Search Results (691)

Background: Acute intermittent porphyria (AIP) is the most common and severe form of acute hepatic porphyria, caused by heterozygous mutations in the HMBS gene. Due to its non-specific clinical manifestations and low clinical awareness among clinicians, AIP is frequently misdiagnosed, leading to significant diagnostic delays and potentially fatal complications. Case presentation: We report a 20-year-old female patient who presented with a 9-month history of recurrent abdominal pain, paralytic ileus, unexplained liver injury, and hyponatremia, followed by progressive limb weakness. She was initially misdiagnosed with Guillain–Barré syndrome (GBS) and received intravenous immunoglobulin and systemic glucocorticoids. However, her condition deteriorated, and she developed life-threatening respiratory muscle paralysis requiring invasive mechanical ventilation. The diagnosis of AIP was confirmed by positive urinary porphobilinogen (PBG) testing and identification of the heterozygous HMBS c.517C>T pathogenic variant. The patient was treated with high-dose carbohydrate loading therapy and comprehensive supportive care, resulting in gradual clinical improvement. Discussion and Conclusions: This case exemplifies the substantial diagnostic challenges associated with AIP, especially when it manifests with peripheral neuropathy that closely mimics GBS. The triad of absent albuminocytologic dissociation in cerebrospinal fluid, preceding visceral symptoms, and inadequate response to standard first-line GBS therapy should immediately raise clinical suspicion for AIP. Enhanced clinical awareness of this rare disorder and timely implementation of urinary PBG screening are of paramount importance to prevent irreversible neurological complications and optimize long-term patient outcomes. Full article

This study evaluated the effects of dietary coenzyme Q10 (CoQ10) supplementation on growth performance, slaughter performance, meat quality, antioxidant capacity, serum profiles, and intestinal morphology in Minxinan black rabbits. A total of 250 rabbits were allocated to five dietary treatments containing 0, 30, 60, 120, or 240 mg/kg CoQ10 for 14 weeks after a 1-week adaptation period. Results indicated that supplementation with 60 mg/kg CoQ10 resulted in the highest final body weight (2.83 kg) and average daily gain (29.54 g/day), with a significantly reduced feed-to-gain ratio and mortality rate compared to the control group. Regarding slaughter performance, the 60 mg/kg group significantly reduced the abdominal fat rate. In terms of meat quality, the 60 and 120 mg/kg groups showed significantly reduced drip loss and shear force, while meat lightness (L*) increased in all supplemented groups. Cooking loss was significantly reduced in the 60 mg/kg group. Antioxidant capacity in cardiac muscle and longissimus thoracis et lumborum (LTL) muscle was enhanced, particularly at 60 mg/kg, with significantly elevated activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC), alongside reduced malondialdehyde (MDA) content. Furthermore, the 60 mg/kg group increased LTL muscle polyunsaturated fatty acid (PUFA) content, elevated serum levels of triiodothyronine (T3), growth hormone (GH), and insulin-like growth factor-1 (IGF-1), enhanced immunoglobulin concentrations, and improved intestinal morphology. In conclusion, dietary supplementation with 60 mg/kg CoQ10 improved growth performance, carcass leanness, PUFA content, and antioxidant status in broiler rabbits. Full article

Background: Stress urinary incontinence (SUI) is defined as involuntary urine loss during activities that increase intra-abdominal pressure. It is highly prevalent among women and significantly affects physical, emotional, and social well-being. Pelvic floor muscle training (PFMT) is the gold-standard conservative therapy. Second-generation radiofrequency (RF) therapy has shown promise as an alternative. It stimulates collagen synthesis and promotes tissue remodeling. This study will compare the effects of PFMT, RF, and their combination on pelvic floor function, urethral stability, and health-related quality of life (HRQoL) in women with SUI due to urethral hypermobility. Methods/Design: This will be a single-blinded, three-arm, randomized controlled trial conducted at Clínica Traña (San José, Costa Rica). Women aged ≥18 years with clinically confirmed SUI and a retrovesical (β) angle ≥ 140° during the Valsalva maneuver on functional transperineal ultrasound will be randomized (1:1:1) to PFMT (16 weeks, twice-weekly supervised sessions), RF (5 weekly sessions using Capenergy^® C500 Urogyne), or combined RF + PFMT (39 per arm; total N = 117 accounting for 30% attrition). The primary outcome is the change from baseline in pelvic floor muscle strength at 12 months post-intervention, measured by the modified Oxford scale and vaginal manometry. Secondary outcomes will include urethral stability (retrovesical β angle and bladder neck descent on ultrasound), incontinence severity (Sandvik Severity Index), and HRQoL (ICIQ-UI SF and King’s Health Questionnaire). All outcomes will be assessed at baseline, immediately post-intervention, 15 days, 3 months, 6 months, and 12 months follow-up. Assessments will be performed by blinded evaluators. Analysis will follow intention-to-treat principles using repeated-measures ANOVA or non-parametric equivalents (SPSS v.29; p < 0.05). The trial was prospectively registered on ClinicalTrials.gov (NCT07095283, registered on 24 July 2025), prior to the recruitment of the first participant. Expected outcomes: This study will provide comparative effectiveness data on whether the addition of RF to PFMT offers additional benefits over PFMT alone in the management of SUI. Full article

Background: Portable biofeedback technologies are increasingly used in rehabilitation; however, the validity of surface electromyography (sEMG) as a surrogate indicator of deep abdominal muscle function remains unclear. This study aimed to validate a portable sEMG-based visual biofeedback system by examining its relationship with ultrasound-derived measures of deep abdominal muscle activation. Methods: Twenty-nine healthy adults were randomly assigned to a Visual Biofeedback group (n = 14) or a Verbal Feedback group (n = 15). Both groups performed a standardized 2-week core stabilization program. Muscle activation of the deep abdominal muscle complex (transversus abdominis–internal oblique; TrA–IO) and external oblique (EO) was measured using sEMG (%MVIC), while ultrasound imaging was used to assess transversus abdominis thickness and contractile activity (ADIM–Rest index). Between-group differences and correlations between EMG and ultrasound variables were analyzed. Results: The Visual Biofeedback group demonstrated significantly greater improvements in TrA–IO activation and in the preferential activation ratio (TrA–IO/EO) compared to the Verbal group (p = 0.004). Ultrasound analysis revealed significantly greater increases in TrA thickness and contractile activity in the Visual group (p < 0.001). A significant positive correlation was observed between changes in TrA–IO activation and TrA thickness (ρ = 0.51, p < 0.001). Conclusions: Portable sEMG-based visual biofeedback demonstrated physiological relevance by reflecting ultrasound-derived changes in deep abdominal muscle function. These findings support the use of sEMG as a practical surrogate tool for monitoring deep core muscle activation and highlight the potential of portable biofeedback systems in scalable and accessible rehabilitation. Full article

Background and Clinical Significance: Chronic intestinal pseudo-obstruction (CIPO) clinically presents as a mechanical obstruction. When patients present with signs of impending ischemia, emergency exploratory laparotomy is indicated. Differentiating CIPO from other etiologies preoperatively is highly challenging, making intraoperative findings and definitive histopathology crucial for an accurate diagnosis. This report aims to elucidate a novel macroscopic presentation of myopathic CIPO and explore the potential biomechanical mechanisms underlying the observed structural anomaly. Case Presentation: A 37-year-old male with no prior abdominal surgery presented with a high-grade bowel obstruction and early signs of ischemia. Emergency laparotomy revealed a unique “braided dough twist” anomaly of the distal small bowel, prompting a segmental resection. Subsequent histopathological and immunohistochemical evaluations revealed severe outer longitudinal muscle atrophy with an intact enteric nervous system, confirming myopathic CIPO. Following surgery, the patient recovered uneventfully with significant nutritional improvement. Conclusions: Myopathic CIPO can manifest as a striking “braided” bowel anomaly—a macroscopic presentation previously undocumented in the literature. This case illustrates that determining the optimal extent of resection relies heavily on intraoperative visual and tactile assessment, and that comprehensive histopathological profiling is essential for establishing a definitive diagnosis and elucidating the underlying biomechanical mechanisms of this unique structural anomaly. Full article

Background: Smooth muscle tumors of uncertain malignant potential (STUMPs) are rare uterine neoplasms occupying the diagnostic continuum between benign leiomyoma and overtly malignant leiomyosarcoma. Their preoperative identification remains beyond the capability of current imaging modalities, and the diagnosis is almost invariably established through postoperative histopathological examination. The natural history of STUMP is highly variable, with recurrence rates ranging from approximately 7–27% and a documented potential for malignant transformation, underscoring the need for accurate pathological classification and long-term surveillance. Case Presentation: A 40-year-old woman with a history of hypertension presented with a 5-month history of progressive lower abdominal distension, urinary frequency, and menorrhagia. Transabdominal ultrasonography identified a large uterine fundal mass measuring approximately 10.89 × 8.96 cm. Preoperative laboratory findings demonstrated microcytic anemia. She underwent laparo-endoscopic single-site supracervical hysterectomy with bilateral salpingectomy. Histopathological examination revealed spindle cells with bland to mildly atypical nuclei, a mitotic count of <10/10 high-power fields, and focal necrosis, consistent with a diagnosis of STUMP. The patient remained free of recurrence over a 2-year follow-up period. Conclusions: This case illustrates the diagnostic challenge posed by STUMP in the preoperative setting and highlights the critical importance of thorough histopathological evaluation of all uterine smooth muscle tumor specimens. Minimally invasive hysterectomy with in-bag morcellation represents a feasible surgical approach, and long-term oncological surveillance is warranted given the risk of late recurrence and malignant transformation. Clinicians should maintain a heightened index of suspicion for borderline smooth muscle tumors when evaluating large or symptomatic uterine masses in premenopausal women. Full article

Purpose: To develop a fully automated 2D nnU-Net pipeline for multi-class skeletal muscle segmentation (psoas, paraspinal, and abdominal wall) at the third lumbar (L3) vertebral level, and to quantitatively evaluate its diagnostic performance and reliability compared to manual segmentation. Materials and Methods: A 2D nnU-Net was trained on 164 axial L3 CT slices from the multi-institutional AMOS22 dataset, spanning diverse abdominal pathologies and multivendor imaging. To assess generalizability under severe anatomical distortion, independent external validation was performed in 50 consecutive patients with advanced liver disease from a single institution (January–December 2025; mean age, 63 ± 15 years; 32 women, 18 men), of whom 88% had moderate-to-severe ascites. Model stability was examined by comparing a five-fold ensemble with the best-performing single-fold model. Intra-observer reliability of the manual reference standard was evaluated in a random subset of 30 cases. Inter-observer agreement was additionally assessed using an independent second reader. Performance metrics included the Dice Similarity Coefficient (DSC), Pearson correlation coefficient (r), and Bland–Altman analysis for cross-sectional areas and mean attenuation. The inference workflow was deployed via a custom Streamlit-based graphical user interface (GUI). Results: In this anatomically complex external validation cohort, the 5-fold ensemble 2D nnU-Net achieved an overall mean DSC of 0.937 ± 0.043 (95% CI, 0.925–0.950), with 80% of cases achieving a mean DSC ≥ 0.90. While the mean DSC was statistically comparable to the best single-fold model (0.937, [95% CI, 0.921–0.952], p = 0.736), the ensemble strategy increased the minimum observed DSC (worst-case performance) from 0.720 to 0.822. Class-specific external validation performance for the 5-fold ensemble was highest for the paraspinal muscles (DSC: 0.960; 95% CI, 0.952–0.967), followed by the psoas muscles (DSC: 0.941; 95% CI, 0.927–0.956), and lowest for the anatomically complex abdominal wall muscles (DSC: 0.911; 95% CI, 0.893–0.929). Comparison between the ensemble model and manual segmentation yielded a Pearson correlation of r = 0.955 (p < 0.001) for total skeletal muscle area, with a mean bias of +7.17 cm². Intra- and inter-observer agreements for the manual reference standard demonstrated correlation coefficients of r = 0.995 and 0.090 for total areas, respectively. The automated pipeline required 3–5 s per case for inference and quantitative reporting, compared to 3–5 min for manual segmentation. Conclusions: In patients with advanced liver disease and substantial anatomical distortion from ascites, an ensemble-based 2D nnU-Net provides high quantitative agreement with manual L3 skeletal muscle segmentation, while mitigating lower-bound (worst-case) errors relative to single-fold models. Integration with a dedicated GUI enables substantial time savings and supports scalable quantitative body composition measurement. Full article

Background: Aging is characterized by metabolic dysfunction and neuromuscular decline, and obesogenic diets may exacerbate these processes. High-fat, high-sugar diets (HFHSD) promote adiposity, systemic metabolic dysregulation, and skeletal muscle impairments, yet their impact on motor unit integrity and neuromuscular vulnerability during aging remains unclear. Methods: In a controlled preclinical experiment, late-middle-aged (15-mo-old) female F344 rats were randomized to HFHSD (n = 6) or regular chow (n = 6) for 10 weeks. Longitudinal assessments were conducted at baseline, 6 weeks, and 10 weeks and included body composition, motor unit number estimation (MUNE), forelimb and hindlimb grip strength, gastrocnemius tetanic contractile torque, and post-intervention electrical impedance myography (EIM). Data were analyzed using a two-way mixed-effects ANOVA to assess the effects of diet and time, with statistical significance set at p < 0.05. Results: HFHSD led to significant increases in body mass and adiposity measures (e.g., abdominal circumference, skinfold thickness). Compared with controls, HFHSD rats exhibited significant reductions in hindlimb MUNE (diet effect, p = 0.007) and decreased tetanic contractile torque in both absolute and body mass-normalized values (p ≤ 0.002). Absolute forelimb grip strength increased over time (p = 0.027), though this effect did not persist after normalization to body mass, and hindlimb grip strength did not differ between groups. EIM at 50 kHz revealed elevated resistance in HFHSD rats (p = 0.0497), whereas reactance and phase angle did not differ significantly. Conclusions: This pilot study provides preliminary evidence that an HFHSD, initiated during late middle age, may accelerate neuromuscular decline in female F344 rats prior to the typical onset of age-associated motor unit loss. A 10-week HFHSD intervention was associated with reductions in estimated motor unit numbers, impairments in muscle contractility, and a dissociation between absolute and normalized forelimb grip strength outcomes, indicating a potential early vulnerability of the neuromuscular system to obesogenic dietary exposure. These findings should be interpreted within the context of a modest sample size but collectively support the concept that diet-induced metabolic dysfunction may contribute to early neuromuscular impairment during aging. Full article

Background: Sarcopenia, characterized by progressive loss of skeletal muscle mass and function, is becoming increasingly prevalent with the global population aging. Computed tomography (CT) is widely used for muscle assessment; however, concerns regarding radiation exposure have prompted interest in lower-dose imaging protocols. This study investigated the performance of radiomics-based machine learning (ML) models for sarcopenia detection using abdominal CT (APCT) and low-dose CT (LDCT). Methods: Radiomics features were extracted from CT images following skeletal muscle segmentation, and ML models were developed using logistic regression, support vector machine, and random forest. Model performance was evaluated using fivefold cross-validation with out-of-fold predictions. Results: The random forest model demonstrated the best performance among the evaluated models, achieving an area under the receiver operating characteristic curve of 0.720 (95% CI: 0.532–0.881) for APCT and 0.692 (95% CI: 0.573–0.801) for LDCT. Model interpretation using SHapley Additive exPlanations analysis identified several intensity-based radiomics features, including TotalEnergy, as important contributors to sarcopenia prediction. Conclusions: These findings suggest that radiomics features derived from LDCT images may provide useful information for sarcopenia detection. Because LDCT is widely used in clinical settings such as lung cancer screening, radiomics analysis of LDCT images may offer an additional opportunity for opportunistic sarcopenia assessment. Full article

Background/Objectives: Remnant cholesterol (remnant-C), derived from triglyceride-rich lipoproteins, is an important risk factor for cardiometabolic diseases. Given the metabolic link between dyslipidemia and skeletal muscle dysfunction, we aimed to evaluate the association between remnant-C and two key components of sarcopenia—low muscle mass and myosteatosis (ectopic fat deposition in skeletal muscle). Methods: This cross-sectional study included 11,570 patients who underwent abdominal computed tomography (CT) for health check-ups. Remnant-C was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. We conducted multivariable logistic and linear analyses to assess the association between remnant-C and low muscle mass, defined as appendicular skeletal muscle mass divided by body mass index. Additional analysis examined the relationship between remnant-C and myosteatosis, defined using the NAMA (normal attenuation muscle area) divided by TAMA (total abdominal muscle area) index, a novel index derived from muscle quality mapping of abdominal CT scans. Results: Low muscle mass was observed in 244 males (3.9%) and 74 females (1.4%). Myosteatosis affected 950 males (15.0%) and 800 females (15.3%). There was an increasing prevalence of both low muscle mass and myosteatosis across remnant-C quartiles. The multivariate-adjusted odds ratios (ORs) for low muscle mass in the highest remnant-C quartile compared with the lowest quartile were 2.17 (95% confidence interval [CI] 1.45–3.26) for males and 1.37 (95% CI 0.68–2.76) for females. The corresponding ORs for myosteatosis were 1.37 (95% CI 1.11–1.69) for males and 1.24 (95% CI 0.96–1.59) for females. Conclusions: Elevated remnant-C level is associated with low muscle mass and myosteatosis, especially in male patients. Individuals with higher remnant-C levels may warrant comprehensive evaluation for skeletal muscle health. Full article

This study examined the effects of dietary crude protein (CP) level and starch: fat ratio (SFR) on glucose and lipid metabolism in geese. A total of 360 male Jiangnan White geese were allocated to a 3 × 2 factorial arrangement with two CP levels (14.5% and 16.5%) and three SFRs (SFR_20:1, SFR_11:1, and SFR_5:1) from 28 to 63 days of age. Under the low-protein condition, Both the SFR_11:1 and SFR_5:1 group enhanced body weight of geese at 63 d, but SFR _5:1 increased subcutaneous and abdominal fat deposition. Dietary SFR changed liver cholesterol metabolism and glycogen content, while CP levels mainly affected the activity of enzymes related to liver glucose and lipid metabolism: 14.5% CP increased AMPK and ACC activity, but decreased FAS, CS and G6PC activity. Both CP level and SFR altered muscle fatty acid composition, but the effect of SFR was usually more significant. An SFR of 11:1 was beneficial for improving the muscle fatty acid profile. Gene expression analysis further revealed that low protein compensatorily regulated liver energy metabolism, while excessive fat in low SFR diets led to lipid metabolism disorders. In conclusion, optimizing the energy structure of low-protein diets, especially by maintaining a medium SFR (11:1), could improve glucose and lipid metabolism in geese while increasing body weight. Full article

Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease characterized by vascular smooth muscle cell (VSMC) dysfunction and disrupted calcium homeostasis. While transient receptor potential canonical 6 (TRPC6) and transient receptor potential canonical 1 (TRPC1) are known to mediate receptor-operated calcium entry (ROCE) and store-operated calcium entry (SOCE), respectively, the specific contributions of SOCE and ROCE to AAA pathogenesis, and the regulatory interaction between transient receptor potential melastatin 8 (TRPM8) and TRPC1 remain unexplored. In this study, we analyzed human AAA tissues, a papain-induced mouse model, and angiotensin II (Ang II)-treated human aortic smooth muscle cells using histology, wire myography, calcium imaging, and patch-clamp electrophysiology. We observed significant upregulation of TRPM8, TRPC1, and TRPC6 in both human and experimental AAA, with TRPC1 identified as a key mediator of SOCE under pathological conditions. Pharmacological activation of TRPM8 by menthol attenuated TRPC1-mediated SOCE and associated vasoconstriction, effects that were partially reversed by the TRPM8 antagonist A-2. In Ang II-treated cells, TRPM8 activation reduced SOCE and store-operated calcium currents (I_SOCC), effects that were largely abolished by TRPC1 knockdown. These findings suggest that TRPM8 may limit excessive calcium ion (Ca²⁺) influx and vascular remodeling in AAA, pointing to a potential endogenous mechanism to counteract maladaptive calcium signaling in AAA progression. Full article

Background/Objectives: Abdominal wall and extrapelvic endometriosis are uncommon entities that may mimic other surgical conditions and delay diagnosis. This study evaluated their clinicopathological, diagnostic, and surgical features in a single-center case series. Methods: This retrospective study included 29 patients with histopathologically confirmed abdominal wall or extrapelvic endometriosis treated at a tertiary referral center between 2009 and 2025. Demographic and clinical characteristics, surgical history, CA-125 levels, imaging findings, lesion size, and surgical features were analyzed. Abdominal wall cases were further evaluated based on the presence of muscle or fascial invasion. Results: Abdominal wall lesions comprised 93.1% of cases, while extrapelvic lesions (6.9%) were all vaginal. Most cases had a history of cesarean section; however, one patient had no prior abdominal surgery, consistent with spontaneous disease, with concomitant endometrioma and deep infiltrating endometriosis. Muscle or fascial invasion was observed in 63.0% of cases. Both CA-125 levels (p = 0.005) and CA-125 positivity (≥35 U/mL) (p = 0.029) were significantly higher in patients with invasion. Cyclic symptoms were present in 89.7% of patients, and mesh repair was required in two cases with large lesions. Conclusions: Abdominal wall endometriosis should be suspected in patients with cyclic pain or swelling at surgical sites, particularly after cesarean delivery, although it may occur without prior surgery. Deep muscle and fascial invasion may be associated with elevated CA-125 levels and increased CA-125 positivity, sometimes requiring wider excision and mesh repair. These findings may support earlier diagnosis and surgical planning. Full article

This study investigated the effects of a 12-week structured aquatic exercise program incorporating multiple immersion depths on muscle strength, postural alignment, and static balance in middle-aged women. Eighteen women in their 40s were randomly allocated to an aquatic exercise group (AG, n = 9) or a control group (CG, n = 9). The AG participated in a 12-week aquatic exercise program twice weekly in an indoor rehabilitation pool with progressively increased intensity (RPE 11–13 for weeks 1–6 and 14–16 for weeks 7–12) and multiple immersion depths (knee, waist, and xiphoid process levels). The CG was instructed to refrain from moderate-to-vigorous physical activity for 12 weeks. Outcomes included dominant handgrip strength, a 60-s abdominal curl-up test, postural alignment (3D posture analysis), and static balance (single-leg stance test). Data were analyzed using two-way mixed ANOVA. Significant group × time interactions were found for handgrip strength (p = 0.003), 60-s abdominal curl-up performance (p < 0.001), pelvic tilt alignment (p = 0.017), and single-leg stance time (p < 0.001). The AG improved handgrip strength (25.62 ± 2.81 to 27.57 ± 2.13 kg), 60-s abdominal curl-up performance (26.89 ± 2.93 to 41.56 ± 3.05 repetitions), pelvic tilt alignment (10.94 ± 3.46 to 7.63 ± 0.17), and single-leg stance time (29.49 ± 2.81 to 34.65 ± 2.60 s), whereas the CG showed no meaningful changes. No significant interaction effects were observed for head displacement, shoulder asymmetry, hip alignment, or knee alignment (all p > 0.05). These preliminary findings suggest that a structured aquatic exercise program incorporating multiple immersion depths may improve muscle strength, trunk muscular endurance, pelvic tilt alignment, and static balance in middle-aged women compared with a non-exercise control group. However, because this study did not include a fixed-depth aquatic exercise comparator, the findings should not be interpreted as evidence that exercise incorporating multiple immersion depths is superior to fixed-depth aquatic exercise. Full article

Assessment of trunk function in sports settings remains challenging, as conventional strength measurements may not reflect integrated trunk stabilization. Abdominal pressure (AP), measured non-invasively using an abdominal cuff device, has been proposed as an indicator of coordinated trunk muscle activity; however, its association with sport-specific performance remains unclear. This study examined the within-session reliability of AP and its task-specific associations with performance measures in adolescent female volleyball players. Twenty-six athletes participated in this cross-sectional study. AP was measured twice within a single session, and reliability was evaluated using intraclass correlation coefficients (ICCs), standard error of measurement, minimal detectable change, and Bland–Altman analysis. Associations between AP and 20 m sprint time, T-test performance, and countermovement jump (CMJ) height were assessed using Pearson’s and partial correlations controlling for normalized trunk and hip flexion strength (N/kg). AP showed high reliability (ICC(3,1) = 0.941; 95% CI: 0.873–0.973). AP was significantly correlated with 20 m sprint time and T-test performance, but not with CMJ height. The association with sprint performance remained after adjustment, whereas that with T-test performance was attenuated. These findings suggest that AP is associated with sprint performance and may reflect task-specific associations, rather than representing a generalized or mechanistic indicator of trunk stabilization. Further longitudinal and interventional studies are needed to clarify causal relationships. Full article