Earticle

Objective To assess the cross-sectional area (CSA) of the muscles for investigating the occurrence of asymmetry of the paraspinal (multifidus and erector spinae) and psoas muscles and its relation to the chronicity of unilateral lumbar radiculopathy using magnetic resonance imaging (MRI).Methods This retrospective study was conducted between January 2012 to December 2014. Sixty one patients with unilateral L5 radiculopathy were enrolled: 30 patients had a symptom duration less than 3 months (group A) and 31 patients had a symptom duration of 3 months or more (group B). Axial MRI measured the CSA of the paraspinal and psoas muscles at the middle between the lower margin of the upper vertebra and upper margin of the lower vertebra, and obtained the relative CSA (rCSA) which is the ratio of the CSA of muscles to that of the lower margin of L4 vertebra.Results There were no differences in the demographics between the two groups. In group B, rCSA of the erector spinae at the L4-5 level, and that of multifidus at the L4-5 and L5-S1 levels, were significantly smaller on the involved side as compared with the uninvolved side. In contrast, no significant muscle asymmetry was observed in group A. The rCSA of the psoas was not affected in either group.Conclusion The atrophy of the multifidus and erector spinae ipsilateral to the lumbar radiculopathy was observed only in patients suffering from unilateral radiculopathy for 3 months or more.

Progressive muscular atrophy (PMA) is a rare disease involving lower motor neuron degeneration. Hypokalemic periodic paralysis (HypoPP) is a genetic disorder that causes temporary muscle paralysis due to decreased serum potassium levels. Mutations in the CACNA1S gene cause HypoPP. An altered locus closely linked near the CACNA1S gene suggests the possibility of motor neuron degeneration. However, PMA with HypoPP is very rare worldwide because HypoPP usually causes progressive muscle weakness involving a form of myopathy without motor neuron disease. In this report, we describe the case of a 64-year-old man who initially complained of weakness in only the left lower extremity, which subsequently progressed bilaterally. Hence, the patient was diagnosed with PMA with HypoPP based on serial electromyography and the presence of a CACNA1S mutation. Therefore, serial electromyography is necessary for middle-aged patients with progressive muscle weakness and a history of HypoPP.

Objective To compare the motor recovery following transverse myelitis in pediatric patients with and without spinal cord atrophy. Method From January 1995 through December 2009, twenty children (8 boys and 12 girls with an onset at 5.7±3.8years) that were diagnosed with transverse myelitis at a Children’s Hospital in Korea, and undertaken an initial and follow-up spine magnetic resonance image (MRI) were included. Medical records and spine MRI scans were reviewed retrospectively. An initial MRI was taken 5.1±8.7 days after the onset. Th e interval between an initial and follow-up MRIs was 33.4±23.0 days. Th e motor recovery diff erences between subjects with and without spinal cord atrophy on follow-up MRIs were determined. Motor recovery was defi ned as the elevation of one or more grades of manual muscle tests of the Medical Research Council. Results Eight patients had developed spinal cord atrophies and 12 patients had not. Of the 8 patients with spinal cord atrophy, 7 showed no motor improvement. Among the 12 patients without atrophy, 11 had motor improvement. Spinal cord atrophy on follow-up MRIs were related to the risk of no motor improvement (odds ratio=77.0, 95% confi dence interval [4.114-1441.049], p-value=0.001). Conclusion Children with transverse myelitis who had developed spinal cord atrophy on follow-up MRIs had poor motor recovery than those who had not. The appearance of spinal cord atrophy on follow-up MRI could be an indicator of poor prognosis in pediatric transverse myelitis.

Objective To assess the atrophy of cervical multifidus muscles in patients with unilateral cervical disc herniation or radiculopathy quantitatively and to investigate whether asymmetric muscle atrophy has the relationship with the severity of cervical disc herniation or radiculopathy. Method Twenty-four patients who had cervical disc herniation in magnetic resonance imaging (MRI) were evaluated. The patients were divided into 2 groups; patients with unilateral cervical radiculopathy in electrodiagnosis (RAD) and patients without definite radiculopathy (HIVD). Twenty six controls without disc herniation were also evaluated. Cervical multifidus muscles from C4-5 to C7-T1 levels were detected in T1 axial MRI, and total cross-sectional area (CSA) of multifidus muscle (TMA) and pure muscle CSA (PMA) were measured. Results The ratios of TMA in involved side to TMA in uninvolved side (ITMA/UTMA) and PMA in involved side to PMA in uninvolved side (IPMA/UPMA) in HIVD and RAD groups was significantly lower than those in control group especially at C7-T1 level (p＜0.05). We divided the levels of cervical spine into three parts according to lesions found in MRI or electrodiagnosis; above lesion level, at lesion level and below lesion level. Abnormal cases of IPMA/UPMA were not different among levels in HIVD group, but RAD group showed that most of abnormal cases were below lesion (60%). Conclusion Asymmetric multifidus atrophy was seen in patients with cervical disc herniation and radiculopathy. The ratio of pure muscle CSA between involved and uninvolved sides might be a useful parameter to differentiate patients with unilateral cervical radiculopathy from patients without radiculopathy.

Muscle atrophy is characterized by the loss of muscle function. Many efforts are being made to prevent muscle atrophy, and exercise is an important alternative. Methylglyoxal is a well-known causative agent of metabolic diseases and diabetic complications. This study aimed to evaluate whether methylglyoxal induces muscle atrophy and to evaluate the ameliorative effect of moderate-intensity aerobic exercise in a methylglyoxal-induced muscle atrophy animal model. Each mouse was randomly divided into three groups: control, methylglyoxal-treated, and methylglyoxal-treated within aerobic exercise. In the exercise group, each mouse was trained on a treadmill for 2 weeks. On the last day, all groups were evaluated for several atrophic behaviors and skeletal muscles, including the soleus, plantaris, gastrocnemius, and extensor digitorum longus were analyzed. In the exercise group, muscle mass was restored, causing in attenuation of muscle atrophy. The gastrocnemius and extensor digitorum longus muscles showed improved fiber cross-sectional area and reduced myofibrils. Further, they produced regulated atrophy-related proteins (i.e., muscle atrophy F-box, muscle RING-finger protein-1, and myosin heavy chain), indicating that aerobic exercise stimulated their muscle sensitivity to reverse skeletal muscle atrophy. In conclusion, shortness of the gastrocnemius caused by methylglyoxal may induce the dynamic imbalance of skeletal muscle atrophy, thus methylglyoxal may be a key target for treating skeletal muscle atrophy. To this end, aerobic exercise may be a powerful tool for regulating methylglyoxal-induced skeletal muscle atrophy.

Objective: The purpose of this study is to compare chronic low back pain patients' pain provocation position so as to identify the relevance with lumbar stabilizing muscles atrophy and pain provocation position. Design: Cross-sectional study. Methods: Fifty five chronic low back pain patients were participated in this study. Subjects were eligible for study participation if they were 35-55 years old and had experienced low back pain for more than 3 months. Subjects were questioned about pain and pain provocation test were done. And then they were inspected their cross sectional area (CSA) of lumbar muscles (erector spinae, iliopsoas, and multifidus) by using computed tomography. Analyze the relevance through the result data with painful area, aspect of pain and pain provocation position. Results: CSA of erector spinae showed significant decrease on ipsilateral extension position (p<0.05). Iliopsoas muscle showed significant decrease on contralateral position (p<0.05). Multifidus showed significant decrease on the position of contralateral extension and contralateral flexion (p<0.05). Conclusions: Based on the results of our study, it may be possible to evaluate muscle atrophy by assessing causing position.

Objective To investigate the utility of ultrasonography to objectively examine morphological changes (i.e., muscle atrophy and fatty infiltration) of the supraspinatus muscle. Methods Thirty-four patients were prospectively enrolled in this study. The degrees of muscle atrophy and fat infiltration were measured using ultrasonography 3?4 months after arthroscopic supraspinatus tendon repair. Shoulder function (i.e., shoulder active range of motion, visual analogue scale, and constant score) was examined. Using the symmetricity of the muscles in the human body, the degrees of morphological changes of the supraspinatus muscle were quantitatively measured. The associations between the morphological changes of the supraspinatus muscle and shoulder function were identified. Results There were statistically significant differences in the cross-sectional area (CSA) and echogenicity between the surgery and non-surgery sides (p<0.001). The CSA ratio, which represents the degree of muscle atrophy, was associated with shoulder forward flexion, external rotation, and constant score; however, the echogenicity ratio, which represents the degree of fat infiltration, was not associated with shoulder function after surgery. Conclusion This study demonstrated that shoulder function could be predicted by evaluating the morphological changes of the supraspinatus muscle using ultrasonography and that objective evaluation is possible through quantitative measurement using the symmetricity of the human body.

Objective To identify the correlations between the location of multifidus atrophy and the level of lumbar radiculopathy.Methods Thirty-seven patients who had unilateral L4 or L5 radiculopathy were divided into 2 groups; the L4 radiculopathy (L4 RAD) group and the L5 radiculopathy (L5 RAD) group. Bilateral lumbar multifidus muscles at the mid-spinous process level of L4 vertebra (L4 MSP), the mid-spinous process level of L5 vertebra (L5 MSP), and the mid-sacral crest level of S1 vertebra (S1 MSC) were detected in T1 axial magnetic resonance imaging. The total muscle cross-sectional area of multifidus muscles (TMCSA) and the pure muscle cross-sectional area of multifidus muscles (PMCSA) were measured by a computerized analysis program, and the ratio of PMCSA to TMCSA (PMCSA/TMCSA) was calculated.Results There were no significant differences in TMCSA between the involved and the uninvolved sides in both groups. PMCSA was only significantly smaller at the S1 MSC on the involved side as compared with the uninvolved side in the L5 RAD group. The ratio of PMCSA to TMCSA was the lowest at the L5 MSP on the involved side in the L4 RAD group and at the S1 MSC on the involved side in the L5 RAD group. Conclusion Our findings suggest that the most severe atrophy of multifidus muscle may occur at the mid-spinous process or mid-sacral crest level of the vertebra which is one level below the segmental number of the involved nerve root in patients with a single-level, unilateral lumbar radiculopathy.

The retinal degenerative disease, progressive retinal atrophy (PRA) is a major reason of vision impairment in canine population. Canine PRA signifies an inherently dissimilar category of retinal dystrophies which has solid resemblances to human retinis pigmentosa. Even though much is known about the biology of PRA, the knowledge about the intricate connection among genetic loci, genes and pathways associated to this disease in dogs are still remain unknown. Therefore, we have performed a genome wide association study (GWAS) to identify susceptibility single nucleotide polymorphisms (SNPs) of PRA. The GWAS was performed using a case?control based association analysis method on PRA dataset of 129 dogs and 135,553 markers. Further, the gene-set and pathway analysis were conducted in this study. A total of 1,114 markers associations with PRA trait at p < 0.01 were extracted and mapped to 640 unique genes, and then selected significant (p < 0.05) enriched 35 gene ontology (GO) terms and 5 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways contain these genes. In particular, apoptosis process, homophilic cell adhesion, calcium ion binding, and endoplasmic reticulum GO terms as well as pathways related to focal adhesion, cyclic guanosine monophosphate)-protein kinase G signaling, and axon guidance were more likely associated to the PRA disease in dogs. These data could provide new insight for further research on identification of potential genes and causative pathways for PRA in dogs.

Purpose: The purpose of this study was to determine the effect of dehydroepiandrosterone (DHEA) on recovery of muscle atrophy induced by Parkinson's disease. Methods: The rat model was established by direct injection of 6-hydroxydopamine (6-OHDA, 20 ${\mu}g$) into the left striatum using stereotaxic surgery. Rats were divided into two groups; the Parkinson's disease group with vehicle treatment (Vehicle; n=12) or DHEA treatment group (DHEA; n=22). DHEA or vehicle was administrated intraperitoneally daily at a dose of 0.34 mmol/kg for 21 days. At 22-days after DHEA treatment, soleus, plantaris, and striatum were dissected. Results: The DHEA group showed significant increase (p<.01) in the number of tyrosine hydroxylase (TH) positive neurons in the lesioned side substantia nigra compared to the vehicle group. Weights and Type I fiber cross-sectional areas of the contralateral soleus of the DHEA group were significantly greater than those of the vehicle group (p=.02, p=.00). Moreover, extracellular signal-regulated kinase (ERK) phosphorylation significantly decreased in the lesioned striatum, but was recovered with DHEA and also in the contralateral soleus muscle, Akt and ERK phosphorylation recovered significantly and the expression level of myosin heavy chain also recovered by DHEA treatment. Conclusion: Our results suggest that DHEA treatment recovers Parkinson's disease induced contralateral soleus muscle atrophy through Akt and ERK phosphorylation.

The impact of disease-modifying therapy ranges from cure to no impact with a wide range of intermediates. In cases where the intermediate group reaches a plateau after the acquisition of some muscle strength, it is necessary to set a functional level appropriate for increased motor power and establish a long-term exercise plan to maintain it. As the disease status stabilizes and the life span increases, early nonsurgical interventions are required, such as using a standing frame to prevent joint contracture, applying a spinal brace at the early stage of scoliosis, and maintaining sitting postures that exaggerate lumbar lordosis. In cases where scoliosis and hip displacement occur and progress even after conservative managements are implemented, early referral to surgery should be considered. Oromotor activity and swallowing function are influenced not only by the effects of disease-modifying drugs, but also by post-birth experience and training. Therefore, although the feeding tube cannot be removed, it is necessary to make efforts to simulate the infant feeding development while maintaining partial oral feeding. Since the application period of non-invasive ventilators has increased, it has become more important to prevent long-term complications such as facial abrasion, skin allergy, orthodontic deformities, and maxillary flattening caused by the interface. Dual ventilator mode or interface can also be utilized.

This study was peformed to investigate the effects on skeletal muscle recovery with aqua-exercise; swimming to take the muscle endurance for 20 days on two group of white rats which were the low extremity atrophy group(control groups) by fixed for two weeks and aqua-exercise group(experimental groups) after it. The effects was observed with light and electron microcope to measure the morphological changes of muscle fibers. The results obtained were as follow. 1. Light microscope: In the case of control groups, quadriceps fibers had been irregular alignment, decreased muscle width and the irregular alignment nuclear appeared, as it is degenerative muscle fibers. In the case of experimental groups, the fibers had been regular alignment cells and fibers. The nucleus of muscle had been normal characterized by oval shape and fiber sarcomere clearly classified. 2. Electron microscope: In the case of control groups, there were the quadriceps which was Z-line streaming phenomenon induced at the sarcomere and cells nuclear separated from basal membrane. It was not only observed the sarcomere alignment irregularly and mitochondria damaged, but also vacuoles found. In the case of experimental groups, A band, I band, H band had been clearly appeared, classified at the myofibrils of quadriceps, and electronic dense M-line found in sarcomere. There were observed satellite cells and basal laminas that usually to be appeared at the time of mitochondrial development, skeletal muscle fiber regeneration or development. This results suggest that the aqua-exercise assisted to inhibit the degenerative morphological changes of skeletal muscle cells and help to recover from abnormal states. Especially, it is considered to effect on a normal structural formation.

Purpose: We examined the self-care experiences of adolescents with spinal muscle atrophy (SMA) and their perceptions of the interactions between their body and the environment. Methods: We interviewed ten adolescents with SMA aged 13-18 years regarding personal care practices. Purposive sampling was conducted in two medical centers in northern Taiwan. Data were analyzed using the Giorgi analysis method. Results: Four constitutions were identified: (1) limited space for independent development, (2) multiple reconstructions of self-image to improve physical ability, (3) self-care of disease, and (4) developing activity styles to accommodate social culture. Conclusion: The self-care lived experiences of patients reflect dynamic changes in the body and environment. Self-existence was exhibited by adjustment, practice, and creativity of physical activity to integrate into society. Nursing staff should understand the self-care experiences and needs of adolescents with SMA to develop a database of self-care skills. This study recommended that nursing staff improve their ability to guide patients in taking care of themselves by developing body awareness self-care courses and individual care plans in response to various stages of disability to help patients delay deterioration, realize their physical potential, and promote independence and social development.

An isolated musculocutaneous nerve (MCN) injury is a rare condition that can be easily missed if it presents late. A 28-year-old man reported painless and progressive wasting of the right arm for 6 months. On examination, there was visible wasting of the right biceps brachii muscle along with its slight weakness, depressed biceps jerk, and an impaired pinprick sensation in the lateral antebrachial cutaneous nerve distribution. He described a history of a road traffic accident 14 months beforehand. Based on the history and clinical examination, the differential diagnosis included an isolated MCN injury, upper trunk plexopathy, lateral cord plexopathy, C5/6 radiculopathy, and monomelic amyotrophy involving the C5/6 myotomes on the right side. The results of nerve conduction studies and electromyography were consistent with chronic proximal MCN neuropathy (right). In cases of arm wasting without pain or numbness, MCN injury should be included in the differential diagnosis, even in the presence of good power of the elbow flexors. The importance of detailed history-taking and clinical correlation cannot be over-emphasized in such cases.

Objectives: Bulbo-spinal muscular atrophy (BSMA) is an inherited motor neuronopathy, but it is known that subclinical sensory neuropathy can be found. The objective of this study is to clarify the features of sensory neuropathy by cross-sectional and longitudinal studies. Method: We analyzed the clinical and electrodiagnostic data of 41 BSMA patients who were genetically confirmed. Follow-up studies were performed in 10 patients among them. Results: Of 41 patients, 11 complained of sensory symptoms (26.8%), such as numbness or paresthesia of distal extremities. However, sensory neuropathy was observed in 23 patients (56.1%) with nerve conduction study (NCS). Reduced amplitude of action potentials was the most remarkable finding of the group with sensory neuropathy. For 10 patients with follow-up NCS, the mean follow-up interval was 8 years. There was no significant temporal change between the first and the follow-up sensory NCS. Conclusion: Subclinical sensory neuropathy was found in 56.1% of BSMA patients. The longitudinal study shows that subclinical sensory neuropathy in BSMA may not progress over time.

Objective To evaluate whether the change of heel pad thickness improves the pain after Modified Low-Dye Taping (MLDT) in the patient with heel pad atrophy. Method Thirty-five feet of 20 volunteers with heel pad atrophy were selected for the measurement of heel-pad thickness and compressibility index (CI) of the center of calcaneus bone using ultrasound. The subjects were laid in prone with the knees flexed to 90o, and an electronic body weight scale was inserted beneath the anterior surface of their knees to take measurements of both UHPT (unloaded heel pad thickness) and LHPT (6 kg-loaded heel pad thickness), which were repeated 3 times respectively. CI was calculated base on LHPT divided by UHPT. After MLDT, the same method was repeated. visual analogue scale (VAS) score was checked at first visit and followed up at second visit. Results Prior to MLDT, the average value of UHPT (cm), LHPT (cm) and CI value was 0.92±0.11, 0.25±0.06 and 0.27±0.04 respectively. After MLDT, the average was 1.24±0.17 for UHPT (cm) and 0.42±0.11, for LHPT (cm) while CI stood at 0.33±0.06. VAS before MLDT was 7.35±1.27 and after MLDT was 3.50±1.36, which presented 54% of decrease than initial. Conclusion It was confirmed that the average values of the heel-pad thickness, CI and VAS of patients with heel pad atrophy were improved for MLDT. Accordingly it is considered that application of MLDT is an efficacious treatment and thus further study is needed to develop foot orthoses for heel pad atrophy using the principle of MLDT.

Sarcopenia, a condition characterized by chronic systemic inflammation and a significant decline in the quality of life, is primarily associated with aging and degenerative diseases. Several studies have shown that milk exosomes contain a substantial number of miRNAs that are involved in immunity, inflammation, osteoporosis, and gut microbiota regulation. This study aimed to evaluate the potential functional role of bovine colostrum-derived exosomes (BCE) in reducing muscle atrophy. BCE treatment enhanced the viability of C2C12 myotube and stimulated myogenic differentiation, while inhibiting muscle atrophy markers MuRF1 and atrogin-1 that were upregulated by dexamethasone (DEX) exposure. In Caenorhabditis elegans, BCE supplementation significantly prolonged lifespan and upregulated key myogenic structural genes, such as myo-3 and unc-54. BCE also modulated gut microbiome composition by significantly increasing Lachnospiraceae abundance while promoting an increase in Muribaculaceae and a decrease in Bacteroidaceae levels. These microbial changes were associated with a reduction in cholesterol levels in DEX-treated mice. Furthermore, BCE restored metabolic homeostasis by reversing DEX-induced alterations in succinic acid and L-Alanine levels, both of which are critical for muscle metabolism and lipid regulation. Taken together, our findings support the role of BCE in modulating gut microbiota and metabolites, highlighting the therapeutic potential of BCE in counteracting muscle atrophy.

Objective To investigate and compare the effect of low-dye taping (LDT) and figure-8 modification of LDT (MLDT) on peak plantar pressure and heel pain in patients with heel pad atrophy. Methods There were reviewed 32 feet of 19 patients who have been diagnosed with heel pad atrophy who were enrolled in this study. The patients were diagnosed with heel pad atrophy with clinical findings, and loaded heel pad thickness measured by ultrasonography. At the first visit, patients were taught how to do LDT and MLDT. They were instructed to do daily living with barefoot, LDT and MLDT at least one time per day. Patients performed pedobarography with barefoot, LDT and MLDT within 2 weeks. The severity of heel pain was also checked with the visual analogue scale (VAS) during daily living with barefoot, LDT and MLDT. Results VAS of hindfoot were significantly decreased after LDT and MLDT (p<0.01). Peak plantar pressure under hindfoot were also decreased after LDT and MLDT (p<0.01). The effect of MLDT in decreasing peak plantar pressure of hindfoot (p<0.01) and pain relief (p=0.001) was better than the effect of LDT. Conclusion The LDT technique is clinically useful for pain management and reducing peak plantar pressure of hindfoot in patients with heel pad atrophy. MLDT is more effective than LDT in reducing peak plantar pressure and heel pain in patients with heel pad atrophy.