Does the Analysis of Separate Bands of Echo Intensity Strengthen the Relationship to Muscle Function?

Ultrasound echo intensity (EI) has been proposed as a method of assessing muscle quality through the use of non-invasive imaging. Traditionally, EI is assessed as the mean pixel brightness that ranges from 0-255 within an area of interest. However, it may be reasonable to consider that additional portions of the ultrasound EI signal (i.e., bands of signal) may provide novel insight to muscle function. The determination of which band of signal may be more related to a given functional outcome may increase the sensitivity of EI. Thus far, there is no research analyzing the association between EI bands and fatigue. PURPOSE: The purpose of this study was to compare relationships between mean echo intensity and unique bands of ultrasound signal of the vastus lateralis with metrics of whole muscle performance in healthy adults. METHODS: Twenty-four participants (mean ± age = 22 ± 3.9 yrs; BMI = 25.7 ± 3.4 kg/m2), completed two visits to the laboratory. On the first visit, subjects completed Brightness mode (B-mode) ultrasound imaging and were familiarized with the fatigue assessment. Between two and seven days later, subjects returned for the testing visit. B-mode ultrasound was used to image the vastus lateralis (VL) at 50% muscle length. The VL cross-sectional area was traced using the polygon tool. As much of the muscle was selected without selecting any of the surrounding fascia. Each pixel is assigned a brightness value from 0-255 based on gray scale; 0 representing true black and 255 is pure white. Mean EI was quantified from within the selected portion of the image. Echo intensity bands were calculated in pixel value intervals of 0-49, 50-99, 100-149, 150-199, 200-255. The percentage of pixels per band compared to the total number of pixels in each image was assessed by: (number of pixels in each band/ total number of pixels in the selected portion of the image)*100. For the fatigue assessment, participants completed 100 repeated, maximal, isokinetic muscle actions (120°/sec). Isokinetic peak torque was analyzed offline using custom written software by selecting individual torque peaks from each muscle action. Initial and final isokinetic peak torque were calculated by averaging the highest 3 of the first 5 and the highest 3 of the last 5 contractions. Isokinetic peak torque percent decline (%Decline) was calculated by: %Decline = (initial – PT – final - PT)/initial - PT. Pearson’s correlation coefficient (r) was used to assess the relationship between each EI band and %Decline as well as mean EI and %Decline. The Stieger’s Z procedure was used to compare the correlation coefficients between mean EI and each EI band. RESULTS: There were no significant correlation between mean EI and %Decline (r=0.03, p=0.88) or any of the EI bands and %Decline (r=-0.07-0.3, p=0.16-0.89). Additionally, there were no significant relationships between the mean EI and any of the EI bands (z=0.001-0.88, p=0.38-0.99). CONCLUSION: The findings suggest that unique bands of ultrasound signal do not offer different relationships compared to overall mean EI when assessing fatigue from repetitive isokinetic muscle actions

Reliability of Differing Muscle Size and Quality Analysis Techniques

Brightness-mode (B-mode) ultrasonography is a popular tool to examine anatomical cross-sectional area (ACSA) and echo intensity (EI). Muscle ACSA and EI provide valuable insight into muscle function due to their unique mechanisms which influence performance. Manually analyzing ultrasound images potentially increases variability which may increase error, thus decreasing the reliability of manual image analysis. Recently an automated program was created to improve reliability and reduce the time of ultrasound image analysis. PURPOSE: The purpose of this study was to investigate the reliability of manual compared to automatic ultrasound analyses of muscle cross-sectional area and echo intensity. METHODS: Twenty-two participants (mean ± SD age = 24 ± 4 yrs; BMI = 24.19 ± 3.26 kg/m2) volunteered for this study. The participants completed one visit to the laboratory consisting of two data collection trials separated by 10 minutes. Ultrasound scans were taken with a B-mode ultrasound imaging device and image settings were held constant (i.e., depth = 6 cm, frequency = 12 MHz, gain = 52 dB). For each trial, participants remained supine while ACSA scans of the vastus lateralis (VL) were taken at 50% the length of the proximal to distal musculo-tendon junctions. The ACSA of the VL was manually analyzed by an experienced technician with ImageJ using the polygon tool and tracing the area of interest. Echo intensity was quantified as the mean pixel brightness of the traced portion of the image. Images were automatically analyzed with the Deep Anatomical Cross-Sectional Area (DeepACSA) program which is an algorithm that is designed to automatically trace the area of interest of an ultrasound image. Test-retest reliability statistics (i.e., intraclass correlation coefficient [ICC] model 2,1, standard error of measure expressed as a percentage of the mean [SEM%], and the minimal differences [MD] values needed to be considered real) were calculated for trials 1 and 2. One-way repeated measures analysis of variance determined differences in trial 1 compared to trial 2. RESULTS: Manual analyses of ACSA (ICC2,1 = 0.98, SEM (%) = 3.39%, MD = 2.09 cm2, p = 0.046) were more reliable than automatic analyses (ICC2,1 = 0.87, SEM (%) = 12.33%, MD = 7.77 cm2, p = 0.216). Manual analyses of EI (ICC2,1 = 0.73, SEM (%) = 6.44%, MD = 10.83 cm2, p = 0.514) had similar reliability to the automatic analyses (ICC2,1 = 0.88, SEM (%) = 3.60%, MD = 6.30 cm2, p = 0.003). CONCLUSION: These results suggest that this automated analysis program may be less reliable compared to the manual analysis of muscle ACSA of the VL. Conversely, DeepACSA displayed similar reliability for EI of the VL when compared to the manual analysis

Test-Retest Reliability of Automatic and Manual Image Analyses of Muscle Size

Brightness-mode (B-mode) ultrasound is a non-invasive imaging modality that has risen in popularity. In research settings, B-mode ultrasound is often used to assess skeletal muscle size via the quantification of the anatomical cross-sectional area (ACSA). Typically, these images are analyzed by an experienced investigator using open-source software, though it is a time-consuming process that may introduce implicit bias into the analysis. Recently, a novel, automatic ultrasound image analysis tool has been developed which may reduce bias and increase the reliability of ultrasound ACSA image analysis. PURPOSE: The purpose of the project was to compare the test-retest reliability of manual and automatic ACSA quantification techniques. METHODS: Nine participants (mean ± SD: age = 25 ± 3 years; BMI = 23.96 ± 2.62 kg/m2) completed one laboratory visit where each participant had non-invasive ultrasound imaging performed on their rectus femoris (i.e., RF) for two data collection trials separated by 10 minutes. For each participant, ultrasound image settings were held constant (i = 6 cm, frequency = 10 MHz, gain = 52 dB). All images were manually analyzed by an experienced technician using an open-source image analysis tool. The investigator would carefully select only the surrounding muscle fascia of the RF. Automatic analyses were performed using DeepACSA, a deep learning approach for the assessment of ACSA. Both manual and automatic analyses were conducted on all images. Analysis of variance (ANOVA) was conducted to compare differences between trials and test-retest reliability (i.e., intraclass correlation coefficients [ICC] model 2,1, standard error of measure expressed as a percentage of the mean [SEM%], and the minimal differences [MD] values needed to be considered real) were calculated from the ANOVA output. RESULTS: The manual analyses of ACSA (p = 0.20, ICC2,1 = 0.84, SEM (%) = 11.67%, MD = 1.75 cm2) were more reliable than the DeepACSA analyses (p = 0.13, ICC2,1 = 0.47, SEM (%) = 30.28%, MD = 4.70 cm2). CONCLUSION: The results of the present investigation suggest that the DeepACSA approach may be less reliable compared to the manual quantification of RF muscle size. Future studies should investigate using a larger sample size and additional muscle groups

Bioimpedance Spectroscopy Compared to Ultrasound-derived Measures of Quadriceps Muscle Quality

Muscle quality is often measured using ultrasound-derived echo intensity (EI). Recent works have shown tissue frequency-dependent electrical impedance from bioimpedance spectroscopy may be a modality for assessing tissue quality. PURPOSE: The purpose of the project was to examine the association between ultrasound-derived EI of the quadriceps muscles (i.e., vastus lateralis [VL], vastus medialis [VM], vastus intermedius [VI], rectus femoris [RF]) and measures of thigh tissue frequency-dependent electrical impedance (i.e., R0, R1, C, a, fp). METHODS: Twenty-four participants (13 women; mean ± SD; age: 22 ± 4 years; BMI: 25.47 ± 3.26 kg/m2) were recruited. Participants completed one laboratory visit where quadriceps tissue quality was assessed via ultrasound and bioimpedance spectroscopy (BIS). Participants laid supine on a portable exam table to undergo imaging of the dominant leg VL using ultrasound in conjunction with a multi-frequency linear array probe (L4 – 12t – RS, 4.2-13 MHz, 47.1mm field of view). The VL was marked at the proximal and distal musculo-tendon junctions determined via ultrasound and the length was measured with a tape measure. Participants had cross-sectional scans of the VM, VL, VI, and RF at 25, 50, 75% of the length of the VL. Images were analyzed using the polygon tool in ImageJ to trace the muscles and provide EI values. Subcutaneous fat width was measured using the straight-line tool. Echo intensity was calculated using ImageJ gray-scale analysis and histogram function as well as corrected for subcutaneous fat. For statistical analyses, the average corrected EI for each muscle was created across scan sites. For BIS, participants were seated in a chair with Ag/AgCl electrodes placed above the patella and below the hip. Electrodes were placed 6cm apart and the Cole-impedance model was used to represent frequency-dependent thigh tissue data. Signals were analyzed using a custom-written software program. Pearson’s correlation coefficient (r) was used to determined associations between the VL, VM, VI, RF and BIS variables (R0, R1, C, a, fp). An alpha level of p ≤ 0.05 determined statistical significance. RESULTS: The results suggest that VL, VM, VI and RF echo intensity was significantly related to R0 (r = 0.65 – 0.81; p \u3c 0.01). For VI and RF, they were significantly related to a (r = -0.51 – -0.50; p = 0.01), but not for VL or VM (r = -0.39 - -0.22; p \u3e 0.06). Lastly, R1, C, and fp were not significantly correlated to the quadriceps muscles (r = -0.38 – 0.33; p \u3e 0.07). CONCLUSION: Our findings suggest that BIS-derived R0 may be a metric of muscle quality of the quadriceps as it was significantly related to ultrasound-derived measures of echo intensity of the VL, VM, VI, and RF. Further investigation of other muscle groups may be warranted

Optical absorption spectra in fullerenes C60 and C70: Effects of Coulomb interactions, lattice fluctuations, and anisotropy

Effects of Coulomb interactions and lattice fluctuations in the optical absorption spectra of C60 and C70 are theoretically investigated by using a tight binding model with long-range Coulomb interaction and bond disorder. Anisotropy effects in C70 are also considered. Optical spectra are calculated by using the Hartree-Fock approximation followed by the configuration interaction method. The main conclusions are as follows: (1) The broad peaks at excitation energies, 3.7eV, 4.7eV, and 5.7eV, observed in experiments of C60 molecules in a solution are reasonably described by the present theory. Peak positions and relative oscillator strengths are in overall agreement with the experiments. The broadening of peaks by lattice fluctuations is well simulated by the bond disorder model. (2) The optical gap of C70 is larger when the electric field of light is parallel to the long axis of the molecule. The shape of the frequency dispersion also depends on the orientation of the molecule. These properties are common in the free electron model and the model with Coulomb interactions. (3) The spectrum of C70 averaged over bond disorder and random orientations is compared with experiments in a solution. There is an overall agreement about the spectral shape. Differences in the spectra of C60 and C70 are discussed in connection with the symmetry reduction from a soccerball to a rugbyball.Comment: PACS numbers: 78.66.Qn, 78.20.Dj, 71.35.+z, 31.20.Tz; LaTeX, 15 pages, 5 figures (Physical Review B); Note: Please request figures to Authors. They will be sent via snail mai

Body Composition and Anthropometric Changes During a 10-week Training Academy in Police Recruits

Obesity and cardiometabolic risk factors are often present in law enforcement personnel, which may compromise physical readiness and long-term health. As such, physical fitness interventions are warranted for promoting officers\u27 performance and wellbeing. PURPOSE: To determine the body composition and anthropometric changes experienced by police recruits undergoing a departmental training academy. METHODS: Twenty-one police recruits (20 M, 1 F; age: 25.1 ± 5.0 y; BMI: 27.8 ± 4.3 kg/m2) were tested before and after a 10-week training academy in Lubbock, Texas. Supervised physical training was conducted 5 times per week and consisted of ~1–1.5 hours of high-intensity, multi-modal (i.e., running, weightlifting, calisthenics), functional training following linear periodization. Dual-energy X-ray absorptiometry (DXA; GE Lunar iDXA) and 3-dimensional optical imaging (3DO; Size Stream SS20) were performed to assess body composition and anthropometry. Paired-samples t-tests were performed to compare values before and after the training academy, and Cohen’s d effect sizes were generated. After Bonferroni correction, statistical significance was accepted at p\u3c0.003. Changes are presented as mean ± SD. RESULTS: From DXA, statistically significant decreases in total fat mass (FM; -3.3 ± 3.1 kg, p\u3c0.001, d=1.1), trunk FM (-2.1 ± 2.2 kg, p\u3c0.001, d=1.0), arms FM (-0.3 ± 0.3 kg, p=0.001, d=1.1), legs FM (-0.9 ± 0.9 kg, p\u3c0.001, d=1.1), and body fat percentage (-3.1 ± 2.5%, p\u3c0.001, d=1.2) were observed. Increases in total lean soft tissue (LST; 1.3 ± 1.3 kg, p=0.002, d=1.0) and trunk LST (0.8 ± 0.9 kg, p\u3c0.001, d=0.9) were also noted, with trends for increases in leg LST (0.2 ± 0.7 kg, p=0.096, d=0.4) and arm LST (0.2 ± 0.4, p=0.04, d=0.5). Decreases in 3DO abdomen circumference (-3.5 ± 3.8 cm, p\u3c0.001, d=0.9) and hip circumference (-2.2 ± 2.2 cm, p\u3c0.001, d=1.0) were noted, with trends for decreases in the circumferences of the waist (-2.4 ± 3.6 cm, p=0.007, d=0.7) and upper arm (-0.9 ± 1.5 cm, p=0.02, d=0.6). No significant changes in thigh circumference (-0.7 ± 1.9 cm, p=0.12, d=0.4) or calf circumference (-0.2 ± 1.5 cm, p=0.52, d=0.1) were noted. A trend for a decrease in body mass (-2.0 ± 3.1 kg, p=0.007, d=0.7) was also observed. CONCLUSION: The present study indicates that police academy training significantly improves recruits\u27 body composition, both reducing FM and increasing LST, which has the potential to positively affect operational performance. Future studies should track these changes over time to help develop ongoing health and fitness strategies for career police officers, ultimately improving their long-term wellbeing and job readiness

High Natality Rates of Endangered Steller Sea Lions in Kenai Fjords, Alaska and Perceptions of Population Status in the Gulf of Alaska

Steller sea lions experienced a dramatic population collapse of more than 80% in the late 1970s through the 1990s across their western range in Alaska. One of several competing hypotheses about the cause holds that reduced female reproductive rates (natality) substantively contributed to the decline and continue to limit recovery in the Gulf of Alaska despite the fact that there have been very few attempts to directly measure natality in this species. We conducted a longitudinal study of natality among individual Steller sea lions (n = 151) at a rookery and nearby haulouts in Kenai Fjords, Gulf of Alaska during 2003–2009. Multi-state models were built and tested in Program MARK to estimate survival, resighting, and state transition probabilities dependent on whether or not a female gave birth in the previous year. The models that most closely fit the data suggested that females which gave birth had a higher probability of surviving and giving birth in the following year compared to females that did not give birth, indicating some females are more fit than others. Natality, estimated at 69%, was similar to natality for Steller sea lions in the Gulf of Alaska prior to their decline (67%) and much greater than the published estimate for the 2000s (43%) which was hypothesized from an inferential population dynamic model. Reasons for the disparity are discussed, and could be resolved by additional longitudinal estimates of natality at this and other rookeries over changing ocean climate regimes. Such estimates would provide an appropriate assessment of a key parameter of population dynamics in this endangered species which has heretofore been lacking. Without support for depressed natality as the explanation for a lack of recovery of Steller sea lions in the Gulf of Alaska, alternative hypotheses must be more seriously considered

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

The V471A polymorphism in autophagy-related gene ATG7 modifies age at onset specifically in Italian Huntington disease patients

The cause of Huntington disease (HD) is a polyglutamine repeat expansion of more than 36 units in the huntingtin protein, which is inversely correlated with the age at onset of the disease. However, additional genetic factors are believed to modify the course and the age at onset of HD. Recently, we identified the V471A polymorphism in the autophagy-related gene ATG7, a key component of the autophagy pathway that plays an important role in HD pathogenesis, to be associated with the age at onset in a large group of European Huntington disease patients. To confirm this association in a second independent patient cohort, we analysed the ATG7 V471A polymorphism in additional 1,464 European HD patients of the “REGISTRY” cohort from the European Huntington Disease Network (EHDN). In the entire REGISTRY cohort we could not confirm a modifying effect of the ATG7 V471A polymorphism. However, analysing a modifying effect of ATG7 in these REGISTRY patients and in patients of our previous HD cohort according to their ethnic origin, we identified a significant effect of the ATG7 V471A polymorphism on the HD age at onset only in the Italian population (327 patients). In these Italian patients, the polymorphism is associated with a 6-years earlier disease onset and thus seems to have an aggravating effect. We could specify the role of ATG7 as a genetic modifier for HD particularly in the Italian population. This result affirms the modifying influence of the autophagic pathway on the course of HD, but also suggests population-specific modifying mechanisms in HD pathogenesis