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The generalized skeletal muscle disorder that involves (in elderly subjects) the progressive loss of muscle mass and function has been defined sarcopenia, whereas the rapid-onset (traumatic or surgical) and focal (unilateral) loss of skeletal muscle with resultant functional impairment has been defined volumetric muscle loss. Different tools and approaches are commonly used in the clinical settings to quantify the loss of muscle or lean mass and to assess the consequent motor impairment. This review describes the technical principles and provides a summary of the main parameters that can be obtained to assess lean mass (and its distribution) or muscle size (and its structure) through the two imaging techniques most easily accessible and therefore frequently adopted in the clinical practice: dual-energy X-ray absorptiometry and muscle ultrasonography.

Ultrasonography allows non-invasive and real time-measurement of the visible cross-sectional area (CSA) of muscles, which is a clinically relevant descriptor of muscle size. The aim of this study was to develop and validate a fully automatic method called transverse muscle ultrasound analysis (TRAMA) for segmentation of the muscle in B-mode transverse ultrasound images and measurement of muscle CSA. TRAMA was tested on a database of 200 ultrasound images of the rectus femoris, vastus lateralis, tibialis anterior and medial gastrocnemius muscles. The automatic CSA measurements were compared with manual measurements obtained by two operators. There were no statistical differences between the automatic and manual measurements of CSA of the four muscles, and TRAMA performance was comparable to intra-operator variability in terms of the Dice similarity coefficient and Hausdorff distance between the automatic and manual segmentations. Compared with manual segmentation, the Dice similarity coefficient for the proposed method was always higher than 93%; the Hausdorff distance never exceeded 4 mm, and the maximum absolute error was 62 mm 2 . TRAMA is the first automated algorithm that analyzes and segments ultrasound scans of the muscle in the transverse plane. It can be adopted in future studies for automatic segmentation of muscle regions of interest to enhance and automatize a multitexture analysis of muscle structure.

The proper assessment and follow-up of obesity and sarcopenia are relevant for the proper management of the complications of cardiometabolic and musculoskeletal frailty. A total body dual-energy X-ray absorptiometry (DXA) scan should be systematically incorporated in the rehabilitative routine management of patients with obesity and sarcopenia. In the former patients, the total body DXA can be used to assess the fat tissue amount and distribution, while in the latter patients, it can be used to quantify the reduction of appendicular lean mass and to investigate the inter-limb lean mass asymmetry. This tutorial article provides an overview of different DXA-derived fat and lean indices and describes a step-by-step procedure on how to produce a complete DXA report. We suggest that the systematic incorporation of these indices into routine examinations of the patients with obesity and sarcopenia can be useful for identifying the patients at risk for cardiometabolic and neuromuscular impairment-related comorbidities and for evaluating the effectiveness of pharmacological and rehabilitative interventions.

Purpose Neuromuscular electrical stimulation (NMES) has been considered as a promising approach for the early rehabilitation of patients during and/or after intensive care unit (ICU) stay. The overall objective of this study is to evaluate the NMES effectiveness to counteract the post-ICU impairment in physical function of COVID-19 patients. The specific aim of this manuscript is to describe the study design, protocol, content of interventions, primary and secondary outcomes and to discuss the clinical rehabilitation impact of the expected experimental results. Methods This prospective, randomized, controlled, parallel-group, single-blind trial will include 80 patients who had undergone mechanical or non-invasive ventilation following pneumonia-induced respiratory failure. Patients are randomized to a control group (routine physical therapy for 3 weeks) or a NMES group (routine physical therapy plus NMES of quadriceps and gastrocnemius muscles for 3 weeks). The primary outcome is physical performance assessed through the Short Physical Performance Battery (SPPB). Secondary outcomes include independence level, perceived fatigue, muscle strength, rectus femoris thickness, and walking performance. The SPBB and walking performance are assessed once (after the intervention), while all other outcomes are assessed twice (before and after the intervention). Conclusion NMES is a simple and non-invasive technique for muscle strengthening that is usually well tolerated, does not produce adverse effects, requires no or little cooperation from patients and is quite inexpensive. Therefore, proving the effectiveness of NMES therapy for physical and muscle function in COVID-19 patients could support its systematic incorporation in post-ICU rehabilitation protocols of patients presenting with post-intensive care syndrome.

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

The Imaging X-ray Polarimetry Explorer (IXPE) is a scientific observatory with the purpose of expand observation space adding polarization property to the X-ray source's currently measured characteristics. The mission selected in the context of NASA Small Explorer (SMEX) is a collaboration between NASA and ASI that will provide to observatory the instrumentation of focal plane. IXPE instrument is composed by three photoelectric polarimeters based on the Gas Pixel Detector (GPD) design, integrated by INFN inside the detector unit (DU) that comprises of the electrical interfaces required to control and communicate with the GPD. The three DUs are interfaced with spacecraft through a detector service unit (DSU) that collect scientific and ancillary data and provides a basically data handling and interfaces to manage the three DUs. AIV has been planned to combine calibration of DUs and Instrument integration and verification activities. Due the tight schedule and the scientific and functional requirements to be verified, in IAPS/INAF have been assembled two equipment's that work in parallel. The flight model of each DU after the environmental tests campaign was calibrated on-ground using the Instrument Calibration Equipment (ICE) and subsequently integrated in the instrument in the AIV-T process on a AIV and Calibration Equipment (ACE), both the facilities managed by Electrical Ground Support Equipment (EGSE) that emulate the spacecraft interfaces of power supply, functional and thermal control and scientific data collection. AIV activities test functionalities and nominal/off-nominal orbits activities of IXPE instrument each time a calibrated DU is connected to DSU flight model completing step by step the full instrument. Here we describe the details of instrumentation and procedures adopted to make possible the full integration and test activities compatibly with calibration of IXPE Instrument.

OBJECTIVE: The optimal protein intake for elderly individuals who exercise regularly has not yet been clearly defined. The aim of this study was to test the hypothesis that protein intake level is associated with muscle strength in elderly elite athletes. METHODS: We evaluated 50 elite senior athletes (38 men and 12 women) participating in the European Master Games 2011 in an observational cross-sectional study. Participants were divided into two groups-lower (LPI) or higher (HPI) protein intake-according to the median value of their ratio of urinary urea nitrogen to urinary creatinine (i.e., 8.8 g/L), as a marker of protein intake. A dietary interview confirmed differences in protein consumption between the LPI and HPI groups. We also evaluated body composition (bioimpedance), muscle strength, and hematochemical indices. RESULTS: LPI and HPI groups were homogeneous for age (72 [68-74] and 71 [68-74] y, respectively), fat-free mass index (18.4 [17-19.4] and 18.2 [17-19.1] kg/m2), body fat (18.3% [12.3-20.7%] and 16.6% [13.6-21.2%]), and glomerular filtration rate (57.7 [53.8-64.9] and 62.7 [56.1-69.3] mL/min/1.73 m2). The HPI group showed greater leg and trunk muscle strength (N) compared with the LPI group (left leg extension, 339 [238-369] versus 454 [273-561], respectively, P < 0.05; right leg extension, 319 [249-417] versus 432 [334-635], P ≤ 0.05; trunk extension, 435 [370-467] versus 464 [390-568], P ≤ 0.05). CONCLUSIONS: Higher protein intake in elite senior athletes is associated with a greater muscle strength.

The aims of this study were to develop a clinical-feature based scoring system for muscle injury screening and to assess its diagnostic accuracy when large number of injuries are suspected.A prospective diagnostic accuracy study was performed according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. The diagnostic accuracy of the Strength and Pain Assessment (SPA) score (index test) was assessed in relation to muscle ultrasonography (reference standard). A large (n = 175) number of male soccer players met the inclusion/exclusion criteria: clinical assessment (i.e., evaluation of pain onset modality, location, distribution, impact on performance, and manual muscle strength testing) and ultrasonography were performed in all players after 48 hours from the sudden or progressive onset of muscle pain during or after a soccer competition.91 of 175 cases (52%) were classified as functional muscle disorders, while signs of muscle tear were observed in the remaining 84 of 175 (48%) cases that were classified as structural muscle injuries. The median (1st - 3rd quartile) value of the SPA score was significantly (P 0.001) lower in the functional disorder group [9 (9-10)] compared to the structural injury group [12 (12-13)]. The area under the Receiver Operating Characteristic curve for different cutoff points of the SPA score was 0.977 (95% confidence intervals: 0.957-0.998) and the optimal cutoff value of the SPA score providing the greatest sensitivity and specificity (respectively, 99% and 89%) was 11.This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.

Adaptive behavior emerges through a dynamic interaction between cognitive agents and changing environmental demands. The investigation of information processing underlying adaptive behavior relies on controlled experimental settings in which individuals are asked to accomplish demanding tasks whereby a hidden regularity or an abstract rule has to be learned dynamically. Although performance in such tasks is considered as a proxy for measuring high-level cognitive processes, the standard approach consists in summarizing observed response patterns by simple heuristic scoring measures. With this work, we propose and validate a new computational Bayesian model accounting for individual performance in the Wisconsin Card Sorting Test (WCST), a renowned clinical tool to measure set-shifting and deficient inhibitory processes on the basis of environmental feedback. We formalize the interaction between the task’s structure, the received feedback, and the agent’s behavior by building a model of the information processing mechanisms used to infer the hidden rules of the task environment. Furthermore, we embed the new model within the mathematical framework of the Bayesian Brain Theory (BBT), according to which beliefs about hidden environmental states are dynamically updated following the logic of Bayesian inference. Our computational model maps distinct cognitive processes into separable, neurobiologically plausible, information-theoretic constructs underlying observed response patterns. We assess model identification and expressiveness in accounting for meaningful human performance through extensive simulation studies. We then validate the model on real behavioral data in order to highlight the utility of the proposed model in recovering cognitive dynamics at an individual level. We highlight the potentials of our model in decomposing adaptive behavior in the WCST into several information-theoretic metrics revealing the trial-by-trial unfolding of information processing by focusing on two exemplary individuals whose behavior is examined in depth. Finally, we focus on the theoretical implications of our computational model by discussing the mapping between BBT constructs and functional neuroanatomical correlates of task performance. We further discuss the empirical benefit of recovering the assumed dynamics of information processing for both clinical and research practices, such as neurological assessment and model-based neuroscience.

Background The Victorian Institute of Sports Assessment for gluteal tendinopathy (VISA-G) questionnaire has recently been proposed as a condition-specific patient reported outcome measurement tool to assess the tendinopathy-related disability. Aim The aim was to evaluate the reliability of the Italian version of the VISA-G questionnaire and its construct validity and to investigate the association between tendinopathy-related disability and pain. Design It consists in a cross-sectional study. Setting The location of the study was a university laboratory. Population We evaluated patients with gluteal tendinopathy (N.=38) and healthy controls (N.=38). Methods Subjects were asked to fill the VISA-G questionnaire twice to evaluate its reliability. The construct validity was evaluated by comparing the VISA score with the Oswestry Disability Index score. Moreover, pain intensity, extent and location were also investigated. Results The VISA-G scores showed non-significant changes in the median values and the values of intraclass correlation coefficient showed very high correlation between the first and second administration (ICC>0.90 in both populations). No significant correlations were found between VISA-G score and either pain extent (R=-0.05, P=0.76), or resting pain intensity (R=-0.13, P=0.45), or palpation pain intensity (R= 0.01, P=0.97). Conversely, a high (and significant) negative correlation was obtained between VISA-G score and Oswestry Disability Index score (R=-0.80, P Conclusions These results indicated that the VISA-G Italian version presents excellent test-retest reliability. Clinical rehabilitation impact The evaluation of gluteal tendinopathy-related disability through VISA-G can be useful for the prognostic assessment and/or follow-up of tendinopathy patients in combination with the pain drawing assessment of pain extent.

Aims of the study were to evaluate the reliability and validity of the Italian version of the Majeed and Iowa questionnaires and to investigate the long-term surgical outcomes following sacroiliac joint arthrodesis. Twenty one patients who underwent a sacroiliac joint arthrodesis and 21 healthy subjects were evaluated. The experimental procedure consisted of gait analysis and a physical activity assessment (in both groups) and of administration of outcome questionnaires and pain assessment (in the patient group). The Majeed and Iowa questionnaires showed excellent reliability, excellent (for the Majeed questionnaire) and good (for the Iowa questionnaire) construct validity, and poor convergent validity (for both questionnaires) relative to walking speed. Most of the patients reported no pain and minimum pain-related disability and their physical activity profile was comparable to healthy controls. Patients showed an impaired walking performance (i.e., they walked slower and using shorter steps) compared with healthy controls. Long-term walking pattern abnormalities following sacroiliac joint arthrodesis may occur despite excellent clinical results. Given their excellent reliability and construct validity, the Majeed and Iowa questionnaires can be used in combination with the assessment of spatiotemporal gait parameters for the prognostic assessment and/or follow-up of surgical patients.

BACKGROUND There is little evidence on intra-articular (IA) treatment in knee osteoarthritis (KOA) and there is a lack of long-term follow-up studies. OBJECTIVE To assess the long-term effectiveness and safety of IA oxygen-ozone (O2O3) and hyaluronic acid (HA) in terms of functioning in KOA patients over a 31-week period. METHODS Patients aged ⩾ 60 years with KOA were randomly allocated to receive 4 IA knee injections (1/week) of O2O3 or HA (T0-T3) and a follow-up visit 4 weeks after the fourth injection (T4). In this extension study we assessed VAS and safety in patients with Visual Analogue Scale (VAS) ⩾ 4 at the at 6-month follow-up visit (T5), undergoing a second treatment cycle (T5-T8) and 1-month follow-up visit (T9). RESULTS Forty-two patients (aged 70.5 ± 5.8 years) were randomly allocated to O2O3 (n= 22) or HA group (n= 20). Twenty-three underwent another IA cycle: 12 (54.6%) in the O2O3 group and 11 (55.0%) in the HA group. Both groups showed significant reduction in VAS (p< 0.013) compared to baseline during both cycles. At follow-up visits (T4 and T9), VAS was significantly lower in the HA group (p< 0.013). There were no differences in adverse events occurrence between groups. CONCLUSIONS IA O2O3 might be comparable to HA in terms of effectiveness and safety in reducing pain in KOA patients, although at both follow-up visits (T4 and T9) VAS was significantly lower in the HA group.

Comparing competing mathematical models of complex natural processes is a shared goal among many branches of science. The Bayesian probabilistic framework offers a principled way to perform model comparison and extract useful metrics for guiding decisions. However, many interesting models are intractable with standard Bayesian methods, as they lack a closed-form likelihood function or the likelihood is computationally too expensive to evaluate. With this work, we propose a novel method for performing Bayesian model comparison using specialized deep learning architectures. Our method is purely simulation-based and circumvents the step of explicitly fitting all alternative models under consideration to each observed dataset. Moreover, it requires no hand-crafted summary statistics of the data and is designed to amortize the cost of simulation over multiple models and observable datasets. This makes the method particularly effective in scenarios where model fit needs to be assessed for a large number of datasets, so that per-dataset inference is practically infeasible.Finally, we propose a novel way to measure epistemic uncertainty in model comparison problems. We demonstrate the utility of our method on toy examples and simulated data from non-trivial models from cognitive science and single-cell neuroscience. We show that our method achieves excellent results in terms of accuracy, calibration, and efficiency across the examples considered in this work. We argue that our framework can enhance and enrich model-based analysis and inference in many fields dealing with computational models of natural processes. We further argue that the proposed measure of epistemic uncertainty provides a unique proxy to quantify absolute evidence even in a framework which assumes that the true data-generating model is within a finite set of candidate models.

The male gonadal axis function is strongly affected by physical exercise. Relatively short, intense exercise usually increases while more prolonged exercise usually decreases serum testosterone levels. The exercise-associated increment in circulating testosterone is considered not to be mediated by LH whereas a neuroendocrine dysfunction has been indicated as the cause of testosterone reduction in response to prolonged exercise, along with increased cortisol levels, a primary testicular dysfunction, or even an accumulation of metabolic waste materials. Chronic physical exercise may induce a state of oligospermia, a reduction of the total number of motile sperm and an increase in abnormal or immature spermatozoa. Alterations in the hormonal milieu but also the oxidative stress associated with endurance exercise may be involved.

Doping is defined as the use of substances or techniques to illegally improve athletic performance. Considering the relatively high prevalence of usage, and the pleiotropic actions exerted by doping agents, it is conceivable that chronic exposure might increase the risk of potential long-term complications, including osteoporosis, which is a frequent side effect of many substances, also used as doping agents. Nevertheless, with the exception of athletes using anabolic androgenic agents, which display an increased bone mineral content and density, and extremely low fracture rate, turning into increased osteoporosis, and hip or vertebral fracture rates, at withdrawal, scant investigation has been performed in athletes with the current use or history of doping. Conversely, other commonly used doping substances have been proven to negatively impact on bone status, in different pathological conditions which might be used as a surrogate model of doping in athletes. In particular, aromatase inhibitors use for the treatment of late-onset hypogonadism in elderly men might represent a suitable model to depict the potential adverse effects on bone of aromatase inhibitors used as performance-enhancing drugs, although partially controversial evidences are available concerning the effects on bone health. More convincing is the model of women with breast cancer administered with aromatase inhibitors, displaying increased bone resorption, decreased bone mineral density at the femoral neck and lumbar spine, and increased risk of fractures, although these effects seem to be reversible, at discontinuation of treatment. Growth hormone excess in acromegalic patients, leading to alteration of bone trabecular microstructure, might be responsible for the associated bone impairment, represented by osteoporosis, arthralgia, and osteoarthritis, and is associated to an increased risk of vertebral fractures, in acromegalic patients, compared to the general population, with a slight predominance in men. Moreover, a direct action of growth hormone on bone turnover is confirmed by the fact that bone markers are significantly higher in healthy volunteers treated with growth hormone, and are efficiently measured in blood as a marker for growth hormone abuse in athletes. Indirect evidences from studies on subjects using β2-adrenergic receptor agonists for respiratory disorders, or β-adrenergic receptor blockers for the treatment of cardiovascular diseases, and reporting increased or reduced risk for fractures, respectively, suggest that β2-adrenergic receptor agonists might decrease osteoblastic activity and increase bone resorption. Lastly, glucocorticoid doping, which is well modelled by the use of glucocorticoid as anti-inflammatory or immunosoppressive therapy and by the hypercortisolism in Cushing’s syndrome, might also determine bone status impairment, as suggested by osteopenia, osteoporosis, and skeletal fractures, which are frequently reported as disease comorbidities, and by the reduced bone mineral density, which successfully improves after hypercortisolism remission.

The clinical success of neuromuscular electrical stimulation (NMES) for neuromuscular rehabilitation is greatly compromised by the poor consideration of different physiological and methodological issues that are not always obvious to the clinicians. Therefore, the aim of this narrative review is to reexamine some of these fundamental aspects of NMES using a tripartite model perspective. First, we contend that NMES does not actually bypass the central nervous system but results in a multitude of neurally mediated responses that contribute substantially to force generation and may engender neural adaptations. Second, we argue that too much emphasis is generally placed on externally controllable stimulation parameters while the major determinant of NMES effectiveness is the intrinsically determined muscle tension generated by the current (ie, evoked force). Third, we believe that a more systematic approach to NMES therapy is required in the clinic and this implies a better identification of the patient-specific impairment and of the potential "responders" to NMES therapy. On the basis of these considerations, we suggest that the crucial steps to ensure the clinical effectiveness of NMES treatment should consist of (1) identifying the neuromuscular impairment with clinical assessment and (2) implementing algorithm-based NMES therapy while (3) properly dosing the treatment with tension-controlled NMES and eventually amplifying its neural effects.

Purpose: This study investigated the effects of short-term glucocorticoid administration on voluntary activation and intracortical inhibitory and facilitatory circuits. Methods: Seventeen healthy men participated in a pseudorandomized double-blind study to receive either dexamethasone (8 mgIdj1, n = 9 subjects) or placebo (n = 8 subjects) for 7 d. The ankle dorsiflexion torque, corresponding EMG of the tibialis anterior, and voluntary activation assessed by the interpolated twitch method using transcranial magnetic stimulation (TMS) were measured during a maximal voluntary contraction (MVC). Short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed at rest and during submaximal contraction (50%MVC torque) by paired-pulse TMS with the conditioning stimulus set at 0.8 of motor threshold and delivered 2 ms (SICI) and 13 ms (ICF) before the test stimulus (1.2 motor threshold). Results: The MVC torque (+14%), tibialis anterior EMG (+31%), and voluntary activation (+3%) increased after glucocorticoid treatment (P G 0.05). The increase in voluntary activation was associated with the gain in MVC torque (r2 = 0.56; P = 0.032). The level of SICI and the duration of the EMG silent period that followed the test TMS decreased (j18.6% and j13.5%, respectively) during the 50% MVC after treatment (P G 0.05), whereas no significant change was observed for ICF. Neither SICI nor ICF changed after treatment when assessed at rest. Conclusions: Short-term dexamethasone treatment induced specific decrease in the excitability of intracortical inhibitory circuits that likely contributed to the increase in the voluntary activation and associated MVC torque.

Higher-order cognitive functions can be seen as a class of cognitive processes which are crucial in situations requiring a flexible adjustment of behaviour in response to changing demands of the environment. The cognitive assessment of these functions often relies on tasks which admit a dynamic, or longitudinal, component requiring participants to flexibly adapt their behaviour during the unfolding of the task. An intriguing feature of such experimental protocols is that they allow the performance of an individual to change as the task unfolds. In this work, we propose a Latent Markov Model approach to capture some dynamic aspects of observed response patterns of both healthy and substance dependent individuals in a set-shifting task. In particular, data from a Wisconsin Card Sorting Test were analysed in order to represent performance trends in terms of latent cognitive states dynamics. The results highlighted how a dynamic modelling approach can considerably improve the amount of information a researcher, or a clinician, can obtain from the analysis of a set-shifting task.

To investigate the glucocorticoid-induced impairments of muscle mass and structure in patients presenting different stages of steroid myopathy progression. Thirty-three patients (28 women) affected by active (N = 20) and remitted (N = 13) Cushing’s disease were recruited and the following variables were assessed: walking speed, handgrip strength, total body and appendicular muscle mass by bioelectrical impedance analysis (BIA), thickness and echo intensity of lower limb muscles by ultrasonography. The two groups of patients showed comparable values of both handgrip strength [median (interquartile range) values: active disease: 27.4 (7.5) kg vs. remitted disease: 26.4 (9.4) kg; P = 0.58] and walking speed [active disease: 1.0 (0.2) m/s vs. remitted disease: 1.1 (0.3) m/s; P = 0.43]. Also, the thickness of the four muscles and all BIA-derived sarcopenic indices were comparable (P > 0.05 for all comparisons) between the two groups. On the contrary, the echo intensity of vastus lateralis, tibialis anterior (lower portion), and medial gastrocnemius was significantly (P

Mouse-tracking recording techniques are becoming very attractive in experimental psychology. They provide an effective means of enhancing the measurement of some real-time cognitive processes involved in categorization, decision-making, and lexical decision tasks. Mouse-tracking data are commonly analysed using a two-step procedure which first summarizes individuals' hand trajectories with independent measures, and then applies standard statistical models on them. However, this approach can be problematic in many cases. In particular, it does not provide a direct way to capitalize the richness of hand movement variability within a consistent and unified representation. In this article we present a novel, unified framework for mouse-tracking data. Unlike standard approaches to mouse-tracking, our proposal uses stochastic state-space modeling to represent the observed trajectories in terms of both individual movement dynamics and experimental variables. The model is estimated via a Metropolis-Hastings algorithm coupled with a non-linear recursive filter. The characteristics and potentials of the proposed approach are illustrated using a lexical decision case study. The results highlighted how dynamic modeling of mouse-tracking data can considerably improve the analysis of mouse-tracking tasks and the conclusions researchers can draw from them., Comment: The manuscript consists of 29 pages, 10 figures, and 5 tables. It also contains Supplementary Materials (10 pages, 8 figures, and 3 tables) providing extended results along with a simulation study

In this review, we examined the responses of skeletal muscles and tendons to exercise and their possible implications in the development of positive and negative effects associated with acute and chronic exercise such as muscle function changes, muscle soreness, and muscle and tendon hypertrophy. We contend that the understanding of these effects is essential to guide clinical recommendations for exercise prescription in healthy and pathological subjects.

In stroke survivors, rectus femoris (RF) spasticity is often implicated in gait pattern alterations such as stiff knee gait (SKG). Botulinum toxin type A (BoNT-A) is considered the gold standard for focal spasticity treatment. However&mdash, even if the accuracy of injection is crucial for BoNT-A efficacy&mdash, instrumented guidance for BoNT-A injection is not routinely applied in clinical settings. In order to investigate the possible implications of an inadequate BoNT-A injection on patients&rsquo, clinical outcome, we evaluated the ultrasound-derived RF characteristics (muscle depth, muscle thickness, cross-sectional area and mean echo intensity) in 47 stroke survivors. In our sample, we observed wide variability of RF depth in both hemiparetic and unaffected side of included patients (0.44 and 3.54 cm and between 0.25 and 3.16 cm, respectively). Moreover, our analysis did not show significant differences between treated and non-treated RF in stroke survivors. These results suggest that considering the inter-individual variability in RF muscle depth and thickness, injection guidance should be considered for BoNT-A treatment in order to optimize the clinical outcome of treated patients. In particular, ultrasound guidance may help the clinicians in the long-term follow-up of muscle quality.

Understanding dependencies between brain functioning and cognition is a challenging task which might require more than applying standard statistical models to neural and behavioural measures to be accomplished. Recent developments in computational modelling have demonstrated the advantage to formally account for reciprocal relations between mathematical models of cognition and brain functional, or structural, characteristics to relate neural and cognitive parameters on a model-based perspective. This would allow to account for both neural and behavioural data simultaneously by providing a joint probabilistic model for the two sources of information. In the present work we proposed an architecture for jointly modelling the reciprocal relation between behavioural and neural information in the context of risky decision-making. More precisely, we offered a way to relate Diffusion Tensor Imaging data to cognitive parameters of a computational model accounting for behavioural outcomes in the popular Balloon Analogue Risk Task (BART). Results show that the proposed architecture has the potential to account for individual differences in task performances and brain structural features by letting individual-level parameters to be modelled by a joint distribution connecting both sources of information. Such a joint modelling framework can offer interesting insights in the development of computational models able to investigate correspondence between decision-making and brain structural connectivity.

Objective To investigate the prevalence and outcomes of surgery for lumbar disc herniation in professional football players. Design Retrospective case series. Setting Sports rehabilitation center. Participants A period of 10 seasons of the Italian Football First League (Serie A) was retrospectively investigated. Thirty-three teams (for a total of 1960 players) took turns in the 10 seasons, and 42 team doctors were requested to provide information about the number of players who underwent surgery for lumbar disc herniation. Intervention Survey distributed to team doctors. Main outcome measures Prevalence and match incidence of the lumbar discectomy, proportion of players returning to competition after surgery, recovery time and preintervention and postintervention number of appearances in official matches were analyzed. Results Eleven players underwent the surgical intervention during the considered period. The prevalence of the surgical treatment was 0.6%, whereas the match incidence was 0.09 cases/1000 match hours. All players returned to competitions 6.0 (3.5-7.7) months after surgery, with no significant difference between different roles. The number of appearances in official matches was comparable during the seasons before and after surgery. Conclusions The lumbar discectomy must be considered a rare surgical procedure performed in professional football players. All players returned to competitions after surgery. The postintervention number of appearances in official matches was comparable with the preintervention one.

Abnormalities in B-mode ultrasound images of the patellar tendon often take place in asymptomatic athletes but it is still not clear if these modifications forego or can predict the development of tendinopathy. Subclinical tendinopathy can be arbitrarily defined as either (1) the presence of light structural changes in B-mode ultrasound images in association with mild neovascularization (determined with Power Doppler images) or (2) the presence of moderate/severe structural changes with or without neovascularization. Up to now, the structural changes and neovascularization of the tendon are evaluated qualitatively by visual inspection of ultrasound images. The aim of this study is to investigate the capability of a quantitative texture-based approach to determine tendon abnormality of “pallapugno” players. B-mode ultrasound images of the patellar tendon were acquired in 14 players and quantitative texture parameters were calculated within a Region of Interest (ROI) of both the non-dominant and the dominant tendon. A total of 90 features were calculated for each ROI, including 6 first-order descriptors, 24 Haralick features, and 60 higher-order spectra and entropy features. These features on the dominant and non-dominant side were used to perform a multivariate linear regression analysis (MANOVA) and our results show that the descriptors can be effectively used to determine tendon abnormality and, more importantly, the occurrence of subclinical tendinopathy.

We present a patient with adrenal Cushing's syndrome causing steroid myopathy. The purpose of the case report is to illustrate the clinical usefulness of quantitative muscle ultrasonography for the assessment of glucocorticoid-induced changes in muscle mass (MM) and structure.Assessments of physical performance, muscle strength, MM (i.e., total body skeletal MM, appendicular skeletal MM, and thickness of lower limb muscles), and muscle structure (i.e., echo intensity of lower limb muscles) were performed in the patient both in the active phase of the disease (preoperatively) and 6 months after surgical intervention (postoperatively).Muscle strength, physical performance, and MM were low both preoperatively and postoperatively. We also found preoperatively an increased echo intensity that normalized postoperatively.Clinical implications of these findings are double-fold. First, although the muscle structure can recover quickly in steroid myopathy patients, the recovery of MM may take months to years. Second, we show that muscle echo intensity can be useful to track the progression of steroid myopathy overtime and may help to indicate early response to therapeutic interventions. Further prospective studies are needed to confirm the value of muscle echo intensity in patients with endogenous or exogenous Cushing's syndrome presenting with steroid myopathy.

Steroid myopathy is a well-known sign of endogenous Cushing’s syndrome as well as a side effect of glucocorticoid administration. The clinical finding of muscle weakness and the clinical inspection of the muscle size are the most commonly used diagnostic tools, sometimes in combination with needle electromyography, but there are no means to detect the myopathy before the appearance of clinical or electrodiagnostic signs. Until now, no guidelines have been produced for a disease-specific evaluation of muscle impairment in patients with Cushing’s syndrome. We reviewed the measurement properties and limitations of the following tools that are currently adopted in clinical research and routine care for diagnosis and monitoring of steroid myopathy: muscle strength assessment; needle biopsy; intramuscular and surface electromyography; laboratory assays; muscle mass assessments (through bioelectrical impedance analysis, dual-energy X-ray absorptiometry, and computed tomography). We suggest that the management of steroid myopathy patients in clinical research and practice would benefit from a multidisciplinary approach based on the combined assessment of muscle mass, strength, and performance. However, further studies are required to establish an operational definition of steroid myopathy and to identify population-specific criteria for diagnosis of the myopathic process.

PURPOSE: Aims of this study were to evaluate the agreement between the short and long versions of the International Physical Activity Questionnaire (IPAQ: Italian versions), their reproducibility (agreement and reliability) and construct validity (relative to pedometry) in a clinical population. METHODS: Ninety patients affected by obesity (N = 39), type 2 diabetes mellitus (N = 26) or both (N = 25) were recruited. They were asked to maintain their usual physical activity habits during two consecutive weeks and to fill the questionnaires twice (at the end of each week). They were also asked to wear a pedometer for 7 consecutive days after the first administration of the questionnaires. RESULTS: We found acceptable agreement between the IPAQ short and long versions (ICC2,1 values were 0.81 and 0.77 for the 1st and 2nd administration), uncertain reproducibility (acceptable reliability but poor agreement) and inadequate validity relative to pedometry (the correlation coefficients between all IPAQ scores and daily steps were

Background The "contralateral effect" phenomenon refers to the strength gain in the opposite, untrained homonymous muscle following unilateral training. Previous studies showed that neuromuscular electrical stimulation (NMES) of the right quadriceps facilitated maximal voluntary strength and efferent neural drive of the left knee extensors, while no previous study investigated the contralateral effect elicited by focal muscle vibration. Aim The aim of this study was to investigate whether quadriceps NMES and focal vibration, when applied unilaterally, have the same potential to enhance the contralateral muscle strength and the associated neural drive. Design Randomized controlled experimental study. Setting University laboratory. Population Healthy subjects. Methods Subjects completed several maximal voluntary contractions (MVCs) of the left quadriceps (tested muscle) while the right quadriceps (treated muscle) received no conditioning stimulation (control condition), NMES or focal vibration. Paired supramaximal stimuli were delivered to the left quadriceps during and immediately after the MVCs to assess voluntary activation. The EMG activity of vastus lateralis, vastus medialis, and rectus femoris muscles of the left quadriceps was also concomitantly recorded. Results MVC torque and voluntary activation of the left quadriceps increased during contralateral NMES and vibration. A remarkable inter-individual variability was observed in the contralateral effect of NMES and vibration. In fact, MVC and voluntary activation increases were particularly evident in subjects "responders" to both treatments (who showed NMES-elicited increases in MVC and voluntary activation of 22.5% and 15.8%, respectively, and vibration-elicited increases of 13.1% and 10.7%, respectively). Moreover, we found that the increases in voluntary activation and EMG activity elicited by NMES were higher than those elicited by focal vibration. We also found that voluntary activation increases were higher in subjects presenting lower baseline levels of voluntary activation. Conclusions The short-duration unilateral application of quadriceps NMES and focal vibration increased MVC torque and efferent neural drive of the contralateral homologous muscle in healthy subjects. Clinical rehabilitation impact As the two physical therapy modalities can be useful to maximize motor unit recruitment contralaterally to the side of application, they could be incorporated in rehabilitation protocols when unilateral voluntary contractions are uncomfortable, painful or not feasible.

The association between the hypothalamic-pituitary-adrenal (HPA) axis and sleep is well described. It is also known that HPA axis disturbances have an effect on sleep. In fact, patients affected by Cushing's syndrome (CS) often complain about poor sleep quality. Our aim was to evaluate objective sleep quality and duration in patients with Cushing's syndrome in active phase, using wrist actigraphy.In 12 patients with active CS without ongoing specific therapy (11 F, 1 M; age 40.0 ± 10.9 years; BMI 28.4 ± 6.7 kg/m(2)) and 12 healthy control subjects (HS) (11 F, 1 M; age 44.0 ± 11.0 years; BMI 23.9 ± 4.2 kg/m(2)) an actigraphic evaluation was performed on 3 consecutive days under free living conditions. Objective measurement of sleep duration and quality was estimated by an actiwatch, which is a wristwatch-like device used to detect motor activity.In CS patients, wrist actigraphy showed higher fragmented sleep (fragmentation index CS 16.2 ± 4.2, HS 13.0 ± 3.6; p = 0.034) and increased nocturnal motor activity (total activity score CS 8318 ± 4308, HS 4971 ± 2372; p = 0.020; mean activity score CS 8.7 ± 4.2, HS 5.4 ± 2.2; p = 0.030; mean score in active time CS 104.8 ± 39.2, HS 74.8 ± 23.1; p = 0.030). On the contrary, actual sleep time resulted similar in CS and HS. No correlation was found between sleep alterations and urinary free cortisol in patients.The impaired actigraphic parameters described in our study suggest that hypercortisolism is associated with sleep alterations, which could contribute to the worsening of life quality and metabolic comorbidities associated with CS. These results have to be confirmed in a larger cohort of patients, using more accurate instruments for sleep assessment.

Introduction: The aim of this study was to understand the effects of short-term glucocorticoid administration in healthy subjects. Methods: Five healthy men received dexamethasone (8 mg/day) for 7 days. Vastus lateralis muscle biopsy and knee extension torque measurement were performed before and after administration. A large number of individual muscle fibers were dissected from the biopsy samples (pre-administration: n = 165, post-administration: n = 177). Results: Maximal knee extension torque increased after administration (∼13%), whereas both type 1 and type 2A fibers had decreased cross-sectional area (type 1: ∼11%, type 2A: ∼17%), myosin loss (type 1: ∼18%, type 2A: ∼32%), and loss of specific force (type 1: ∼24%, type 2A: ∼33%), which were preferential for fast fibers. Conclusion: Short-term dexamethasone administration in healthy subjects elicits quantitative and qualitative adaptations of muscle fibers that precede (and may predict) the clinical appearance of myopathy in glucocorticoid-treated subjects. Muscle Nerve 52: 631–639, 2015

Introduction: In this study we evaluated the validity of garment-based quadriceps stimulation (GQS) for assessment of muscle inactivation in comparison with femoral nerve stimulation (FNS). Methods: Inactivation estimates (superimposed doublet torque), self-reported discomfort, and twitch and doublet contractile properties were compared between GQS and FNS in 15 healthy subjects. Results: Superimposed doublet torque was significantly lower for GQS than for FNS at 20% and 40% maximum voluntary contraction (MVC) (P < 0.01), but not at 60%, 80%, and 100% MVC. Discomfort scores were systematically lower for GQS than for FNS (P < 0.05). Resting twitch and doublet peak torque were lower for GQS, and time to peak torque was shorter for GQS than for FNS (P < 0.01). Conclusions: GQS can be used with confidence for straightforward evaluation of quadriceps muscle inactivation, whereas its validity for assessment of contractile properties remains to be determined. Muscle Nerve 51: 117–124, 2015

Neuromuscular electrical stimulation (NMES) with large electrodes and multiple current pathways (m-NMES) has recently been proposed as a valid alternative to conventional NMES (c-NMES) for quadriceps muscle (re)training. The main aim of this study was to compare discomfort, evoked force and fatigue between m-NMES and c-NMES of the quadriceps femoris muscle in healthy subjects. Ten healthy subjects completed two experimental sessions (c-NMES and m-NMES), that were randomly presented in a cross-over design. Maximal electrically evoked force at pain threshold, self-reported discomfort at different levels of evoked force, and fatigue-induced force declines during and following a series of 20 NMES contractions were compared between c-NMES and m-NMES. m-NMES resulted in greater evoked force (P

Introduction/Background Intra-articular (IA) oxygen-ozone (O2O3) has recently grown as a novel therapeutic option in knee osteoarthritis (KOA) and few studies in literature explored its safety and impact on pain and functional status in these patients. The aim of this study was to assess the effectiveness and safety of IA O2O3 compared to ialuronic acid (HA) in terms of pain, knee function, and health-related quality of life in patients affected by KOA over 31 weeks. Material and method In this randomized, single-blind, controlled study patients aged ≥ 60 years affected by KOA have been enrolled and randomly allocated to receive 4 IA knee injections once per week for 4 consecutive weeks of O2O3 or HA (T0–T3) and a follow-up visit 4 weeks after the fourth injection (T4). Patients having a Visual Analogue Scale (VAS) ≥ 4 at 6 months follow-up visit (T5) underwent a second treatment cycle (T5–T8) and a 1-month follow-up visit (T9). All adverse events occurred, VAS, Oxford Knee Questionnaire, 12-Item Short Form Health Survey, and European Quality of Life-5 dimensions scores have been assessed. Results Forty-six patients (mean aged 70.8 ± 2.4 years) were enrolled and randomly allocated to O2O3 (n = 23) or HA treatment group (n = 23). Nineteen patients reported a VAS ≥ 4 at T5, undergoing a second treatment cycle: 10 in O2O3 group and 9 in HA group. There were no significant differences in adverse events occurrence between the two groups. VAS scores showed a statistically significant reduction (P Conclusion IA O2O3 therapy could be comparable to IA HA in terms of safety profile and effectiveness in reducing pain in patients with KOA, even on a multiple injection cycles and long term follow-up.

The aims were to investigate the plasticity of the myosin heavy chain (MHC) phenotype following neuromuscular electrical stimulation (NMES) and to assess the correlation between MHC isoform distribution and muscle fibre conduction velocity (MFCV).14 men were subjected to 24 sessions of quadriceps NMES. Needle biopsies were taken from the dominant vastus lateralis and neuromuscular tests were performed on the dominant thigh before and after training. NMES significantly increased the quadriceps maximal force by 14.4±19.7% (P=0.02), vastus lateralis thickness by 10.7±8.6% (P=0.01), vastus lateralis MFCV by 11.1±3.5% (P

Musculoskeletal ultrasound imaging allows non-invasive measurement of skeletal muscle thickness. Current techniques generally suffer from manual operator dependency, while all the computer-aided approaches are limited to be semi-automatic or specifically optimized for a single muscle. The aim of this study was to develop and validate a fully automatic method, named MUSA (Muscle UltraSound Analysis), for measurement of muscle thickness on longitudinal ultrasound images acquired from different skeletal muscles. The MUSA algorithm was tested on a database of 200 B-mode ultrasound images of rectus femoris, vastus lateralis, tibialis anterior and medial gastrocnemius. The automatic muscle thickness measurements were compared to the manual measurements obtained by three operators. The MUSA algorithm achieved a 100% segmentation success rate, with mean differences between the automatic and manual measurements in the range of 0.06–0.45 mm. MUSA performance was statistically equal to the operators and its measurement accuracy was independent of the muscle thickness value.

FULL ARTICLE Label-free and non-invasive discrimination of HaCaT and melanoma cells in a co-culture model by hyperspectral confocal reflectance microscopy Francesca R. Bertani 1 , Elisabetta Botti 2 , Luisa Ferrari 1 , Valentina Mussi 1 , Antonio Costanzo 2 , Marco D ' Alessandro 1 , Francesco Cilloco 1 , and Stefano Selci * ,1 1 CNR-ISC Istituto del Sistemi Complessi, Consiglio Nazionale delle Ricerche, Via fosso del Cavaliere, 100 00133 Rome, Italy 2 Dermatology Unit, NESMOS Department, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy Received 5 March 2015, revised 8 July 2015, accepted 5 August 2015 Published online 17 September 2015 Key words: hyperspectral microscopy, multivariate analysis, melanoma cells HaCaT cells co-culture. 1. Introduction The possibility of discriminating single cell and tissue properties without perturbation of their metabolic or differentiation status has enormous potential impact in diagnostic [1] and therapeutic fields [2]. The chance of gaining information from cells living and evolving in their environment opens a new way for cell therapy, regenerative medicine, personalized im- munotherapy and cancer treatment [3]. The defini- tion of methods for label free and non-invasive high resolution imaging represents one of the principal goals of several methodological and instrumental ap- proaches. In recent years, we are experiencing a sort of change of paradigm in imaging methods, similarly to what happened in life sciences. There, the change in genomic paradigm has meant the transition from the strict correspondence of one protein to only one function, to a more complex view of genetic and epi- genetic world. As regards the imaging methods we are going toward the " global analysis " of cell fea- * Corresponding author: e-mail: stefano.selci@isc.cnr.it , Phone: +39 06 4993 4167, Fax: +39 06 4548 8043 A novel hyperspectral confocal microscopy method to se- parate different cell populations in a co-culture model is presented here. The described methodological and instru- mental approach allows discrimination of different cell types using a non-invasive, label free method with good accuracy with a single cell resolution. In particular, mela- noma cells are discriminated from HaCaT cells by hyper- spectral confocal imaging, principal component analysis and optical frequencies signing, as confirmed by fluores- cence labelling cross check. The identification seems to be quite robust to be insensitive to the cellular shape within the studied samples, enabling to separate cells according to their cytotype down to a single cell sensitivity.

Objective To establish muscle-specific cut-off values for ultrasound-based detection of low muscle mass, and to assess its prevalence in a population of frail older subjects when applying the cut-points of different muscles and those of different sarcopenic indices. Design Cross-sectional study. Setting Geriatric outpatient clinic and clinical research laboratory. Methods A total of 44 older adults (30 women and 14 men, mean age 82 years, range 67-93 years) and 60 younger individuals (30 women and 30 men, mean age 26 years, range 20-36 years) participated. Body composition and thickness of 4 lower limb muscles (rectus femoris, vastus lateralis, tibialis anterior, medial gastrocnemius) were respectively assessed by bioelectrical impedance analysis (BIA) and ultrasonography. Main Outcome Measurements Site-specific cut-points for ultrasound-based assessment of low muscle mass (muscle thickness values 2 standard deviations below the gender-specific means of our sample of younger subjects) and comparative prevalence rates of low muscle mass. Results The following site-specific cut-points for muscle thickness were identified: rectus femoris: 20 mm in men and 16 mm in women; vastus lateralis: 17 mm in men and 15 mm in women; tibialis anterior: 23 mm in men and 22 mm in women; and medial gastrocnemius: 13 mm in both men and women. The prevalence of low muscle mass in older adults was highly dependent on the muscle being investigated; it varied from 86% for thigh muscles to 30% for leg muscles. Moreover, the prevalence of low muscle mass was highly dependent on the applied diagnostic criterion and on the adopted cut-off value; it ranged from 2% to 75% for different BIA-derived criteria. Conclusions We suggest that muscle ultrasonography provides physiatrists with a practical and accurate tool for identifying individuals with low muscle mass. However, the usability of cut-off values established in our group of healthy younger subjects of white ethnicity to identify low muscle mass in older individuals of different ethnic groups remains to be demonstrated in future studies.

Non-technical summary There is still a debate on the origin of muscle cramps, which may be from the peripheral or the central nervous system. In this study we show that cramps electrically induced in the abductor hallucis of healthy men do occur with and without a proximal nerve block. However, cramps elicited during the nerve block required greater stimulation frequency, lasted for a substantially shorter interval, and presented different motor unit behaviour with respect to cramps induced without the block. These findings suggest the relevance of spinal involvement in both the origin and sustenance of muscle cramps.

Contrary to other widespread forms of electrical stimulation, such as transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES) is generally delivered to the muscle in static conditions (without functional movement occurring) and at sufficiently high current intensities to evoke visible muscle contractions (beyond motor threshold). NMES has received increasing attention in the last few years, because it has the potential to serve as

The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18–50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (

Electrical stimulation of innervated muscles has been investigated for many decades with alternations of high and low clinical interest in the fields of rehabilitation medicine and sports sciences. Early work demonstrated that afferent fibers have lower thresholds and are usually activated first (therefore eliciting an H-reflex). In the case of nerve trunk stimulation, the order of recruitment is mostly conditioned by the axonal dimension and excitability threshold. In the case of muscle motor point stimulation, the spatial distribution of nerve branches plays a predominant role. Sustained stimulation produces a progressive increase of force that is often maintained in subsequent voluntary activation by stroke patients. This observation suggested a facilitation mechanism at the spinal and/or supraspinal level. Such facilitation has been observed in healthy subjects as well, and may explain the generation of cramps elicited during stimulation and sustained for dozens of seconds after the stimulation has been interrupted. The most recent interpretations of facilitation resulting from peripheral stimulation focused on presynaptic (potentiation of neurotransmitter release from afferent fibers) or postsynaptic (generation of "persistent inward currents" in spinal motor neurons or interneurons) mechanisms. The renewed attention to these phenomena is once more increasing the interest toward electrical stimulation of the neuromuscular system. This is an opportunity for a structured investigation of the field aimed to resolving elements of confusion and controversy that still plague this area of electrophysiology.

Epidemiological studies pointed out to a strong association between vitamin D deficiency and type 2 diabetes prevalence. However, the role of vitamin D supplementation in the skeletal muscle, a tissue that play a crucial role in the maintenance of glucose homeostasis, has been scarcely investigated so far. On this basis, this study aimed to evaluate the effect of vitamin D supplementation in a murine model of diet-induced insulin resistance with particular attention to the effects evoked on the skeletal muscle. Male C57BL/6J mice (n = 40) were fed with a control or a High Fat-High Sugar (HFHS) diet for 4 months. Subsets of animals were treated for 2 months with vitamin D (7 μg·kg-1, i.p. three times/week). HFHS diet induced body weight increase, hyperglycemia and impaired glucose tolerance. HFHS animals showed an impaired insulin signaling and a marked fat accumulation in the skeletal muscle. Vitamin D reduced body weight and improved systemic glucose tolerance. In addition, vitamin D restored the impaired muscle insulin signaling and reverted myosteatosis evoked by the diet. These effects were associated to decreased activation of NF-κB and lower levels of TNF-alpha. Consistently, a significantly decreased activation of the SCAP/SREBP lipogenic pathway and lower levels of CML protein adducts and RAGE expression were observed in skeletal muscle of animals treated with vitamin D. Collectively, these data indicate that vitamin D-induced selective inhibition of signaling pathways (including NF-κB, SCAP/SREBP and CML/RAGE cascades) within the skeletal muscle significantly contributed to the beneficial effects of vitamin D supplementation against diet-induced metabolic derangements.

Musculoskeletal ultrasound imaging can be used to investigate the skeletal muscle structure in terms of architecture (thickness, cross-sectional area, fascicle length and fascicle pennation angle) and texture. Gray-scale analysis is commonly used to characterize transverse scans of the muscle. Gray mean value is used to distinguish between normal and pathologic muscles, but it depends on the image acquisition system and its settings. In this study, quantitative ultrasonography was performed on five muscles (biceps brachii, vastus lateralis, rectus femoris, medial gastrocnemius and tibialis anterior) of 20 healthy patients (10 women, 10 men) to assess the characterization performance of higher-order texture descriptors to differentiate genders and muscle types. A total of 53 features (7 first-order descriptors, 24 Haralick features, 20 Galloway features and 2 local binary pattern features) were extracted from each muscle region of interest (ROI) and were used to perform the multivariate linear regression analysis (MANOVA). Our results show that first-order descriptors, Haralick features (energy, entropy and correlation measured along different angles) and local binary pattern (LBP) energy and entropy were highly linked to the gender, whereas Haralick entropy and symmetry, Galloway texture descriptors and LBP entropy helped to distinguish muscle types. Hence, the combination of first-order and higher-order texture descriptors (Haralick, Galloway and LBP) can be used to discriminate gender and muscle types. Therefore, multi-texture analysis may be useful to investigate muscle damage and myopathic disorders.

The massed action potential (M wave) elicited through nerve stimulation underpins a wide range of physiological and mechanical understanding of skeletal muscle structure and function. Although systematic approaches have evaluated the effect of different factors on M waves, the effect of the location and distribution of activated fibers within the muscle remains unknown. By detecting M waves from the medial gastrocnemius (MG) of 12 participants with a grid of 128 electrodes, we investigated whether different populations of muscle units have different spatial organization within MG. If populations of muscle units occupy discrete MG regions, current pulses of progressively greater intensities applied to the MG nerve branch would be expected to lead to local changes in M-wave amplitudes. Electrical pulses were therefore delivered at 2 pps, with the current pulse amplitude increased every 10 stimuli to elicit different degrees of muscle activation. The localization of MG response to increases in current intensity was determined from the spatial distribution of M-wave amplitude. Key results revealed that increases in M-wave amplitude were detected somewhat locally, by 10–50% of the 128 electrodes. Most importantly, the electrodes detecting greatest increases in M-wave amplitude were localized at different regions in the grid, with a tendency for greater stimulation intensities to elicit M waves in the more distal MG region. The presented results indicate that M waves recorded locally may not provide a representative MG response, with major implications for the estimation of, e.g., the maximal stimulation levels, the number of motor units, and the onset and normalization in H-reflex studies.

Summary objective It has been reported previously that the paired interpretation of the corticotrophin-releasing hormone (CRH) test and the 8-mg dexamethasone suppression test (HDDST) could have higher diagnostic power than any single test in the differential diagnosis of ACTH-dependent Cushing's syndrome. This finding has not been confirmed thereafter in large series. The aim of the present study has been to assess the operating characteristics of either the CRH test or the overnight HDDST and also to evaluate the potential utility of combining the interpretation of both tests in the differential diagnosis of ACTH-dependent Cushing's syndrome. design and patients We have reviewed the medical records of 59 consecutive cases with ACTH-dependent Cushing's syndrome: 49 patients with proven Cushing's disease (CD) and 10 patients with proven ectopic ACTH syndrome (EAS). Univariate curves of the receiver operating characteristics (ROC) have been performed to define the best cut-off values, the sensitivity and the specificity for CRH and overnight HDDST. A comparison between the areas under the ROC curves has also been performed. results For the CRH test, the point on the ROC curve closest to 1 corresponded to a value of ACTH percentage increment of 50%[sensitivity 86% (72·6–94·8) and specificity 90% (55·5–98·3)]. The best threshold for cortisol percentage (30%) increment gave inferior results [sensitivity 61% (45·5–75·6) and specificity 70% (34·8–93·0)]. For the HDDST, the point on the ROC curve closest to 1 corresponded to a value of cortisol decrease from the baseline of 50%[sensitivity 77% (62·7–88·5), specificity 60% (26·4–87·6)]. The area under the ROC curve of the ACTH percentage increment after CRH was significantly greater than the area under the diagonal [0·9 (0·7–1·0), P= 0·0001]. Conversely, the area under the cortisol percentage decrement after dexamethasone was not different from that obtained by chance [0·7 (0·5–0·9), P= ns]. The area under the ROC curve of CRH is significantly greater than that of overnight HDDST (P = 0·03). A correct diagnosis has been achieved by the CRH test in 86·5% of cases and by the HDDST in 73% (P = 0·06). The combination of both tests has given a correct diagnosis in a significantly lower percentage of cases than the CRH test alone (69%, P= 0·04). The bilateral inferior petrosal sinus sampling (BIPSS) has been performed in 29 patients (24 CD, five EAS) who had negative imaging and/or discordant results of the noninvasive tests. Considering the criterion of a central to peripheral ACTH ratio > 3 after CRH stimulation, a correct diagnosis was achieved in all cases. conclusions The present data suggest that the CRH is likely to be the most reliable noninvasive diagnostic procedure for the differential diagnosis of the ACTH-dependent Cushing's syndrome. The criterion for a diagnosis of EAS is an ACTH percentage increment lower than 50%. The use of a combination of tests is not recommended because it does not add valuable information and may even impair the outcome of the CRH test. Cases with discordant results in pituitary imaging and CRH test should undergo BIPSS. The validity of this approach, which is straightforward and easily applicable in clinical practice, should be verified in larger series.

Increasing context heterogeneity has been found to reduce attention deployment towards an embedded target item. Heterogeneity in visual search tasks is typically induced by segmenting the background into several perceptual groups. In the present study, however, context heterogeneity was induced by varying whole-field heterogeneity, i.e., the degree of distractor variability within the entire context. This allowed us to (i) more gradually vary context heterogeneity, and (ii) investigate attention deployment on a whole-field scale. Results showed that both search performance and amplitude of the N2pc (lateralized ERP; posterior contralateral negativity in the N2 range) monotonically decreased with increasing context heterogeneity, which confirmed that there was less efficient attention deployment for more heterogeneous contexts. The amplitude of the bilateral N2 exhibited a U-shaped function, suggesting global perception for the lowest and highest levels of heterogeneity, but local processing for intermediate heterogeneity levels. Independent component analyses revealed an occipital ERP-contributing effective source cluster that may reflect stimulus representations on a saliency map. With increasing heterogeneity, these sources exhibited more theta band activity for distractors and less theta band activity for targets. Alpha band activity of a second component cluster varied with heterogeneity level, and low-theta/delta activity of a third source cluster distinguished target presence versus absence. In sum, our results suggest that independent brain sources contributed to the differential processing of heterogeneous versus homogeneous contexts.

Background Ultrasonographic abnormalities of the patellar tendon frequently occur in asymptomatic athletes and it is not always clear whether they precede (and may predict) the development of tendinopathy. Objective This study aimed to investigate by ultrasonography the prevalence of patellar tendon abnormalities in players of "pallapugno" and to establish whether structural tendon abnormalities predict tendinopathy development. Methods Ultrasound B-mode images of the patellar tendon of both sides were acquired in fourteen throwers. Qualitative assessments of tendon structure and neovascularization and quantitative assessments of tendon thickness, cross sectional area (CSA), and echo-intensity were performed. Results Qualitative assessments showed a subclinical tendinopathy of the non-dominant tendon in 5 out of 14 throwers (35% of cases), while quantitative assessments showed abnormalities of the non-dominant tendon in 8 out of 14 players (57% of cases). Echo-intensity and CSA were the quantitative variables most discriminant between asymptomatic players without structural tendon abnormalities and those with tendon abnormalities. Two players (2 out of 8 cases: 25%) developed a clinical tendinopathy after a follow-up of six months. Conclusion The prevalence of subclinical tendinopathy in the non-dominant patellar tendon of throwers was high. Patellar tendon abnormalities at baseline seem to increase the risk of development of subsequent patellar tendinopathy. Level of evidence II b (individual cohort study).

In this article a combustor burning hydrogen and air in mild regime is numerically studied by means of computational fluid dynamic simulations. All the numerical results show a good agreement with experimental data. It is seen that the flow configuration is characterized by strong exhaust gas recirculation with high air preheating temperature. As a consequence, the reaction zone is found to be characteristically broad and the temperature and concentrations fields are sufficiently homogeneous and uniform, leading to a strong abatement of nitric oxide emissions. It is also observed that the reduction of thermal gradients is achieved mainly through the extension of combustion in the whole volume of the combustion chamber, so that a flame front no longer exists ('flameless oxidation'). The effect of preheating, further dilution provided by inner recirculation and of radiation model for the present hydrogen/air mild burner are analyzed.