OBJECTIVE: To study the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in individuals with dystrophinopathy compared with the general population.
METHODS: Retrospective chart review to examine the prevalence of ADHD and ASD, diagnosed both formally and informally, in individuals with dystrophinopathy receiving care in the multidisciplinary neuromuscular clinic at the Ann and Robert H. Lurie Children\'s Hospital of Chicago.
RESULTS: Our results demonstrate an ADHD prevalence of 18.40% and ASD prevalence of 12.73%, both significantly higher than those reported for the general population. Our results revealed a significant association between ADHD diagnosis and a positive family history but did not show a statistically significant association between prevalence of ADHD and the use of steroids.
CONCLUSIONS: Based on our current study results, we plan to further evaluate the prevalence, in a prospective cross-sectional manner, using validated screens for both ADHD and ASD.

UNASSIGNED: Firefighter physical fitness (PF) plays a crucial role in mitigating health issues and supporting occupational performance. The influence of rank on firefighter PF remains understudied and previous research is often limited by small sample sizes of firefighters volunteering for research studies, potentially biasing results towards fitter firefighters not representative of entire departments.
UNASSIGNED: To examine the PF profile of firefighters in a large urban fire department and the influence of age and rank on PF.
UNASSIGNED: Data, including muscular fitness, estimated aerobic capacity (VO2max), and body fat percentage (BF%) measures from 1361 firefighters (90% male; age: 37.4±10.1yrs; 60 recruits, 973 firefighters, 290 lieutenants/captains, 38 chiefs) were analyzed. Correlation and ANCOVAs were conducted to examine the impact of rank on PF while controlling for age. Score distributions were scrutinized to profile the PF of the department.
UNASSIGNED: Age was negatively associated with pull-ups (r = - 0.39), sit-ups (r = - 0.39), and push-ups (r = - 0.32), but positively associated with relative VO2max (r = 0.17) and BF% (r = 0.39). Rank had a statistically significant, but trivial effect size, on pull-ups (p = 0.028, η2 = 0.007) and sit-ups (p = 0.034, η2 = 0.005). Firefighters with lower PF levels were older, had higher BF%, lower fat-free mass, and were a greater proportion of females.
UNASSIGNED: Firefighters exhibited diverse levels of PF. Age, not rank, appeared to influence firefighters\' PF. The findings that firefighters who were older, female, with poorer body composition are more likely to have lower PF levels highlights the need for individualized PF training to enhance occupational performance and health across the fire department.

Primary intramuscular hydatid cysts are uncommon due to the contractile nature of muscles and their lactic acid content. Hydatid cysts with spinal extension are sometimes seen with primary vertebral body involvement. Our patient presented with a slow-growing posterior abdominal wall mass, and upon magnetic resonance imaging (MRI), it was revealed to be several cystic lesions in the abdomen wall with extension through the neural foramina into the spinal canal. The key differentials for spinal canal masses with neural foraminal expansion and muscle involvement are peripheral nerve sheath tumors. Our case report adds hydatid cysts to the differentials for well-defined cysts with variable intensities on MRI.

Ventricular septation is a complex process which involves the major genes of cardiac development, acting on myocardial cells from first and second heart fields, and on mesenchymal cells from endocardial cushions. These genes, coding for transcription factors, interact with each other, and their differential expression conditions the severity of the phenotype. In this chapter, we will describe the formation of the ventricular septum in the normal heart, as well as the molecular mechanisms leading to the four main anatomic types of ventricular septal defects: outlet, inlet, muscular, and central perimembranous, resulting from failure of development of the different parts of the ventricular septum. Experiments on animal models, particularly transgenic mouse lines, have helped us to decipher the molecular determinants of ventricular septation. However, a precise description of the anatomic phenotypes found in these models is mandatory to achieve a better comprehension of the complex mechanisms responsible for the various types of VSDs.

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability.
OBJECTIVE: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session.
METHODS: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes.
RESULTS: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=-0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants\' performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program.
CONCLUSIONS: The study\'s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation.

UNASSIGNED: Currently, the fusion of technology and sports is inevitable. The integration of various systems and devices has brought about significant transformations in established sports practices, impacting not only the rules but also physiological, biomechanical, and even psychological aspects.
UNASSIGNED: The purpose of this study was to analyze the effect of an attention intervention through a video game on young soccer players.
UNASSIGNED: Twelve young male soccer players (age: mean 8.5, SD 1 years) were divided into 2 groups: a control group (CG; n=10) and an experimental group (EG; n=10). During the 6-week training program, the EG received attention training through a video game twice a week for 15 minutes per session. Pre- and postintervention measurements included a specific decision-making soccer test and interviews with coaching staff. Additionally, success in the video game, muscular activity, and sweat levels were monitored.
UNASSIGNED: The EG demonstrated a significant improvement in video game success following the intervention program, as indicated by the achieved level (P<.001). However, no significant differences were found between groups regarding electromyographic (EMG) activity (P=.21) and sweating (P=.20). Prior to implementing the attention training program, both groups exhibited similar data for variables related to decision-making and execution mechanisms (≤10%). Only 2 decision-making variables exceeded 10% but remained below 15% (Shot_D=13.35%; Marking_with_Ball_D=-12.64%). Furthermore, changes in attacking action variables were more pronounced in execution-related variables, except for dribbling and fixing. Conversely, in defensive action variables, changes were greater in decision-related variables, except for marking with the ball and marking without the ball.
UNASSIGNED: Our findings reveal that incorporating a specific attentional video game into a soccer training program enhances decision-making compared to a program without the video game. Therefore, it is advisable for practitioners to consider using this tool due to its high efficiency in terms of economic and temporal costs, particularly in improving a key psychological variable.

OBJECTIVE: Muscular strength and body composition are important components of health-related fitness (HRF). Grip strength and body fat percent, in particular, are associated with chronic disease and affected by health behaviours. Evidence suggests relationships between the neighbourhood built environment (BE) and HRF exist, however, few studies have focused on grip strength and body fat percent. Therefore, our study aimed to estimate the sex-specific associations between the neighbourhood BE, grip strength, and body fat percent among urban-dwelling Canadian adults.
METHODS: We analyzed cross-sectional survey and HRF data collected in 2011-2015 from 4052 males and 7841 females (Alberta\'s Tomorrow Project, Canada). Grip strength and body fat percent were measured via handgrip dynamometry and bioelectrical impedance analysis, respectively. Walkability (Canadian Active Living Index) and greenness (Normalized Difference Vegetation Index) estimates were linked to participant data. Sex-stratified covariate-adjusted linear regression models estimated the associations between the BE and HRF variables.
RESULTS: Walkability was negatively associated with grip strength and body fat percent in males (β -0.21, 95%CI: -0.31 to -0.11 and β -0.08, 95%CI: -0.15 to -0.02, respectively) and females (β -0.06, 95%CI: -0.10 to -0.01 and β -0.08, 95%CI: -0.14 to -0.02, respectively). Greenness was positively associated with grip strength in males (β 6.99, 95%CI: 3.62 to 10.36) and females (β 2.72, 95%CI: 1.22 to 4.22) but not with body fat percent. Controlling for physical activity and sitting did not attenuate these associations.
CONCLUSIONS: Characteristics of the neighbourhood BE appear to be associated with muscular strength and body composition, independent of physical activity and sedentary behaviour.

UNASSIGNED: Stride Velocity 95th Centile (SV95C) is the first wearable device-derived clinical outcome assessment (COA) to receive European Medicines Agency (EMA) qualification as a primary endpoint in ambulant patients with Duchenne muscular dystrophy (DMD) aged ≥4 years.
UNASSIGNED: To compare SV95C-in its first-ever clinical trial application as a secondary endpoint-with established motor function COAs used in the trial (Four-Stair Climb [4SC] velocity, North Star Ambulatory Assessment [NSAA], and Six-Minute Walk Distance [6MWD]).
UNASSIGNED: SV95C was a secondary endpoint in a subset (n = 47) of participants in the SPITFIRE/WN40227 trial of taldefgrobep alfa, which was discontinued due to lack of clinical benefit. Participants in the ≤48-week SV95C sub-study were 6-11 years old and received corticosteroids for ≥6 months pre-treatment. Pearson correlations were used to compare SV95C with the other COAs. Responsiveness and changes over time were respectively assessed via standardized response means (SRMs) based on absolute changes and mixed models for repeated measures.
UNASSIGNED: SV95C change at Week 24 was -0.07 m/s, with limited variability (standard deviation: 0.16, n = 27). The SRM for SV95C indicated moderate responsiveness to clinical change at the earliest timepoint (Week 12, n = 46), while those of the other COAs did not indicate moderate responsiveness until Week 36 (6MWD, n = 33) or Week 48 (4SC velocity, n = 20; NSAA total score, n = 20). Baseline correlations between SV95C and other COAs were strong (r = 0.611-0.695). Correlations between SV95C change from baseline to Week 48 and changes in other COAs were moderate to strong (r = 0.443-0.678).∥.
UNASSIGNED: Overall, SV95C demonstrated sensitivity to ambulatory decline over short intervals, low variability, and correlation with established COAs. Although the negative trial precluded demonstration of SV95C\'s sensitivity to drug effect, these findings support the continued use of SV95C in DMD clinical trials.

OBJECTIVE: The purposes of this pilot study were to compare short-term outcomes of the Perception-Action Approach (P-AA) and standard care based on 5 components of first-choice interventions listed in the congenital muscular torticollis (CMT) clinical practice guideline. Changes in postural alignment, symmetrical use of both sides of the body during movement and play, gross motor development, and behavior observed during therapy were considered.
METHODS: Thirty-two participants were enrolled in a 2-group (P-AA and standard care) randomized, single-blind trial with pre-posttest measures. Participants were infants with CMT, age range 5 to 35 weeks at enrollment. Outcome measures administered at initial and final evaluations included still photography, arthrodial goniometry, Muscle Function Scale, Alberta Infant Motor Scale, and Functional Symmetry Observation Scale. Participants in both groups attended 3 intervention sessions. Their behavior exhibited during therapy was compared using the Therapy Behavior Scale Version 2.2.
RESULTS: Data collection was interrupted by the COVID-19 pandemic lockdown. Twenty-four infants completed the study (10 in P-AA and 14 in the standard care group). There were no significant differences between the groups in performance at initial and final evaluations. Both groups improved on most outcome measures. The P-AA group made greater gains on the Functional Symmetry Observation Scale, and the Therapy Behavior Scale Version 2.2 scores were higher in the P-AA group; however, these results did not reach significance.
CONCLUSIONS: Results suggest that similar short-term outcomes may be obtained in infants with CMT undergoing P-AA and standard care interventions. Definitive conclusions regarding the efficacy of the P-AA in infants with CMT cannot be made at this time. Nevertheless, the pilot findings provide valuable preliminary data for a future efficacy trial, which will require funding.
CONCLUSIONS: This was the first randomized controlled trial to provide evidence for use of P-AA intervention in infants with CMT.
BACKGROUND: Compared to standard treatment, the Perception-Action Approach (P-AA) provided similar short-term benefits to infants with congenital muscular torticollis. The P-AA group participants demonstrated higher symmetry and behavior scores, which needs to be confirmed in a larger future study.

Precise protein supplementation strategies for muscle improvement are still lacking. The timing or type of protein supplementation has been debated as a window of opportunity to improve muscle mass, strength, and physical performance. We conducted a network meta-analysis of randomized controlled trials with protein supplements and resistance training. PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases were searched until May 1, 2023. We included 116 eligible trials with 4,711 participants that reported on 11 timing and 14 types of protein supplementation. Compared with placebo, protein supplementation after exercise (mean difference [MD]: 0.54 kg [95% confidence intervals 0.10, 0.99] for fat-free mass, MD: 0.34 kg [95% confidence intervals 0.10, 0.58] for skeletal muscle mass) and at night (MD: 2.85 kg [0.49, 5.22] for handgrip strength, MD: 12.12 kg [3.26, 20.99] for leg press strength) was most effective in improving muscle mass and strength, respectively (moderate certainty). Milk proteins (milk, whey protein, yogurt, casein, and bovine colostrum), red meat, and mixed protein were effective for gains in both muscle mass and strength (moderate certainty). No timing or type of protein showed a significant enhancement in physical performance (timed up-to-go test, 6-min walk test, and gait speed). Pre/postexercise and Night are key recommended times of protein intake to increase muscle mass and strength, respectively. Milk proteins are the preferred types of protein supplements for improving muscle mass and strength. Future randomized controlled trials that directly compare the effects of protein timing or types are needed. This trial was registered at International Prospective Register of Systematic Reviews as CRD42022358766.