Contribution of Protein Intake and Concurrent Exercise to Skeletal Muscle Quality with Aging.

BACKGROUND: The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass. OBJECTIVES: This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance). MEASUREMENTS: All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding. RESULTS: One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01). CONCLUSION: Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.

Precision of total and regional body fat estimates from dual-energy X-ray absorptiometer measurements.

OBJECTIVES: To evaluate the precision of both total %fat and all the regional %fat measures acquired from both the Lunar Prodigy and Lunar iDXA software. DESIGN: Cross-sectional study. SETTING: University-based research laboratory. PARTICIPANTS: The sample consisted of 300 individual test records from men and women who had volunteered to participate in dual-energy x-ray absorptiometer (DXA) technician precision training studies. Subjects ranged in age from 20-84 years and in body mass index from 15.7-52.0 kg.m-2. MEASUREMENTS: A total of 27 different technicians performed three total body scan measurements on 10-15 different subjects. The Lunar Prodigy and Lunar iDXA were used for 253 and 47 precision training evaluations, respectively. The regions of interest (ROI) were automatically determined by the enCORE software (autoROI) for total body, android, gynoid, trunk, legs, and arms regions and the region %fat data were used for analyses. RESULTS: The CV for total body %fat was 1.9% and 0.9% for the Prodigy and iDXA, respectively. CV's for %fat measures at regional sites ranged from 1.2-4.4% for the Prodigy measures and 0.9-2.4% for the iDXA measures. The ICC for both devices ranged from 0.990 to 0.999. CONCLUSION: Monitoring the status of body composition changes with age is gaining more clinical acceptance. Thus, it is important that practitioners use measures that are both precise and accurate. The findings from the current study add support that DXA measurements can be used with a high level of confidence for serial testing of patients.

Association between objectively measured sedentary behavior and body mass index in preschool children.

OBJECTIVE: To determine the association between accelerometry-derived sedentary behavior and body mass index (BMI) z-score in preschool children, and to determine whether the association changed when applying three different accelerometry cutpoints for sedentary behavior. DESIGN AND SUBJECTS: Cross-sectional design. Data came from two completed studies: Children's Activity and Movement in Preschool Study (CHAMPS) and the Environmental Determinants of Physical Activity in Preschool Children (EDPAPC) study. Children of ages 3-5 years with complete data on sedentary behavior, BMI z-score, physical activity and other covariates were included in the analyses (N=263 in CHAMPS and N=155 in EDPAPC). Accelerometry data were summarized as time spent in sedentary behavior (min h(-1)) using three different cutpoints developed specifically for preschool children (<37.5, <200 and <373 counts per 15 s). Linear mixed regression models were used to determine the association between time spent in sedentary behavior and BMI z-score; age, gender, race, parental education, preschools and moderate-to-vigorous physical activity (MVPA) were included as covariates. RESULTS: In both CHAMPS and EDPAPC studies, no independent association between time spent in sedentary behavior and BMI z-score was observed after adjusting for MVPA. The observed null association between sedentary behavior and BMI z-score was maintained even with different sedentary behavior cutpoints. CONCLUSIONS: Regardless of cutpoints used, accelerometry-derived sedentary behavior was not independently associated with BMI z-score in two independent samples of preschool children. Longitudinal studies addressing this research question are needed.

Value of 3D MR lumbosacral radiculography in the diagnosis of symptomatic chemical radiculitis.

BACKGROUND AND PURPOSE: Radiologic methods for the diagnosis of chemical radiculitis associated with anular tears in the lumbar spine have been rare. Provocative diskography is one of the methods for diagnosing diskogenic chemical radiculitis but is invasive. A reliable imaging method for replacing provocative diskography and diagnosing chemical radiculitis is required. Our aim was to investigate the value of 3D MR radiculography depicted by rendering imaging in the diagnosis of symptomatic chemical radiculopathy associated with anular tears. MATERIALS AND METHODS: The study population consisted of 17 patients (age range, 32-88 years) with unilateral radiculopathy. Symptomatic chemical radiculopathy was confirmed with provocative CT diskography and/or provocative selective nerve root block for agreement of sides and levels. Through adhering to the principles of selective excitation (Proset imaging), we acquired 3D coronal FFE sequences with selective water excitation. Morphologic changes in the ipsilateral symptomatic nerve root caused by chemical radiculopathy were compared with those in the contralateral nerve root on 3D MR lumbosacral radiculography. RESULTS: Pain reproduction at the contrast-leak level during diskography (n = 4) and selective nerve root injection (n = 13) showed concordant pain in all patients. All patients with symptomatic chemical radiculopathy showed nerve root swelling in both ipsilateral levels and sides on 3D MR radiculography. The most common nerve root affected by the chemical radiculopathy was the L5 nerve root (n = 13), while the most common segment exhibiting nerve root swelling was the exit nerve root (n = 16). CONCLUSIONS: All patients with radicular leg pain caused by chemical radiculopathy showed nerve root swelling on 3D MR radiculography. We believe that in cases without mechanical nerve root compression caused by disk herniation or stenosis in the lumbar spine, nerve root swelling on 3D MR radiculography in patients with radiculopathy associated with an anular tear may be relevant in the diagnosis of symptomatic chemical radiculopathy.

Combined functional magnetic resonance imaging and transcranial magnetic stimulation evidence of ipsilateral motor pathway with congenital brain disorder: a case report.

We present the case of 28-year-old man with schizencephaly who had mild left hemiparesis with mirror movement. Brain mapping using functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) for both hand muscles was done to evaluate his neurologic state. Motor evoked potential (MEP) from both abductor pollicis brevis (APB) muscles was obtained simultaneously. fMRI showed that the left primary sensorimotor cortex became active when the right fingers performed the flexion-extension exercise. The left primary sensorimotor cortex, left prefrontal area, and both supplementary motor areas were activated with flexion-extension exercise of the left hand. Brain mapping for both APB muscles using TMS showed that no MEP was evoked in the right hemisphere, but a APB total of 5 sites were evoked in the left hemisphere simultaneously. The optimal scalp site for both APB muscles was present at the same site. The MEPs of both muscles which were evoked by stimulation of the optimal scalp site, showed similar latencies, amplitudes, and figures of potential. The similarities in both MEPs and the same optimal scalp site support the assumption that MEPs of both APB muscles are produced by the corticospinal tract originating from the same motor cortex. Our results showed that the ipsilateral motor pathway extended from the unaffected left hemisphere to both hand muscles. This finding may reflect functional reorganization of motor area in a patient with congenital brain disorder.

MR imaging findings of Rathke's cleft cysts: significance of intracystic nodules.

BACKGROUND AND PURPOSE: Rathke's cleft cysts often may be difficult to differentiate from other intrasellar or suprasellar masses on radiologic studies. The purpose of this study was to describe the significance of intracystic nodules, a diagnostic characteristic found in Rathke's cleft cysts, on MR images. METHODS: A retrospective review of MR studies was conducted for 13 patients who, after pathologic analysis, were diagnosed as having Rathke's cleft cyst. These patients underwent unenhanced and contrast-enhanced T1- and T2-weighted axial and coronal spin-echo sequential imaging. The signal intensity and incidence of the intracystic nodules on T1- and T2-weighted images were analyzed. The signal intensity of the nodule was compared with that of white matter and surrounding cyst fluid. The signal intensity of cyst fluid was compared with the intraoperative appearance of the cyst fluid. Biochemical and pathologic analyses of the intracystic nodules were conducted in two cases. RESULTS: An intracystic nodule having high signal intensity on T1-weighted images and low signal intensity on T2-weighted images was observed in 10 (77%) of the cases. At surgery, intracystic nodules were yellow, waxy, solid masses. Pathologic analysis showed this nodule to be a mucin clump. Biochemical analysis of the intracystic nodules showed cholesterol and proteins as the main constituents. In the Rathke's cleft cyst with intracystic nodules, cyst fluid revealed low signal intensity to isointensity relative to the intensity of the nodules on T1-weighted images, and isointensity to high signal intensity on T2-weighted images. Intracystic nodules were clearly visible on T2-weighted images. CONCLUSION: Because cyst fluid of Rathke's cleft cysts shows variable intensities on MR images, the specific diagnosis is often difficult when based on MR signal intensity values alone. The presence of an intracystic nodule with characteristic signal intensities on MR images may be indicative of the diagnosis of Rathke's cleft cyst.

Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica.

STUDY DESIGN: Magnetic resonance imaging of symptomatic herniated lumbar discs was investigated longitudinally and prospectively for the presence of tear in the posterior longitudinal ligament (PLL). OBJECTIVES: To clarify the effect of transligamentous extension through the PLL of herniated disc on its regression and to determine the factors contributing to a successful clinical outcome. SUMMARY OF BACKGROUND DATA: Greater regression of the herniated fragment has been noted with larger initial disc herniations. The exposure of herniated disc materials to the epidural vascular supply through the ruptured PLL has been suspected to play a part in the mechanism of disappearance of the herniated nucleus pulposus. However, it had not been shown clinically. METHODS: Clinical outcomes and magnetic resonance images of 36 patients with symptomatic lumbar disc herniations, treated conservatively, were analyzed. Patients were divided into three groups: subligamentous, transligamentous, and sequestered herniations. The size of the herniated disc was measured by herniation ratio, which is defined as the ratio of the area of herniated disc to that of the thecal sac on the axial view. Factors associated with the natural regression of herniated disc and the successful clinical outcome were explored. RESULTS: Of the 36 herniated discs, 25 decreased in size. Ten (56%) of 18 subligamentous herniations, 11 (79%) of 14 transligamentous herniations, and all 4 (100%) sequestered herniations were reduced in size. The average decreases in herniation ratio of the subligamentous, transligamentous, and sequestered disc groups were 17%, 48%, and 82% respectively. The decrease in herniation ratio was related to the presence of transligamentous extension but was not related to the initial size of herniation. Successful outcome correlated with a decrease in herniation of more than 20%. CONCLUSION: Transligamentous extension of herniated disc materials through the ruptured PLL is more important to its reduction in size than is the initial size of the herniated disc. Decrease in herniation ratio of more than 20% seems to correspond to successful clinical outcome.

Guillain-Barré syndrome: MR imaging findings of the spine in eight patients.

PURPOSE: To evaluate magnetic resonance (MR) imaging findings of the spine in patients with Guillain-Barré syndrome. MATERIALS AND METHODS: MR imaging findings in eight patients (three male, five female; age range, 2-47 years) with Guillain-Barré syndrome were retrospectively reviewed. Guillain-Barré syndrome was diagnosed mainly on the basis of symptoms and also on the basis of supportive ancillary data, such as the results cerebrospinal fluid analysis and electrophysiologic evaluation. In addition, follow-up MR imaging was performed in three patients, who had slight clinical improvement. RESULTS: All patients had thickening of the intrathecal spinal nerve roots and cauda equina, with varying degrees of enhancement on gadolinium-enhanced axial T1-weighted images. Two enhancement patterns were noted. One was enhancement of both the anterior and posterior spinal nerve roots (n = 2); the other was enhancement of the anterior spinal nerve roots only (n = 6). Follow-up MR imaging in the three patients with slight improvement of symptoms revealed that the thickening and the degree of enhancement of the spinal nerve roots were diminished. CONCLUSION: Although the enhancement of the intrathecal spinal nerve roots is not specific to Guillain-Barré syndrome and can be seen in neoplasia and other inflammatory processes, the enhancement of only the anterior spinal nerve roots is strongly suggestive of Guillain-Barré syndrome.

A study on family policy in Korea -- with special focus on the welfare policies for women and children.

PIP: A literature review and survey research analyzed the beneficiaries, the delivery system, and the financing of women's and children's welfare services with laws and supportive government policies to clarify family policy and to improve the situation by expansion of foster care and curtailment of institutionalization of children in Korea. Women's welfare services are classified according to the beneficiaries. In 1989, fatherless families in urgent need numbered 75,889 households or .69% of the total; unwed mothers seeking help from social welfare centers declined from 10,383 persons in 1985 to 6156 persons in 1989; and the number of prostitutes decreased from 17,478 in 1975 to 8033 in 1989. The Welfare Act for Fatherless Families was enacted on April 1, 1989, but as of 1990 no budget allocations had been made. The Prostitution Prevention Law was enacted in 1961, and in 1989 there were 23 vocational guidance centers for such women and 22 vocation counseling centers. There are 10 room-and-board facilities for unwed mothers, a Vocational Guidance Center for Women, 22 comprehensive Women's Counseling Centers (and 79 semicomprehensive ones), and 4 adoption agencies. Article 19 of the Welfare Act for Fatherless Families contains a provision on battered wives, but there is no crisis intervention agency. In 1990 there were 13,677,000 persons under 18 years of age or 31.7% of the population. 663,00 children were in need, 4.8% of al children. There are 54 child counseling centers and 28 temporary protection centers. There are 380 child welfare guidance personnel, and 5225 persons appointed as Child Committee members. The number of abandoned and lost children decreased from 18,791 in 1985 to 11,167 in 1989. The Korean government has recently realized the importance of preventive family policy and embarked on the implementation of a comprehensive family policy with urgent measures to deal with the low-income families, child welfare, and day care.^ieng