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Šarabon N, Vreček N, Hofer C, Löfler S, Kozinc Ž, Kern H. Physical Abilities in Low Back Pain Patients: A Cross-Sectional Study with Exploratory Comparison of Patient Subgroups. Life (Basel) 2021; 11:life11030226. [PMID: 33802214 PMCID: PMC8000067 DOI: 10.3390/life11030226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022] Open
Abstract
An abundance of literature has investigated the association between low back pain (LBP) and physical ability or function. It has been shown that LBP patients display reduced range of motion, decreased balance ability, impaired proprioception, and lower strength compared to asymptomatic persons. The aim of this study was to investigate the differences between LBP patients and healthy controls in terms of several physical abilities. Based on the premised that different biomechanical and physiological causes and consequences could be related to different types of LBP, a secondary exploratory attempt of the study was to examine the differences between LBP subgroups based on the pain location (local or referred) or type of pathology (discogenic or degenerative) on the level of impairment of function and ability. Participants performed range of motion tests, trunk maximal voluntary contraction force tests, a sitting balance assessment, the timed up-and-go test, the chair rise test, and the trunk reposition error test. Compared to the control group, symptomatic patients on average showed 45.7% lower trunk extension (p < 0.001, η2 = 0.33) and 27.7 % lower trunk flexion force (p < 0.001, η2 = 0.37) during maximal voluntary contraction. LBP patients exhibited decreased sitting balance ability and lower scores in mobility tests (all p < 0.001). There were no differences between groups in Schober’s test and trunk repositioning error (p > 0.05). No differences were observed among the LBP subgroups. The exploratory analyses are limited by the sample size and uncertain validity of the diagnostic procedures within this study. Further studies with appropriate diagnostic procedures and perhaps a different subgrouping of the LBP patients are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function.
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Affiliation(s)
- Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Laboratory for Motor Control and Motor Behaviour, S2P, Science to Practice Ltd., 1000 Ljubljana, Slovenia
- Human Health Department, InnoRenew CoE, 6310 Izola, Slovenia
- Correspondence:
| | - Nace Vreček
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Andrej Marušič Institute, University of Primorska, 6000 Koper, Slovenia
| | - Helmut Kern
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
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2
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Liu J, Wang Z, Shen D, Yang X, Liu M, Cui L. Split phenomenon of antagonistic muscle groups in amyotrophic lateral sclerosis: relative preservation of flexor muscles. Neurol Res 2020; 43:372-380. [PMID: 33372862 DOI: 10.1080/01616412.2020.1866354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: In addition to the split hand sign, other split phenomena of different muscles also exist in amyotrophic lateral sclerosis (ALS). We analyzed the incidence of split phenomena in multiple antagonistic muscle groups in ALS patients and explored whether clinical factors affected their occurrence.Methods: 618 ALS patients were included from a single ALS center. Muscle strength in upper and lower limbs was evaluated using the modified Medical Research Council (MRC) scoring system (range from 1 to 13). Split phenomena between different antagonistic muscle groups were summarized, and the correlations with clinical factors were analyzed.Results: Split phenomena were detected in 22.3% antagonistic muscles for flexion and extension of the elbow, 11.9% for the wrist, 23.9% for fingers, 18.2% for the ankle, and 14.7% for toes. These manifestations were characterized by preferential wasting of the elbow, wrist, and finger extensor muscles compared with the flexor muscles, and the ankle and toe dorsiflexor muscles compared with the plantar flexor muscles. The presence of muscle wasting was more common when the muscle strength was stronger than a modified MRC grade 6. No definite correlation was found between split phenomena and clinical factors, including age-at-onset, gender, disease duration, the region of onset, and pyramidal tract damage.Discussion: Split phenomena of antagonistic muscle groups widely exist in ALS patients. No definitive and consistent clinical factors were observed that affected the occurrence of these phenomena.
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Affiliation(s)
- Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xunzhe Yang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
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3
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Bolotta A, Filardo G, Abruzzo PM, Astolfi A, De Sanctis P, Di Martino A, Hofer C, Indio V, Kern H, Löfler S, Marcacci M, Zampieri S, Marini M, Zucchini C. Skeletal Muscle Gene Expression in Long-Term Endurance and Resistance Trained Elderly. Int J Mol Sci 2020; 21:ijms21113988. [PMID: 32498275 PMCID: PMC7312229 DOI: 10.3390/ijms21113988] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Physical exercise is deemed the most efficient way of counteracting the age-related decline of skeletal muscle. Here we report a transcriptional study by next-generation sequencing of vastus lateralis biopsies from elderly with a life-long high-level training practice (n = 9) and from age-matched sedentary subjects (n = 5). Unsupervised mixture distribution analysis was able to correctly categorize trained and untrained subjects, whereas it failed to discriminate between individuals who underwent a prevalent endurance (n = 5) or a prevalent resistance (n = 4) training, thus showing that the training mode was not relevant for sarcopenia prevention. KEGG analysis of transcripts showed that physical exercise affected a high number of metabolic and signaling pathways, in particular those related to energy handling and mitochondrial biogenesis, where AMPK and AKT-mTOR signaling pathways are both active and balance each other, concurring to the establishment of an insulin-sensitive phenotype and to the maintenance of a functional muscle mass. Other pathways affected by exercise training increased the efficiency of the proteostatic mechanisms, consolidated the cytoskeletal organization, lowered the inflammation level, and contrasted cellular senescence. This study on extraordinary individuals who trained at high level for at least thirty years suggests that aging processes and exercise training travel the same paths in the opposite direction.
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Affiliation(s)
- Alessandra Bolotta
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, 40138 Bologna, Italy; (A.B.); (P.D.S.); (M.M.); (C.Z.)
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Provvidenza Maria Abruzzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, 40138 Bologna, Italy; (A.B.); (P.D.S.); (M.M.); (C.Z.)
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
- Correspondence: ; Tel.: +39-051-2094122
| | - Annalisa Astolfi
- Giorgio Prodi Interdepartimental Center for Cancer Research, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.A.); (V.I.)
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Paola De Sanctis
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, 40138 Bologna, Italy; (A.B.); (P.D.S.); (M.M.); (C.Z.)
| | - Alessandro Di Martino
- Second Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1160 Wien, Austria; (C.H.); (H.K.); (S.L.)
| | - Valentina Indio
- Giorgio Prodi Interdepartimental Center for Cancer Research, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.A.); (V.I.)
| | - Helmut Kern
- Ludwig Boltzmann Institute for Rehabilitation Research, 1160 Wien, Austria; (C.H.); (H.K.); (S.L.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, 1160 Wien, Austria; (C.H.); (H.K.); (S.L.)
| | - Maurilio Marcacci
- Department of Biomedical Sciences, Knee Joint Reconstruction Center, 3rd Orthopaedic Division, Humanitas Clinical Institute, Humanitas University, 20089 Milan, Italy;
| | - Sandra Zampieri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy;
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Marina Marini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, 40138 Bologna, Italy; (A.B.); (P.D.S.); (M.M.); (C.Z.)
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Cinzia Zucchini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, 40138 Bologna, Italy; (A.B.); (P.D.S.); (M.M.); (C.Z.)
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the metabolic background of the cachectic syndrome and to analyze the recent therapeutic approaches designed to counteract the wasting suffered by the cancer patient with cachexia. RECENT FINDINGS The main changes associated with the development of this multiorganic syndrome are glucose intolerance, fat depletion and muscle protein hypercatabolism. Among the most promising approaches for the treatment of cachexia include the use of ghrelin agonists, beta-blockers, beta-adrenergic agonists, androgen receptor agonists and antimyostatin peptides. The multitargeted approach seems essential in these treatments, which should include the combination of both nutritional support, drugs and a suitable program of physical exercise, in order to ameliorate both anorexia and the metabolic changes associated with cachexia. In addition, another very important aspect for the design of clinical trials for the treatment of cancer cachexia is to staging cancer patients in relation with the degree of cachexia, in order to start as early as possible, this triple approach in the course of the disease, even before weight loss can be detected. SUMMARY Cancer cachexia has two main components: anorexia and metabolic alterations and both have to be taken into consideration for the treatment of the syndrome.
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5
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Albertin G, Ravara B, Kern H, Hofer C, Loefler S, Jurecka W, Guidolin D, Rambaldo A, Porzionato A, De Caro R, Zampieri S, Pond A, Alaibac M, Carraro U. Two-years of home based functional electrical stimulation recovers epidermis from atrophy and flattening after years of complete Conus-Cauda Syndrome. Medicine (Baltimore) 2019; 98:e18509. [PMID: 31876739 PMCID: PMC6946537 DOI: 10.1097/md.0000000000018509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To evaluate progression of skin atrophy during 8 years of complete Conus-Cauda Syndrome and its recovery after 2 years of surface Functional Electrical Stimulation a cohort study was organized and implemented.Functional assessments, tissue biopsies, and follow-up were performed at the Wilhelminenspital, Vienna, Austria; skin histology and immunohistochemistry at the University of Padova, Italy on 13 spinal cord injury persons suffering up to 10 years of complete conus/cauda syndrome. Skin biopsies (n. 52) of both legs were analyzed before and after 2 years of home-based Functional Electrical Stimulation delivered by large anatomically shaped surface electrodes placed on the skin of the anterior thigh. Using quantitative histology we analyzed: 1. Epidermis atrophy by thickness and by area; 2. Skin flattening by computing papillae per mm and Interdigitation Index of dermal-epidermal junctions; 3. Presence of Langerhans cells.Linear regression analyses show that epidermal atrophy and flattening worsen with increasing years post- spinal cord injury and that 2 years of skin electrostimulation by large anatomically shaped electrodes reverses skin changes (pre-functional Electrical Stimulation vs post-functional Electrical Stimulation: thickness 39%, P < .0001; area 41%, P < .0001; papillae n/mm 35%, P < 0.0014; Interdigitation index 11%, P < 0.018), producing a significant recovery to almost normal levels of epidermis thickness and of dermal papillae, with minor changes of Langerhans cells, despite 2 additional years of complete Conus-Cauda Syndrome.In complete Conus-Cauda Syndrome patients, the well documented beneficial effects of 2 years of surface h-b Functional Electrical Stimulation on strength, bulk, and muscle fiber size of thigh muscles are extended to skin, suggesting that electrical stimulation by anatomically shaped electrodes fixed to the skin is also clinically relevant to counteract atrophy and flattening of the stimulated skin. Mechanisms, pros and cons are discussed.
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Affiliation(s)
| | - Barbara Ravara
- Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova
- A&C M-C Foundation for Translational Myology, Padova, Italy
| | - Helmut Kern
- Physiko- und Rheumatherapie, St. Poelten
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten
| | - Stefan Loefler
- Physiko- und Rheumatherapie, St. Poelten
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten
| | | | | | - Anna Rambaldo
- Department of Neuroscience, Section of Human Anatomy
| | | | | | - Sandra Zampieri
- Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova
- A&C M-C Foundation for Translational Myology, Padova, Italy
- Physiko- und Rheumatherapie, St. Poelten
| | - Amber Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, IL
| | - Mauro Alaibac
- Department of Medicine, Section of Dermatology Clinic, University of Padova, Italy
| | - Ugo Carraro
- Interdepartmental Research Center of Myology, Department of Biomedical Sciences, University of Padova
- A&C M-C Foundation for Translational Myology, Padova, Italy
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6
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Stecco C, Caro RD. 2019 Ejtm Special on Muscle Fascia. Eur J Transl Myol 2019; 29:8060. [PMID: 31019664 PMCID: PMC6460217 DOI: 10.4081/ejtm.2019.8060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/09/2019] [Indexed: 02/06/2023] Open
Abstract
For many years the fasciae have been considered by the anatomists only as a "white envelope for the muscles", that is generally removed in anatomical tables, to recognize muscle nerves and vessels. This is one of the reasons that different descriptions of the fasciae exist. On the other hand, in the last years the fasciae and their properties are becoming of central importance to clinicians practicing in various conventional and alternative therapies. The results from the worldwide research activities constitute a body of significant and important data, but this clinical interest is not supported by in-depth comprehension to how integrate the new knowledge about fasciae with the classical biomechanical models based on muscles, tendons and bones. To close this gap an Ejtm Special on "Muscle Fascia" will be published September 30, 2019, but the typescripts will be added to the Ejtm Early Release list as soon as all authors will approve their Epub papers. Deadline for original articles and reviews is June 1st, 2019, but the Editors hope that authors submit their typescripts much earlier.
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Affiliation(s)
- Carla Stecco
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
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7
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Argilés JM, López-Soriano FJ, Stemmler B, Busquets S. Therapeutic strategies against cancer cachexia. Eur J Transl Myol 2019; 29:7960. [PMID: 31019661 PMCID: PMC6460215 DOI: 10.4081/ejtm.2019.7960] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/18/2018] [Indexed: 01/06/2023] Open
Abstract
Cancer cachexia has two main components: anorexia and metabolic alterations. The main changes associated with the development of this multi-organic syndrome are glucose intolerance, fat depletion and muscle protein hypercatabolism. The aim of this paper is to review the more recent therapeutic approaches designed to counteract the wasting suffered by the cancer patient with cachexia. Among the most promising approaches we can include the use of ghrelin agonists, beta-blockers, beta-adrenergic agonists, androgen receptor agonists and anti-myostatin peptides. The multi-targeted approach seems essential in these treatments, which should include the combination of both nutritional support, drugs and a suitable program of physical exercise, in order to ameliorate both anorexia and the metabolic changes associated with cachexia. In addition, another very important and crucial aspect to be taken into consideration in the design of clinical trials for the treatment of cancer cachexia is to staging cancer patients in relation with the degree of cachexia, in order to start as early as possible this triple approach in the course of the disease, even before the weight loss can be detected.
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Affiliation(s)
- Josep M Argilés
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Biology Faculty of the Barcelona University, Barcelona, Spain.,Biomedicine Institute, Barcelona University (IBUB), Barcelona, Spain
| | - Francisco Javier López-Soriano
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Biology Faculty of the Barcelona University, Barcelona, Spain.,Biomedicine Institute, Barcelona University (IBUB), Barcelona, Spain
| | | | - Sílvia Busquets
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Biology Faculty of the Barcelona University, Barcelona, Spain.,Biomedicine Institute, Barcelona University (IBUB), Barcelona, Spain
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8
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Palanova P, Mrkvicova V, Nedbalkova M, Sosikova M, Konecny P, Jarkovsky J, Marques E, Novakova M, Pohanka M, Soucek M, Dobsak P. Home‐based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study. Artif Organs 2019; 43:796-805. [DOI: 10.1111/aor.13421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Petra Palanova
- Institute of Public Health, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Veronika Mrkvicova
- Institute of Public Health, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Marta Nedbalkova
- 2nd Department of Internal Medicine, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Michaela Sosikova
- Department of Sports Medicine and Rehabilitation, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Petr Konecny
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Jiri Jarkovsky
- Institute of Biological Analyses, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Emanuel Marques
- Department of Dermatovenerology, Hospital na Bulovce Prague Czech Republic
| | - Marie Novakova
- Institute of Physiology, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Michal Pohanka
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
| | - Miroslav Soucek
- 2nd Department of Internal Medicine, St. Anne´s Faculty Hospital Brno Czech Republic
| | - Petr Dobsak
- Department of Sports Medicine and Rehabilitation, St. Anne´s Faculty Hospital Brno Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University Brno Czech Republic
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9
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Giuriati W, Ravara B, Porzionato A, Albertin G, Stecco C, Macchi V, De Caro R, Martinello T, Gomiero C, Patruno M, Coletti D, Zampieri S, Nori A. Muscle spindles of the rat sternomastoid muscle. Eur J Transl Myol 2018; 28:7904. [PMID: 30662700 PMCID: PMC6317131 DOI: 10.4081/ejtm.2018.7904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023] Open
Abstract
The sternomastoid (SM) muscle in rodents presents a peculiar distribution of fiber types
with a steep gradient from the ventral, superficial, white portion to the dorsal, deep,
red region, where muscle spindles are restricted. Cross section of the medial longitudinal
third of the rat SM contains around 10,000 muscle fibers with a mean diameter of
51.28±12.62 (μm +/- SD). Transverse sections stained by Succinate Dehydrogenase
(SDH) reaction clearly presents two distinct regions: the dorsal deep red portion
encompassing a 40% cross section area contains a high percentage of packed SDH-positive
muscle fibers, and the ventral superficial region which contains mainly SDH-negative
muscle fibers. Indeed, the ventral superficial region of the rat SM muscle contains mainly
fast 2B muscle fibers. These acidic ATPase pH 4.3-negative and SDH-negative 2B muscle
fibers are the largest of the SM muscle, while the acidic ATPase pH 4.3-positive and
SDH-positive Type 1 muscle fibers are the smallest. Here we show that in thin transverse
cryosections only 2 or 3 muscle spindle are observed in the central part of the dorsal
deep red portion of the SM muscle. Azan Mallory stained sections allow at the same time to
count the spindles and to evaluate aging fibrosis of the skeletal muscle tissue. Though
restricted in the muscle red region, SM spindles are embedded in perimysium, whose changes
may influence their reflex activity. Our findings confirm that any comparisons of changes
in number and percentage of muscle spindles and muscle fibers of the rat SM muscle will
require morphometry of the whole muscle cross-section. Muscle biopsies of SM muscle from
large mammals will only provide partial data on the size of the different types of muscle
fibers biased by sampling. Nonetheless, histology of muscle tissue continue to provide
practical and low-cost quantitative data to follow-up translational studies in rodents and
beyond.
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Affiliation(s)
- Walter Giuriati
- Department of Biomedical Sciences, Interdepartmental Research Institute of Myology, University of Padova, Padova, Italy
| | - Barbara Ravara
- Department of Biomedical Sciences, Interdepartmental Research Institute of Myology, University of Padova, Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Giovanna Albertin
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Veronica Macchi
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Tiziana Martinello
- Department of Comparative Biomedicine and Food Science, University of Padova, Legnaro, Padova, Italy
| | - Chiara Gomiero
- Department of Comparative Biomedicine and Food Science, University of Padova, Legnaro, Padova, Italy
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padova, Legnaro, Padova, Italy
| | - Dario Coletti
- Sorbonne Universités, UPMC Univversté Paris 06 (CNRS, UMR 8256, INSERM ERL U1164), Institut Biologie Paris-Seine, Paris, France.,Department. of Anatomy, Histology, Forensic Medicine & Orthopaedics, School of Medicine Sapienza University of Rome, Rome, Italy.,Interuniversity Institute of Myology, 00185 Rome, Italy
| | - Sandra Zampieri
- Department of Biomedical Sciences, Interdepartmental Research Institute of Myology, University of Padova, Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy.,Physiko- und Rheumatherapie, St. Poelten, Austria
| | - Alessandra Nori
- Department of Biomedical Sciences, Interdepartmental Research Institute of Myology, University of Padova, Padova, Italy
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10
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Taylor MJ, Fornusek C, Ruys AJ. The duty cycle in Functional Electrical Stimulation research. Part II: Duty cycle multiplicity and domain reporting. Eur J Transl Myol 2018; 28:7733. [PMID: 30662696 PMCID: PMC6317134 DOI: 10.4081/ejtm.2018.7733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022] Open
Abstract
In part I of this review, we introduced the duty cycle as a fundamental parameter in controlling the effect of electrical stimulation pulse trains on muscle structural and functional properties with special emphasis on fatigue. Following on from a survey of the literature, we discuss here the relative ability of intermittent and continuous stimulation to fatigue muscle. In addition, pertinent literature is explored on a more deeper level, highlighting contentions regarding the duty cycle across studies. In response to literature inconsistencies, we propose frameworks upon which the duty cycle parameter may be specified. We present the idea of domain reporting for the duty cycle, and illustrate with practical examples. In addition we dig further into the literature and present a set of notations that have been used by different researchers to report the duty cycle. We also propose the idea of the duty cycle multiple, which together with domain reporting, will help researchers understand more precisely duty cycles of electrical stimulation. As a case study, we also show how the duty cycle has been looked at by researchers in the context of pressure sore attenuation in patients. Together with part I, it is hoped that the frameworks suggested provide a complete picture of how duty cycle has been discussed across the literature, and gives researchers a more trans-theoretical basis upon which they may report the duty cycle in their studies. This may also lead to a more precise specification of electrical stimulation protocols used in patients.
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Affiliation(s)
- Matthew J. Taylor
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | - Ché Fornusek
- Faculty of Medicine and Health, University of Sydney, Lidcombe, Australia
| | - Andrew J. Ruys
- Faculty of Engineering and IT, University of Sydney, Camperdown, Australia
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11
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Carraro U. EJTM3 is also covering Mobility and Medicine at large, an update. Eur J Transl Myol 2018; 28:7814. [PMID: 30344982 PMCID: PMC6176385 DOI: 10.4081/ejtm.2018.7814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 01/13/2023] Open
Abstract
Since the first 2018 issue, the European Journal of Translational Myology expanded its authorship and readership from the strict topics of biology, physiology, diagnostic, management and rehabilitation of skeletal muscle to the more clinically relevant fields of human mobility to those of general medicine. This third issue opens with a review on Chronic Fatigue Syndrome, a very complex medical problem, as its other names testify (Myalgic Encephalomyelitis or Systemic Exertion Intolerance Disease). A more typical molecular myology original article follows (Increasing autophagy does not affect neurogenic muscle atrophy), but then several Rapid Reports cover different Medical Specialties fields, related or unrelated to neuromyology, mobility problems and their potential solutions. The Advisors of EJTM invite Authors to submit typescripts, taking into account that the journal is keen to publish high-level papers in the fields of Translational Myology, Mobility and Medicine at large.
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Affiliation(s)
- Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Italy
- A&C M-C Foundation for Translational Myology
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12
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Pietrangelo T, Fulle S, Coscia F, Gigliotti PV, Fanò-Illic G. Old muscle in young body: an aphorism describing the Chronic Fatigue Syndrome. Eur J Transl Myol 2018; 28:7688. [PMID: 30344981 PMCID: PMC6176399 DOI: 10.4081/ejtm.2018.7688] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022] Open
Abstract
The chronic fatigue syndrome (CFS) otherwise known as myalgic encephalomyelitis (ME), is a debilitating syndrome whose identification is very complex due to lack of precise diagnostic criteria. This pathology begins with limitations in duration and intensity of exercise and rapid onset of pain during physical activity. Its etiology is unknown, and symptoms are not limited to the muscles. Epidemiology is rather difficult to delimit, even if it affects mainly young (20-40 years), female subjects. The results of muscular research show some peculiarities that can justify what has been observed in vivo. In particular, 1. presence of oxidative damage of lipid component of biological membranes and DNA not compensated by the increase of the scavenger activity; 2. Excitation-Contraction (E-C) alteration with modification of Ca2+ transport; 3. passage from slow to fast fiber phenotype; 4. inability to increase glucose uptake; 5. presence of mitochondrial dysfunction; and 6. genes expressed differentially (particularly those involved in energy production). The skeletal muscles of CFS / ME patients show a significant alteration of the oxidative balance due to mitochondrial alteration and of the fiber phenotype composition as shown in sarcopenic muscles of the elderly. Vice versa, the muscle catabolism does not appear to be involved in the onset of this syndrome. The data support the hypothesis that patients with CFS are subjected to some of the problems typical for muscle aging, which is probably related to disorders of muscle protein synthesis and biogenesis of mitochondria. Patients with CFS can benefit from an appropriate training program because no evidence suggests that physical exercise worsens symptoms. Type, intensity and duration of any physical activity that activates muscle contraction (including Electrical Stimulation) require further investigation even if it is known that non-exhaustive physical activity decreases painful symptomatology.
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Affiliation(s)
- Tiziana Pietrangelo
- Department of Neuroscience Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
- IIM-Interuniversity Institute of Myology, Italy
| | - Stefania Fulle
- Department of Neuroscience Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
- IIM-Interuniversity Institute of Myology, Italy
| | - Francesco Coscia
- Sport Medicine Service of Autonome Provinz Bozen, San Candido-Innichen, Italy
- Laboratory of Sport Physiology, San Candido-Innichen, Italy
| | - Paola Virginia Gigliotti
- Sport Medicine Service of Autonome Provinz Bozen, San Candido-Innichen, Italy
- Laboratory of Sport Physiology, San Candido-Innichen, Italy
| | - Giorgio Fanò-Illic
- Department of Neuroscience Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
- IIM-Interuniversity Institute of Myology, Italy
- A&C M-C Foundation for Translational Myology, Padova, Italy
- Free University of Alcatraz, Santa Cristina di Gubbio, Italy
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13
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U C, G A, P G, B R, F P, S Z, H K, Pond A. Muscle and skin improve by home-based FES and full-body in-bed gym. ACTA ACUST UNITED AC 2018; 3. [PMID: 30820477 PMCID: PMC6390968 DOI: 10.15761/bem.1000s1003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
All progressive muscle contractile impairments, including advanced age-related muscle power decline, need permanent management. Most elderly persons, in particular octogenarians, spend small amounts of time in daily physical activity, resulting in a decline in body condition with more and more frequent hospitalizations and finally potentially forcing them to bed permanently. Further several neurological injuries, which are even more acutely debilitating than those problems related to aging, are responsible for early limitation of mobility. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based functional electrical stimulation (h-bFES) in both elderly and SCI patients, we suggest that the elderly and early aging patients participate in hbFES and add a 20 min daily routine of 12 easy and safe physical exercises, namely home-based Full-Body In-Bed Gym. Continued regularly, h-bFES and the Full-Body In-Bed Gym will help to maintain the independence of frail older people and may reduce the risks of serious consequences of accidental falls and pressure sore complications.
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Affiliation(s)
- Carraro U
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy.,IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
| | - Albertin G
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Gargiulo P
- Institute for Biomedical and Neural Engineering/Biomedical Technology Centre Reykjavik University and Landspitali, Reykjavik, Iceland
| | - Ravara B
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy
| | - Piccione F
- IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
| | - Zampieri S
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,Physiko- und Rheumatherapie, St. Poelten, Austria
| | - Kern H
- Physiko- und Rheumatherapie, St. Poelten, Austria
| | - Amber Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, Il, USA
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14
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Coletti D. Chemotherapy-induced muscle wasting: an update. Eur J Transl Myol 2018; 28:7587. [PMID: 29991991 PMCID: PMC6036312 DOI: 10.4081/ejtm.2018.7587] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
The majority of cancers are associated to cachexia, a severe form of weight loss mostly accounted for by skeletal muscle wasting. Cancer patients are often treated with chemotherapy, whose side effects are at times neglected or underestimated. Paradoxically, chemotherapy itself can induce muscle wasting with severe, cancer-independent effects on muscle homeostasis. Since muscle wasting is a primary marker of poor prognosis for cancer patients and negatively affects their quality of life, the systemic consequences of chemotherapy in this context must be fully characterized and taken into account. Ten years ago a precursor study in an animal cancer model was published in the European Journal of Translation Myology (back then, Basic and Applied Myology), highlighting that the side effects of chemotherapy include muscle wasting, possibly mediated by NF-κB activation. This paper, entitled «Chemotherapy-induced muscle wasting: association with NF-κB and cancer cachexia», is now being reprinted for the inaugural issue of the «Ejtm Seminal Paper Series». In this short review we discuss those results in the light of the most recent advances in the study of chemotherapy-induced muscle wasting.
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Affiliation(s)
- Dario Coletti
- (1) Biology of Adaptation and Aging, Sorbonne Université, Paris, France; (2) Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Italy
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15
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Sarabon N, Löfler S, Cvecka J, Hübl W, Zampieri S. Acute effect of different concentrations of cayenne pepper cataplasm on sensory-motor functions and serum levels of inflammation-related biomarkers in healthy subjects. Eur J Transl Myol 2018; 28:7333. [PMID: 29686821 PMCID: PMC5895990 DOI: 10.4081/ejtm.2018.7333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/17/2018] [Accepted: 02/17/2018] [Indexed: 02/06/2023] Open
Abstract
Physical medicine therapies are often used in treating widespread musculoskeletal disorders, such as neck and low back pain. Herbal cataplasms containing rubefacient substances, such as Cayenne pepper, or galenic preparations like Munari cataplasm are commonly used as natural medications to treat painful areas. In this paper we show the effects of a 20-min application of Cayenne pepper and kaolin powder cataplasm (CPC) on healthy subjects. Treatment effects were evaluated by cold/hot feeling on visual analogue scale, blood pressure, body temperature, skin light touch sensations, two-point discrimination, and pain threshold to a mechanical stimulus, before and immediately after, 15 min after and 30 min after different concentration of Cayenne pepper in CPC preparation on healthy subjects. Maximal voluntary trunk extension force and trunk extension submaximal force matching error were also measured. In addition, the resulting optimal CPC mixture was tested for its safety by measuring changes in circulating levels of inflammatory-related biomarkers after 20-min application. The results indicate that the 5% concentration of Cayenne pepper in the preparation of CPC is the best choice, since no additional effects can be obtained with the 10% concentration, and the effects are higher than those observed at the 2.5% concentration. Importantly, 5% CPC application did not induce a significant increase of inflammatory-related biomarkers, suggesting that 20-min application has no negative side effects at systemic levels. Further studies are needed to investigate the immediate and long-term effects of repeated CPC applications as well as to understand the intersecting underlying mechanisms activated by Capsaicin and other identified factors, in order to be more extensively used in the field of physical medicine therapies.
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Affiliation(s)
- Nejc Sarabon
- University of Primorska, Faculty of Health Sciences, Koper, Slovenia.,S2P, Science to Practice Ltd., Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
| | - Stefan Löfler
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Jan Cvecka
- Comenius University in Bratislava, Institute for Human Performance, Bratislava, Slovakia
| | - Wolfgang Hübl
- Department of Laboratory Medicine, Wilhelminenspital, Vienna, Austria
| | - Sandra Zampieri
- Laboratory of Translation Myology, Department of Biomedical Sciences, Padova, Italy
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16
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Carraro U. Exciting perspectives for Translational Myology in the Abstracts of the 2018Spring PaduaMuscleDays: Giovanni Salviati Memorial - Chapter III - Abstracts of March 16, 2018. Eur J Transl Myol 2018; 28:7365. [PMID: 30057727 PMCID: PMC6047881 DOI: 10.4081/ejtm.2018.7365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/23/2022] Open
Abstract
Myologists working in Padua (Italy) were able to continue a half-century tradition of studies of skeletal muscles, that started with a research on fever, specifically if and how skeletal muscle contribute to it by burning bacterial toxin. Beside main publications in high-impact-factor journals by Padua myologists, I hope to convince readers (and myself) of the relevance of the editing Basic and Applied Myology (BAM), retitled from 2010 European Journal of Translational Myology (EJTM), of the institution of the Interdepartmental Research Center of Myology of the University of Padova (CIR-Myo), and of a long series of International Conferences organized in Euganei Hills and Padova, that is, the PaduaMuscleDays. The 2018Spring PaduaMuscleDays (2018SpPMD), were held in Euganei Hills and Padua (Italy), in March 14-17, and were dedicated to Giovanni Salviati. The main event of the “Giovanni Salviati Memorial”, was held in the Aula Guariento, Accademia Galileiana di Scienze, Lettere ed Arti of Padua to honor a beloved friend and excellent scientist 20 years after his premature passing. Using the words of Prof. Nicola Rizzuto, we all share his believe that Giovanni “will be remembered not only for his talent and originality as a biochemist, but also for his unassuming and humanistic personality, a rare quality in highly successful people like Giovanni. The best way to remember such a person is to gather pupils and colleagues, who shared with him the same scientific interests and ask them to discuss recent advances in their own fields, just as Giovanni have liked to do”. Since Giovanni’s friends sent many abstracts still influenced by their previous collaboration with him, all the Sessions of the 2018SpPMD reflect both to the research aims of Giovanni Salviati and the traditional topics of the PaduaMuscleDays, that is, basics and applications of physical, molecular and cellular strategies to maintain or recover functions of skeletal muscles. The translational researches summarized in the 2018SpPMD Abstracts are at the appropriate high level to attract approval of Ethical Committees, the interest of International Granting Agencies and approval for publication in top quality, international journals. The abstracts of the March 16, 2018 Padua Muscle Day are listed in this chapter III. All 2018SpPMD Abstracts are indexed at the end of the Chapter IV.
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Affiliation(s)
- Ugo Carraro
- Laboratory of Translational Myology, Department of Biomedical Sciences, University of Padova.,A&C M-C Foundation for Translational Myology, Padova.,IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
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17
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Merico A, Cavinato M, Gregorio C, Lacatena A, Gioia E, Piccione F, Angelini C. Effects of combined endurance and resistance training in Amyotrophic Lateral Sclerosis: A pilot, randomized, controlled study. Eur J Transl Myol 2018; 28:7278. [PMID: 29686818 PMCID: PMC5895987 DOI: 10.4081/ejtm.2018.7278] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/11/2022] Open
Abstract
Based on available evidence, muscle strengthening and cardiovascular exercises can help maintain function and not adversely affect the progression of disease in patients with ALS. However, this evidence is not sufficiently detailed to recommend a specific exercise prescription. The purpose of this project was to assess clinical outcomes of a combined exercise programme to increase knowledge of rehabilitation in ALS patients. 38 ALS patients were assigned randomly to two groups: one group underwent a specific exercise programme (ALS-EP) based on a moderate aerobic workout and isometric contractions, and the second group followed a standard neuromotor rehabilitation treatment. Objective evaluation consisted of cardiovascular measures, muscle strength and fatigue. Some positive effects of physical activity on ALS patients were found. Among the benefits, an overall improvement of functional independence in all patients, independently of the type of exercise conducted was seen. In addition, improvements in muscle power, oxygen consumption and fatigue were specifically observed in the ALS-EP group, all hallmarks of a training effect for the specific exercises. In conclusion, moderate intensity exercise is beneficial in ALS, helping in avoiding deconditioning and muscle atrophy resulting from progressive inactivity.
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Affiliation(s)
- Antonio Merico
- Neurorehabilitation Department, San Camillo Hospital Foundation, Institute of Care and Research, Venice. Italy
| | - Marianna Cavinato
- Neurorehabilitation Department, San Camillo Hospital Foundation, Institute of Care and Research, Venice. Italy
| | - Caterina Gregorio
- Department of Economic, mathematical and statistical sciences, University of Trieste, Italy
| | | | - Elisabetta Gioia
- Rehabilitation Department, Unità Locale Socio-Sanitaria Serenissima, Venice, Italy
| | - Francesco Piccione
- Neurorehabilitation Department, San Camillo Hospital Foundation, Institute of Care and Research, Venice. Italy
| | - Corrado Angelini
- Neurorehabilitation Department, San Camillo Hospital Foundation, Institute of Care and Research, Venice. Italy
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18
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To Reverse Atrophy of Human Muscles in Complete SCI Lower Motor Neuron Denervation by Home-Based Functional Electrical Stimulation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:585-591. [PMID: 30390271 DOI: 10.1007/978-981-13-1435-3_27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
After spinal cord injury (SCI), patients spend daily several hours in wheelchairs, sitting on their hamstring muscles. SCI causes muscle atrophy and wasting, which is especially severe after complete and permanent damage to lower motor neurons. A European Union (EU)-supported work demonstrates that electrical fields produced by large electrodes and purpose-developed electrical stimulators recover both quadriceps and hamstring muscles, producing a cushioning effect capable of benefitting SCI patients, even in the worst case of complete and long-term lower motor neuron denervation of leg muscles. We reported that 20 out of 25 patients completed a 2-year h-bFES program, which resulted in (1) a 35% increase in cross-sectional area of the quadriceps muscles (P < 0.001), (2) a 75% increase in mean diameter of quadriceps muscle fibers (P < 0.001), and (3) improvement of the ultrastructural organization of contractile machinery and of the Ca2+-handling system. Though not expected, after 2 years during which the 20 subjects performed 5 days per week h-bFES of the atrophic quadriceps muscles, the CT cross-sectional area of the hamstring muscles also augmented, increasing from 26.9+/-8.4 (cm2) to 30.7+/-9.8 (cm2), representing a significant (p ≤ 0.05) 15% increase. Here we show by quantitative muscle color computed tomography (QMC-CT) that h-bFES-induced tissue improvements are present also in the hamstring muscles: a once supposed drawback (lack of specificity of muscle activation by large surface electrodes) is responsible for a major positive clinical effect. Interestingly, 2 years of home-based FES by large surface electrodes reversed also the denervation-induced skin atrophy, increasing epidermis thickness. Finally, we would like to attract attention of the readers to quantitative muscle color computed tomography (QMC-CT), a sensitive quantitative imaging analysis of anatomically defined skeletal muscles introduced by our group to monitor atrophy/degeneration of skeletal muscle tissue. Worldwide acceptance of QMC-CT will provide physicians an improved tool to quantitate skeletal muscle atrophy/degeneration before and during rehabilitation strategies so that therapy for mobility-impaired persons can be better prescribed, evaluated, and altered where needed.
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