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This randomized controlled trial aimed to compare abdominal muscle thickness between intensive care patients and healthy controls, and to evaluate the impact of IMT on expiratory muscle thickness using ultrasound. In this single-blind randomized controlled trial, 20 post-extubation intensive care patients were randomly assigned to either an a conventional physiotherapy (CP) group or IMT + CP group. Both interventions were applied for five days. An additional 10 healthy individuals served as controls for comparison. Abdominal muscle thicknesses—including external oblique (EOA), internal oblique (IOA), transversus abdominis (TRA), and rectus abdominis (RA)—were measured using ultrasound. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were also recorded. At baseline, healthy controls had significantly higher MIP, MIP% predicted, MEP, MEP% predicted, and RA muscle thickness compared to both patient groups (p < 0.05). Following intervention, both IMT and CP groups showed significant improvements in MIP (p < 0.05), but only the IMT group demonstrated significant increases in MEP, MEP% predicted, IOA, and RA muscle thickness (p < 0.05). The IMT group showed significantly greater improvements in MIP, MEP, IOA, and RA muscle thickness compared to the CP group (p < 0.05). Post-extubation IMT may improve not only inspiratory but also expiratory muscle strength and abdominal wall thickness. These findings suggest that IMT could support weaning processes in intensive care, although larger studies are needed. •Rectus abdominis thickness, MIP, MIP% predicted, MEP and MEP% predicted are higher in the healthy individiuals than in ICU patients•IMT increasesinternal oblique and rectus abdominis thickness in respiratory ICU patients.•IMT improves both MIP,MEPand predict

Muscle ultrasound has been shown to be a valid and safe imaging modality to assess muscle wasting in critically ill patients in the intensive care unit (ICU). This typically involves manual delineation to measure the rectus femoris cross-sectional area (RFCSA), which is a subjective, time-consuming, and laborious task that requires significant expertise. We aimed to develop and evaluate an AI tool that performs automated recognition and measurement of RFCSA to support non-expert operators in measurement of the RFCSA using muscle ultrasound. Twenty patients were recruited between Feb 2023 and July 2023 and were randomized sequentially to operators using AI (n = 10) or non-AI (n = 10). Muscle loss during ICU stay was similar for both methods: 26 ± 15% for AI and 23 ± 11% for the non-AI, respectively ( p  = 0.13). In total 59 ultrasound examinations were carried out (30 without AI and 29 with AI). When assisted by our AI tool, the operators showed less variability between measurements with higher intraclass correlation coefficients (ICCs 0.999 95% CI 0.998–0.999 vs. 0.982 95% CI 0.962–0.993) and lower Bland Altman limits of agreement (± 1.9% vs. ± 6.6%) compared to not using the AI tool. The time spent on scans reduced significantly from a median of 19.6 min (IQR 16.9–21.7) to 9.4 min (IQR 7.2–11.7) compared to when using the AI tool ( p  < 0.001). AI-assisted muscle ultrasound removes the need for manual tracing, increases reproducibility and saves time. This system may aid monitoring muscle size in ICU patients assisting rehabilitation programmes.

We previously demonstrated that rumination is produced by an unperceived, somatic response to food ingestion, and we developed an original biofeedback technique based on electromyography (EMG)-guided control of abdomino-thoracic muscular activity. Our aim was to demonstrate the superiority of biofeedback vs. placebo for the treatment of rumination. Randomized, placebo-controlled trial performed in a referral center. Consecutive patients who fulfilled the Rome III criteria for rumination (18 women, 6 men; 19-79 years age) were selected and all included in the study; 1 patient assigned to placebo withdrew because of an unrelated accident. Abdomino-thoracic muscle activity after a challenge meal was recorded by EMG. The patients in the biofeedback group were shown the signal and instructed to control muscle activity, whereas the patients in the placebo group were not shown the signal and were given oral simethicone. Each patient underwent 3 sessions over a 10-day period. number of rumination events as measured by questionnaires for 10 consecutive days before and after intervention. Patients on biofeedback (n=12) but not on placebo (n=11) effectively learned to reduce intercostal activity (by 51±6% vs. 10±7% increment on placebo; P<0.001) and anterior wall muscle activity (by 52±4% vs. 9±2% increment on placebo; P<0.001). Biofeedback treatment resulted in a 74±6% reduction in rumination activity (from 29±6 before to 7±2 daily events after intervention) vs. 1±14% on placebo; P=0.001 (from 21±2 before to 21±4 daily events after intervention). Rumination can be effectively corrected by biofeedback-guided control of abdomino-thoracic muscular activity.

Purpose The neck extensor muscles contribute to spinal support and posture while performing head and neck motion. Muscle stiffness relates to passive elasticity (support) and active tensioning (posture and movement) of muscle. It was hypothesized that support and motion requirements are reflected in the distribution of stiffness between superficial and deep neck extensor muscles. Methods In ten healthy participants, shear modulus (stiffness) of five neck extensor muscles was determined in prone at rest and during isometric head lift at three intensities using shear wave elastography. Results Shear modulus differed between muscles ( P  < 0.001), and was larger for the deeper muscles: (median (interquartile range)) trapezius 7.7 kPa (4.4), splenius capitis 6.5 kPa (2.5), semispinalis capitis 8.9 kPa (2.8), semispinalis cervicis 9.5 kPa (2.5), multifidus 14.9 kPa (1.4). Shear modulus differed between the resting condition and head lift ( P  < 0.001) but not between levels of head lift intensity. Conclusion Shear wave elastography revealed highest passive and active stiffness of the deep neck extensor muscles most close to the spine. The highest active increase of stiffness during the head lift was found in the semispinalis cervicis muscle. The non-invasive, clinically applicable estimates of muscle stiffness have potential for the assessment of muscular changes associated with neck pain/injury.

Objectives Total tooth loss is common in the aging population resulting in insufficient chewing function with subsequent weakening of the masticatory muscles. The study aims to evaluate the changes in thicknesses of the masseter and anterior temporal muscle in edentulous patients following the reconstruction of implant-supported fixed prostheses and compare them with the dentate individuals. Materials and methods The study was designed as a prospective, single-center, controlled clinical trial. A total of 60 participants were included in the present study. The patients were divided into two groups; Group I (Test Group): 30 edentulous patients who received implant-supported fixed prostheses, Group II (Control Group): 30 dentate individuals of an age and sex-matched group. Ultrasonography was used to measure the cross-sectional thickness of the left and right musculus masseter and anterior temporalis immediately after the cementation of the prosthetic rehabilitation (T1), on the 1st (T2) and 6th (T3) months after rehabilitation and at a single time point in the control group. Results The results showed that there were significant comparison differences in muscle thickness at the baseline measurements between groups while at the end of the 6th month, these differences were not significant. The muscle thicknesses of both the masseter and anterior temporalis muscles increased significantly at T2 and T3 compared to T1 in the test group. The asymmetry index between the left and right muscles in the test group and the asymmetry differences between groups also decreased significantly at the end of the 6th month. Conclusion The implant-supported fixed prostheses significantly increase the thicknesses of the masseter and anterior temporal muscle together with a decrease in the asymmetry between the left and right muscles. At six months, implant-treated patients showed similar muscle thicknesses compared to dentate individuals. Clinical relevance The findings suggest that implant-supported fixed prostheses can improve the masticatory function and facial symmetry of edentulous patients.

Computed tomography (CT) is increasingly used in clinical research for single-slice assessment of muscle mass to correlate with clinical outcome and evaluate treatment efficacy. The third lumbar level (L3) is considered as reference for muscle, but chest scans generally do not reach beyond the first lumbar level (L1). This study investigates if pectoralis muscle and L1 are appropriate alternatives for L3. CT scans of 115 stage IV non-small cell lung cancer patients were analyzed before and during tumor therapy. Skeletal muscle assessed at pectoralis and L1 muscle was compared to L3 at baseline. Furthermore, the prognostic significance of changes in muscle mass determined at different locations was investigated. Pearson's correlation coefficient between skeletal muscle at L3 and L1 was stronger ( =0.90, <0.001) than between L3 and pectoralis muscle ( =0.71, <0.001). Cox regression analysis revealed that L3 (HR 0.943, 95% CI: 0.92-0.97, <0.001) and L1 muscle loss (HR 0.954, 95% CI: 0.93-0.98, <0.001) predicted overall survival, whereas pectoralis muscle loss did not. L1 is a better alternative than pectoralis muscle to substitute L3 for analysis of muscle mass from regular chest CT scans.

Background Post-stroke spasticity (PSS) in the ankle plantar flexors leads to abnormal gait, increased energy expenditure, and a higher risk of falls. Ultrasonographic measures, such as muscle fascicle length (MFL) and pennation angle (PA), provide insight into muscle changes associated with spasticity. This study aimed to investigate the dose-dependent effects of focused extracorporeal shockwave therapy (ESWT) on ultrasonographic muscle properties and clinical outcomes in patients with PSS of the ankle plantar flexors. Methods This post hoc analysis was based on a double-blind, randomized controlled trial investigating different ESWT doses for post-stroke ankle spasticity treatment. A total of 39 patients with PSS of the ankle plantar flexors were randomized into two groups: the double-dose ESWT group received 4,000 focused shockwave pulses per session, while the control ESWT group received 2,000 pulses per session. Both groups received four ESWT sessions over a two-week intervention period, followed by a 24-week follow-up period for outcome assessments. Outcome measures included ultrasonographic assessments of MFL, PA, and strain elastography, as well as clinical evaluations using the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), passive range of motion (PROM), Timed Up and Go (TUG) test, and Barthel Index at baseline, and at 1, 4, 12, and 24 weeks post-treatment. Results No significant within-group changes in PA or MFL were observed for either ESWT group over the 24-week period. Generalized estimation equation analysis showed no significant group effects on PA, MFL, or strain elastography. However, when analyzing all participants, a significant time-related improvement in MFL was identified. In the double-dose ESWT group, MFL was significantly correlated with MTS, PROM, and TUG test, while PA was significantly correlated with MAS. Given that this was a post hoc analysis, these results should be interpreted conservatively. Conclusions While PA and MFL did not show significant differences between groups, the double-dose ESWT group exhibited improved clinical outcomes linked to MFL. These findings suggest that increased ESWT dosage may enhance muscle architecture and function in stroke rehabilitation.

PurposeThis study aimed to examine the effect of age on the mechanical properties, muscle size, and muscle quality in the upper and lower limb and trunk muscles.MethodsWe evaluated the shear modulus (G), muscle thickness (MT), and echo intensity (EI) of the upper and lower limb and trunk muscles of 83 healthy women (21–83-year-old). The G values of some limb muscles were measured in relaxed and stretched positions.ResultsRegarding the effect of age on G at the distinct positions, the G of the upper limb muscles were not significantly correlated with age in the relaxed and stretched positions. In contrast, the G of the iliacus showed a significant negative correlation in both positions. Additionally, the G of the rectus femoris had a significant negative correlation only in the relaxed position. Regarding differences among body parts, the G of the lower limb and oblique abdominal muscles showed a significant negative correlation, but no correlation in the upper limb, rectus abdominis, and back muscles. Moreover, MT showed a significant negative correlation with age in the lower limb, abdominal, and erector spinae muscles, but no correlation was detected in the upper limb and lumbar multifidus muscles. EI had a significant positive correlation in all the muscles.ConclusionThe effect of age on G depended on body parts, and the G of the lower limb and oblique abdominal muscles negatively associated with age. Additionally, G in the relaxed position may be more susceptible to aging than G in the stretched position.

Objective This study aimed to assess the thickness and ultrasonographic pattern of the masticatory and suprahyoid muscles in OSA patients and compare the effects of mono-bloc (MB) and bibloc (BB) mandibular advancement devices (MADs) via ultrasonographic measurements. Methods This pilot study of 20 patients with mild-to-moderate OSA who were diagnosed by full-night polysomnography (manually scored by the American Academy of Standards and Methods (AASM) manual, version 2.4) and treated randomly with mono-bloc or bibloc MAD ( n  = 10). The baseline thickness and pattern (types I, II, and III) of the masticatory and suprahyoid muscles were assessed by an oral radiologist. The same procedure was repeated at the 3-month and 6-month follow-up time points for participants after appliance use. Results Both types of MAD devices significantly increased the thickness of all muscles ( p  < 0.05). The changes in ultrasonographic muscle patterns were significant only in the BB group for the SCM muscle ( p  = 0.006). no other significant changes were observed in the studied ultrasonographic muscle patterns in the MB and BB devices up to 6 months ( P  > 0.05). No significant differences in muscle thickness or patterns were detected between the MB and BB modalities ( P  > 0.05). Conclusion The results of the present study indicate that MAD treatments do not have contraindications based on changes in muscle thickness and ultrasonographic muscle patterns. However, the BB group showed significant changes in the SCM ultrasonographic muscle pattern. Nevertheless, further studies are required to validate these findings.

In the current study, we investigated the effect of lengthening velocity during eccentric exercise on the modulation of the physiological cross-sectional area (PCSA) and fascicle length of the vastus lateralis (VL) muscle. We hypothesized a greater increase in muscle PCSA after training with lower lengthening velocities and a greater increase in fascicle length after higher lengthening velocities. Forty-seven young men were randomly assigned to either a control (n = 14) or an intervention group (n = 33). The participants of the intervention group were randomly allocated to one of four isokinetic eccentric training protocols of the knee extensors, with four different knee angular velocities (45°/s, 120°/s, 210°/s and 300°/s), yet similar range of motion (25–100° knee joint angle), load magnitude (100% of isometric maximum) and load volume (i.e. similar time under tension for one training set). Before and after an 11-week training period with 3 times per week exercise, muscle volume, pennation angle, fascicle length and PCSA of the VL muscle were measured using magnetic resonance imaging and ultrasonography. After the training, the VL muscle volume and fascicle length increased similarly and approximately 5% in all investigated protocols. The PCSA and pennation angles of the VL did not change after any exercise protocol, indicating negligible radial muscle adaptation after the training. The reason for the found hypertrophy of VL muscle after eccentric training in a wide range of lengthening velocities was mainly a longitudinal muscle growth. Further, the longitudinal muscle growth was independent of the lengthening velocity.