INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.
- MeSH
- Lumbar Vertebrae * surgery diagnostic imaging MeSH
- Spinal Fusion * methods MeSH
- Paraspinal Muscles * diagnostic imaging pathology MeSH
- Cortical Bone surgery diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pedicle Screws MeSH
- Postoperative Complications diagnostic imaging MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Spondylolisthesis * surgery diagnostic imaging MeSH
- Muscular Atrophy * etiology diagnostic imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Skeletal muscle alterations are associated with higher mortality and morbidity in patients with liver cirrhosis. Assessing these changes seems to be a promising method for identifying patients at a high risk of poor outcomes following liver transplantation (LT). This is particularly important given the current global shortage of organ donors. However, evidence of the impact of these alterations on the prognosis of patients undergoing LT is inconclusive. The aim of our prospective study was to evaluate the impact of skeletal muscle changes, reflected in sarcopenia, myosteatosis and metabolic changes in the calf muscles, on perioperative outcomes and long-term survival after LT. We also sought to determine the posttransplant evolution of the resting muscle metabolism. METHODS: We examined 134 adult LT candidates. Of these, 105 underwent LT. Sarcopenia and myosteatosis were diagnosed by measuring the skeletal muscle index and mean psoas muscle radiation attenuation, respectively, which were obtained from computed tomography (CT) scans taken during pretransplant assessment. Additionally, patients underwent 31P MR spectroscopy (MRS) of the calf muscles at rest before LT and 6, 12 and 24 months thereafter. The median follow-up was 6 years. RESULTS: Patients with abnormal 31P MRS results and CT-diagnosed myosteatosis prior to LT had significantly worse long-term survival after LT (hazard ratio (HR), 3.36; 95% confidence interval (CI), 1.48-7.60; p = 0.0021 and HR, 2.58; 95% CI, 1.06-6.29; p = 0.03, respectively). Multivariable analysis showed that abnormal 31P MR spectra (HR, 3.40; 95% CI, 1.50-7.71; p = 0.003) were a better predictor of worse long-term survival after LT than myosteatosis (HR, 2.78; 95% CI, 1.14-6.78; p = 0.025). Patients with abnormal 31P MR spectra had higher blood loss during LT (p = 0.038), required a higher number of red blood cell transfusions (p = 0.006) and stayed longer in ICU (p = 0.041) and hospital (p = 0.007). Myosteatosis was associated with more revision surgeries following LT (p = 0.038) and a higher number of received red blood cell transfusion units (p = 0.002). Sarcopenia had no significant effect on posttransplant patient survival. An improvement in the resting metabolism of the calf muscles was observed at 12 and 24 months after LT. CONCLUSIONS: Abnormal 31P MRS results of calf muscles were superior to CT-based diagnosis of myosteatosis and sarcopenia in predicting perioperative complications and long-term survival after LT. Resting muscle metabolism normalized 1 year after LT in most recipients.
- MeSH
- Adult MeSH
- Muscle, Skeletal * diagnostic imaging metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Spectroscopy * methods MeSH
- Tomography, X-Ray Computed * methods MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Sarcopenia etiology metabolism MeSH
- Aged MeSH
- Liver Transplantation * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Pulsed field ablation (PFA) of atrial fibrillation is a new method in clinical practice. Despite a favorable safety profile of PFA in atrial fibrillation ablation, rare cases of renal failure, probably due to hemolysis, have recently been reported. OBJECTIVE: The aim of this study was to determine the rate of hemolysis and cardiac cell death during in vitro PFA with different electric field intensities. METHODS: Blood samples from healthy volunteers and mouse HL-1 cardiomyocyte cell lines were subjected to in vitro irreversible electroporation using 216 bipolar pulses, each lasting 2 μs with intervals of 5 μs, repeated 20 times at a frequency of 1 Hz. These pulses varied from 500 V to 1500 V. Cell-free hemoglobin levels were assessed spectrophotometrically, and red blood cell microparticles were evaluated by flow cytometry. Cardiomyocyte death was quantified with propidium iodide. RESULTS: Pulsed field energy (1000 V/cm, 1250 V/cm, and 1500 V/cm) was associated with a significant increase in cell-free hemoglobin (0.32 ± 0.16 g/L, 2.2 ± 0.96 g/L, and 5.7 ± 0.39 g/L; P < .01) and similar increase in the concentration of red blood cell microparticles. Significant rates of cardiomyocyte death were observed at electric field strengths of 750 V/cm, 1000 V/cm, 1250 V/cm, and 1500 V/cm (26.5% ± 5.9%, 44.3% ± 6.2%, 55.5% ± 6.9%, and 74.5% ± 17.8% of cardiomyocytes; P < .01). CONCLUSION: The most effective induction of cell death in vitro was observed at 1500 V/cm. This intensity was also associated with a significant degree of hemolysis.
- MeSH
- Electroporation * methods MeSH
- Atrial Fibrillation physiopathology surgery MeSH
- Hemolysis * physiology MeSH
- Myocytes, Cardiac * metabolism MeSH
- Cells, Cultured MeSH
- Humans MeSH
- Mice MeSH
- Flow Cytometry MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Mice MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1-4). The mean distance of the most distal branch was 35 mm (range 26-40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16-26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.Level of evidence: V.
- MeSH
- Ulnar Artery * surgery MeSH
- Surgical Flaps * blood supply MeSH
- Muscle, Skeletal * blood supply MeSH
- Humans MeSH
- Cadaver * MeSH
- Median Nerve surgery MeSH
- Forearm * surgery blood supply MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
This study aimed to investigate the effects of performing either eccentric-only (ECC) or eccentric-concentric (ECC-CON) back squats (BS) with a supramaximal load on countermovement jump (CMJ) performance. Changes in front thigh skin surface temperature and mechanical properties (oscillation frequency and stiffness) of the vastus lateralis were also examined. Fourteen male powerlifters participated in this study (age: 22.5 ± 2.3 years, body weight: 84.2 ± 11.1 kg, height: 178 ± 7 cm, training experience: 5.4 ± 1.6 years, BS one-repetition maximum [1RM]: 177 ± 22.8 kg). The experimental sessions included 2 sets of 2 BS at 110% 1RM of either ECC-CON (load distributed by half on the barbell [55%] and on weight releasers [55%]) or ECC (only eccentric phase of BS) and CTRL with no CA applied. CMJ performance, mechanical properties, and skin surface temperature were measured before and at the third, sixth, ninth, and 12th min. After each protocol, only the ECC-CON condition led to a significant increase in CMJ height after individual optimal rest time compared to pre-CA (38.1 ± 5.2 vs. 39.8 ± 5.0 cm; p = 0.003; effect size [ES] = 0.32; Δ = 4.9 ± 5.0%) with a significant rise in skin surface temperature (32.98 ± 1.24 vs. 33.69 ± 0.96°C; p = 0.006; ES = 0.62; Δ = 2.2 ± 2.6%) and no significant changes in mechanical properties of the vastus lateralis. The ECC-CON condition led to a significant acute improvement in CMJ height and an increase in front thigh skin surface temperature among powerlifters. The ECC-CON supramaximal lower limb PAPE protocol should be effectively used among males representing high levels of lower limb muscle strength (>2 × body mass).
- MeSH
- Biomechanical Phenomena MeSH
- Quadriceps Muscle physiology MeSH
- Adult MeSH
- Muscle, Skeletal physiology MeSH
- Humans MeSH
- Young Adult MeSH
- Resistance Training MeSH
- Athletic Performance * physiology MeSH
- Thigh physiology MeSH
- Muscle Strength physiology MeSH
- Skin Temperature * physiology MeSH
- Weight Lifting * physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
There is increasing pressure on meat producers worldwide due to the need for higher yields and improved meat quality. This is why anabolic androgenic steroids (AAS) have been widely used in most countries, due to their ability to accelerate animal muscle growth. However, out of concern for their side effects, EU states have banned their use and implemented control mechanisms. But they are reaching their limits, and therefore, it is necessary to look for new ways and investigate the mechanism of action of AAS on muscle tissue. This study replicated the administration of banned AAS (testosterone, nandrolone and their combination) and observed their effect on pig muscle. The pig model was purposely chosen for the study, as no such research has been carried out on this species. At the same time, pork is one of the most consumed meats in Europe. It focused on histological changes in muscle structure, specifically the size of muscle fibres and the number of satellite cells per muscle fibre. Furthermore, ultrastructural changes in muscle fibres, the diameter of myofibrils, the number of myofibrils per area, the distance between myofibrils and the size of sarcomeres were examined. The results using the techniques of histology, fluorescent labelling and transmission electron microscopy showed that, after the application of AAS, there is an increase in the diameter of muscle fibres, an increase in the diameter of myofibrils, a decrease in the number of myofibrils per surface area and, in the case of testosterone, an increase in the distance between myofibrils and an increase in the length of sarcomeres. There was also a significant increase in the number of satellite cells per muscle fibre. The detected statistically significant differences between control and experimental groups provide evidence that selected histological parameters could be additional mechanisms for detecting the presence of AAS in pork meat in the future.
- MeSH
- Anabolic Agents * pharmacology MeSH
- Muscle Fibers, Skeletal * drug effects ultrastructure MeSH
- Muscle, Skeletal drug effects anatomy & histology ultrastructure MeSH
- Myofibrils * drug effects ultrastructure MeSH
- Nandrolone * pharmacology MeSH
- Swine anatomy & histology MeSH
- Sarcomeres drug effects ultrastructure MeSH
- Satellite Cells, Skeletal Muscle drug effects ultrastructure MeSH
- Testosterone * pharmacology MeSH
- Microscopy, Electron, Transmission veterinary MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
The majority of motor tasks in sports are executed unilaterally, however research on the impact of unilateral conditioning activities (CAs) on both unilateral and bilateral sports tasks remains limited. Therefore, the aim of this study was to evaluate the effects of isometric and plyometric unilateral CAs on unilateral and bilateral jumping performance. The study involved fifteen resistance-trained males who participated in three experimental sessions: 3 sets of 3 s of maximum isometric single-leg quarter-squats or 3 sets of 5 single-leg tuck jumps as CAs, along with a control condition without CA. Measurements of single-leg jump (SLJ) and countermovement jump (CMJ) were taken 5 min before, and at approximately the 3th, 6th and 9th minute after the CA. The analysis did not show any statistically significant interactions nor a main effect of condition or time (p > 0.05) for CMJ height and relative peak power. However, a main effect of time (p = 0.02) to increase non-dominant SLJ height from baseline to best post-CA time-point was found (+ 0.8 ± 2.5 cm; Cohen's d = 0.22). Neither isometric nor plyometric CAs significantly affected CMJ and SLJ performance. The observed increase in jump height for the non-dominant leg is likely due to motor learning rather than the effects of the applied CAs.
- MeSH
- Adult MeSH
- Muscle, Skeletal physiology MeSH
- Humans MeSH
- Young Adult MeSH
- Resistance Training methods MeSH
- Plyometric Exercise MeSH
- Athletic Performance physiology MeSH
- Muscle Strength * physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
Defekty pánevního dna u žen jsou velmi rozšířeným problémem. Odhaduje se, že až 11 % žen potřebuje řešit nějakou formu prolapsu pánevních orgánů (POP, Pelvic Organ Prolapse). Jen stěží lze předpokládat, že se bude tento statistický údaj výrazněji měnit. Operační postupy stále procházejí zákonitým vývojem. V minulosti prováděné samostatné kolporafie v dnešní době již nejsou aktuální a kolpokleiza je indikována výjimečně. Významný počet neuspokojivých výsledků po klasických operacích byl příčinou hledání nových chirurgických technologií v této oblasti. Prevalence reoperací v zemích, kde probíhají relevantní klinické studie, je vysoká. Olsen a kol. ve své studii uvádí 29,2% výskyt recidiv, Whiteside v prospektivní studii prezentuje dokonce 58 % recidiv po vaginálních operacích pro POP (1, 2). Zavedení síťkových implantátů do operativy pánevních prolapsů znamenalo zásadní zvrat v této problematice. Síťkové implantáty začaly být užívány při operacích pánevních prolapsů po dobrých zkušenostech se síťkami při řešení břišních kýl a také po přelomových zkušenostech při řešení stresové inkontinence (SI) implantacemi tahuprostých suburetrálních pásek. Přinesly do operativy POP jeden zásadní prvek - schopnost přemostit i velké plošné defekty pojivové tkáně vzniklé porodním traumatem nebo pánevní operací. Jejich použití při operaci POP je však daleko náročnější než při operacích břišních kýl, protože POP je specifickou kýlou v dynamicky náročném prostoru. Při těchto operacích zasahujeme do velmi citlivých funkcí, jakými jsou močení, defekace a sexuální funkce. Jejich zavedení do chirurgické praxe lze jednoznačně považovat za pokrok, přesto že klinické výsledky při jejich používání byly někdy rozpačité. Především se objevily zcela nové typy komplikací, s jejichž řešením nebyly žádné zkušenosti. Přes řadu komplikací při zavádění pánevních implantátů vývoj dosáhl takové úrovně, kdy lze dosahovat prakticky anatomických rekonstrukcí pánevního dna s vynikajícími funkčními výsledky. Pánevní implantáty lze zavádět transvaginálně nebo transabdominálně. U transabdominálního přístupu je aktuální miniinvazivní laparoskopická nebo roboticky asistovaná technologie implantace. Kvalitní rekonstrukci pánevního dna bez použití síťkových implantátů v současné době není možné provést.
Pelvic floor disorders in women are a very common issue. It is estimated that up to 11% of women are experiencing some form of pelvic organ prolapse (POP). It can hardly be assumed that this statistic will change significantly. Operating technologies are still evolving. Separate colporrhaphys performed in the past are no longer relevant and colpocleisis are indicated rarely. A high rate of unsatisfactory outcomes following conventional surgeries has driven the search for new surgical technologies in this area. Reoperation rates are notably high in countries where relevant clinical trials are ongoing. Olsen et al. report a 29.2% incidence of recurrences, while Whiteside et al. present even 58% of recurrences after vaginal surgery for POP in a prospective study (1, 2). The introduction of mesh implants into pelvic prolapse surgery meant a significant turning point in the treatment of this condition. Mesh implants began to be used in pelvic prolapse surgeries following successful experience with meshes in the treatment of abdominal hernias and also after groundbreaking experience in dealing with stress incontinence (SI) through tension-free suburethral tape implantation. They brought one essential element to POP operations - the ability to bridge even large surface defects of connective tissue caused by childbirth trauma or previous pelvic surgeries. However, their use in POP surgery is far more demanding than in abdominal hernia surgery, because POP is a specific type of hernia in a dynamically demanding space. These operations interfere with very sensitive functions such as urination, defecation and sexual function. While their introduction into surgical practice can clearly be considered a progress, the clinical results of their use have sometimes been less satisfactory. New types of complications emerged, and there was initially no experience in managing them. Despite these challenges, the development of pelvic implant technology has progressed to the point where it is possible to achieve practically anatomical reconstructions of the pelvic floor with excellent functional results. Pelvic implants can be inserted transvaginally or transabdominally. In the transabdominal approach, minimally invasive laparoscopic or robot-assisted implantation technology is currently available. A high-quality pelvic floor reconstruction is not possible without the use of mesh implants.
The sternalis is an occasional muscle of the pectoral region with a reported incidence of around 7.8%. Higher rates of occurrences have been noted in females and in Asians. The muscle becomes clinically relevant as the muscle can be mis-interpreted as a pathological mass. Routine dissection was performed in a 68-year-old male and a 65-year-old female donated cadavers in the pectoral region. Gross anatomical features were meticulously noted, photographed and measurements were recorded with digital Vernier callipers. In the male cadaver, a long, slender, flat bi-tendinous sternalis was found, and in the female cadaver, tripartite sternalis possessing three distinct bellies was observed. Both the sternalis was right sided and were supplied by 2nd, 3rd and 4th intercostal nerves. Single bellied and tripartite sternalis are rare and they need to be recognized in the diagnostic images and during surgeries to avoid confusion.
- MeSH
- Muscle, Skeletal anatomy & histology MeSH
- Humans MeSH
- Cadaver * MeSH
- Pectoralis Muscles MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
The sartorius muscle is typically innervated by two branches of the femoral nerve arising from the lumbar plexus. We present an unreported variant where the sartorius muscle was innervated by an accessory branch arising from the ilioinguinal nerve in addition to the proper two branches from the femoral nerve. The iliohypogastric nerve was fused with the ilioinguinal nerve. More proximally, the lumbar plexus also showed unusual arrangement. The anterior branch of the lateral femoral cutaneous nerve arose from the femoral branch of the genitofemoral nerve while the posterior branch arose directly from the second lumbar nerve. The genital branch of the genitofemoral nerve pierced the psoas major muscle more distally than usual, and featured a close proximity with the femoral nerve. Possible variable appearance of these nerves should be kept in mind during several surgical and diagnostic procedures since their iatrogenic or traumatic damage, or their susceptibility to entrapment, pose unpredictable clinical consequences.
