Subacromial Motion Metrics in Painful Shoulder Impingement: A Dynamic Quantitative Ultrasonography Analysis.

OBJECTIVES: To explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies. DESIGN: This cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Individuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method. RESULTS: Approximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (ß coefficient: -0.123cm, 95% confidence interval [CI], -0.199 to -0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (ß coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (ß coefficient: -2.903cm; 95% CI, -5.693 to -0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy. CONCLUSIONS: Shoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders.

Genetic diversity of the Thao people of Taiwan using Y-chromosome, mitochondrial DNA and HLA gene systems.

BACKGROUND: Despite attempts in retracing the history of the Thao people in Taiwan using folktales, linguistics, physical anthropology, and ethnic studies, their history remains incomplete. The heritage of Thao has been associated with the Pazeh Western plains peoples and several other mountain peoples of Taiwan. In the last 400 years, their culture and genetic profile have been reshaped by East Asian migrants. They were displaced by the Japanese and the construction of a dam and almost faced extinction. In this paper, genetic information from mitochondrial DNA (mtDNA), Histoleucocyte antigens (HLA), and the non-recombining Y chromosome of 30 Thao individuals are compared to 836 other Taiwan Mountain and Plains Aborigines (TwrIP & TwPp), 384 Non-Aboriginal Taiwanese (non-TwA) and 149 Continental East Asians. RESULTS: The phylogeographic analyses of mtDNA haplogroups F4b and B4b1a2 indicated gene flow between Thao, Bunun, and Tsou, and suggested a common ancestry from 10,000 to 3000 years ago. A claim of close contact with the heavily Sinicized Pazeh of the plains was not rejected and suggests that the plains and mountain peoples most likely shared the same Austronesian agriculturist gene pool in the Neolithic. CONCLUSIONS: Having been moving repeatedly since their arrival in Taiwan between 6000 and 4500 years ago, the Thao finally settled in the central mountain range. They represent the last plains people whose strong bonds with their original culture allowed them to preserve their genetic heritage, despite significant gene flow from the mainland of Asia. Representing a considerable contribution to the genealogical history of the Thao people, the findings of this study bear on ongoing anthropological and linguistic debates on their origin.

Correction to: Genetic diversity of the Thao people of Taiwan using Y-chromosome, mitochondrial DNA and HLA gene systems.

Following publication of the original article [1], we have been notified that Additional file 3 was published with track changes.

The impact of shoulder pathologies on job discontinuation and return to work: a pilot ultrasonographic investigation.

BACKGROUND: Ultrasound imaging has emerged as one of the most useful tools for evaluating shoulder disorders. To date, the association between shoulder ultrasonography and a patient's work status has rarely been explored by antecedent studies. AIM: This study aimed to investigate the association between sonographically diagnosed shoulder pathologies and job discontinuation and return to work. DESIGN: A cross-sectional study. SETTING: Outpatient clinic in the university hospital. POPULATION: Fifty-nine patients who were older than 20 years of age and had worked in a full-time job within the past three years. METHODS: All participants underwent clinical evaluation using the visual analog scale (for pain), Shoulder Pain and Disability Index, Pittsburgh Sleep Quality Index, and shoulder ultrasound examination. The work-related ergonomic risks, including dealing with heavy objects, repeated use and requiring forceful motion of the affected upper extremity, were assessed. The ultrasound-identified shoulder pathologies associated with job discontinuation, that is, sick leave due to painful shoulder for more than two consecutive months, were considered as the primary outcome. In the job discontinuation subgroup, we further investigated the association between return to work and the clinical/sonographic findings. RESULTS: Univariate analysis revealed a positive association between job discontinuation and shoulder surgery or work types requiring forceful upper-limb movements. Multivariate analysis demonstrated that job discontinuation was positively associated with supraspinatus tendon full-thickness tears (risk ratio, 8.80; 95% CI, 1.77-10.56; P=0.018). Of the patients who received shoulder surgery, 46.6% had recurrent rotator cuff tears. Return to work was likely to be related to pain scores during overhead activities and shoulder function impairment but not to sonographic findings. CONCLUSIONS: Job discontinuation is associated with shoulder surgery, work that necessitates forceful upper-extremity movements and supraspinatus tendon full-thickness tears detected by ultrasound. CLINICAL REHABILITATION IMPACT: Sonographic findings should not be used as the only standard for evaluating the patient's work capability.

Enhancing diagnosis and treatment of superior cluneal nerve entrapment: cadaveric, clinical, and ultrasonographic insights.

OBJECTIVES: Low back pain is a prevalent public health issue caused by superior cluneal nerve (SCN) entrapment. This study aimed to explore the course of SCN branches, cross-sectional area (CSA) of the nerves, and effects of ultrasound-guided SCN hydrodissection. METHODS: SCN distance relative to the posterior superior iliac spines was measured and compared with ultrasound findings in asymptomatic volunteers. The CSA of the SCN, pressure-pain threshold, and pain measurements were obtained from asymptomatic controls and patients with SCN entrapment at various time points after hydrodissection (with 1 mL of 50% dextrose, 4 mL of 1% lidocaine, and 5 mL of 1% normal saline) in the short-axis view. RESULTS: Twenty sides of 10 formalin-fixed cadavers were dissected. The SCN locations on the iliac crest did not differ from the ultrasound findings in 30 asymptomatic volunteers. The average CSA of the SCN across different branches and sites ranged between 4.69-5.67 mm2 and did not vary across different segments/branches or pain statuses. Initial treatment success was observed in 77.7% (n = 28) of 36 patients receiving hydrodissection due to SCN entrapment. A group with initial treatment success experienced symptom recurrence in 25% (n = 7) of cases, and those with recurrent pain had a higher prevalence of scoliosis than those without symptom recurrence. CONCLUSIONS: Ultrasonography effectively localizes SCN branches on the iliac crest, whereby increased nerve CSA is not useful for diagnosis. Most patients benefit from ultrasound-guided dextrose hydrodissection; however, those with scoliosis may experience symptom recurrence and whether structured rehabilitation can reduce recurrence post-injection should be considered as one perspective in future research. Trial registration ClinicalTrials.gov (NCT04478344). Registered on 20 July 2020, https://clinicaltrials.gov/ct2/show/NCT04478344?cond=Superior+Cluneal+Nerve&cntry=TW&draw=2&rank=1 . Critical relevance statement Ultrasound imaging accurately locates SCN branches on the iliac crest, while enlargement of the CSA is not useful in diagnosing SCN entrapment; however, approximately 80% of SCN entrapment cases respond positively to ultrasound-guided dextrose hydrodissection.

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.

Shear wave sonoelastography (SWS) can reliably assess the stiffness of masticatory muscles.Orofacial pain, particularly affecting the ipsilateral masseter muscles, exhibited increased stiffness, with a similar trend observed in the temporalis muscle as revealed by SWS. However, the stiffness of the lateral pterygoid muscle appeared to remain unaffected.These findings establish a foundational framework for the objective and quantitative assessment of orofacial pain and indicate the potential utility of SWS as a tool for evaluating treatment outcomes.

Enhanced serum levels of tumor necrosis factor-α, interleukin-1ß, and -6 in sarcopenia: alleviation through exercise and nutrition intervention.

BACKGROUND: Limited research has been conducted on the post-intervention inflammatory status in sarcopenic patients, despite previous studies revealing elevated pro-inflammatory markers. This study aimed to investigate the potential elevation of specific pro-inflammatory cytokines in sarcopenic patients and evaluate the effects of exercise and nutritional support interventions on these cytokine levels. METHODS: In this post-hoc analysis of a randomized controlled trial (RCT), 57 individuals with sarcopenia from the RCT and 57 non-sarcopenic participants from the same geriatric community cohort that did not participate in the RCT were enrolled. Grip strength and body composition measurements were recorded. Tumor necrotizing factor (TNF)-α, interleukin (IL)-1ß, IL-6, and IL-15 levels were assessed at baseline for both groups and after a 12-week intervention consisting of resistive exercise and supplementation with branched-chain amino acids, calcium, and vitamin D3 in the patients with sarcopenia. RESULTS: The sarcopenic group demonstrated significantly lower body weight, body mass index, grip strength, and skeletal muscle mass index. Moreover, sarcopenic patients exhibited higher levels of TNF-α (p=0.007), IL-1ß (p<0.001), and IL-6 (p<0.001), while no significant difference was observed in IL-15 (p=0.345) between participants with and those without sarcopenia. Following the intervention, the sarcopenic group experienced significant improvements in grip strength and skeletal muscle mass index with a notable reduction in TNF-α (p=0.003), IL-1ß (p=0.012) and IL-6 (p=0.001) levels. CONCLUSIONS: Sarcopenic patients exhibit elevated levels of TNF-α, IL-1ß, and IL-6, which declined after nutrition support and exercise interventions. However, further research is necessary to evaluate the long-term impact of these interventions on cytokine levels.

Deep learning algorithm for predicting subacromial motion trajectory: Dynamic shoulder ultrasound analysis.

Subacromial motion metrics can be extracted from dynamic shoulder ultrasonography, which is useful for identifying abnormal motion patterns in painful shoulders. However, frame-by-frame manual labeling of anatomical landmarks in ultrasound images is time consuming. The present study aims to investigate the feasibility of a deep learning algorithm for extracting subacromial motion metrics from dynamic ultrasonography. Dynamic ultrasound imaging was retrieved by asking 17 participants to perform cyclic shoulder abduction and adduction along the scapular plane, whereby the trajectory of the humeral greater tubercle (in relation to the lateral acromion) was depicted by the deep learning algorithm. Extraction of the subacromial motion metrics was conducted using a convolutional neural network (CNN) or a self-transfer learning-based (STL)-CNN with or without an autoencoder (AE). The mean absolute error (MAE) compared with the manually-labeled data (ground truth) served as the main outcome variable. Using eight-fold cross-validation, the average MAE was proven to be significantly higher in the group using CNN than in those using STL-CNN or STL-CNN+AE for the relative difference between the greater tubercle and lateral acromion on the horizontal axis. The MAE for the localization of the two aforementioned landmarks on the vertical axis also seemed to be enlarged in those using CNN compared with those using STL-CNN. In the testing dataset, the errors in relation to the ground truth for the minimal vertical acromiohumeral distance were 0.081-0.333 cm using CNN, compared with 0.002-0.007 cm using STL-CNN. We successfully demonstrated the feasibility of a deep learning algorithm for automatic detection of the greater tubercle and lateral acromion during dynamic shoulder ultrasonography. Our framework also demonstrated the capability of capturing the minimal vertical acromiohumeral distance, which is the most important indicator of subacromial motion metrics in daily clinical practice.

Application of deep learning algorithms in automatic sonographic localization and segmentation of the median nerve: A systematic review and meta-analysis.

OBJECTIVE: High-resolution ultrasound is an emerging tool for diagnosing carpal tunnel syndrome caused by the compression of the median nerve at the wrist. This systematic review and meta-analysis aimed to explore and summarize the performance of deep learning algorithms in the automatic sonographic assessment of the median nerve at the carpal tunnel level. METHODS: PubMed, Medline, Embase, and Web of Science were searched from the earliest records to May 2022 for studies investigating the utility of deep neural networks in the evaluation of the median nerve in carpal tunnel syndrome. The quality of the included studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies. The outcome variables included precision, recall, accuracy, F-score, and Dice coefficient. RESULTS: In total, seven articles were included, comprising 373 participants. The deep learning and related algorithms comprised U-Net, phase-based probabilistic active contour, MaskTrack, ConvLSTM, DeepNerve, DeepSL, ResNet, Feature Pyramid Network, DeepLab, Mask R-CNN, region proposal network, and ROI Align. The pooled values of precision and recall were 0.917 (95 % confidence interval [CI], 0.873-0.961) and 0.940 (95 % CI, 0.892-0.988), respectively. The pooled accuracy and Dice coefficient were 0.924 (95 % CI, 0.840-1.008) and 0.898 (95 % CI, 0.872-0.923), respectively, whereas the summarized F-score was 0.904 (95 % CI, 0.871-0.937). CONCLUSION: The deep learning algorithm enables automated localization and segmentation of the median nerve at the carpal tunnel level in ultrasound imaging with acceptable accuracy and precision. Future research is expected to validate the performance of deep learning algorithms in detecting and segmenting the median nerve along its entire length as well as across datasets obtained from various ultrasound manufacturers.

Ultrasound Imaging, Guidance, and Treatment for Shoulder-related Pain Syndrome: A Bibliometric Analysis.

BACKGROUND: Ultrasound imaging is shown to be superior to other imaging tools for the evaluation of shoulder disorders in a primary care settings. In addition to its diagnostic utility, ultrasound diathermy is useful as a deep heat modality for the management of shoulder pain. OBJECTIVE AND STUDY DESIGN: In this study, we analyzed the bibliometric data of publications that have focused on ultrasound imaging/therapy for shoulder-related pain syndrome. METHODS: We searched the Web of Science (WoS) database for articles published between January 1, 1976, and June 24, 2022. The CiteSpace Version 6.1R2 software was used to analyze publication output, authoritative journals/countries/institutions/authors, keywords, references, and citations. RESULTS: We analyzed 1185 articles in this study and observed a significant trend of an increase in publications per year (beta coefficient 1.8165, R2 = 0.7519, P < 0.001). The maximum number of relevant citations was identified in 2009, and these declined in subsequent years. The Journal of Ultrasound in Medicine, the United States of America, and the League of European Research Universities were identified as the journal, country, and institution with the highest number of publications, respectively. Keyword analysis revealed that "ultrasonography" showed the strongest citation bursts, followed by "arthroscopic findings" and "painful shoulders." LIMITATIONS: We only analyzed publications indexed in the WoS because most indicators required for bibliometric analysis can be efficiently extracted from its website. CONCLUSION: This study highlights a significant trend of an increase in the number of publications focused on ultrasound imaging for shoulder-related pain syndrome. Ultrasound was shown to be a highly popular imaging modality among health care practitioners for the evaluation of shoulder disorders. Randomized controlled trials and state-of-the-art reviews are warranted to boost the citation count and conclusively establish the role of ultrasound applications in patients with shoulder pain syndrome.

Ultrasound Imaging of Facial Vascular Neural Structures and Relevance to Aesthetic Injections: A Pictorial Essay.

The facial and submental regions are supplied by complicated neurovascular networks; therefore, facial aesthetic injections may be associated with serious adverse events such as skin necrosis and blindness. Pre-injection localization of neurovascular structures using high-resolution ultrasound can theoretically prevent unexpected complications. Therefore, a systematic protocol that focuses on these facial neurovascular structures is warranted. In this pictorial essay, we discuss the sonoanatomy of facial and submental neurovascular structures and its relevance to aesthetic injections. Moreover, we have highlighted the mechanisms underlying potential neurovascular injuries during aesthetic injections.

Quantitative Analysis of Dynamic Subacromial Ultrasonography: Reliability and Influencing Factors.

Objective: Current imaging methods used to examine patients with subacromial impingement syndrome (SIS) are limited by their semi-quantitative nature and their capability of capturing dynamic movements. This study aimed to develop a quantitative analytic model to assess subacromial motions using dynamic ultrasound and to examine their reliability and potential influencing factors. Method: We included 48 healthy volunteers and examined their subacromial motions with dynamic ultrasound imaging. The parameters were the minimal vertical acromiohumeral distance, rotation radius, and degrees of the humeral head. The generalized estimating equation (GEE) was used to investigate the impact of different shoulder laterality, postures, and motion phases on the outcome. Result: Using the data of the minimal vertical acromiohumeral distance, the intra-rater and inter-rater reliabilities (intra-class correlation coefficient) were determined as 0.94 and 0.88, respectively. In the GEE analysis, a decrease in the minimal vertical acromiohumeral distance was associated with the abduction phase and full-can posture, with a beta coefficient of -0.02 cm [95% confidence interval (CI), -0.03 to -0.01] and -0.07 cm (95% CI, -0.11 to -0.02), respectively. The abduction phase led to a decrease in the radius of humeral rotation and an increase in the angle of humeral rotation, with a beta coefficient of -1.28 cm (95% CI, -2.16 to -0.40) and 6.60° (95% CI, 3.54-9.67), respectively. A significant negative correlation was observed between the rotation angle and radius of the humeral head and between the rotation angle and the minimal vertical acromiohumeral distance. Conclusion: Quantitative analysis of dynamic ultrasound imaging enables the delineation of subacromial motion with good reliability. The vertical acromiohumeral distance is the lowest in the abduction phase and full-can posture, and the rotation angle of the humeral head has the potential to serve as a new parameter for the evaluation of SIS.

Ultrasound Imaging of the Facial Muscles and Relevance with Botulinum Toxin Injections: A Pictorial Essay and Narrative Review.

High-resolution ultrasound is preferred as the first-line imaging modality for evaluation of superficial soft tissues, such as the facial muscles. In contrast to magnetic resonance imaging and computed tomography, which require specifically designated planes (axial, coronal and sagittal) for imaging, the ultrasound transducer can be navigated based on the alignment of facial muscles. Botulinum toxin injections are widely used in facial cosmetic procedures in recent times. Ultrasonography is recognized as a useful tool for pre-procedure localization of target muscles. In this pictorial review, we discuss the detailed sonoanatomy of facial muscles and their clinical relevance, particularly with regard to botulinum toxin injections. Furthermore, we have summarized the findings of clinical studies that report ultrasonographic imaging of facial muscles.

Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain.

BACKGROUND: Older people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging. METHODS: Participants aged ≥60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve's cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation. RESULTS: Among the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (ß coefficient = 4.068 mm2, p < 0.001). CONCLUSION: In the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.

Suboptimal Tongue Pressure Is Associated with Risk of Malnutrition in Community-Dwelling Older Individuals.

The tongue plays an important role in swallowing, and its dysfunction theoretically leads to inadequate oral intake and subsequent malnutrition. This study aimed to explore how different levels of tongue pressure are related to malnutrition among community-dwelling older individuals. The target population was community-dwelling adults aged ≥ 65 years. Tongue pressure was measured using the Iowa Oral Performance Instrument, whereas the mini nutrition assessment (MNA) test was administered to determine the nutritional status. A full MNA score of less than 24 points was defined as risk of malnutrition. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) of risk of malnutrition among different quartiles of tongue pressure. Among the 362 participants, 26 (7.1%) were classified as having risk of malnutrition. Body weight, body mass index, handgrip strength, skeletal muscle mass index, sum MNA score, and serum levels of albumin were lower in the malnutrition risk groups than in the normal nutrition status group. A positive correlation was identified between tongue pressure and the MNA score (r = 0.143, p < 0.01). Treating the subgroup of the highest quartile of tongue pressure as the reference, the crude odds ratio (OR) of having risk of malnutrition was 5.37 (95% CI, 1.14-25.28) in the subgroup at the third quartile, 3.10 (95% CI, 0.60-15.84) in the subgroup at the second quartile, and 3.95 (95% CI, 0.81-19.15) in the subgroup at the lowest quartile. After adjustment for age and sex, the subgroup in the third quartile still presented with a significantly higher risk (OR, 4.85; 95% CI, 1.02-22.99) of risk of malnutrition. Compared with the subgroup at the highest quartile of tongue pressure, the crude OR for all the subgroups in the lower three quartiles was 4.17 (95% CI, 0.96-18.04), showing borderline significance (p = 0.05). In conclusion, we found hints for an association between decreased tongue pressure and an increased risk of malnutrition in community-dwelling older individuals. Older people with suboptimal tongue pressure should undergo a thorough assessment of their nutritional status and swallowing function for the early identification of subclinical malnutrition and dysphagia.

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.

Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments.

Ultrasound has emerged as the most useful imaging tool for investigating wrist and hand disorders, with several published ultrasound protocols having demonstrated their practicality in scanning the wrist tendons and nerves. However, ligaments of the wrist are networked in a complex manner, deterring sonographers from examining them with an organized strategy. Furthermore, because of the non-parallel alignment between the radiocarpal, mid-carpal, and carpal-metacarpal joints, precise recognition of the carpal bones is challenging, although ultrasound is paramount for visualizing the wrist ligaments. In this regard, the current article for point of view aims to elaborate sonoanatomy of the carpal bones and to present a stepwise systematic approach for navigating the extrinsic and intrinsic wrist ligaments.

Ion-pairing liquid chromatography with on-line electrospray ion trap mass spectrometry for the structural analysis of N-unsubstituted heparin/heparan sulfate.

The rare N-unsubstituted glucosamine (GlcNH3(+)) residues in heparan sulfate (HS) have important biological and pathophysiological roles. In this study, a high-resolution method for the separation and analysis of N-unsubstituted disaccharides of heparin/HS is described. Four N-unsubstituted disaccharides, together with eight N-substituted species, can be well-separated by ion-pair reverse-phase ultra-performance liquid chromatography. Each disaccharide can then be detected and its relative abundance quantified using electrospray ionization mass spectrometry in the negative mode. Because of its high sensitivity, without interference from proteins and other sample impurities, this method is particularly useful in the analysis of low content GlcNH3(+) residues in small amounts of biological materials, eg. sera, tissue and cell culture-derived samples. This would lead to a better understanding of the biological origin of GlcNH3(+) residues and their increasingly important function in human health and disease.

[Effect of electroacupuncture in different frequencies on electromyography and ambulation in stroke patients with lower-extremity spasticity: a randomized controlled study].

OBJECTIVE: To assess the effect of electroacupuncture in different frequencies by electromyography and walking function measure in post-stroke patients with lower-extremity (OLE) spasticity and hemiparesis. METHODS: Fifty cases of post-stroke whose motor deficit was classified into Brunnstrom stage II - IV were randomly divided into a 100 Hz group, a 50 Hz group and a 2 Hz group. They were accepted 100 Hz, 50 Hz or 2 Hz of electroacupuncture (EA) therapy combined with standard rehabilitation program. Main outcome measures included integrated electromyography (IEMG) score during maximum isometric voluntary contraction (MIVC) of the knee flexors and extensors, ankle dorsiflexors and planterflexors in the affected LE recorded by surface EMG, Co-contraction ratio calculated by IEMG score of the antagonist over that of the agonist plus antagonist, Composite Spasticity Scale (CSS), Fugl-Meyer Motor Scale (FMS) and Functional Ambulation Categories (FAC) on LE. All outcomes were assessed at the baseline and after treatment by the professional practitioners who blinded to the treatment. RESULTS: After EA treatment, IEMG of rectus femoris were decreased in 100 Hz and 50 Hz groups (P < 0.01, P < 0.05), and better than that in 2 Hz group (both P < 0.05); gastrocnemius IEMG were decreased in 100 Hz and 50 Hz groups (P < 0.05, P < 0.01); but IEMG of tibialis anterior muscle was increased only in 50 Hz group (P < 0.05). During knee flexion, EMG co-contraction ratio in MIVC declined in 100 Hz and 50 Hz groups were decreased significantly (P < 0.05, P < 0.01), and the co-contraction ratio between the non-affected and affected side were increased significantly in all the 3 groups after treatment (P < 0.01, P < 0.05). During ankle dorsiflexion, co-contraction ratio were decreased significantly in all the 3 groups (P < 0.05, P < 0.01), and cocontraction ratio between the non-affected and affected side was increased significantly only in 100 Hz after treatment (P < 0.01). FMS score, CSS and FAC were improved in all the 3 groups after treatment (all P < 0.01), but only FAC in 100 Hz group showed better effect than that in 50 Hz group or 2 Hz group (both P < 0.05). CONCLUSION: Electroacupuncture therapy combined with rehabilitation program is effective for the spasticity status of lower-extremity in post-stroke. The therapeutic effect of EA in the frequencies of 100 Hz or 50 Hz is superior to that of 2 Hz stimulation and parameter of 100 Hz may be optimal.