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\"In On Muscle, Bonnie Tsui brings her signature blend of science, culture, immersive reporting, and personal narrative to examine not just what muscles are but what they mean to us. Cardiac, smooth, skeletal--these three different types of muscle in our bodies make our hearts beat; push food through our intestines, blood through our vessels, babies out the uterus; attach to our bones and allow for motion. Tsui also traces how muscles have defined beauty--and how they have distorted it--through the ages, and how they play an essential role in our physical and mental health\"-- Provided by publisher.

INTRODUCTION:Patients with achalasia often present with symptoms including bloating, early satiety and abdominal discomfort suggesting there might be an underlying concomitant gastric motility dysfunction. Moreover, treatments such as botulinum toxin injection are efficacious in both achalasia and gastroparesis. There are a lack of studies in the literature examining the association between achalasia and gastroparesis. We hypothesized that patients with achalasia would have a higher prevalence of gastric motility dysfunction, contributing, in part to the upper GI symptoms. The aim of this study was to compare the prevalence of gastroparesis in achalasia to the general population using a large population based commercial database.METHODS:The database used was Explorys Inc. (Cleveland, OH, USA) which contains electronic health records from 26 major integrated US healthcare systems. We identified patients with achalasia who were diagnosed with gastroparesis in the last 5 years based on Systemized Nomenclature of Medicine – Clinical Terms and compared it to patients with gastroparesis in the general population without achalasia.RESULTS:Of the 36,825,640 active patients within the last 5 years in the database, we identified 19,630 (0.05%) patients who had a diagnosis of achalasia and 104,140 (0.28%) patients with gastroparesis out of which only 600 (0.57%) were related to diabetes mellitus. A total of 990 cases of gastroparesis were observed in patients with achalasia, and 103,150 cases of gastroparesis in patients without achalasia. The overall Relative Risk (RR) of developing gastroparesis in patients with achalasia was 17.96 (95% CI 16.90 to 19.10; P < 0.0001) compared to general population without achalasia. Patients aged 18-64 (RR 20.50, 95% CI 18.94 to 22.39, P < 0.0001) and those aged ≥ 65 (RR 10.24, 95% CI 9.38 to 11.19, P < 0.0001) both had an increased risk of developing gastroparesis. Gender-based and race-based relative risk are shown in Table 1.CONCLUSION:Gastroparesis has a higher prevalence among people with achalasia compared to general population, with a relative risk of nearly 18. This increase in risk is seen across all age-groups. The findings of this analysis prove that there might be an underlying pathophysiological relationship between the esophageal and gastric motility disorders.Table 1.Prevalence of gastroparesis in achalasia compared to general population

We determined the effectiveness of a multi-strain probiotic (Hexbio®) containing microbial cell preparation MCP®BCMC® on constipation symptoms and gut motility in PD patients with constipation. PD patients with constipation (ROME III criteria) were randomized to receive a multi-strain probiotic (Lactobacillus sp and Bifidobacterium sp at 30 X 109 CFU) with fructo-oligosaccaride or placebo (fermented milk) twice daily for 8 weeks. Primary outcomes were changes in the presence of constipation symptoms using 9 items of Garrigues Questionnaire (GQ), which included an item on bowel opening frequency. Secondary outcomes were gut transit time (GTT), quality of life (PDQ39-SI), motor (MDS-UPDRS) and non-motor symptoms (NMSS). Of 55 recruited, 48 patients completed the study: 22 received probiotic and 26 received placebo. At 8 weeks, there was a significantly higher mean weekly BOF in the probiotic group compared to placebo [SD 4.18 (1.44) vs SD 2.81(1.06); (mean difference 1.37, 95% CI 0.68, 2.07, uncorrected p<0.001)]. Patients in the probiotic group reported five times higher odds (odds ratio = 5.48, 95% CI 1.57, 19.12, uncorrected p = 0.008) for having higher BOF (< 3 to 3-5 to >5 times/week) compared to the placebo group. The GTT in the probiotic group [77.32 (SD55.35) hours] reduced significantly compared to placebo [113.54 (SD 61.54) hours]; mean difference -36.22, 95% CI -68.90, -3.54, uncorrected p = 0.030). The mean change in GTT was 58.04 (SD59.04) hour vs 20.73 (SD60.48) hours respectively (mean difference 37.32, 95% CI 4.00, 70.63, uncorrected p = 0.028). No between-groups differences were observed in the NMSS, PDQ39-SI, MDS-UPDRS II and MDS-UPDRS III scores. Four patients in the probiotics group experienced mild reversible side effects. This study showed that consumption of a multi-strain probiotic (Hexbio®) over 8 weeks improved bowel opening frequency and whole gut transit time in PD patients with constipation.

To investigate the correlation of prostatic calculi (PC) with semen parameters inmen with fertility intention, this retrospective case–control study enrolled1,303 participants ranging from 20 to 59 years old; 725 were diagnosed with PCusing abdominal ultrasonography. Patients with PC were classified into the typeA calculi group (discrete and small echoes) and type B calculi group (coarse andlarge masses of multiple echoes). Five hundred and seventy-eight men without PCwere recruited for the control group. The clinical data of each group werecollected and analyzed. The total motility was significantly lower for subjectswith type B calculi (41.84% ± 17.50%) than for subjects in the type A calculi(51.78% ± 20.84%; p < .001) and control (54.47% ± 20.74%;p < .001) groups. The percentage of progressively motilewas significantly lower for the type B calculi (31.66% ± 14.68%) group than thetype A calculi (40.17% ± 17.09%; p < .001) and control(41.83% ± 17.05%; p < .001) groups. The results of thehypo-osmotic swelling test yielded significantly lower percentages in the type Bcalculi group (59.88% ± 17.13%) than the type A calculi (65.28 ± 14.43%;p = .005) and control (66.92 ± 16.12%; p< .001) groups. The type B calculi group had a significantly higherpercentage of round cell concentration than control (4.5% vs. 1.0%;p = .007) did. Small and discrete PC may not influencesemen quality among adult men with fertility intention, but larger and coarserPC are associated with decreased sperm motility.

Purpose of Review High-resolution manometry (HRM) is increasingly performed worldwide, to study esophageal motility. The Chicago classification is subsequently applied to interpret the manometric findings and facilitate a diagnosis of esophageal motility disorders. This review will discuss new insights regarding the diagnosis and management using the Chicago classification. Recent Findings Recent studies have demonstrated that high-resolution manometry is superior to conventional manometry, and has a higher sensitivity to diagnose achalasia. Furthermore, the subclassification of achalasia as used in the Chicago classification has prognostic value and can be used to direct treatment. Diagnosis of esophageal spasm has been improved by using the distal latency as diagnostic criterion. Recently, criteria for minor disorders of peristalsis have been sharpened, leading to a lower rate of patients with abnormal results, thereby increasing the relevance of a diagnosis. Summary High-resolution manometry is now considered the gold standard for diagnosis of esophageal motility disorders. The Chicago classification provides a standardized approach for analysis and categorization of abnormalities that has led to a significant increase in our knowledge regarding the diagnosis and management of motility disorders. Further refinement of the classification will be required.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. (2013) Correction: Characterization of Spontaneous and TGF-β-Induced Cell Motility of Primary Human Normal and Neoplastic Mammary Cells In Vitro Using Novel Real-Time Technology.

To describe CONCUSS, a randomized clinical trial (RCT) designed to compare the following: the effectiveness of immediate office-based vergence/accommodative therapy with movement (OBVAM) to delayed OBVAM as treatments for concussion-related convergence insufficiency (CONC-CI) to understand the impact of time (watchful waiting), the effect of OBVAM dosage (12 versus 16 therapy sessions), and to investigate the underlying neuro-mechanisms of OBVAM on CONC-CI participants. CONCUSS is an RCT indexed on https://clinicaltrials.gov/study/NCT05262361 enrolling 100 participants aged 11-25 years with medically diagnosed concussion, persistent post-concussive symptoms 4-24 weeks post-injury, and symptomatic convergence insufficiency. Participants will receive standard concussion care and will be randomized to either immediate OBVAM or delayed (by six weeks) OBVAM. At the Outcome 1 examination (week 7), clinical assessments of success as determined by changes in the near point of convergence (NPC), positive fusional vergence (PFV), and symptoms will be compared between the two treatment groups. After the Outcome 1 visit, those in the delayed group receive 16 visits of OBVAM, while those in the immediate OBVAM group receive four more therapy visits. Outcome 2 assessment will be used to compare both groups after participants receive 16 sessions of OBVAM. The primary measure is the between-group differences of the composite change in the NPC and PFV at the Outcome 1 visit. Secondary outcome measures include individual clinical measures, objective eye-tracking parameters, and functional brain imaging. Major features of the study design include formal definitions of conditions and outcomes, standardized diagnostic and treatment protocols, a delayed treatment arm, masked outcome examinations, and the incorporation of objective eye movement recording and brain imaging as outcome measures. CONCUSS will establish best practices in the clinical care of CONC-CI. The objective eye movement and brain imaging, correlated with the clinical signs and symptoms, will determine the neuro-mechanisms of OBVAM on CONC-CI.