ABSTRACTThe purpose of this study was to investigate the effect of a supplementation with specific collagen peptides (SCP) combined with resistance training (RT) on changes in structural properties of the patellar tendon. Furthermore, tendon stiffness as well as maximal voluntary knee extension strength and cross-sectional area (CSA) of the rectus femoris muscle were assessed. In a randomized, placebo-controlled study, 50 healthy, moderately active male participants completed a 14-week resistance training program with three weekly sessions (70-85% of 1 repetition maximum [1RM]) for the knee extensors. While the SCP group received 5g of specific collagen peptides daily, the other group received the same amount of a placebo (PLA) supplement. The SCP supplementation led to a significant greater (p < 0.05) increase in patellar tendon CSA compared with the PLA group at 60% and 70% of the patellar tendon length starting from the proximal insertion. Both groups increased tendon stiffness (p < 0.01), muscle CSA (p < 0.05) and muscular strength (p < 0.001) throughout the intervention without significant differences between the groups. The current study shows that in healthy, moderately active men, supplementation of SCP in combination with RT leads to greater increase in patellar tendon CSA than RT alone. Since underlying mechanisms of tendon hypertrophy are currently unknown, further studies should investigate potential mechanisms causing the increased morphology adaptions following SCP supplementation.Trial registration: German Clinical Trials Register identifier: DRKS00029244..
A daily supplementation of 5 g of specific collagen peptides during 14 weeks of high-load resistance training increase patellar tendon hypertrophy compared to the same training regimen and placebo.The resistance training-induced CSA increase, which was most pronounced on proximal and medial patellar tendon sites, is uniformly potentiated along the entire tendon length by supplementation.Patellar tendon stiffness, CSA of the rectus femoris muscle and maximal voluntary knee extension strength increase due to training independently from supplementation.Increased tendon CSA as a result of a stimulating effect of the supplementation with specific collagen peptides on collagen synthesis might be able to decrease tendon stress and support tendon healing.

UNASSIGNED: Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed.
UNASSIGNED: Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab.
UNASSIGNED: A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups.
UNASSIGNED: Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.

UNASSIGNED: Sarcopenia is an age-related skeletal muscle dysfunction syndrome that is lacking validated treatments. Maximizing muscle strength in young adulthood may be a promising way to prevent sarcopenia in the elderly. The phytomolecule puerarin has been extensively used in clinical practice and reported to increase energy metabolism in skeletal muscle by directly targeting the skeletal muscle fiber. However, the bioavailability of puerarin is very poor, and almost 93% of puerarin stays in the intestine until excretion. Therefore, we hypothesize that puerarin may regulate gut microbiota to improve skeletal muscle strength and/or mass in adults.
UNASSIGNED: Twenty three-month old male Sprague Dawley rats were divided into two groups according to average weights, puerarin group (puerarin dissolved in 0.5% CMC-Na, 150 ​mg/kg/day, N ​= ​10), and control group (equal volume 0.5% CMC-Na, N ​= ​10). The treatment lasted for 8 weeks. Muscle weight, muscle fiber types and cross-sectional area (CSA), ex vivo muscle contraction test and grip strength were measured. 16S rDNA sequencing was employed to evaluate the gut microbiota composition in the sample of cecal content. Short-chain fatty acids (SCFAs) in cecal and serum were analyzed by gas chromatography-mass spectrometry. Adenosine triphosphate (ATP) concentration in skeletal muscle was also detected. Pearson\'s correlation was used to analyze the relations between SCFAs, ATP concentration and muscle function.
UNASSIGNED: After puerarin treatment, grip strength, the specific twitch force, and the tetanic forces in the soleus (SOL) and extensor digitorum longus (EDL) muscle were significantly higher than those of the control group. The percentage and CSA of type II muscle fiber in EDL was higher in the puerarin group than those in the control group. Puerarin treatment significantly changed the gut microbial constitutes. Two SCFAs-productive microbiota, the families Peptococcaceae and Closteridiales, were significantly higher in the puerarin group than those in the control group, while the ratio of Prevotellaceae/Bacteroidaceae (P/B), a muscle atrophy indicator, was lower in the puerarin group. As expected, there were significant linear correlations between the concentrations of SCFAs, including cecal total SCFAs, serum n-butyric acid and total SCFAs, and skeletal muscle strength and function, including the twitch force and tetanic force of SOL and EDL, as well as the forelimb grip strength.
UNASSIGNED: In conclusion, puerarin improved the forelimb grip strength and muscle contraction function in young adult rats. The underlying mechanism may include that puerarin increased SCFAs production by regulating gut microbiota, augmented ATP synthesis and skeletal muscle strength. The translational potential of this article : Our study finds that a clinical used phytomolecule puerarin has the potential of improving skeletal muscle strength in young adult rats. As puerarin has long-term clinical experience and shows good safety, it might be a potential candidate for developing muscle strengthening agents.

UNASSIGNED: Sarcopenia is a new and emerging risk factor aggravating the quality of life of elderly population. Because Korean Red Ginseng (RG) is known to have a great effect on relieving fatigue and enhancing physical performance, it is invaluable to examine its potential as an anti-sarcopenic drug.
UNASSIGNED: Anti-sarcopenic effect of non-saponin fraction of Korean Red Ginseng (RGNS) was evaluated in C2C12 myoblasts treated with C2-ceramide to induce senescence phenotypes, and 22-month-old mice fed with chow diet containing 2% RGNS (w/w) for 4 further months.
UNASSIGNED: The RGNS treatment significantly alleviated cellular senescence indicated by intracellular lipid accumulation, increased amount of lysosomal β-galactosidase, and reduced proliferative capacity in C2C12 myoblasts. This effect was not observed with saponin fraction. In an aged mouse, the 4-month-RGNS diet significantly improved aging-associated loss of muscle mass and strength, assessed by the weights of hindlimb skeletal muscles such as tibialis anterior (TA), extensor digitorum longus (EDL), gastrocnemius (GN) and soleus (SOL), and the cross-sectional area (CSA) of SOL muscle, and the behaviors in grip strength and hanging wire tests, respectively. During the same period, an aging-associated shift of fast-to slow-twitch muscle in SOL muscle was also retarded by the RGNS treatment.
UNASSIGNED: These findings suggested that the long-term diet of RGNS significantly prevented aging-associated muscle atrophy and reduced physical performance, and thus RGNS has a strong potential to be developed as a drug that prevents or improves sarcopenia.

OBJECTIVE: Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring.
METHODS: We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.
RESULTS: FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures.
CONCLUSIONS: Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.

Patients with chronic kidney disease are at elevated risk for adverse events after traditional coronary angiography and percutaneous intervention with contrast media. The case presented in this report highlights the potential benefits of zero-contrast multivessel percutaneous coronary intervention in a patient presenting with a non-ST-segment elevation acute coronary syndrome. (Level of Difficulty: Beginner.).

UNASSIGNED: To determine whether physical activity is associated with lower limb muscle size and strength within the general population.
UNASSIGNED: Six databases were systematically searched from inception using 3 main constructs: lower extremity, muscle volume, and muscle strength.
UNASSIGNED: Studies that measured physical activity (using either objective or subjective measurements), lower limb muscle size, and strength were included. Available discrete group data were standardized using previously published age- and sex-specific normative values prior to analysis.
UNASSIGNED: The final analysis included 47 studies from an initial yield of 5402 studies. Standardized scores for outcome measures were calculated for 97 discrete groups.
UNASSIGNED: As anticipated, lower limb muscle size was positively correlated with lower limb muscle strength (r=0.26, P<.01; n=4812). Objectively measured physical activity (ie, accelerometry, pedometry) (n=1944) was positively correlated with both lower limb muscle size (r=0.30, P<.01; n=1626) and lower limb strength (r=0.24, P<.01; n=1869). However, subjectively measured physical activity (ie, questionnaires) (n=3949) was negatively associated with lower limb muscle size (r=-0.59, P<.01; n=3243) and lower limb muscle strength (r=-0.48, P<. 01; n=3882).
UNASSIGNED: This review identified that objective measures of physical activity are moderately associated with lower limb muscle size and muscle strength and can, therefore, be used to predict muscle changes within the lower limbs associated with exercise-based rehabilitation programs.

Modification of bone is continuous throughout life and influenced by many factors, including physical activity. This study investigated changes in areal bone mineral density (aBMD) and hip structure among male and female collegiate distance runners and non-athlete controls over 12 months. Using dual-energy x-ray absorptiometry (DXA) and hip structure analysis (HSA) software, aBMD at the posterior-anterior (PA) and lateral spine, femoral neck, total hip (TH), whole body (WB), and bone geometry at the narrow neck (NN) of the femur was measured three times over 12 months. HSA included cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and Z-section modulus (Z). Male runners had significantly higher aBMD at TH and WB and greater CSA, CSMI, and Z than male controls at the end of 12 months. Female controls had higher aBMD at the PA spine than female runners at the end of 12 months. Male runners had significant increases in aBMD at the PA (p = 0.003) and lateral spine (p = 0.002), and TH (p = 0.002), female runners had significant decreases in aBMD at TH (p = 0.015) and WB (p = 0.002), male controls had significant increases in aBMD at the PA spine (p < 0.001) and WB (p < 0.001), and female controls had significant decreases in aBMD at lateral spine and TH (p = 0.008) over the year. When applying covariates of bone-free lean mass and vitamin D, male distance runners demonstrated significant improvement in CSA (3.602 ± 0.139 vs. 3.675 ± 0.122 cm2, p = 0.05), CSMI (3.324 ± 0.200 to 3.467 ± 0.212 cm4, p < 0.05), and Z (1.81 ± 0.08 to 1.87 ± 0.08 cm3, p = 0.05) during the study. No other changes in hip structure occurred over the year. Distance running may be beneficial to aBMD and hip structure in college-age males but not females. Further research is needed on potential influences of weight-bearing activity, energy availability, and hormonal status on aBMD and hip structure in males and females.

UNASSIGNED: Cross-sectional area (CSA) measurement of the ulnar nerve in the adult population by using ultrasonography (US) at elbow extension and flexion has previously been reported, but not much evidence showed a significant difference between elbow extension and flexion position.
UNASSIGNED: To compare the ulnar nerve CSA between elbow extension and flexion position.
UNASSIGNED: A comparative cross-sectional study was conducted by involving 36 healthy adults with normally functioning ulnar nerve proven by Nerve Conduction Study (NCS) or Electroneurography. The ulnar nerve CSA was measured on each elbow by using US at the level of the medial epicondyle, 2 cm distal and 2 cm proximal from the medial epicondyle.
UNASSIGNED: The average ulnar nerve CSA at the medial epicondyle, 2 cm distal and proximal to the medial epicondyle at elbow extension respectively were 5.95 ± 0.74 mm2, 6.27 ± 0.92 mm2, and 5.92 ± 0.73 mm2. At elbow flexion, the average ulnar nerve CSA at the positions was 5.70 ± 0.83 mm2, 5.23 ± 0.87 mm2, dan 5.73 ± 0.71 mm2 respectively. The CSA of the ulnar nerve at elbow extension was significantly larger compared to the flexion position in the three areas observed in this study (p < 0.001).
UNASSIGNED: The CSA of the ulnar nerve at elbow extension position was larger compared to the flexion position. Elbow position should be considered in measuring CSA of the ulnar nerve.

UNASSIGNED: To compare the magnitude changes in muscle thickness (MTH) of the anterior mid-thigh between the supine and standing postures.
UNASSIGNED: Experimental.
UNASSIGNED: University hospital laboratory.
UNASSIGNED: Inpatients (N=283) between the ages of 29 and 93 years (193 men, 90 women) with cardiovascular disease who volunteered for this study.
UNASSIGNED: Not applicable.
UNASSIGNED: MTH of the anterior mid-thigh was measured with a 10 MHz ultrasound probe while the participants stood or lay supine in a relaxed position with their arms extended and by their sides.
UNASSIGNED: Age and percentage of body fat were greater (P<.01) in women than in men (74.3±12.3 vs 67.7±12.1y and 32.6±10.3% vs 27.4±7.4%, respectively), but standing height, body weight, and body mass index were greater (P<.01) in men than in women (164.9±6.3 vs 149.1±7.5 cm, 65.4±12.7 vs 49.5±11.1 kg, and 23.8±3.9 vs 22.1±4.4 kg/m2, respectively). Correlations were found between the standing posture and supine position in the anterior-mid thigh MTH for both men (r=0.85; P<.01) and women (r=0.82; P<.01). In the anterior-mid thigh for men and women, MTH was greater in the standing posture (3.7±1.0 vs 2.5±0.7 cm) than in supine position (3.1±0.8 vs 2.1±0.7 cm) (both P<.01).
UNASSIGNED: In this study, MTH of the anterior mid-thigh during prolonged hospitalization was approximately 16% higher in men than in women regardless of posture, and was approximately 32% higher in standing posture than in the supine position regardless of sex.