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Purpose: This study aimed to investigate the impact of sarcopenia and lumbar paraspinal muscle composition (PMC) on patient-reported outcomes (PROs) after lumbar fusion surgery with 12-month follow-up (12 M-FU). Methods: A prospective investigation of patients undergoing elective lumbar fusion was conducted. Preoperative MRI-based evaluation of the cross-sectional area (CSA), the functional CSA (fCSA), and the fat infiltration(FI) of the posterior paraspinal muscles (PPM) and the psoas muscle at level L3 was performed. Sarcopenia was defined by the psoas muscle index (PMI) at L3 (CSAPsoas [cm2]/(patients' height [m])2). PROs included Oswestry Disability Index (ODI), 12-item Short Form Healthy Survey with Physical (PCS-12) and Mental Component Scores (MCS-12) and Numerical Rating Scale back and leg (NRS-L) pain before surgery and 12 months postoperatively. Univariate and multivariable regression determined associations among sarcopenia, PMC and PROs. Results: 135 patients (52.6% female, 62.1 years, BMI 29.1 kg/m2) were analyzed. The univariate analysis demonstrated that a higher FI (PPM) was associated with worse ODI outcomes at 12 M-FU in males. Sarcopenia (PMI) and higher FI (PPM) were associated with worse ODI and MCS-12 at 12 M-FU in females. Sarcopenia and higher FI of the PPM are associated with worse PCS-12 and more leg pain in females. In the multivariable analysis, a higher preoperative FI of the PPM (β = 0.442; p = 0.012) and lower FI of the psoas (β = −0.439; p = 0.029) were associated with a worse ODI at 12 M-FU after adjusting for covariates. Conclusions: Preoperative FI of the psoas and the PPM are associated with worse ODI outcomes one year after lumbar fusion. Sarcopenia is associated with worse ODI, PCS-12 and NRS-L in females, but not males. Considering sex differences, PMI and FI of the PPM might be used to counsel patients on their expectations for health-related quality of life after lumbar fusion. [ABSTRACT FROM AUTHOR]

Background: Deteriorated sinusitis and increased adiposity relative to muscle mass may affect quality of life in patients with asthma. However, whether these effects are observed regardless of intrapulmonary pathology is unknown. Objectives: We evaluated the correlation of the cross-sectional ratio of abdominal visceral fat (VF) to erector spinae muscle (ESM) and sinus findings based on Lund-Mackey scoring system (LMS) on computed tomography (CT) with the impaired score of the Asthma Quality of Life Questionnaire (AQLQ), regardless of airway and parenchymal disease, in patients with asthma. Methods: We recruited participants from the Hokkaido-based severe asthma cohort who had completed AQLQ and CT examination at the entry. The participants were divided into high (highest) and low (other quartiles) groups on the bases of the extrapulmonary indices. Multivariate analysis examined the association of VF/ESM for the adiposity-to-muscle ratio and LMS with AQLQ after adjusting for the airway fractal dimension for airway index and percentage of low attenuation volume to lung volume for parenchymal index. Results: No significant differences were observed in VF/ESM and LMS in terms of sex. The AQLQ score in the high VF/ESM group and high LMS group was lower than those in low VF/ESM group and low LMS group (63 male and 100 female subjects). High VF/ESM (estimate [95% confidence interval] (−0.43 [−0.61, −0.25]) and high LMS scores (−0.22 [−0.41, −0.03]) were associated with low AQLQ scores when adjusted for age, body mass index, smoking status, blood eosinophil count, and intrapulmonary CT indices. Conclusions: Increased VF relative to ESM mass and high LMS may deteriorate asthma-related quality of life, regardless of presence of intrapulmonary disease.

It has not been fully elucidated that nutritional parameters affect the change of activities of daily living (ADL) during pneumonia treatment. This study assessed the impact of nutritional status, including erector spinae muscle (ESM) size on ADL changes from admission to discharge among older patients with community-acquired pneumonia (CAP). We retrospectively included patients (age: ≥65 years) who were admitted to the hospital for CAP and underwent chest computed tomography (CT) on admission. ADL was evaluated using the Barthel index, and patients were divided into the maintained or improved ADL group and the declined ADL group from admission through discharge. The ESM cross-sectional area was measured on a single-slice CT image. Logistic regression models were applied for assessing factors associated with changes in ADL. A total of 523 patients hospitalized for CAP (median age 86 years) were evaluated. The declined group had significantly higher ADL levels on admission, a greater frequency of smoking history and malignancy, and a lower frequency of cerebrovascular disease and dementia. No significant difference in ESM size was observed between the groups. Multivariate analysis revealed that higher ADL levels on admission (odds ratio 1.034, interquartile range 1.026–1.043) and malignancy (3.002, 1.150–7.836) were associated with a decline in ADL, whereas cerebrovascular disease (0.579, 0.373–0.900) was related to improvement or maintenance of ADL. Although nutritional status might not affect the change of ADL among older patients hospitalized with pneumonia, a cerebrovascular disease history may be a good predictor for ADL improvement. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PCNL) is a standard procedure to remove and disintegrate large kidney stones. Despite minimal invasiveness, it is associated with significant postoperative pain. Erector spinae plane block (ESPB) is a novel interfacial plane block recently introduced to provide analgesia in acute and chronic pain. The current study was conducted to compare the efficacy of ultrasound (USG) guided ESPB and conventional analgesia (CA) following PCNL. Methodology: After obtaining the institute's ethical committee approval and informed consent, 50 patients were included in the study and were randomized into two equal groups of 25 to receive ESPB with 20 ml of 0.25% bupivacaine or CA. Patients in both groups were given intravenous paracetamol 8th hourly and intravenous tramadol 2mg/kg as rescue analgesia. Results: Both study and control groups were similar in demographic profile. Pain assessment by Visual analogue scale (VAS) scores in the postoperative period were significantly lower at hours of 20min, 40min, and 1,3,6,12 hrs (P<0.0001) and at 9,18 hrs (P<0.05) in the group E, than the control group. The time to first rescue analgesia was observed longer in the ESPB group than in the control group (2.28± 0.58hrs Vs 15.48± 3.17 hrs) (P<0.0001). The average tramadol consumption was less in the ESPB group compared to the control group (139.28±41.36 mg Vs 337.20± 38.66mg) (P< 0.0001). Conclusion: Ultrasound-guided ESPB provides safe and effective postoperative analgesia following PCNL, with decreased VAS scores. ESPB extends the retrieval analgesia time and lessen the requirement for tramadol. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To investigate the impact of acute muscle wasting on 90-day mortality in older patients with severe community-acquired pneumonia using ultrasound and chest computed tomography. Findings: Acute muscle wasting assessed by ultrasound and chest CT independently predicted all-cause 90-day mortality in older patients with severe community-acquired pneumonia. A higher muscle loss had an increased risk of 90-day mortality. Message: Acute muscle wasting is an independent predictor of adverse outcomes in older patients with severe community-acquired pneumonia. Purpose: To investigate the impact of acute muscle wasting on 90-day mortality in older patients with severe pneumonia using ultrasound and chest computed tomography (CT). Methods: Quadriceps muscle layer thickness was measured via ultrasound on days 1, 7, and 14, and cross-sectional area of the erector spinae muscle was assessed using chest CT on days 1 and 14 in patients aged ≥ 65 years old. The primary outcome was all-cause 90-day mortality. Receiver operating characteristic curves were conducted for muscle loss to predict 90-day mortality. Cox proportional hazard models and Kaplan–Meier survival curves were employed to evaluate the association between muscle loss and 90-day mortality. Results: Sixty-two patients were enrolled with median age of 80.2 years, 29 (46.8%) were men and 28 (45.2%) patients died. Muscle mass measured using ultrasound and CT decreased significantly from baseline to day 14 in the non-survivor group. Muscle loss assessed by ultrasound (with minimum and maximum pressure) and CT independently predicted all-cause 90-day mortality (adjusted hazard ratios = 1.497, 1.400 and 1.082; P < 0.001, P = 0.002, and P = 0.004; respectively), and cutoff values of muscle loss were 0.34 cm, 0.11 cm and 4.92 cm2, correspondingly. A higher muscle loss had an increased risk of 90-day mortality. Conclusions: Acute muscle wasting assessed by ultrasound and chest CT persisted for 14 days and was an independent predictor of adverse outcomes in older patients with severe pneumonia. A greater decline in muscle mass was associated with a higher 90-day mortality risk. [ABSTRACT FROM AUTHOR]

Abstract Background Older patients with diabetes mellitus are more susceptible to frailty. Although some imaging markers of appendicular skeletal muscle mass obtained using dual-energy X-ray absorptiometry or computed tomography (CT) imaging can reflect frailty status, the association between imaging indices obtained by abdominal CT scans and frailty in older inpatients has not been reported. Methods A total of 151 older inpatients with diabetes mellitus (median age, 79 years; men, 42%) who underwent abdominal CT scans close to the admission date were studied to examine the associations between abdominal CT indices and frailty. Two frailty definitions were used: the modified Cardiovascular Health Study (mCHS) criteria and Kihon Checklist (KCL) criteria. Using the imaging analysis software SYNAPSE VINCENT®, we compared the cross-sectional areas (CSA) of four truncal muscles (erector spinae, iliopsoas, rectus abdominis, and abdominal oblique muscles) and the liver-to-spleen ratio (L/S), the ratio of the CT values of the liver and spleen between frail and non-frail patients. The muscle areas that showed the strongest associations with frailty were also investigated in relation to grip strength and walking speed. Finally, multivariate binominal logistic regression analyses were performed to assess the independent associations of CSA of muscle and L/S with the prevalence of frailty. Results The prevalence of frailty defined by the mCHS and KCL criteria was 55% and 52%, respectively. The CSA of the erector spinae muscle was most significantly associated with frailty, and was significantly smaller in both sexes of mCHS-defined frail patients and in men with KCL-defined frailty. The CSA of erector spinae muscle was also positively correlated with grip strength and walking speed. In contrast, the L/S was higher in men with KCL-defined frailty. Multivariate logistic regression analyses revealed that the CSA of the erector spinae muscle was independently associated with mCHS-defined frailty in women, and the L/S was associated with KCL-defined frailty in men. Conclusions The CSA of erector spinae muscle and low liver fat content could be indices of frailty in older patients with diabetes.

Abstract Aims Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. Methods and results A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end‐diastolic internal diameter and left ventricular end‐systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626–0.811, P

Abstract Background No multivariable model incorporating erector spinae muscle (ESM) has been developed to predict clinical outcomes in older patients with severe community-acquired pneumonia (SCAP). This study aimed to construct a nomogram based on ESM to predict in-hospital mortality in patients with SCAP. Methods Patients aged ≥ 65 years with SCAP were enrolled in this prospective observational study. Least absolute selection and shrinkage operator and multivariable logistic regression analyses were used to identify risk factors for in-hospital mortality. A nomogram prediction model was constructed. The predictive performance was evaluated using the concordance index (C-index), calibration curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis. Results A total of 490 patients were included, and the in-hospital mortality rate was 36.1%. The nomogram included the following independent risk factors: mean arterial pressure, peripheral capillary oxygen saturation, Glasgow Coma Scale score (GCS), lactate, lactate dehydrogenase, blood urea nitrogen levels, and ESM cross-sectional area. Incorporating ESM into the base model with other risk factors significantly improved the C-index from 0.803 (95% confidence interval [CI], 0.761–0.845) to 0.836 (95% CI, 0.798–0.873), and these improvements were confirmed by category-free NRI and IDI. The ESM-based nomogram demonstrated a high level of discrimination, good calibration, and overall net benefits for predicting in-hospital mortality compared with the combination of confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65), Pneumonia Severity Index (PSI), Acute Physiology and Chronic Health Evaluation II (APACHEII), and Sequential Organ Failure Assessment (SOFA). Conclusions The proposed ESM-based nomogram for predicting in-hospital mortality among older patients with SCAP may help physicians to promptly identify patients prone to adverse outcomes. Trial registration This study was registered at www.chictr.org.cn (registration number Chi CTR-2300070377).

Background and Aims: Aspiration pneumonia is generally associated with deterioration of skeletal muscle mass, which is usually evaluated by the erector spinae muscle cross-sectional area (ESMCSA); however, no report has assessed ESMCSA in patients with aspiration pneumonia. Furthermore, erector spinae muscle thickness (ESMT) was developed to be easier to measure than ESMCSA. Therefore, this study investigated the relationship between ESMT and ESMCSA in aspiration pneumonia patients compared to bacterial pneumonia patients. Methods: We retrospectively collected data for 164 patients with aspiration pneumonia and 480 patients with bacterial pneumonia who were hospitalized at Fukujuji Hospital between September 2018 and May 2022. We assessed the correlations between ESMCSA and ESMT and compared the data between the two groups. Results: ESMT had a strong, proportional relationship with ESMCSA in all patients (r = 0.908, p < 0.001) and those with aspiration pneumonia (r = 0.896, p < 0.001). ESMCSA (median 671.8 mm2 [range 164.0–1636.7] vs. median 1057.0 mm2 [range 161.3–2412.5], p < 0.001) and ESMT (median 17.1 mm [range 6.95–34.4] vs. median 23.8 mm [range 6.95–43.7], p < 0.001) were significantly lower in patients with aspiration pneumonia. A multivariate analysis of aspiration pneumonia diagnosis showed significant independent differences from bacterial pneumonia in ESMCSA (odds ratio 0.998 [95% CI: 0.996–0.999], p = 0.001) and ESMT (odds ratio 0.90 [95% CI: 0.84–0.96], p = 0.002). Conclusion: This study demonstrates a strong correlation between ESMCSA and ESMT. ESMT can be more easily used to evaluate skeletal muscle mass and can help in diagnosing aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Objctive. To evaluate the analgesic efficacy of prolonged erector spinae fascial plane (ESFP) block in patients with multiple rib fractures.Material and methods. The study included 40 patients with multiple rib fractures. Based on anesthesia methods, patients were divided into 2 groups, where systemic analgesics were used for pain management in the control group (N=20), and additional supplementation with prolonged erector spinae fascial plane (ESFP) block in the main group (N=20). The study monitored the severity of pain measured by the numeric rating scale (NRS) at rest and during coughing, forced vital capacity (FVC), and the need for injectable narcotic analgesics.Results. The NRS measures at rest in the main group were statistically significantly superior to the control group results: at stage II — 1.5 points (IQR: 1.0–3.0) vs 3.0 points (IQR: 3.0–4.0); at stage III — 2.0 points (IQR: 1.0–2.0) vs 4.0 points (IQR: 3.0–5.0); at stage IV — 1.5 points (IQR: 0.8–2.2) vs. 4.5 points (IQR: 4.0–5.0); at stage V — 1 point (IQR: 0–2,0) vs. 3.0 points (IQR: 2.8–4.0), respectively (P0.001). Percentages of predicted FVC depending on patient’s gender, age, height and weight in the control group were as follows: at stage II — 38± 8% (95%CI: 34–41); stage III — 44± 8% (95%CI: 40–47); stage IV — 41±10% (95%CI: 36–45) and stage V — 49±10% (95%CI: 45–53). In the main group, the following FVC values were obtained: 49±15% at stage II (95%CI: 42–56), 50±13% at stage III (95%CI: 44–57), 53±13% at stage IV (95%CI: 47–59), and 57±11% at stage V (95%CI: 52–63). Therefore, statistically significant FVC reduction in the control group vs the main group came up to 22%, 14%, 24% and 15% at stages II-V, respectively (P0.05). The amounts of injected narcotic analgesics on day 1 and day 2 after initiation of the study were 5.0 mg (IQR: 5–10) and 5.0 mg (IQR: 0–5.0) in the main group vs 10.0 mg (IQR: 5.0–15.0) and 7.5 mg (IQR: 5.0–10.0) in the control group, respectively (P0.05).Conclusion. The prolonged erector spinae fascial plane block improves the quality of analgesia and FVC values in patients with multiple rib fractures.

Aims: Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. Methods and results: A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end‐diastolic internal diameter and left ventricular end‐systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626–0.811, P < 0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end‐diastolic internal diameter and left ventricular end‐systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418–0.633, P < 0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively. Conclusions: The ESM is of great value in predicting the onset and severity of CHF. [ABSTRACT FROM AUTHOR]

Background: No multivariable model incorporating erector spinae muscle (ESM) has been developed to predict clinical outcomes in older patients with severe community-acquired pneumonia (SCAP). This study aimed to construct a nomogram based on ESM to predict in-hospital mortality in patients with SCAP. Methods: Patients aged ≥ 65 years with SCAP were enrolled in this prospective observational study. Least absolute selection and shrinkage operator and multivariable logistic regression analyses were used to identify risk factors for in-hospital mortality. A nomogram prediction model was constructed. The predictive performance was evaluated using the concordance index (C-index), calibration curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis. Results: A total of 490 patients were included, and the in-hospital mortality rate was 36.1%. The nomogram included the following independent risk factors: mean arterial pressure, peripheral capillary oxygen saturation, Glasgow Coma Scale score (GCS), lactate, lactate dehydrogenase, blood urea nitrogen levels, and ESM cross-sectional area. Incorporating ESM into the base model with other risk factors significantly improved the C-index from 0.803 (95% confidence interval [CI], 0.761–0.845) to 0.836 (95% CI, 0.798–0.873), and these improvements were confirmed by category-free NRI and IDI. The ESM-based nomogram demonstrated a high level of discrimination, good calibration, and overall net benefits for predicting in-hospital mortality compared with the combination of confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65), Pneumonia Severity Index (PSI), Acute Physiology and Chronic Health Evaluation II (APACHEII), and Sequential Organ Failure Assessment (SOFA). Conclusions: The proposed ESM-based nomogram for predicting in-hospital mortality among older patients with SCAP may help physicians to promptly identify patients prone to adverse outcomes. Trial registration: This study was registered at www.chictr.org.cn (registration number Chi CTR-2300070377). [ABSTRACT FROM AUTHOR]

Background: Older patients with diabetes mellitus are more susceptible to frailty. Although some imaging markers of appendicular skeletal muscle mass obtained using dual-energy X-ray absorptiometry or computed tomography (CT) imaging can reflect frailty status, the association between imaging indices obtained by abdominal CT scans and frailty in older inpatients has not been reported. Methods: A total of 151 older inpatients with diabetes mellitus (median age, 79 years; men, 42%) who underwent abdominal CT scans close to the admission date were studied to examine the associations between abdominal CT indices and frailty. Two frailty definitions were used: the modified Cardiovascular Health Study (mCHS) criteria and Kihon Checklist (KCL) criteria. Using the imaging analysis software SYNAPSE VINCENT®, we compared the cross-sectional areas (CSA) of four truncal muscles (erector spinae, iliopsoas, rectus abdominis, and abdominal oblique muscles) and the liver-to-spleen ratio (L/S), the ratio of the CT values of the liver and spleen between frail and non-frail patients. The muscle areas that showed the strongest associations with frailty were also investigated in relation to grip strength and walking speed. Finally, multivariate binominal logistic regression analyses were performed to assess the independent associations of CSA of muscle and L/S with the prevalence of frailty. Results: The prevalence of frailty defined by the mCHS and KCL criteria was 55% and 52%, respectively. The CSA of the erector spinae muscle was most significantly associated with frailty, and was significantly smaller in both sexes of mCHS-defined frail patients and in men with KCL-defined frailty. The CSA of erector spinae muscle was also positively correlated with grip strength and walking speed. In contrast, the L/S was higher in men with KCL-defined frailty. Multivariate logistic regression analyses revealed that the CSA of the erector spinae muscle was independently associated with mCHS-defined frailty in women, and the L/S was associated with KCL-defined frailty in men. Conclusions: The CSA of erector spinae muscle and low liver fat content could be indices of frailty in older patients with diabetes. [ABSTRACT FROM AUTHOR]

Lumbar stabilization exercises (LSE) lead to high levels of erector spinae muscle (ESM) activation, which has a positive effect on improving physical function. The purpose of this study is to identify factors explaining changes in muscle strength after 7 weeks of LSE and to evaluate changes in stiffness and contraction of the ESM. All participants (male: n = 42, age = 28.26 ± 10.97) were assessed for 60°/s isokinetic extensor muscle strength and tension using a tensiomyography (TMG) and isokinetic device before and after LSE. Maximum displacement (Dm) and average velocity up to 90% Dm (Vc 90) were significantly different before and after LSE. Additionally, participants' 60°/s isokinetic extensor strength was significantly higher after exercise. A regression analysis was conducted to test the explanatory power of the variables, and positive results were obtained in the increase in extensor strength before and after Vc 90 and LSE. Furthermore, statistical significance was set at p < 0.05. After LSE, the increase in 60°/s isokinetic extensor strength and ESM's Dm and Vc 90 can be interpreted as positive changes post-exercise in endurance muscles with a higher percentage of type I fibers. Our results can contribute to predicting the long-term exercise effect in sedentary workers and developing an individualized strategic exercise program. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Erector spinae muscle (ESM) is an antigravity muscle group that can be evaluated as an index of muscle loss on chest computed tomography. The amount of ESM has been reported to be related to the prognosis of several respiratory diseases. However, few studies clarify the impact on postoperative non-small-cell lung cancer (NSCLC). We investigated the relationship between ESM and postoperative prognosis in patients with early-stage NSCLC. METHODS We reviewed the medical records of 534 patients with stage I NSCLC who underwent lobectomy or segmentectomy. The ESM was identified by preoperative computed tomography, and the amount was normalized according to height and sex. Overall survival, lung cancer-related deaths and non-lung cancer-related deaths (NLCRD) were analysed using log-rank and Gray's tests. Multivariable analyses were conducted to identify factors that influenced overall survival (OS) and NLCRD. RESULTS The amount of ESM normalized according to height and sex was significantly associated with age and body mass index. When the amount was low, OS (5-year OS, 79.6 vs 89.5%; P < 0.001) and NLCRD (5-year cumulative mortality rate, 14.7 vs 6.8%; P < 0.001) were significantly worse, although no difference was found in lung cancer-related deaths. CONCLUSIONS The amount of preoperative ESM was strongly related to non-lung cancer-related death and was a significant prognostic factor for stage I NSCLC. Patients with a low amount of the muscle should be treated based on proper risk assessment. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis. Method: The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis. Result: The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people.Conclusion: The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people. [ABSTRACT FROM AUTHOR]

21398167 23 Kim C.-Y., Choi J.-D., Kim S.-Y., Oh D.-W., Kim J.-K., Park J.-W. Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment. EMG, ultrasound imaging, low back pain, erector spinae muscle, thoracolumbar fascia, multifidus muscle, muscle spindle Keywords: EMG; ultrasound imaging; low back pain; thoracolumbar fascia; erector spinae muscle; multifidus muscle; muscle spindle EN EMG ultrasound imaging low back pain thoracolumbar fascia erector spinae muscle multifidus muscle muscle spindle 1735 16 11/17/22 20221101 NES 221101 1. ES, erector spinae muscle; LD, latissimus dorsi muscle; SPI, serratus posterior inferior muscle; TLF, thoracolumbar fascia; sEMG, surface electromyography; orange dot shows the LD/TLF junction. [Extracted from the article]

Objectives: The peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed to confirm whether a decrease in PEFR over 6 months was associated with survival in IPF patients. Methods: Consecutive IPF patients who had been assessed at a single center were retrospectively analyzed. The relative decline in PEFR over 6 months was assessed. Survival analyses were performed by univariate and multivariate Cox proportional hazard models. Results: A total of 61 eligible cases (average age 70 years) were examined, and 21 patients (34.4%) died. The univariate Cox regression analysis showed that the body mass index, baseline % predicted forced vital capacity (FVC), baseline % predicted PEFR, % predicted diffusion capacity for carbon monoxide (DLCO), relative decline in FVC, and relative decline in PEFR were prognostic factors. On multivariate analyses, relative decline in PEFR (hazard ratio [HR] 1.037, p < .05) and baseline % predicted FVC (HR 0.932, p < .001) were independent prognostic factors, whereas relative decline in FVC was not. Conclusion: A decrease in PEFR after 6 months may predict worse survival in patients with IPF. [ABSTRACT FROM AUTHOR]

Weight loss is a factor that affects prognosis in patients with chronic obstructive pulmonary disease (COPD) independent of lung function. One of the major factors for weight loss is energy malnutrition. There have been no reports on the factors related to energy malnutrition in COPD patients. This retrospective observational study aimed to investigate these factors. We included 163 male subjects with COPD. Respiratory quotient (RQ), an index of energy malnutrition, was calculated by expiratory gas analysis using an indirect calorimeter. RQ < 0.85 was defined as the energy-malnutrition group and RQ ≥ 0.85 as the no energy-malnutrition group. Factors related to energy malnutrition were examined by multivariate and decision-tree analysis. We finally analyzed data from 56 selected subjects (median age: 74 years, BMI: 22.5 kg/m2). Energy malnutrition was observed in 43%. The independent factors associated with energy malnutrition were tidal volume (VT) (OR 0.99; 95% CI 0.985–0.998; p = 0.015) and Th12 erector spinae muscle cross-sectional area SMI (Th12ESMSMI) (OR 0.71; 95% CI 0.535–0.946; p = 0.019). In decision-tree profiling of energy malnutrition, VT was extracted as the first distinguishable factor, and Th12ESMSMI as the second. In ROC analysis, VT < 647 mL (AUC, 0.72) or Th12ESMSMI < 10.1 (AUC, 0.70) was the cutoff value for energy malnutrition. Energy malnutrition may be an early warning sign of nutritional disorders. [ABSTRACT FROM AUTHOR]

Objectives: The peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed to confirm whether a decrease in PEFR over 6 months was associated with survival in IPF patients. Methods: Consecutive IPF patients who had been assessed at a single center were retrospectively analyzed. The relative decline in PEFR over 6 months was assessed. Survival analyses were performed by univariate and multivariate Cox proportional hazard models. Results: A total of 61 eligible cases (average age 70 years) were examined, and 21 patients (34.4%) died. The univariate Cox regression analysis showed that the body mass index, baseline % predicted forced vital capacity (FVC), baseline % predicted PEFR, % predicted diffusion capacity for carbon monoxide (DLCO), relative decline in FVC, and relative decline in PEFR were prognostic factors. On multivariate analyses, relative decline in PEFR (hazard ratio [HR] 1.037, p <.05) and baseline % predicted FVC (HR 0.932, p <.001) were independent prognostic factors, whereas relative decline in FVC was not. Conclusion: A decrease in PEFR after 6 months may predict worse survival in patients with IPF. [ABSTRACT FROM AUTHOR]

The aim of the study: to improve the efficacy of erector spinae plane (ESP) fascial block for pain management in patients with multiple rib fractures. Materials and methods. We observed 4 patients with multiple rib fractures who were treated with ESP fascial block with subsequent prolonged administration of local anesthetic for pain relief. To evaluate the efficacy of the ESP block, the visual analogue scale (VAS) for pain intensity, cough performance index and forced vital capacity (FVC), as well as a modified 3-item scale were used. The distribution of local anesthetic (10% lidocaine solution) and contrast (iohexol solution, 350 mg iodine/ml) media was analyzed by computed tomography and correlated with the data on reduced pain perception according to the thoracic vertebrae (Th) levels.Results. After the ESP block in patients with multiple rib fractures, we found a decrease in VAS pain intensity at rest by 3-4 points and on coughing by 3-6 points, an increase in cough performance by 1 point and in the modified 3-item scale by 1-3 points. The distribution of the local anesthetic solution was registered mainly in the cranial-caudal and anterior direction to the intertransversal space without significant leakage in lateral and medial directions. In all 4 cases the local anesthetic and contrast media spread from the catheter tip cranially several levels of thoracic vertebrae farther than in caudal direction.Conclusion. ESP block in patients with multiple rib fractures is a reasonably effective method of pain relief. Catheterization of the fascial plane of erector spinae muscle should be performed at the level of vertebra corresponding to the underlying fractured rib. The data obtained may serve as a basis for further studies with more patients included.

Lumbar stabilization exercises (LSE) lead to high levels of erector spinae muscle (ESM) activation, which has a positive effect on improving physical function. The purpose of this study is to identify factors explaining changes in muscle strength after 7 weeks of LSE and to evaluate changes in stiffness and contraction of the ESM. All participants (male: n = 42, age = 28.26 ± 10.97) were assessed for 60°/s isokinetic extensor muscle strength and tension using a tensiomyography (TMG) and isokinetic device before and after LSE. Maximum displacement (Dm) and average velocity up to 90% Dm (Vc 90) were significantly different before and after LSE. Additionally, participants’ 60°/s isokinetic extensor strength was significantly higher after exercise. A regression analysis was conducted to test the explanatory power of the variables, and positive results were obtained in the increase in extensor strength before and after Vc 90 and LSE. Furthermore, statistical significance was set at p < 0.05. After LSE, the increase in 60°/s isokinetic extensor strength and ESM’s Dm and Vc 90 can be interpreted as positive changes post-exercise in endurance muscles with a higher percentage of type I fibers. Our results can contribute to predicting the long-term exercise effect in sedentary workers and developing an individualized strategic exercise program.

Background: Whether muscle mass and muscle quality affect the prognosis of elderly patients with aspiration pneumonia is unclear. This study aimed to evaluate the relationship between erector spinae muscle mass and muscle quality on the 30-day prognosis of elderly patients with aspiration pneumonia., Methods: Two hundred fifty-eight patients who were diagnosed with aspiration pneumonia and admitted to Sanuki Municipal Hospital for pulmonary rehabilitation intervention were included. The cross-sectional area (ESM CSA /BSA) and CT values (ESM CT ) of the erector spinae muscles at the 12th thoracic vertebra were measured on chest CT images to represent muscle mass and quality, respectively. The primary outcome was defined as 30-day survival., Results: Twenty-six patients died within 30 days after hospitalization. The ESM CSA /BSA ratio was significantly greater in the survival group than in the nonsurvival group (p = 0.001). The cutoff values for 30-day survival were calculated as follows: the ESM CSA /BSA was 11.046 cm 2 /m 2 in male patients and 9.600 cm 2 /m 2 in female patients; the ESM CT was 26.85 HU in male patients and 8.00 HU in female patients. A higher ESM CSA /BSA significantly improved 30-day survival, while ESM CT did not show a significant difference. Cox proportional hazards regression analysis revealed that the ESM CSA /BSA was independently associated with 30-day short-term prognosis (hazard ratio 0.34, p = 0.034)., Conclusion: The short-term prognosis of elderly patients with aspiration pneumonia may be more strongly influenced by muscle mass than by the muscle quality of the erector spinae muscles., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae and multifidus muscle (ESM) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality (GC) were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). GC showed a direct effect of TLF deformation on ESM activation only in the aLBP group (p < 0.03). Conclusions: The results suggest that in aLBP, ESM activity is significantly affected by TLF, whereas this relationship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.

Objective The daily step count is associated with mortality in idiopathic pulmonary fibrosis (IPF). However, the factors associated with this phenomenon are not yet fully understood. We therefore clarified its association with clinical parameters. Methods Fifty-nine patients with IPF with available data for daily step counts; 6-minute walk distance (6MWD); chest, abdominal, and pelvic computed tomography (CT); pulmonary function; psychological evaluations; and sarcopenia assessments were prospectively enrolled. The daily step count was measured continuously for seven consecutive days. The cross-sectional areas of the erector spinae muscles at the level of the 12th vertebra (ESM CSA ) and psoas major muscle volume (PMV) obtained by CT were assessed. Results The average age of the patients was 73.3±8.1 years old, and the percent predicted forced vital capacity was 81.6%±15.8%. The median daily step count was 4,258 (2,155-6,991) steps. The average 6MWD, ESM CSA , and PMV were 413±97 m, 25.5±6.7 cm 2 , and 270±75.6 cm 3 , respectively. A linear regression analysis for daily step count showed that the ESM CSA and 6MWD were independent factors for the daily step count, whereas the PMV and skeletal muscle index were not. The daily step count, ESM CSA , and 6MWD were lower in patients with sarcopenia than in those without sarcopenia. Conclusion A lower daily step count was associated with a smaller erector spinae muscle area and sarcopenia in patients with IPF. Further studies are warranted to confirm the importance of physical therapy for muscle strengthening in patients with IPF.

Background: Deteriorated sinusitis and increased adiposity relative to muscle mass may affect quality of life in patients with asthma. However, whether these effects are observed regardless of intrapulmonary pathology is unknown., Objectives: We evaluated the correlation of the cross-sectional ratio of abdominal visceral fat (VF) to erector spinae muscle (ESM) and sinus findings based on Lund-Mackey scoring system (LMS) on computed tomography (CT) with the impaired score of the Asthma Quality of Life Questionnaire (AQLQ), regardless of airway and parenchymal disease, in patients with asthma., Methods: We recruited participants from the Hokkaido-based severe asthma cohort who had completed AQLQ and CT examination at the entry. The participants were divided into high (highest) and low (other quartiles) groups on the bases of the extrapulmonary indices. Multivariate analysis examined the association of VF/ESM for the adiposity-to-muscle ratio and LMS with AQLQ after adjusting for the airway fractal dimension for airway index and percentage of low attenuation volume to lung volume for parenchymal index., Results: No significant differences were observed in VF/ESM and LMS in terms of sex. The AQLQ score in the high VF/ESM group and high LMS group was lower than those in low VF/ESM group and low LMS group (63 male and 100 female subjects). High VF/ESM (estimate [95% confidence interval] (-0.43 [-0.61, -0.25]) and high LMS scores (-0.22 [-0.41, -0.03]) were associated with low AQLQ scores when adjusted for age, body mass index, smoking status, blood eosinophil count, and intrapulmonary CT indices., Conclusions: Increased VF relative to ESM mass and high LMS may deteriorate asthma-related quality of life, regardless of presence of intrapulmonary disease., Competing Interests: The Hokkaido-based Investigative Cohort Analysis for Refractory Asthma (Hi-CARAT) study is supported by the Ministry of Education, Culture, Sports, Science, and Technology of Japan (24249049 to M.N., 26461151 to S.K.) and a research grant from 10.13039/501100012626Japan Allergy Foundation, AstraZeneca, and Kyorin Pharmaceutical. Disclosure of potential conflict of interest: M. Suzuki has received grants from GlaxoSmithKline, 10.13039/100004336Novartis, and 10.13039/100004325AstraZeneca outside this work. N. Tanabe and S. Sato received a grant from Fujifilm Medical outside this work. The rest of the authors declare that they have no relevant conflicts of interest., (© 2024 The Author(s).)

Abstract Background Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. Case presentation A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with continuous epidural anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient. Conclusions Treatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheter-related meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that epidural anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.

Idiopathic pulmonary fibrosis (IPF), an incurable lung disease of unknown cause, often presents with losses of skeletal muscle mass. IPF requires comprehensive care, but it has not been investigated which skeletal muscle mass index reflects holistic management factors: pulmonary function, patient-reported outcomes (PROs), and physical performance. We compared three representative indices of skeletal muscle mass with holistic management factors in IPF patients. Twenty-seven mild to severe IPF patients (21 male) with the mean age of 76.1 ± 5.9 years were enrolled. The three indices were appendicular skeletal muscle mass index (ASMI), cross-sectional area of pectoralis major (PMCSA), and cross-sectional area of erector spinae muscles (ESMCSA). ASMI is considered as a gold standard for sarcopenia assessment, while PMCSA and ESMCSA are frequently used in IPF. As PROs, we assessed breathlessness with the modified Medical Research Council dyspnea scale (mMRC), symptoms with the chronic obstructive pulmonary disease assessment test (CAT), and health-related quality of life with St. George's Respiratory Questionnaire (SGRQ). For physical performance, peripheral muscle strength and 6-min walk distance (6MWD) were investigated. In this cross-sectional study, ASMI showed the greatest number of significantly correlated indices, such as pulmonary function, peripheral muscle strength, 6MWD, mMRC, and SGRQ. PMCSA showed the next greatest number of correlations, with peripheral muscle strength, 6MWD, and mMRC, whereas ESMCSA showed no significant correlations with any index. Thus, ASMI correlated with both PROs and physical performance, and PMCSA correlated mainly with physical performance. In conclusion, assessing ASMI is helpful for the comprehensive care of patients with IPF. [ABSTRACT FROM AUTHOR]

Background Menopause is an aging process of the female reproductive system characterized by reduced estrogen levels. This results in increased osteoclastic activity, causing increased bone resorption and thus reduced bone mineral density (BMD). In addition to being influenced by osteoclastic activity, BMD of the lumbar vertebrae is also affected by the erector spinae muscle. The purpose of this study was to determine an association between postural scoliosis and erector spinae muscle endurance and its relation to BMD in postmenopausal women. Methods This was a cross-sectional study conducted on postmenopausal women, who were selected by simple random sampling among residents of Mampang Prapatan subdistrict. The postural abnormality of scoliosis was determined by physical examnation, while erector spinae muscle endurance time was assessed using a modified Biering-Sorensen technique, and BMD was measured by bone mineral densitometry, to categorize into normal, osteopenia, and osteoporosis. Results A total of 213 postmenopausal women with mean age of 53.52 ± 3.64 years participated in the study. The prevalence of scoliosis was 54.0%, and osteoporosis was 38.1%. The prevalence of osteoporosis was higher in women with scoliosis (48.7%) in comparison with those without scoliosis (31.6%) (p=0.411). In postmenopausal women with strong erector spinae muscle endurance the risk of of scoliosis was lower (0.76;95% Confidence Interval = 0.58 - 0.99) Conclusions In post menopausal women with postural scoliosis found a higher incidence of osteoporosis. High endurance of erector spinae muscle lowers the risk of scoliosis. Exercise to improve posture and increase endurance of erector spinae muscle need to be done to prevent decline of BMD.

Introduction The needle electromyography ( EMG) serves to supply additional information in patients with suspected neuromuscular disorders. We aimed to provide motor unit potential ( MUP) data by concentric needle EMG in the erector spinae ( ES) in comparison with biceps brachii ( BB) and lateral vastus ( LV). Methods Electromyography MUP data ( n) were obtained in ES (517), BB (539), and LV (627) in 32 healthy volunteers (16f). Results Motor unit potential data: amplitude (μV) 393 ± 174 ( ES), 375 ± 162 ( BB), and 577 ± 304 ( LV); duration (ms) 10.4 ± 2.4 ( ES), 10.1 ± 2.1 ( BB), and 11.1 ± 2.3 ( LV), area (μV × ms) 585 ± 327 ( ES), 538 ± 267 ( BB), and 881 ± 492 ( LV); phase number 3.23 ± 0.94 ( ES), 2.98 ± 0.76 ( BB), and 3.19 ± 0.81 ( LV); size index 0.60 ± 0.56 ( ES), 0.51 ± 0.53 ( BB), and 0.96 ± 0.55 ( LV). LV displayed higher values ( p at least <.001) for MUP amplitude, duration, area, and size index as compared to both, BB and ES. Conclusion Concentric needle EMG investigations in healthy adult human subjects revealed similar MUP parameters in the ES and BB muscles, while in the LV muscle MUP amplitude, duration, area, and size index were significantly larger. Different neuromuscular disorders display a predominant involvement of proximally located muscles such as truncal muscles. The present results given here may facilitate the diagnosis of neuromuscular disorders. [ABSTRACT FROM AUTHOR]

Erector spinae muscle, Early non-small-cell lung cancer, Postoperative prognosis, Sarcopenia In addition, the erector spinae muscle was associated with physical inactivity as an anti-gravity muscle [[5]]. Keywords: Erector spinae muscle; Early non-small-cell lung cancer; Postoperative prognosis; Sarcopenia EN Erector spinae muscle Early non-small-cell lung cancer Postoperative prognosis Sarcopenia 1 1 1 07/04/23 20230601 NES 230601 We would like to thank Dr. Zhou and Yu for their thoughtful consideration of our paper 'Impact of the amount of preoperative erector spinae muscle in stage I non-small-cell lung cancer' [[1]]. [Extracted from the article]

Sarcopenia, Lung cancer, Prognosis, Erector spinae muscle Keywords: Sarcopenia; Lung cancer; Erector spinae muscle; Prognosis EN Sarcopenia Lung cancer Erector spinae muscle Prognosis 1 1 1 07/04/23 20230601 NES 230601 To the Editor, We read with great interest the article [[1]] that reviewed 534 patients with stage I NSCLC who underwent lobectomy or segmentectomy. [Extracted from the article]

Background Menopause is an aging process of the female reproductive system characterized by reduced estrogen levels. This results in increased osteoclastic activity, causing increased bone resorption and thus reduced bone mineral density (BMD). In addition to being influenced by osteoclastic activity, BMD of the lumbar vertebrae is also affected by the erector spinae muscle. The purpose of this study was to determine an association between postural scoliosis and erector spinae muscle endurance and its relation to BMD in postmenopausal women. Methods This was a cross-sectional study conducted on postmenopausal women, who were selected by simple random sampling among residents of Mampang Prapatan subdistrict. The postural abnormality of scoliosis was determined by physical examnation, while erector spinae muscle endurance time was assessed using a modified Biering-Sorensen technique, and BMD was measured by bone mineral densitometry, to categorize into normal, osteopenia, and osteoporosis. Results A total of 213 postmenopausal women with mean age of 53.52 ± 3.64 years participated in the study. The prevalence of scoliosis was 54.0%, and osteoporosis was 38.1%. The prevalence of osteoporosis was higher in women with scoliosis (48.7%) in comparison with those without scoliosis (31.6%) (p=0.411). In postmenopausal women with strong erector spinae muscle endurance the risk of of scoliosis was lower (0.76;95% Confidence Interval = 0.58 - 0.99) Conclusions In post menopausal women with postural scoliosis found a higher incidence of osteoporosis. High endurance of erector spinae muscle lowers the risk of scoliosis. Exercise to improve posture and increase endurance of erector spinae muscle need to be done to prevent decline of BMD.

BACKGROUND: The erector spinae is more resistant to fatigue in adult women than men. However, no study has reported the sex differences in back muscle fatigue in children. OBJECTIVE: The aim of this study was to evaluate the fatigability of erector spinae in prepubertal children and adults, in both males and females. METHODS: Fourteen prepubertal boys, 13 prepubertal girls, 14 adult men, and 13 adult women performed the Sørensen back isometric endurance test until exhaustion. The results of electromyographic (EMG) power spectral analysis of erector spinae were compared between both age groups and sexes. RESULTS: The slopes of EMG power spectral median and mean power frequency were significantly higher in males than in females, in both age groups. Furthermore, the slopes were significantly lower in prepubertal children than in adults, in both males and females. CONCLUSIONS: Our results showed major differences in the fatigue threshold of the erector spinae between boys and girls and children and adults. The muscle fatigued faster in prepubertal boys and adult men than in prepubertal girls and adult women. In both sexes, a lower slope of EMG power spectrum parameters of the erector spinae was noted during endurance test in prepubertal children compared to adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous literatures showed no evidence that wearing an external breast prosthesis may prevent changes in body posture in women who underwent mastectomy. OBJECTIVE: To determine whether the weight of an external breast prosthesis can contribute to posture changes in women post mastectomy. METHODS: Fifty-one women with unilateral mastectomy (age 58 ± 11.39 years) were divided into 2 subgroups by their operation side. Asymmetry of body posture was evaluated by using the electromyography activity of erector spinae muscles with four different weights of breast prosthesis. RESULTS: Despite the operation side, the erector spinae muscle activities on the operation side and non-operation side were significantly different. Overall, for patients who had operation on the left side, their erector spinae muscle activity imbalance will be smaller, compared to the imbalance among patients with right operation side. The weight of the external breast prosthesis did not influence the differences of erector spinae muscle activities on the operation side and non-operation side. CONCLUSIONS: The weight of an external breast prosthesis for women after mastectomy may not be crucial when choosing a proper prosthesis. [ABSTRACT FROM AUTHOR]

This study investigates whether sweep rowers activate their low back muscles asymmetrically when exercising on a rowing ergometer. Given that indoor rowing imposes equal loading demands to left and right back muscles, any side differences in activation are expected to reflect asymmetric adaptations resulting from sweep rowing. In addition to trunk kinematics, surface electromyograms ( EMGs) were sampled from multiple skin locations along the lumbar spine of six elite, sweep rowers. The distribution of EMG amplitude along the spine was averaged across strokes and compared between sides. Key results indicate a significant effect of trunk side on EMG amplitude and on the low back region where EMG amplitude was greatest. Such side differences were unlikely because of trunk lateral inclination and rotation, which were smaller than 5° for all rowers tested. Moreover, asymmetries manifested differently between participants; there was not a clear predominance of greater EMG amplitude toward the right/left side in portside/starboard rowers. These results suggest that (a) even during indoor rowing, sweep rowers activate asymmetrically their low back muscles; (b) factors other than rowing side might be associated with low back asymmetries; (c) spatial distribution of surface EMG amplitude is sensitive to bilateral changes in back muscles' activation. [ABSTRACT FROM AUTHOR]

We prospectively studied the effectiveness of the repositioning suture of the erector spinae muscle for lumbar spine surgery using the posterior approach. 393 patients undergoing lumbar spine surgery were randomized to receive the repositioning or conventional suture of the erector spinae muscle. Time to stitch removal and drainage volume was recorded at 24 and 48 h after operation. Hemoglobin loss rate was determined at 48 h post operation and the rate of malunion (redness, swelling and effusion at stitch removal and would disruption after stitch removal) was recorded. Low back pain was evaluated using the visual analog scale (VAS) preoperatively and 6 and 12 months after operation. Time to stitch removal was comparable in lumbar spine surgery patients receiving the repositioning or conventional suture of the erector spinae muscle ( P > 0.05). Compared with the conventional suture, the repositioning suture was associated with significantly reduced drainage volume both at 24 ( P < 0.01) and 48 h after operation ( P < 0.05). Hemoglobin loss rate at 48 h post operation was also markedly lower in lumbar spine surgery patients receiving the repositioning suture than in those receiving the conventional suture ( P < 0.01 or 0.05). Furthermore, the malunion rate in lumbar spine surgery patients using the repositioning suture was markedly lower than that in the conventional group ( P < 0.05 or 0.001). There was no difference in preoperative VAS scores in both the groups ( P > 0.05). Compared with the conventional suture, the repositioning suture was associated with significantly reduced VAS scores both at 24 and 48 h after operation ( P < 0.01 in both). The repositioning suture of the erector spinae muscle is superior to the conventional suture in posterior lumbar spine surgery with marked lessened pain and reduced drainage volume. [ABSTRACT FROM AUTHOR]

Abstract: Injection of hypertonic saline into deep tissues of the back (subcutis, muscle, or the surrounding fascia) can induce acute low back pain (LBP). So far, no study has analyzed differences in temporal, qualitative, and spatial pain characteristics originating from these tissues. The current study aimed to investigate the role of the thoracolumbar fascia as a potential source of LBP. In separate sessions, 12 healthy subjects received ultrasound-guided bolus injections of isotonic saline (0.9%) or hypertonic saline (5.8%) into the erector spinae muscle, the thoracolumbar fascia (posterior layer), and the overlying subcutis. Subjects were asked to rate pain intensity, duration, quality, and spatial extent. Pressure pain thresholds were determined pre and post injection. Injections of hypertonic saline into the fascia resulted in significantly larger area under the curve of pain intensity over time than injections into subcutis (P <0.01) or muscle (P <0.001), primarily based on longer pain durations and, to a lesser extent, on higher peak pain ratings. Pressure hyperalgesia was only induced by injection of hypertonic saline into muscle, but not fascia or subcutis. Pain radiation and pain affect evoked by fascia injection exceeded those of the muscle (P <0.01) and the subcutis significantly (P <0.05). Pain descriptors after fascia injection (burning, throbbing, and stinging) suggested innervation by both A- and C-fiber nociceptors. These findings show that the thoracolumbar fascia is the deep tissue of the back that is most sensitive to chemical stimulation, making it a prime candidate to contribute to nonspecific LBP but not to localized pressure hyperalgesia. [Copyright &y& Elsevier]

Objectives: Erector spinae muscle (ESM) is an antigravity muscle group that can be evaluated as an index of muscle loss on chest computed tomography. The amount of ESM has been reported to be related to the prognosis of several respiratory diseases. However, few studies clarify the impact on postoperative non-small-cell lung cancer (NSCLC). We investigated the relationship between ESM and postoperative prognosis in patients with early-stage NSCLC., Methods: We reviewed the medical records of 534 patients with stage I NSCLC who underwent lobectomy or segmentectomy. The ESM was identified by preoperative computed tomography, and the amount was normalized according to height and sex. Overall survival, lung cancer-related deaths and non-lung cancer-related deaths (NLCRD) were analysed using log-rank and Gray's tests. Multivariable analyses were conducted to identify factors that influenced overall survival (OS) and NLCRD., Results: The amount of ESM normalized according to height and sex was significantly associated with age and body mass index. When the amount was low, OS (5-year OS, 79.6 vs 89.5%; P< 0.001) and NLCRD (5-year cumulative mortality rate, 14.7 vs 6.8%; P< 0.001) were significantly worse, although no difference was found in lung cancer-related deaths., Conclusions: The amount of preoperative ESM was strongly related to non-lung cancer-related death and was a significant prognostic factor for stage I NSCLC. Patients with a low amount of the muscle should be treated based on proper risk assessment., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: The purpose of this study was to elaborate the characteristics of paraspinal muscles in lower lumbar, to compare the differences of paraspinal muscle between patients with lumbar spinal stenosis and normal people and to explore the influencing factors of paraspinal muscle degeneration in patients with lumbar spinal stenosis., Method: The 39 pairs of patients and normal people were selected by propensity score matching. The differences of multifidus muscle and erection spine muscle parameters between the two groups were compared by independent-samples t-test and the relationship between age, paraspinal muscle degeneration and other factors in patients with lumbar spinal stenosis was analyzed by Pearson or Spearman correlation analysis., Result: The general conditions of the two groups (patients with lumbar spinal stenosis and normal people) were well matched. There were significant differences in the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle at L3 level. The fatty infiltration and relative signal intensity of multifidus muscle at L4 level and the relative signal intensity of multifidus muscle at L5 level were also significantly different. For male, the relative fatty cross sectional area, the fatty infiltration and relative signal intensity of multifidus muscle in patients were higher than those in healthy peers. For female, the relative signal intensity of multifidus muscle in patients was higher, too. In patients group, age was significantly correlated with the relative fatty cross sectional area, fatty infiltration and relative signal intensity of multifidus muscle and erector spinae muscle. Weight and BMI were significantly correlated with the relative total cross-sectional area of erector spinae muscle. The fatty infiltration increased more significantly with age in patients than that in normal people., Conclusion: The change rules of paraspinal muscles in patients with lumbar spinal stenosis are similar to those in normal people. The degeneration of paraspinal muscle in patients with lumbar spinal stenosis was more severe than that in normal people, mostly in multifidus muscle. The paraspinal muscle degeneration was related to age in patients, and the effect of age on atrophy of paraspinal muscle was greater than that of normal people., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Guo, Li and Chen.)

The study objective was to verify whether low preoperative radiographic density of erector spinae muscles is associated with poor prognosis after lung transplantation. Preoperative chest computed tomography scans for patients who underwent deceased-donor lung transplantation between 2013 and 2019 at Kyoto University Hospital were retrospectively retrieved. The radiographic density of erector spinae muscles was quantitatively evaluated as the mean attenuation of erector spinae muscles, and low mean radiographic density of the erector spinae muscles was defined as a mean radiographic density of the erector spinae muscles value below the median value for all patients. Overall survival and chronic lung allograft dysfunction-free survival with high and low mean radiographic density of the erector spinae muscles were estimated using the Kaplan–Meier method and evaluated by the log-rank test, as well as by univariate and multivariate Cox proportional hazard analyses. Of the 107 adult patients who underwent primary transplantation, 96 underwent at least 1 chest computed tomography scan within 24 hours before lung transplantation. The median mean radiographic density of the erector spinae muscles in these 96 patients was 49.2 Hounsfield units. A low mean radiographic density of the erector spinae muscles value was significantly associated with decreased overall survival (hazard ratio, 4.50; P =. 030) and chronic lung allograft dysfunction–free survival (hazard ratio, 3.18; P =. 028) in the multivariate analysis. Additionally, patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles value had a worse overall survival (P <. 001) and chronic lung allograft dysfunction–free survival (P <. 001) than patients with preoperative steroid use and a high mean radiographic density of the erector spinae muscles value and those without preoperative steroid use. Low mean radiographic density of the erector spinae muscles was closely associated with a poor prognosis after lung transplantation. The prognosis was particularly poor in patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles. These results may be useful when considering the indications for lung transplantation or preoperative interventions. [Display omitted] Preoperative ESM CT is associated with survival after LTx. Quantitative analysis of antigravity muscles (ESMs) was conducted preoperatively in 96 patients who underwent LTx using quantitative chest CT image analysis. Patients were divided into high or low ESM CT groups according to the median ESM CT of all the included patients. Preoperative low ESM CT was closely associated with poor survival. This result may be useful when considering the indications for LTx or preoperative interventions. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Background context: Previous studies reported that the erector spinae muscle is more resistant to fatigue in healthy adult women than in men. However, no study has reported changes in back muscle fatigue with aging in healthy men and women. Purpose: The aim of this study was to evaluate age-related changes in muscle fatigue of erector spinae muscle in men and women. Study design/setting: This cross-sectional study was conducted in a laboratory. Patient sample: Fifty-three healthy subjects (11 elderly men, 11 elderly women, 17 young men, and 14 young women) without low back pain history. Outcome measures: The median frequency (MF) and mean power frequency (MPF) during trunk holding test were derived from the raw electromyographic (EMG) signal using Fast Fourier Transform spectrum analysis program. The rates of changes in MF and MPF were calculated. Methods: Subjects performed the unsupported trunk holding test until exhaustion. The results of power spectral analysis of the EMG activity of the left erector spinae muscle were compared in both age groups and sexes. Results: The endurance time in young men was significantly shorter than in young women. The slopes of MF and MPF in young men were significantly higher than in young women. There were no significant differences in MF and MPF slopes of elderly men and elderly women. Furthermore, the MF and MPF slopes were significantly lower in elderly men than young men but similar in the two women groups. Conclusions: Age-related changes in the slopes of MF and MPF of erector spinae muscle occur in healthy men but not in healthy women. [Copyright &y& Elsevier]

The effects of work strategy and a rest condition on the physiological changes of the erector spinae muscle were studied. Eleven volunteers repeated fatiguing static contractions of holding an industrial box in 30° trunk flexion for a repetition of 12 times interrupted by rests for which the duration was equal to the duration of each preceding contraction. Each contraction was stopped at two fatigue sensation levels; moderate or strong, which corresponded to Borg's CR-10 3 and 5, as the work strategy conditions. The repeated contractions were performed for a total of eight conditions combined with the two rest conditions, with and without stretch exercise, and two contraction levels of 10 and 40% maximum pulling force in flexed posture (MVC) on separate days. Near-infrared spectroscopy and surface electromyography (EMG) were recorded. Amplitude and median frequency (MF) of EMG, oxy-hemoglobin, and deoxy-hemoglobin were calculated. MF related to fatigue sensation most closely. Oxy-hemoglobin decreased during each contraction. It, however, increased with repetition especially at 10% MVC and the increase was interpreted as adaptation to the work. The effect of the work strategy and the rest conditions was weak. MF decreased more in a strong work strategy condition than in a moderate one. [ABSTRACT FROM AUTHOR]

Reflex pathways connect all four limbs in humans. Presently, we tested the hypothesis that reflexes also link sensory receptors in the lower leg with muscles of the lower back (erector spinae; ES). Taps were applied to the right Achilles’ tendon and electromyographic activity was recorded from the right soleus and bilaterally from ES. Reflexes were compared between sitting and standing and between standing with the eyes open versus closed. Reflexes were evoked bilaterally in ES and consisted of an early latency excitation, a medium latency inhibition, and a longer latency excitation. During sitting but not standing, the early excitation was larger in the ES muscle ipsilateral to the stimulation (iES) than in the contralateral ES (cES). During standing but not sitting, the longer latency excitation in cES was larger than in iES. This response in cES was also larger during standing compared to sitting. Responses were not significantly different between the eyes open and eyes closed conditions. Taps applied to the lateral calcaneus (heel taps) evoked responses in ES that were not significantly different in amplitude or latency than those evoked by tendon taps, despite a 75–94% reduction in the amplitude of the soleus stretch reflex evoked by the heel taps. Electrical stimulation of the sural nerve, a purely cutaneous nerve at the ankle, evoked ES reflexes that were not significantly different in amplitude but had significantly longer latencies than those evoked by the tendon and heel taps. These results support the hypothesis that reflex pathways connect receptors in the lower leg with muscles of the lower back and show that that the amplitude of these reflexes is modulated by task. Responses evoked by stimulation of the sural nerve establish that reflex pathways connect the ES muscles with cutaneous receptors of the foot. In contrast, the large volley in muscle spindle afferents induced by the tendon taps compared to the heel taps did not alter the ES responses, suggesting that the reflex connection between triceps surae muscle spindles and the ES muscles may be relatively weak. These heteronymous reflexes may play a role in stabilizing the trunk for maintaining posture and balance. [ABSTRACT FROM AUTHOR]

Abstract: Background. Although attention has been paid to the relationship between the changes in blood circulation in erector spinae muscles and back pain, little is known about their hemodynamics in several various comparable postures with and without loading. Studies on hemodynamics of erector spinae muscles using near-infrared spectroscopy have been performed on subjects and patients mainly in forward flexion positions. Methods. Two near-infrared spectroscopes were used to measure oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin in bilateral erector spinae muscles at L2–3 in subjects in 9 postures, and holding no load, 10kg or 20kg in maximum flexed and lateral bending. Those three values in each posture and loading condition were expressed as a percentage of their corresponding values obtained in the standing upright position, and designated and statistically analyzed as %Oxy-Hb, %Deoxy-Hb and %Total-Hb, respectively. Findings. %Total-Hb and %Oxy-Hb in maximum flexion were the most decreased. In maximum lateral bending, %Oxy-Hb only in the contralateral erector spinae muscles was decreased. When the load was 20kg, the decreases in %Oxy-Hb were the largest in maximum flexion and lateral bendings. Interpretation. Using two near-infrared spectroscopes allowed us to measure simultaneously the hemodynamics of bilateral muscles. They demonstrated different responses in each side. Asymmetrical posture and loading were accompanied by asymmetrical changes of the bilateral erector spinae muscles. Stretched muscle had less blood volume and oxygenation, both of which decreased with increasing load. These results showed that these postures and conditions might lead to fatigue of the ES muscles. [Copyright &y& Elsevier]

In a prospective study conducted between the years 1999 and 2002 we harvested 26 valuable muscle samples from patients with an unstable lumbar spine from the multifidus muscle and erector spinae muscle at the level of the L4/L5/S1 segments and evaluated them using histochemical methods. Control samples were taken from six patients with a acute fracture of the low lumbar spine. A statistical difference was evident between the experimental and control group in type I fibres from the erector muscle. There was a percentage increase in type I fibres and a decrease in type IIA fibres from the erector muscle compared to the control group. The percentage of IIX and IIC fibres in the musculus erector spinae was the same in both groups. The investigated multifidus muscle underwent significant changes in type IIA fibres, where the percentage decreased and the percentage of type IIX fibres was almost double in comparison to the control group. Fibres of types I and IIC were not statistically changed. Type IIX fibres react to the exceeding of normal ranges of movement in the functional spinal unit to prevent an abnormal shift and thus stabilize the segment. These changes in the multifidus muscle are the premise of its mostly local stabilizing function, whereas the erector muscle has predominantly postural, long-term stabilisation features because of the increase of type I fibres. [ABSTRACT FROM AUTHOR]

Abstract: Surface electromyograms (EMG) of back muscles are often corrupted by electrocardiogram (ECG) signals. This noise in the EMG signals does not allow to appreciate correctly the spectral content of the EMG signals and to follow its evolution during, for example, a fatigue process. Several methods have been proposed to reject the ECG noise from EMG recordings, but seldom taking into account the eventual changes in ECG characteristics during the experiment. In this paper we propose an adaptive filtering algorithm specifically developed for the rejection of the electrocardiogram corrupting surface electromyograms (SEMG). The first step of the study was to choose the ECG electrode position in order to record the ECG with a shape similar to that found in the noised SEMGs. Then, the efficiency of different algorithms were tested on 28 erector spinae SEMG recordings. The best algorithm belongs to the fast recursive least square family (FRLS). More precisely, the best results were obtained with the simplified formulation of a FRLS algorithm. As an application of the adaptive filtering, the paper compares the evolutions of spectral parameters of noised or denoised (after adaptive filtering) surface EMGs recorded on erector spinae muscles during a trunk extension. The fatigue test was analyzed on 16 EMG recordings. After adaptive filtering, mean initial values of energy and of mean power frequency (MPF) were significantly lower and higher respectively. The differences corresponded to the removal of the ECG components. Furthermore, classical fatigue criteria (increase in energy and decrease in MPF values over time during the fatigue test) were better observed on the denoised EMGs. The mean values of the slopes of the energy–time and MPF–time linear relationships differed significantly when established before and after adaptive filtering. These results account for the efficacy of the adaptive filtering method proposed here to denoise electrophysiological signals. [Copyright &y& Elsevier]

Abstract: Background. There is little information about the relationship between the changes of hemodynamics and the morphologic changes of the erector spinae muscle. Methods. Fifty healthy male volunteers participated. Ultrasonography was used to measure muscle thickness, and near-infrared spectroscopy was used to measure tissue blood volume and its oxygenation in the erector spinae muscle at L3 in six different relaxed trunk postures (flexed 20°, flexed 40°, flexed maximum, neutral posture, extended 20°, and extended maximum of the lumbar spine). We also evaluated the reproducibility of the near-infrared spectroscopy measurements. Findings. Near-infrared spectroscopy gave highly reproducible measurements. The thickness of the erector spinae muscle and the total and oxygenated hemoglobin were simultaneously increased during relaxed extension and decreased during relaxed flexion. Changes in the thickness of the erector spinae muscle with various lumbar curvature were similar in pattern to the changes in tissue blood volume and its oxygenation. Interpretation. The erector spinae muscles’ thickness, tissue blood volume, and its oxygenation are simultaneously increased during relaxed extension and decreased during relaxed flexion, as demonstrated by non-invasive near-infrared spectroscopy and ultrasonography. These findings might afford a better understanding of the pathomechanics of posture-related back symptoms. Relevance The erector spinae muscles’ thickness, tissue blood volume, and its oxygenation are simultaneously increased during relaxed extension and decreased during relaxed flexion, as shown by non-invasive near-infrared spectroscopy and ultrasonography. Changes in hemodynamics and morphology of the erector spinae muscles in asymptomatic subjects are given for further research on the pathomechanism of back pain. [Copyright &y& Elsevier]