Search Results (66)

Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article

Background/Objectives: Increasing evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN), a well-established cardiometabolic risk factor, both negatively impact bone metabolism. This study aimed to investigate the associations between bone turnover markers (BTMs)—namely, osteopontin (OPN) and procollagen type 1 N-terminal propeptide (P1NP)—and metabolic health indicators, non-invasive measures of liver disease severity, as well as skeletal muscle mass (SMM), muscle strength, and bone mineral density (BMD) in patients with MASLD and HTN. Methods: We enrolled 117 patients diagnosed with MASLD and HTN and conducted anthropometric measurements, laboratory analyses, abdominal ultrasound, and point shear-wave elastography. Muscle strength was evaluated using grip strength measurements and the Five Times Sit-to-Stand Test (FTSST). SMM and BMD were quantified using dual-energy X-ray absorptiometry (DEXA). Serum OPN and P1NP concentrations were quantified using enzyme-linked immunosorbent assays (ELISAs). Results: Serum OPN concentrations below 2.89 ng/mL were associated with significantly elevated levels of AST (p = 0.001), ALT (p = 0.006), and GGT (p = 0.025), while serum P1NP concentrations above 47.5 pg/mL were associated only with significantly elevated GGT levels (p = 0.024). In addition, patients with MASLD and HTN with lower serum OPN levels had higher liver stiffness values (p = 0.003). Serum OPN concentrations were inversely associated with the following metabolic health indicators: waist circumference (WC, p < 0.001) and epicardial fat thickness (EFT, p = 0.001). In addition, they were significantly elevated in patients with MASLD and HTN who had decreased spinal BMD (p = 0.017). In turn, serum P1NP levels were reduced in patients with decreased SMM (p = 0.023). Conclusions: These findings in patients with MASLD and HTN suggest an association between serum P1NP levels and SMM, and between OPN levels and spinal BMD, indicating a potential interplay among liver function, muscle mass, and bone health. Furthermore, OPN appeared to be strongly associated with overall metabolic health indicators, such as WC and EFT, whereas P1NP exhibited a stronger association with muscle mass. Full article

The abdominal drawing-in maneuver (ADIM) is one of the most valuable exercises for explicitly targeting and strengthening the transversus abdominis (TrA), a key muscle in the deep core. However, using the ADIM for the selective training of the transverse abdominis can be challenging for certain individuals. This study investigated the effects of combining ADIM with blood flow restriction (BFR) training on TrA strengthening in sedentary university students. Forty university students with sedentary lifestyles (mean age: 23.28 ± 2.468 years; range 20–25 years) were randomly assigned to an ADIM+BFR group and a control group (ADIM only). Both groups underwent 25 min ADIM training sessions twice weekly for four weeks. Ultrasound measurements assessed TrA thickness, contraction ratio, and preferential activation. Core stability, strength, and endurance were evaluated using the double leg lowering, abdominal strength, and abdominal static endurance tests. The ADIM+BFR group showed significant improvements in TrA thickness, contraction ratio, and preferential activation compared to the control group following the four-week training intervention (p < 0.05). The ADIM+BFR group demonstrated improved core stability and enhanced abdominal strength and endurance compared to the control group (p < 0.05). The results support the effectiveness of ADIM+BFR training in enhancing TrA contraction and activation in sedentary university students. This approach also improves core stability, strength, and endurance. BFR provides a novel and readily applicable method for promoting TrA activation during ADIM training. Full article

Introduction: Adequate protein intake is essential for maintaining lean body mass during weight loss, particularly for patients undergoing bariatric surgery (BS). Whey protein supplementation may help meet daily protein requirements. This study aimed to assess the effects of whey protein supplementation on weight loss and body composition in women during the medium-term postoperative phase following BS. Methods: In a double-blind, controlled study over four weeks, 24 women received 30 g of whey protein (Whey group), while 19 received 30 g of maltodextrin (Malto group). Body composition, energy expenditure, muscle thickness, muscle strength, walking performance, and dietary intake were evaluated. Results: Compared to the Malto group, the Whey group showed greater reductions in body weight (median: −0.6 kg vs. −0.2 kg, respectively) and fat mass (median: −1.1 kg vs. −0.25 kg, respectively), along with an increase in fat-free mass (−0.7 kg vs. 0.6 kg, respectively). Muscle thickness improved in the Whey compared to the Malto group in the abdominal (0.07 mm vs. −0.04 mm, respectively) and thigh (0.4 mm vs. −0.15 mm, respectively) regions. Additionally, muscle mass reduction was less pronounced in the Whey group (−3 kg vs. −0.13 kg). No significant differences were observed in handgrip strength, gait speed, or nutrient intake. Conclusions: Whey protein supplementation may be beneficial, as it enhances weight loss and preserves fat-free and muscle mass more effectively than a diet without this supplementation in women during the stabilization phase or late postoperative period of BS. Full article

Background and Objectives: This study aimed to evaluate the predictive value of ultrasonographic abdominal muscle thickness and thickening ratios for expiratory muscle strength in SCI patients. Materials and Methods: A case-controlled, cross-sectional study was conducted with 36 SCI patients and 30 age- and sex-matched healthy controls. Ultrasonographic measurements of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were performed at rest and during forced expiration. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. Correlation and regression analyses were performed to determine the relationship between ultrasonography (USG) parameters and expiratory muscle function. Results: SCI patients exhibited significantly lower MIP (76.27 ± 29 cmH₂O vs. 91.63 ± 17.3 cmH₂O, p = 0.007) and MEP (64.52 ± 21.55 cmH₂O vs. 119.1 ± 26.48 cmH₂O, p < 0.001) compared to healthy individuals. Ultrasonographic measurements revealed a significant reduction in forced thickness and thickening ratios of EO, IO, and TrA muscles in SCI patients (p < 0.001). MEP was positively correlated with EO forced thickness (r = 0.333, p = 0.047), IO forced thickness (r = 0.501, p = 0.002), and TrA forced thickness (r = 0.530, p = 0.001). Multiple linear regression analysis identified TrA forced thickness as the strongest predictor of MEP (β = 0.49, p = 0.001). Conclusions: Ultrasonographic measurements of abdominal muscle thickness and thickening ratios provide valuable insights into expiratory muscle dysfunction in SCI patients. TrA forced thickness demonstrated the strongest association with MEP, suggesting its potential as a novel, non-invasive biomarker for expiratory muscle weakness. These results support the use of USG as a practical clinical tool for guiding respiratory assessment and rehabilitation strategies in patients with spinal cord injury. Full article

This study investigated whether the supplementation of prebiotic inulin to gestating sows programmatically affects offspring growth performance and meat quality while exploring its epigenetic effects through histone acetylation modulation. After mating, sixty multiparous sows (Landrace × Yorkshire; parity 2–3) were assigned to a 2 × 2 factorial arrangement with inulin (0% vs. 1.5%) and fat (0% or 5%) supplementation until farrowing. Post-weaning, five litters (10 piglets per litter) per treatment were selected and maintained in their original litter for fattening under standardized feeding. The results demonstrated that maternal inulin supplementation during gestation accomplished the following: (1) Increased offspring liver index by 13.4% at weaning and 6.8% at finishing (p < 0.05) while reducing the finishing-phase backfat thickness by 11.6% (p < 0.01), with a significant inulin × fat interaction attenuating fat-induced abdominal lipid accumulation at weaning (p = 0.05). (2) Decreased longissimus dorsi muscle lightness (L*) by 4.5% in finishing pigs (p = 0.02) without altering the other meat quality parameters. (3) Suppressed offspring liver lipid deposition at birth and finishing (p < 0.05), concomitant with upregulated hepatic PGC-1α and CPT1A expression (p < 0.05). (4) Elevated neonatal serum butyrate by 15.6% (p = 0.06) while inhibiting hepatic histone deacetylase (HDAC) activity and enhancing histone H3/H4 acetylation (p < 0.01). These findings suggest that maternal inulin supplementation during gestation mitigates offspring hepatic lipid deposition through butyrate-mediated epigenetic regulation, where microbial-derived butyrate from inulin fermentation inhibits HDAC activity, enhances histone acetylation levels, and upregulates fatty acid β-oxidation gene expression. This study provides novel mechanistic insights into how maternal dietary fiber nutrition programs offspring development through epigenetic reprogramming. Full article

Reliable acoustic coupling in a non-handheld mode and reducing the form factor of electronics are specific challenges in making ultrasound wearable. Applications relying on a large field of view (such as tracking of large muscles) induce a need for a large element count to achieve high image quality. In our work, we developed a 256-element linear array for imaging of abdominal muscles with four integrated custom-developed 8:32 multiplexer Integrated Circuits (ICs), allowing the array to be driven by our compact 32 ch electronics. The system is optimized for flexible use in R&D applications and allows adjustable transmit voltages (up to +/−100 V), arbitrary delay patterns, and 12-bit analog-to-digital conversion (ADC) with up to 50 MSPS and wireless (21.6 MBit/s) or USB link. Image metrics (SLL, FWHM) were very similar to a fully populated array driven with a 256 ch system. The contrast allowed imaging of lesions down to 7 cm in the phantom. In a first in-vivo study, we demonstrated reliable acoustic contact even during exercise and were able to visualize deep abdominal muscles such as the TrA. In combination with a muscle tracking algorithm, the change of thickness of the TrA during SSE could be monitored, demonstrating the potential of the approach as biofeedback for physiotherapy training. Full article

Bowel sounds, produced by intestinal peristalsis, are essential for diagnosing gastrointestinal disorders. However, acquiring and analyzing bowel sounds is challenging due to their unpredictable nature and individual variability. Biological tissues can affect bowel sounds during propagation, resulting in varying degrees of signal attenuation between the sound source and the transducer. This study aims to develop a numerical model of bowel sound propagation in the abdominal cavity, focusing on the impact of different biological layers on signal attenuation. Validation of the model demonstrated strong consistency between simulated and actual bowel sound signals, confirming the model’s accuracy and reliability. The model accounted for adipose tissue thickness, ranging from 5 to 20 mm across individuals, while muscle and skin thicknesses remained constant. Results indicated that signal attenuation increases with both the propagation distance and adipose tissue thickness. These findings provide insights into how tissue layers influence bowel sound propagation, offering a theoretical foundation for developing personalized and precise monitoring devices. Full article

Background/Objectives: Endometriosis is a benign condition affecting up to 10% of women at reproductive age. The urinary tract is affected in 0.3–12.0% of women with endometriosis and in 19.0–53.0% of women with deep infiltrating endometriosis. The bladder is the most commonly affected organ in the urinary tract. Bladder endometriosis is defined by the presence of endometriosis lesions in the detrusor muscle, with partial or complete thickness involvement. Methods: This was a retrospective study. The study analyzed surgical reports of 11,714 patients who underwent endometriosis laparoscopy, and included only 42 patients with bladder endometriosis. Results: We found that 0.35% of patients with endometriosis had bladder endometriosis. In total, 29 patients underwent phone follow-up. In total, 26 patients (90%) reported a general improvement in their symptoms (e.g., improving the dysmenorrhea, lower abdominal pain), with a 100% improvement in their dysuria. Only two patients (7%) reported no change in symptoms (dysmenorrhea and dyspareunia). Conclusions: Gynecologists can perform laparoscopic surgical treatment of bladder endometriosis in most cases. If ureteroneocystostomy is required or the localization of the endometriosis nodule is unfavorable, an intervention by an interdisciplinary team is recommended. Both laparoscopic partial bladder resection and shaving can be considered effective methods with low complication risk. This surgical approach requires excellent laparoscopic skills. Full article

Abdominal wall endometriosis (AWE) is a clinical disorder with unknown pathogenesis with an incidence between 0.03% and 1% in women affected by cutaneous/scar endometriosis. We investigated the pathological, molecular cytogenetic and cell proliferation features of a primary AWE developed in rectus abdominis muscle in a patient without co-existing pelvic endometriosis. An investigational model of cultured stromal cells was additionally established. Histologically, the lesion revealed areas of endometrial-like glands surrounded by a thick stromal layer in addition to numerous disseminated foci composed exclusively of stromal cells. Beyond the strong expression of Estrogen (ER) and Progesterone receptors (PRs), consistent immunolabeling for several mesenchymal stromal/stem cell antigens and oncoproteins was revealed in both the endometrioma as well as in the cultured stromal cells. The Fluorescence in situ hybridization (FISH) analysis of the endometrioma demonstrated a structural alteration of the c-MYC protooncogene, with a mean of three gene copies in 3% to 5% of both glandular and stromal cells. The FISH assay applied on the cultured cells showed c-MYC gene amplification, with an average number of more than six gene copies in 18% to 25% of the cellular nuclei. Altogether, these results markedly highlight the pathological and molecular features of idiopathic AWE essential for histo-pathogenetic categorization. Full article

Background/Objectives: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. Methods: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. Results: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (F(2, 42) = 0.548, p = 0.58, partial η² = 0.025) or AB (F(2, 36) = 0.812, p = 0.45, partial η² = 0.043). Both groups reported high levels of exercise enjoyment and low task load. Conclusions: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods. Full article

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing–abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing–contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting–contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting–voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature. Full article

Objectives: This scoping review explores the effectiveness of abdominal hollowing (AH) and abdominal bracing (AB) techniques in enhancing trunk stability and facilitating rehabilitation, particularly for individuals with lower back pain (LBP). Methods: The review synthesizes findings from 22 randomized controlled trials (RCTs) that assessed these techniques’ impacts on muscle activation, pain reduction, and functional outcomes. Results: The results demonstrate that both techniques can significantly improve trunk stability, muscle thickness, balance, and gait. However, a notable gap exists in studies directly comparing AH and AB, raising questions about whether they are equally effective. While AH is often associated with selective activation of the transversus abdominis, AB promotes a broader co-contraction of trunk muscles, contributing to robust spinal stability. Conclusions: This review underscores the need for further research to directly compare these techniques and refine their application in clinical practice. The findings suggest that personalized rehabilitation programs incorporating both AH and AB, tailored to individual patient needs and rehabilitation goals, can be effective in managing and preventing LBP. Full article

Objectives: To identify typical patterns of abdominal wall muscle activation in patients with diastasis recti and inguinal hernias compared to controls during the Valsalva maneuver, voluntary coughing, and physical activity. Methods: The study included 15 subjects: 5 with diastasis recti, 4 with inguinal hernias, and 6 healthy controls. The functions of rectus abdominis (RA) and external oblique (OE) muscles were measured by surface electromyography (sEMG). Using ultrasound, the thicknesses of the RA, OE, internal oblique (IO), and transversus abdominis (TA) muscles were assessed as well as the echo intensity (EI) of RA and OE. Results: We found a significant effect of the type of abdominal wall pathology on the maximum sEMG amplitude (p = 0.005). There was a reliable trend in maximum sEMG amplitude, with the highest one in diastasis recti and a significantly lower one in inguinal hernias. Duncan’s test showed a significant difference in muscle thickness, both on the right and left sides, between patients with diastasis and controls, but only on the left side between patients with diastasis and those with inguinal hernia (p < 0.05). Conclusions: The abdominal wall pathology results in a change in the function and structure of the abdominal muscles, which can be detected using electromyography and ultrasound examination. The presence of diastasis recti is accompanied by an increase in bioelectrical activity and a decrease in thickness. Full article

Peripheral magnetic stimulation has recently been introduced as a non-invasive but effective physical agent to improve muscle strength and everyday function. The aim of this study was to evaluate the feasibility and safety of an exercise program focusing on the abdominal muscles in combination with the peripheral magnetic stimulation of the abdominal muscles. Male and female overweight and obese adults (n = 19) participated in an eight-week exercise program with the additional peripheral magnetic stimulation of the abdominal muscles. Outcome measures included changes in abdominal subcutaneous fat thickness, trunk muscle strength, body composition, and self-reported body satisfaction. Subcutaneous fat thickness was significantly reduced after the intervention (p < 0.01–p < 0.001). Trunk flexion and left side flexion strength increased significantly after the intervention, although no significant changes were observed for trunk extension (p = 0.07) and right side flexion strength (p = 0.13). The body satisfaction self-assessment score significantly increased (p < 0.01), while body mass, body mass index, and fat mass significantly decreased after the intervention (p < 0.05). Our findings suggest that an exercise program with the additional peripheral magnetic stimulation is feasible and safe for overweight and obese participants. These results support the use of peripheral magnetic stimulation as a safe adjunct to the voluntary abdominal muscle contraction. Future studies are needed to evaluate the efficacy of the additional peripheral magnetic stimulation of the abdominal muscles compared to the voluntary contraction of the abdominal muscles alone. Full article