests. Fast gait speed was measured using the NIH Toolbox 4-Meter Walk Test. ImageJ software was used to quantify cross-sectional area (CSA), subcutaneous tissue thickness, and echo intensity. Two separate stepwise regression analyses were performed, one using muscle morphology variables as independent variables, and another including the functional outcomes.

RESULTS

The ultrasound variables exhibited weak-to-moderate correlations with fast gait speed (|r| range = 0.168-0.416). The initial regression analysis indicated that the combination of medial gastrocnemius CSA and subcutaneous tissue thickness explained 22.8% of the variance in fast gait speed. The secondary analysis indicated that 30-second chair stand, heel-rise, and grip strength performance explained 45.5% of the variance.

CONCLUSION

While medial gastrocnemius morphology is important, measures of upper and lower-extremity muscle function are better predictors of fast gait speed. These results highlight a dissociation between skeletal muscle morphology and fast gait speed.

Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update

PURPOSE

In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles.

METHODS

A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used.

RESULTS

For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups.

CONCLUSIONS

The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.

Biomechanical Evaluation of Intercostal Muscles in Healthy Children and Adolescent Idiopathic Scoliosis: A Preliminary Study

Spine deformity during adolescent idiopathic scoliosis can induce a rib-cage deformity. This bone deformity can have direct consequences on the chest-wall muscles, including intercostal muscles, leading to respiratory impairments in individuals with severe cases. The aim of this study was to determine whether shear-wave elastography can be used to measure intercostal-muscle shear-wave speed (SWS) in healthy children and those with adolescent idiopathic scoliosis (AIS). Nineteen healthy participants and 16 with AIS took part. SWS measurements were taken by three operators, twice each. Average SWS was 2.3 ± 0.4 m/s, and inter-operator reproducibility was 0.2 m/s. SWS was significantly higher during apnea than in normal breathing (p < 0.01) in both groups. No significant difference was observed between groups in apnea or in normal breathing. Characterization of the intercostal muscles by ultrasound elastography is therefore feasible and reliable for children and adolescents with and without scoliosis.

Sarcopenia, Diet, Physical Activity and Obesity in European Middle-Aged and Older Adults: The LifeAge Study

The revised European consensus defined sarcopenia as a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality. The aim of this study was to determine the prevalence of sarcopenia and analyse the influence of diet, physical activity (PA) and obesity index as risk factors of each criteria of sarcopenia. A total of 629 European middle-aged and older adults were enrolled in this cross-sectional study. Anthropometrics were assessed. Self-reported PA and adherence to the Mediterranean diet were evaluated with the Global Physical Activity Questionnaire (GPAQ) and Prevention with Mediterranean Diet questionnaire (PREDIMED), respectively. The functional assessment included handgrip strength, lower body muscle strength, gait speed and agility/dynamic balance. Of the participants, 4.84% to 7.33% showed probable sarcopenia. Sarcopenia was confirmed in 1.16% to 2.93% of participants. Severe sarcopenia was shown by 0.86% to 1.49% of participants. Male; age group ≤65 years; lower body mass index (BMI); high levels of vigorous PA; and the consumption of more than one portion per day of red meat, hamburgers, sausages or cold cuts and/or preferential consumption of rabbit, chicken or turkey instead of beef, pork, hamburgers or sausages (OR = 0.126-0.454; all p < 0.013) resulted as protective factors, and more time of sedentary time (OR = 1.608-2.368; p = 0.032-0.041) resulted as a risk factor for some criteria of sarcopenia. In conclusion, age, diet, PA, and obesity can affect the risk of having low muscle strength, low muscle mass or low functional performance, factors connected with sarcopenia.

Ultrasound Imaging Is Reliable for Tibialis Posterior Size Measurements

OBJECTIVES

The tibialis posterior (TP) is a vital muscle for controlling the medial longitudinal arch of the foot during weight-bearing activities. Dysfunction of this muscle is associated with a variety of pathologic conditions; thus, it is important to reliably assess its morphologic characteristics. Ultrasound (US) has been used to assess characteristics of TP tendons but not the muscle cross-sectional area (CSA). The purpose of this study was to establish a reliable US technique to measure the TP CSA and thickness.

METHODS

Twenty-three healthy volunteers participated. We evaluated the CSA and thickness at 4 measurement locations (anterior and posterior views at both 30% and 50% of the shank length).

RESULTS

The participants included 12 female and 11 male volunteers (mean age ± SD, 31.23 ± 14.93 years). Excellent reliability was seen for the CSA and thickness at all locations (intraclass correlation coefficients, 0.988-0.998). Limits of agreement (LoA) and standard errors of the measurement (SEMs) were slightly lower at the 30% locations (LoA at 30%, 4.6-9.2; LoA at 50%, 6.4-9.7; SEM at 30%, 0.03-0.05; SEM at 50%, 0.04-0.07). Strong correlations were seen between anterior and posterior measurements of the CSA (30%, r = 0.99; P < .0001; 50%, r = 0.94; P < .0001) and thickness (30%, r = 0.98; P < .0001; 50%, r = 0.95; P = .0001).

CONCLUSIONS

Based on these results, the TP can be measured accurately with US at any of the tested locations. Due to the ease of collection and the quality of the data, we recommend the anterior view at 30% of the shank length to measure the CSA. The ability to assess muscle size of the TP will aid in a variety of medical and research applications.

Changes in Muscle Mass in Patients With Renal Transplants Based on Ultrasound: A Prospective Study

OBJECTIVES

This original research aimed to investigate the value of ultrasound (US), including grayscale US and shear wave elastography (SWE), in quantitatively evaluating muscle mass after kidney transplantation.

METHODS

A total of 52 patients and 54 healthy control participants were recruited. High-frequency US was used to evaluate the echo intensity and muscle morphologic features. Muscle stiffness in the rectus femoris was assessed with SWE. Interclass and intraclass correlation coefficients were used for evaluating measurement reliability. The diagnostic performance of SWE was determined by a receiver operating characteristic curve analysis.

RESULTS

The intraobserver and interobserver repeatability was excellent (all correlation coefficients >0.940; P < .05). The best evaluation point after right iliac fossa transplantation was at the lower third of the right leg. In patients, the skin (0.154 versus 0.192 cm) and rectus femoris (0.700 versus 0.905 cm) were thinner, and the pinnate angle (6.500° versus 8.000°) and area (0.965 versus 1.270 cm² ) were smaller (all P < .05). The US results showed that, compared with the controls, all patients' rectus femoris echo intensity (P < .001 in the transverse section) and elastic modulus (P < .001 in the Young modulus and shear wave speed) increased significantly. The cutoff values were 10.05 and 10.37, and the areas under the receiver operating characteristic curves were 0.843 and 0.845 for predicting kidney transplant and sarcopenia, respectively.

CONCLUSIONS

This noninvasive and convenient technique might be effective for objectively evaluating the muscle mass of patients after kidney transplantation.

MiRNAs, Myostatin, and Muscle MRI Imaging as Biomarkers of Clinical Features in Becker Muscular Dystrophy

Becker muscular dystrophy (BMD) is an X-linked recessive disorder caused by dystrophin gene mutations. The phenotype and evolution of this muscle disorder are extremely clinical variable. In the last years, circulating biomarkers have acquired remarkable importance in their use as noninvasive biological indicators of prognosis and in monitoring muscle disease progression, especially when associated to muscle MRI imaging. We investigated the levels of circulating microRNAs (myo-miRNAs and inflammatory miRNAs) and of the proteins follistatin (FSTN) and myostatin (GDF-8) and compared results with clinical and radiological imaging data. In eight BMD patients, including two cases with evolving lower extremity weakness treated with deflazacort, we evaluated the expression level of 4 myo-miRNAs (miR-1, miR-206, miR-133a, and miR-133b), 3 inflammatory miRNAs (miR-146b, miR-155, and miR-221), FSTN, and GDF-8 proteins. In the two treated cases, there was pronounced posterior thigh and leg fibrofatty replacement assessed by muscle MRI by Mercuri score. The muscle-specific miR-206 was increased in all patients, and inflammatory miR-221 and miR-146b were variably elevated. A significant difference in myostatin expression was observed between steroid-treated and untreated patients. This study suggests that microRNAs and myostatin protein levels could be used to better understand the progression and management of the disease.

Ultrasound-Guided Physiological Saline Injection for Patients with Myofascial Pain

Background:

Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events.

Materials and Methods:

Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author.

Results:

One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated.

Conclusion:

US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.

Ultrasound measurements of superficial and deep masticatory muscles in various postures: reliability and influencers

Masticatory muscle thickness provides objective measurements of the oral motor function, which may change in patients with oral myofascial pain. In this study, we aimed to establish a reliable ultrasound (US) protocol for imaging the superficial and deep masticatory muscles and to identify the potential influencers of the measurements. Forty-eight healthy participants without orofacial pain were enrolled. The intra-and inter-rater reliabilities of US measurements for masseter, temporalis, and lateral pterygoid muscles were assessed. Intraclass correlation coefficients for all muscles were greater than 0.6. The generalised estimating equation was used to analyse the impact of age, gender, laterality, and body mass index on the measurements, whereby age and body mass index were likely to be associated with an increase in masticatory muscle thickness. The thickness tended to be lesser in females. Laterality seemed to exert minimal influence on masticatory muscle thickness. Our study shows acceptable reliability of US in the evaluation of superficial and deep masticatory muscle thickness. Future studies are warranted to validate the usefulness of US imaging in patients with oral myofascial pain syndrome.

Muscle thickness contribution to sit-to-stand ability in institutionalized older adults

BACKGROUND

Ultrasound is a low-cost, safe and accessible tool to use on muscle mass assessment. The relations between muscle thickness and lower limb function have not been investigated in institutionalized elderly people.

AIM

The purpose of the present study was to investigate the associations among sit-to-stand capacity, ultrasound-measured rectus femoris muscle thickness, hand grip strength and anthropometrics in a population of institutionalized older adults.

METHODS

Twelve older adults (nine women and three men, mean age ± SD 86 ± 7 years, body mass index 24 ± 3 kg/m²) participated in this cross-sectional study. Sit-to-stand capacity using five-repetition sit-to-stand test, rectus femoris muscle thickness using B-mode ultrasonography, handgrip and anthropometric were measured. The relationships of the variables were analyzed using Pearson correlation coefficient and multiple linear regression analysis.

RESULTS

Significant bivariate correlations were found between rectus femoris muscle thickness and sit-to-stand test (p < 0.05). Multiple linear regression analysis showed associations between rectus femoris muscle thickness and sit-to-stand test, after adjusting by body mass index and age (p < 0.0001).

DISCUSSION

Rectus femoris thickness in contraction adjusted by body mass index and age was predictors of physical performance. The independent variables shared 78.6% of variance in the sit-to-stand test.

CONCLUSIONS

Rectus femoris muscle thickness measured with ultrasonography, body mass index and age could explain functionality in institutionalized older adults measured by five-repetition sit-to-stand test.

Ultrasound Imaging of the Paraspinal Muscles for Interscapular Pain After Back Massage

Muscle injuries are very common in sports medicine, but involvement of the paraspinal muscles is relatively rare. The diagnosis is usually clinical, but diagnostic imaging modalities (ie, ultrasound and magnetic resonance) identify, in detail, the anatomical site and extension of the lesion helping the physician plan a specific rehabilitation program. Likewise, the authors present an unusual case of a amateur volleyball player who suffered injury of the paraspinal muscles after a session of manual therapy with deep massage. The authors also highlight the potential role of ultrasound imaging in detecting muscle injuries not only in the limbs but also at the level of paraspinal region for prompt management and return to play.

Effectiveness of early versus delayed exercise and nutritional intervention on segmental body composition of sarcopenic elders - A randomized controlled trial

BACKGROUND & AIMS

Although resistance training with nutritional support is considered the best treatment option for sarcopenia, the importance of home-based exercise should not be overlooked. For managing sarcopenia, a fundamental issue is whether home-based exercise or a supervised training program should be administered first. Therefore, the present trial aimed to compare the effect of early versus delayed exercise intervention with nutritional support on the physical performance and body composition of sarcopenic elders.

METHODS

The study was a randomized controlled trial using a parallel-group design. Each group received two therapeutic periods lasted 12 weeks with an interval of 2 weeks in between. Physical performance and body composition were assessed at baseline and immediately following the end of the first and second phases. One phase included hospital-based resistance training and nutritional support (amino acid, calcium, and vitamin D3), whereas the other phase included home-based exercise. In the early intervention group, supervised exercise and nutrition supplementation were administered first followed by home-based exercise, whereas the sequence was reversed in the delayed intervention group. The influence of intervention sequence on the outcome variables was examined using a 3∗2 repeated-measures analysis of variance. The primary endpoints were defined as changes in lean mass and related physical function (grip strength and gait speed) over 12 and 26 weeks of interventions.

RESULTS

A total of 57 sarcopenic elders were randomly assigned to the early (n = 29) and delayed (n = 28) intervention groups. Among the primary endpoints, the only significant group-time interaction was recognized on the changes of lower extremity lean mass (p = 0.039). The early intervention was associated with an earlier increase in lower extremity lean mass (770.8 g, 95% confidence interval (CI), 564.8 g-976.9 g) than delayed intervention (294.2 g, 95% CI, -42.13 to 630.5 g) which was evident from the between-group comparison between baseline and the 1st follow-up (p = 0.016). No significant effect of group-time interaction was observed on the physical performance and other components of body composition.

CONCLUSIONS

Early exercise and nutritional intervention may be helpful in an earlier restoration of lower extremity muscle mass but not physical function in sarcopenic elders. When designing a rehabilitation program for patients with sarcopenia, resistance training with nutrition support can be prescribed first for the rapid enlargement of the muscle volume, and structuralized home-based exercise can be administered subsequently to preserve the prior intervention effect.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02779088).

Independent and combined associations of cardiorespiratory fitness and muscle strength with metabolic syndrome in older adults: A cross-sectional study

BACKGROUND

Studies have shown that low cardiorespiratory fitness (CRF) and low muscle strength are independently associated with metabolic syndrome (MetS) in older adults. This study investigated the isolated and combined associations of low CRF and muscle strength with MetS in older adults.

METHODS

This cross-sectional study included 184 older adults (71% women; aged 65.6 ± 4.3 years) without a prior history of cardiovascular disease. CRF and muscle strength were assessed by the six-minute walking test and 30-s chair stand test, respectively. Results below the 25th percentile of the cohort were used to define low CRF and low muscle strength. MetS was defined according to NCEP-ATP III criteria. Poisson's regression with robust variance was used to determine the prevalence ratio (PR) for MetS. Reference group was composed by older adults with both CRF and muscle strength above 25th percentile.

RESULTS

Prevalence of low CRF, low muscle strength, and combined low CRF and muscle strength was 22.8%, 17.9%, and 10.9%, respectively. The prevalence of MetS was 56.5% in the full cohort. Isolated low CRF (PR 1.05, 95% CI 0.73 to 1.52; p = 0.793) and muscle strength (PR 1.09, 95% CI 0.74 to 1.61; p = 0.651) were not associated with MetS in the adjusted analysis. Combined low CRF and muscle strength was associated with MetS (PR 1.45, 95% CI 1.09 to 1.93; p = 0.011).

CONCLUSIONS

Older adults with combined, but not isolated, low CRF and muscle strength showed an increased risk for MetS.

The Quantitative Skeletal Muscle Ultrasonography in Elderly with Dynapenia but not Sarcopenia Using Texture Analysis

(1) Background: Dynapenia is defined as lower muscle strength alone. Only a few studies have investigated muscle quality in subjects with dynapenia. (2) Methods: The muscle quality, characterized by texture parameters of biceps brachii, triceps brachii, rectus femoris, and medial gastrocnemius muscles, were collected using ultrasonography. The risk of dynapenia was assessed by the multiple logistic regression model. (3) Results: There were a total of 36 participants (72.7 ± 5.8 yrs, 1:1 case-control matched). The values of texture parameters of autocorrelation (AUT) and sum variance (SVAR) in all four muscles were higher in the dynapenia group significantly (p < 0.05). AUT and SVAR had the significant associations for dynapenia in biceps (dds ratio[OR]:2.51, 95% CI = 1.25–5.07 for AUT; OR = 1.45, 95% CI:1.1–1.91 for SVAR), triceps (OR: 2.48, 95% CI = 1.60–5.3 for AUT; OR: 1.57, 95% CI = 1.08–2.28 for SVAR), and rectus femoris (OR: 1.58, 95% CI = 1.01–2.46 for AUT; OR: 1.2, 95% CI = 1.0–1.44 for SVAR). The areas under the receiver-operating curves of all texture parameters was between 0.84–0.94 after adjusting confounding factors. (4) Conclusions: The muscle quality in the dynapenia can be detected by the texture-feature quantitative ultrasound. Ultrasound measurement in the aging muscle might be promising, and further studies should validate its application in the context of dynapenia.

Use of Cine Loops and Structural Landmarks in Ultrasound Image Processing Improves Reliability and Reduces Error in the Assessment of Foot and Leg Muscles

OBJECTIVES

Foot and leg muscle strength and size are crucial to proper function. It is important to assess these characteristics reliably. Our primary objective was to compare the measurement of still images to cine loops. The secondary purpose was to determine interoperator and intraoperator reliability between operators of different experience levels using video clips and internal and external landmarks.

METHODS

Twelve healthy volunteers participated in our study. Internal (navicular tuberosity) and external (lateral leg length at 30% and 50% from the knee joint line) landmarks were used. Two operators each captured and later measured still and cine loop images of selected foot and leg muscles.

RESULTS

The 12 participants included 8 male and 4 female volunteers (mean age ± SD, 23.5 ± 1.9 years). Good to excellent intraoperator and interoperator reliability was seen (intraclass correlation coefficient range of 0.946-0.998). The use of cine loops improved the intraclass correlation coefficients for both intraoperator and interoperator reliability (0.5%-4% increases). The use of cine loops decreased the intraoperator standard error of the measurement and limits of agreement of the novice operator (decreases of 45%-73% and 24%-51%, respectively), and these became comparable to those of experienced operators using still images. The interoperator standard errors of the measurement dropped by 42% to 53%, whereas the limits of agreement dropped by 27% to 40%. No substantial changes were noted in the tibialis anterior across reliability metrics.

CONCLUSIONS

Improved protocols that take advantage of using internal bony landmarks and cine loops during both the image-gathering and measurement processes improve the reliability of research examining muscle size changes in the lower leg or foot associated with muscle changes due to exercise, injury, disuse, or disease.

Assessing the Performance of Morphologic and Echogenic Features in Median Nerve Ultrasound for Carpal Tunnel Syndrome Diagnosis

OBJECTIVES

To assess the feasibility of using ultrasound (US) image features related to the median nerve echogenicity and shape for carpal tunnel syndrome (CTS) diagnosis.

METHODS

In 31 participants (21 healthy participants and 10 patients with CTS), US images were collected with a 30-MHz transducer from median nerves at the wrist crease in 2 configurations: a neutral position and with wrist extension. Various morphologic features, including the cross-sectional area (CSA), were calculated to assess the nerve shape. Carpal tunnel syndrome commonly results in loss of visualization of the nerve fascicular pattern on US images. To assess this phenomenon, we developed a nerve-tissue contrast index (NTI) method. The NTI is a ratio of average brightness levels of surrounding tissue and the median nerve, both calculated on the basis of a US image. The area under the curve (AUC) from a receiver operating characteristic curve analysis and t test were used to assess the usefulness of the features for differentiation of patients with CTS from control participants.

RESULTS

We obtained significant differences in the CSA and NTI parameters between the patients with CTS and control participants (P < .01), with the corresponding highest AUC values equal to 0.885 and 0.938, respectively. For the remaining investigated morphologic features, the AUC values were less than 0.685, and the differences in means between the patients and control participants were not statistically significant (P > .10). The wrist configuration had no impact on differences in average parameter values (P > .09).

CONCLUSIONS

Patients with CTS can be differentiated from healthy individuals on the basis of the median nerve CSA and echogenicity. Carpal tunnel syndrome is not manifested in a change of the median nerve shape that could be related to circularity or contour variability.

Efficacy and Safety of Percutaneous Ozone Injection Around Gasserian Ganglion for the Treatment of Trigeminal Neuralgia: A Multicenter Retrospective Study

Background

Ozone injection around Gasserian ganglion (OIAGG) has been reported to be an effective treatment for trigeminal neuralgia (TN); however, there remain areas for improvement. To overcome one of these limitations, a multicenter examination of application would be extremely helpful.

Objective

The goal of this report was to assess the efficacy of OIAGG for refractory TN across multiple centers and to explore factors predictive of successful treatment.

Design

A multicenter, retrospective study.

Setting

The study was conducted across 3 pain centers across China.

Patients and Methods

A total of 103 subjects from 3 pain centers were enrolled in the study. An ozone-oxygen mixture gas at a concentration of 30 µg/mL was injected into the area around the Gasserian ganglion performed under C-arm X-ray guidance. Primary outcome measures included a pain assessment using a visual analog scale (VAS) and the Barrow Neurological Institute (BNI) pain intensity scale. Clinical assessment of patients for these outcome measures was performed at pretreatment, post-treatment, 6 months, 1 year and 2 years after the OIAGG.

Results

Successful pain relief was defined as a score within BNI grades I–IIIa. The pain relief rates at post-treatment, 6 months, 1 year and 2 years after the procedure were 88.35%, 86.87%, 84.46% and 83.30%, respectively. The VAS at each observation time point was significantly different from the preoperative levels (P<0.05). Logistic regression analysis showed that previous nerve damage had a significant effect on the treatment results. No significant complications or side effects were found during or after treatment.

Conclusion

This multicenter research confirms our previous single center results that OIAGG is both effective and safe for patients with TN.

Expansion of 1 mL of Solution by Ultrasound-Guided Injection Between the Trapezius and Rhomboid Muscles: A Cadaver Study

OBJECTIVE

An ultrasound-guided interfascial injection, which targets the space between the epimysia, is often performed for myofascial neck and shoulder pain. However, the relationship between the injection volume and clinical effectiveness has been controversial. We conducted an anatomical study with cadavers to measure the distribution of a small amount of pigment solution injected into the interfascial space.

DESIGN

An experimental cadaveric study.

SETTING

An institutional clinical anatomy laboratory.

METHODS

We performed 20 ultrasound-guided injections with pigment solutions of 1.0 mL each into the space between the trapezius muscle and rhomboid muscle bilaterally on 10 cadaver specimens. Cadavers were then dissected and macroscopically evaluated for pigment distribution on the fascia of the muscular surfaces. The pigment distribution area of each injection site was visually confirmed and calculated using automatic area calculation software.

RESULTS

Pigment solution exclusively within the interfascial space was visually confirmed in 95% (19/20) of injection sites. The median pigmented surface area (interquartile range) was 24.50 (16.17-30.76) cm2 on the deep side of the trapezius muscle and 18.82 (13.04-24.79) cm2 on the superficial side of rhomboid muscle; these measurements were statistically significantly different (P = 0.033).

CONCLUSIONS

A pigment solution comprising as little as 1.0 mL injected under ultrasound guidance separated two adjacent muscles and spread to the wide area within the interfascial space. The difference in the pigment distribution area between the two adjacent muscles can be explained by the path made by the injection needle and several layers of fascia between the epimysium.

Experience of an isolated use of low-intensity pulsed ultrasound therapy on fracture healing in established non-unions: a prospective case series

Fracture non-unions are responsible for approximately 5% of cases, with low expectation of spontaneous healing thereafter. The fractures that heal without complications can take months to heal completely. An ultrasound, typically at low intensities (0.5-50 mW/cm²), serves a diagnostic purpose, whereas at higher intensities (0.2-100 W/cm²), its role becomes more therapeutic by generating heat energy. Low-intensity pulsed ultrasound (LIPUS) is frequently used to stimulate or to accelerate fracture healing. We present a prospective review of fracture non-unions treated with low-intensity pulsed ultrasound (LIPUS). We enrolled 66 patients during August 2016 and December 2018, 38 males and 28 females; age range 19-85 years (average 49.2 years). All these patients were followed up to minimum 6 months. The average time of referral post-treatment for fractures was 8.2 months (range 6-18 months). Four patients were excluded due to various reasons. 39 out of 62 fractures showed successful healing with symptom improvement and callus formation with 67% success rate. In this case series, we noted LIPUS therapy failure in the post-ORIF scaphoid fracture and post-ankle joint fusion non-union. We did not observe any influence of a medical condition such as diabetes mellitus, osteoporosis or personal habits like smoking. The LIPUS therapy appears to have influence on bone healing, depending on the onset of therapy, fracture type and the approach to fracture care. In this case series, the compliant group showed 67% successful outcome.

The Transverse Infrapatellar View: A New Ultrasound Technique to Measure Distal Femoral Cartilage Thickness

OBJECTIVES

To examine the reliability and face validity of ultrasound (US) measurements of distal femoral cartilage thickness (CT) using the infrapatellar view (IPV) with knee extension compared to the traditional suprapatellar view (SPV) with knee hyperflexion in young asymptomatic participants and patients with painful knee osteoarthritis (KOA).

METHODS

The IPV was obtained in an extended knee position by placing the US transducer on the patellar tendon at a 60° angle tilted toward the distal femoral condyle in 19 young adults (control group) and 70 patients with KOA. The CT was measured at the medial femoral condyle, the intercondylar notch, and the lateral femoral condyle.

RESULTS

The inter-rater intraclass correlation coefficient was higher for IPV-based CT measurement (range, 0.856-0.858) compared to SPV-based CT measurement (range, 0.315-0.523) among the patients with symptomatic KOA. The IPV-based CT differed significantly between the control group and the KOA group at the intercondylar notch (P < .001) and lateral femoral condyle (P = .006). The SPV-based CT differed significantly between the control group and the KOA group only at the lateral femoral condyle region (P = .014).

CONCLUSIONS

An infrapatellar US evaluation of the distal femoral CT can be a reliable alternative method to a suprapatellar US evaluation for patients with KOA.