Experimental Physiology

Longitudinal muscle growth occurs through the addition of sarcomeres in series, a process termed serial sarcomerogenesis. To investigate contraction mode dependence of sarcomerogenesis in Sprague-Dawley rats (n=36, 14 to18 weeks, ~468g), we compared the effects of isometric, eccentric, and concentric training (4 to 6 weeks; 3 times/week) on morphological and mechanical adaptations of the plantar flexors. Isometric training was performed at a joint angle corresponding to the plateau nearing the descending limb of the force length relationship, eccentric contractions began at a shorter muscle length and lengthened to this same joint position, and concentric contractions started at this lengthened position but then actively shortened. Owing to the rapid regulation of serial sarcomere number the 4-and 6-week timepoints were collapsed. While force output increased across all training modes (+16%; p<0.05), longitudinal muscle growth was regulated by contraction type. Both isometric and eccentric training were highly effective at increasing serial sarcomere number when optimal loading conditions (high forces at longer lengths) are provided (+7-9%; p<0.05). Concentric training, even when initiated at long lengths with high forces was not an effective stimulus for longitudinal remodelling (+2%; p>0.05). Therefore, these findings identify the mechanical loading environment associated with isometric and eccentric training as a key driver of serial sarcomerogenesis.

Detection of postoperative pain in mice is challenging, and there is a need for unbiased, automated methods. Home-cage monitoring systems are promising, but their ability to detect mild pain remains unclear. We evaluated whether home-cage activity measures can be used to detect pain-related changes in a plantar incision model of postoperative pain. First, we confirmed the presence of local hypersensitivity using von Frey filaments on 48 C57BL/6JRj mice (24 males, 24 females). Subsequently, we pair-housed 64 mice (32 males, 32 females) and allocated them to receive either a 4 mm plantar incision on the hind paw under anaesthesia, or anaesthesia alone. Baseline locomotion and voluntary wheel-running activity were recorded over five days, followed by four days of postprocedural monitoring in the home cages. Both procedure groups (incision and anaesthesia-only) showed reduced locomotion and running wheel activity relative to baseline. However, activity measures did not differ between incised and anaesthesia-only mice, and we detected no sex-related effects. Under these conditions, home cage activity measures did not reliably discriminate pain-related behavioural changes in the model, despite the model showing local mechanical hypersensitivity in the von Frey test. Together, these findings indicate that, given the mild and localised nature of the plantar incision mouse model, commonly used home-cage metrics cannot yet reliably detect subtle pain-related behavioural changes.

Store-operated calcium entry (SOCE) is a ubiquitous calcium (Ca2+) signalling mechanism that replenishes endoplasmic and sarcoplasmic reticulum Ca2+ stores. We previously identified STIM1L, a skeletal muscle-enriched STIM1 splice variant that enables rapid SOCE activation in human myotubes. To determine its physiological role in vivo, we generated a constitutive knockout mouse model that selectively abolishes STIM1L expression while preserving the canonical STIM1 isoform. Stim1l-KO mice developed normally and exhibited no overt abnormalities, but both sexes showed reduced voluntary wheel-running activity, suggesting neuromuscular perturbation. Skeletal muscle deprived of STIM1L did not show any histological alterations or changes in fibre- type and size. Likewise, force-frequency relationships and fatigue resistance measured ex vivo in isolated extensor digitorum longus and soleus muscles were indistinguishable from control muscles. This lack of difference may be explained by the increased expression of STIM1 in several skeletal muscles and suggests that changes in the voluntary running activity of Stim1l-KO mice may arise from STIM1L loss in non-muscular tissues, including the central nervous system. Notwithstanding, primary myotubes derived from Stim1l-KO mice displayed a marked delay in SOCE activation kinetics, whereas SOCE amplitude remained comparable to controls. This was consistent with a compensatory STIM1 upregulation maintaining overall Ca2+ entry capacity. Interestingly, electrically evoked Ca2+ transients in intact Stim1l-KO flexor digitorum brevis fibres exhibited significantly faster decay kinetics than controls. This revealed another role of STIM1L in Ca2+ handling in skeletal muscle that appears independent of its contribution to SOCE activation. Together, these findings establish STIM1L as a regulator of SOCE activation kinetics and indicate an additional role in myofibre Ca2+ clearance, while suggesting that compensatory upregulation of canonical STIM1 may preserve muscle structure and contractile function in its absence in mice.

Vocal communication depends on the biomechanical integrity of the vocal folds, yet how impairment alters vocal behavior remains poorly understood. We used the California mouse (Peromyscus californicus), a highly vocal species that produces songs through airflow-induced vocal fold vibration, to experimentally examine how defined vocal fold injury alters vocal production. Longitudinal recordings were combined with histological assessment to track changes in vocal function after impairment. Injury produced acute edema of the lamina propria and thyroarytenoid muscle. Despite stable levels of vocal activity, the vocal phenotype shifted characteristically following injury. Thus, vocal behavior can persist despite substantial alteration of the biomechanical tissues underlying sound production, demonstrating that maintenance of behavioral output does not necessarily indicate preservation of the physiological system that generates it. More broadly, these findings establish an experimental link between vocal fold injury and vocal phenotype and provide a framework for understanding how tissue damage and remodeling can reshape acoustic communication even when vocal behavior is maintained. Because repeated vocalization can impose substantial mechanical demands on vocal folds, this framework may have broad relevance for understanding how vocal use, injury, and tissue remodeling interact to shape vocal communication.

Age-related skeletal muscle atrophy differs between upper and lower body muscles and may also differ between lower limb muscles, but these muscle-specific patterns remain poorly characterised. We acquired axial 3T magnetic resonance images from sex-balanced samples of thirty young (24+/-4 years) and thirty older adults (73+/-4 years). Muscle volume of seventeen lower limb muscles/compartments was quantified using manual segmentation and expressed as absolute volume, relative to body mass, and as a percentage of total muscle volume. Absolute muscle volume was lower in older adults in 13 out of 17 muscles compared to young, with substantial heterogeneity in the effect sizes (d=0.01-3.36). Age group * muscle interaction contrasts revealed muscle-specific age-related differences in volume. Three of the quadriceps muscles demonstrated greater age-related atrophy compared to several other muscles (e.g. vastus lateralis differing from 14 of the other 16 muscles; d[&ge;]1.54). Conversely, the anterior and deep posterior compartments of the shank and biceps femoris short head showed significantly smaller age-related atrophy than several other muscles. These interaction effects were exacerbated when expressed in relative terms. Consequently, three of four shank compartments, gluteus maximus and adductor magnus represented a greater proportion of total muscle volume in older adults, whereas the vastus lateralis, vastus intermedius, rectus femoris, semitendinosus, gracilis, and iliopsoas contributed a smaller proportion in older adults. These findings highlight the variability in age-related leg muscle atrophy in a large mixed sex cohort, resulting in a redistribution of muscle volume in the lower limb.

Background: Prone cardiopulmonary resuscitation (CPR) may be necessary when turning a prone patient supine would delay chest compressions. Although prone compressions can generate arterial pressures comparable with or greater than supine CPR, the pathway of pressure transmission is uncertain. We examined synchronized intrathoracic, intra-abdominal, and central arterial pressures in both supine and prone positions. Methods: Two thawed fresh-frozen adult cadavers underwent three, 2-minute mechanical CPR trials per position in a counterbalanced crossover sequence. Solid-state catheters recorded pleural, peritoneal, and central arterial pressures simultaneously. Trial-level outcomes included peak pressure, mean pressure, pressure-time area, and the mean peritoneal-to-pleural pressure gradient. Exploratory fixed-effects models included position, cadaver, and their interaction. Results: Prone CPR increased peak intrathoracic pressure by 7.04 mmHg, peak intra-abdominal pressure by 21.69 mmHg, and peak arterial pressure by 15.40 mmHg. Mean intra-abdominal and arterial pressures increased by 16.22 and 9.90 mmHg, respectively. The mean peritoneal-to-pleural gradient reversed direction from -8.46 mmHg supine to 4.85 mmHg prone. Intrathoracic pressure-time area increased 3.4-fold, from 1.62 to 5.46 mmHg{middle dot}s, and arterial pressure-time area increased 2.2-fold, from 2.96 to 6.42 mmHg{middle dot}s. Conclusions: Compared to supine, prone mechanical CPR generated higher arterial pressures and reversed the pressure relationship across the thoracoabdominal boundary in both cadavers. Higher abdominal pressure coincided with a larger intrathoracic pressure-time area, a pattern compatible with reduced caudal pressure dissipation.

The contribution of persistent inward currents (PICs) to spinal motor neurons discharge rate is lower in old compared to young adults. However, whether this difference further progresses at very old age ([&ge;]80 years) and differs between males and females remains unknown. Thirty young (26 {+/-} 4 years, 15 females), thirty old (72 {+/-} 5 years, 15 females) and twenty-nine very old adults (85 {+/-} 3 years, 15 females) performed isometric dorsiflexion ramp contractions at 20% of maximal voluntary torque. Individual motor unit spike trains were identified from decomposed high-density surface electromyograms of the tibialis anterior. The paired motor unit technique was used to estimate the prolongation effect of PICs ({Delta}F and normalized {Delta}F), and the quasi-geometric approach to estimate neuromodulatory (brace height) and inhibitory pattern (attenuation slope) contributions. {Delta}F was lower in old and very old adults than in young adults, with no difference between old and very old adults regardless of sex. Compared with young adults, normalized {Delta}F was lower in both old and very old males, whereas in females it is only lower in the very old group. Brace height and attenuation slope did not differ across ages or sexes. These findings indicate that age-related changes in spinal motor neuron excitability are established by the seventh decade and do not progress further in healthy active very old adults, following a nonlinear trajectory that may differ between males and females. The absence of age-related differences in the neuromodulatory index does not support a lower monoaminergic drive in older adults.

Background Opioid-free anaesthesia (OFA) has emerged as an alternative to opioid-based anaesthesia (OBA), but its benefit over OBA for postoperative quality of recovery (QoR) remains unclear. To address this question while limiting variability inherent in clinical studies, such as analgesic regimens and patient psychosocial factors, we investigated the effects of OFA versus OBA on postoperative recovery in a controlled preclinical mouse model. Methods Adult male and female C57BL/6J mice underwent laparotomy or sham procedures under isoflurane anaesthesia, and were randomly assigned to saline (control), fentanyl (OBA), or dexmedetomidine (OFA) as intraoperative analgesic adjuncts. All mice received multimodal postoperative analgesia, including carprofen. We adapted a standardised multidimensional recovery model using six behavioural endpoints reflecting human QoR domains: body weight, food intake, locomotor activity, mechanical sensitivity, sucrose preference, and social interaction. These endpoints were assessed on postoperative days 1, 2, 3, and 7. Plasma inflammatory cytokine and brain-derived neurotrophic factor (BDNF) concentrations were also measured in parallel as potential biological correlates of recovery. Results Over the study period, we observed no treatment effect across behavioural endpoints in laparotomised mice, including body weight (P=0.157), food intake (P=0.884), locomotor activity (P=0.864), mechanical sensitivity (P=0.628), sucrose preference (P=0.615), and social interaction (P=0.442). Composite QoR scores did not differ between OFA and OBA groups (P=0.569), with no differences in postoperative circulating inflammatory cytokine or BDNF concentrations. Conclusions Dexmedetomidine-based OFA and fentanyl-based OBA produced similar postoperative behavioural recovery, circulating inflammatory cytokine and BDNF trajectories in laparotomised mice receiving multimodal postoperative analgesia.

Postmenopausal women are vulnerable to metabolic dysfunction. Compelling evidence suggests this is because they lack the protective effects of estrogens. We have shown that circulating estrogens regulate daily eating and activity rhythms in female mice and protect them from obesity and metabolic dysfunction. However, few studies have investigated whether postmenopausal women have disrupted eating and sleep-activity rhythms that could contribute to metabolic dysfunction. The purpose of this cross-sectional study was to investigate the relationship between sleep and eating rhythms and metabolic risk in postmenopausal women with overweight or obesity. Seven days of sleep and food intake behavior data were collected from postmenopausal women with overweight or obesity. Sleep timing was assessed using wrist-worn actigraphy and sleep logs. First and last calorie intake times were collected daily using text messaging. Visceral adipose tissue (DXA), insulin resistance (Matsuda index), blood pressure, and triglycerides were analyzed as markers of metabolic risk. In 122 postmenopausal women (mean {+/-} SD: 58.1 {+/-} 3.6 yr, 33.2 {+/-} 5.2 kg/m2 BMI), we found that later sleep onset was associated with greater visceral adipose tissue (p=0.0007), but not insulin resistance, blood pressure, or triglycerides. Next, we used a random forest model to quantify the relative contributions of sleep and meal timing variables to predict visceral adipose tissue. The top predictors of visceral adipose tissue were time of sleep onset, sleep duration, and time of last caloric intake. These data suggest that interventions that advance sleep onset may reduce metabolic risk in postmenopausal women.

The vestibular system consists of peripheral end organs that provide the brain with temporally precise information about head position in space required for motor coordination and postural stability. Irregular vestibular afferents of the inner ear are particularly sensitive to rapid changes in acceleration, or jerk, which is necessary for making quick, corrective movements and postural adjustments. Vestibular short-latency evoked potentials (VsEPs) are waveforms that provide a measure of synchronous irregular afferent activity originating from peripheral (early peaks) and central (later peaks) vestibular pathways. These VsEPs are elicited by head jerk stimuli, commonly used preclinically. Previous studies have shown that early VsEP waves are dependent upon jerks of an adequate intensity, number, and duration. However, less is known about jerk characteristics necessary for generation of reliable VsEP signals centrally (later peaks). The present study examines the precise temporal dynamics of peripheral and central vestibular centers across a broad range of mechanical vestibular load in rats. We found differential changes in synchrony and timing driven by jerk repetition, intensity, and duration between early and late VsEP waves representing distinct anatomical components of the vestibular circuit. Our results suggest that central components are uniquely sensitive to jerk duration, intensity, and repetition, indicating a disconnect between peripheral and central neuronal recruitment, adaptive plasticity, and time-frequency dynamics. This work provides a foundation for using VsEP to assess jerk-induced physiological vestibular dysfunction and to understand how central relays differentially adapt to variations of mechanical vestibular stress compared with the precise, high-fidelity transmission observed in the periphery.

Background: Head acceleration events (HAEs) are common in contact sports, but season-long exposure and its relationship with cognitive performance in amateur British American football remain poorly characterised. Methods: Thirty male players were recruited from three British American football teams. Cognitive performance was assessed pre-season, mid-season, and post-season using the Sport Concussion Assessment Tool 6 and computerised Stroop, 2-back, Go/No-go, and visual-search tasks. Seasonal cognitive analyses included 23 participants with available data. HAEs were quantified using helmet-mounted accelerometers; exposure-linked analyses were restricted to 19 participants who provided sufficiently complete sensor recordings across contact training sessions and competitive matches. Seasonal cognitive changes were assessed using mixed-effects models. Associations of in-season HAE metrics and previous contact-sport seasons with global cognitive change were examined using simple linear regression and elastic-net regression. Results: In the 19-participant exposure-linked cohort, prior contact-sport exposure showed the strongest nominal univariate association with worse global cognitive change (r squared = 0.337, p = 0.009), although this did not remain significant after correction for multiple comparisons (Benjamini-Hochberg-adjusted p = 0.055). Corrected nested cross-validation indicated little out-of-sample performance for the multivariable elastic-net model (r = 0.144, predictive R squared = -0.008). Although previous contact-sport seasons had the largest standardised coefficient in the final full-cohort fit, predictor retention varied substantially across resamples. Conclusion: Prior contact-sport exposure showed the strongest exploratory association with relatively worse global cognitive change, whereas in-season HAE metrics showed weaker associations. However, the multivariable model did not demonstrate useful out-of-sample predictive performance, and the small exposure-linked cohort precludes firm conclusions regarding the relative importance of individual predictors.

Maternal hyperglycemia can affect offspring development and metabolism, but how its effects on skeletal muscle change during postnatal life remains unclear. We investigated skeletal muscle phenotypes in male offspring of streptozotocin-induced hyperglycemic mice at 4 and 8 weeks of age, representing early post-weaning and later postnatal stages, respectively. Maternal hyperglycemia resulted in lower offspring body and skeletal muscle weights at both time points. Myofiber cross-sectional area was reduced without a reduction in total myofiber number, indicating impaired myofiber growth rather than myofiber loss. At 4 weeks, skeletal muscle showed type I/IIA hybrid myofibers and increased expression of fetal, myogenic, and proliferation-associated genes. This immature profile was not maintained at 8 weeks; instead, the transcriptional profile shifted toward reduced mitochondrial and oxidative metabolism. DNA methylation changes at 4 weeks showed limited correspondence with transcriptional alterations. Taken together, maternal hyperglycemia impaired postnatal myofiber growth at both time points, with distinct molecular profiles at 4 and 8 weeks.

Standing balance relies on the continuous detection of body motion across a wide range of amplitudes and frequencies. According to Weber's law, sensory discrimination should degrade in proportion to stimulus amplitude, yet vestibular self-motion perception deviates from this prediction. Whether this deviation extends to the vestibular control of posture remains unknown. To test this hypothesis, we delivered amplitude-increasing electrical vestibular stimulation (EVS, 0-2 mA) at four frequencies (0.1, 0.2, 0.5, and 1 Hz) to 10 healthy young adults, and quantified balance discrimination thresholds (DTs) from the gain and inter-trial variability of the lateral ground reaction force, using signal detection theory. Balance control DTs increased sublinearly with EVS amplitude at all frequencies, deviating from Weber's law. Both balance-correcting response gain and variability accounted for this deviation: gain decreased more slowly than the strictly inverse relationship that would have alone produced strict adherence to Weber's law, while variability exhibited an initial increase followed by saturation at higher EVS amplitudes, a signal-dependent structure necessary to reproduce the observed DT pattern. EVS frequency modulated the shape of this deviation but affected neither overall DT nor the signal-to-noise ratio of the balance-correcting response, which instead remained similar across frequencies. This study revealed a particular property of postural control discrimination by extending the psychophysical and neural deviations from Weber's law previously reported for vestibular perception. Overall, these results provide a better understanding of the balance control discrimination process and provide potential additional assessment criteria for vestibular impairments.

We investigated the hearing mechanism of Manduca sexta caterpillars to determine whether their behavioural responses to acoustic stimulation are caused by sound-induced substrate vibration or by direct detection of airborne sound. Behavioural response thresholds to direct substrate vibration and airborne sound were measured using pure-tone stimuli at 150 Hz and 2000 Hz. A frequency of 150 Hz was selected based on previous behavioural measurements showing the lowest sound detection thresholds between approximately 100 and 200 Hz, while 2000 Hz was selected based on laser Doppler vibrometry measurements that revealed a mechanical resonance near this frequency in a thoracic hair. At both test frequencies, the direct substrate vibration detection thresholds were more than 100 times greater, on average, than the sound-induced substrate vibrations measured at the behavioural sound detection thresholds. Thus, the behavioural responses to airborne sound cannot be explained by sound-induced substrate vibration. During airborne sound stimulation, caterpillars exhibited graded behavioural responses with increasing sound pressure level, progressing from freezing to twitching and finally to jump-startle. Together, these findings provide direct experimental evidence that the behavioural responses of M. sexta caterpillars to acoustic stimulation cannot be explained by sound-induced substrate vibration and instead support direct detection of airborne sound. Understanding how caterpillars respond to airborne sound may also provide biological inspiration for the development of bio-inspired acoustic sensors.

OBJECTIVE: To describe (1) US emergency department-treated pickleball injury burden and the injury-to-participation measure among total players, with burden among adults aged 60 to 79 years as a descriptive subgroup, and (2) determine whether general internet search interest for 'pickleball' is also associated with total pickleball-related injuries. DESIGN: Ecological time series study, United States, 2014 to 2023. DATA SOURCES: National Electronic Injury Surveillance System (NEISS) emergency department microdata yielded 1,738 adjudicated pickleball cases, 921 of them orthopedic, weighted to an estimated 101,450 injuries nationally. Google Trends, English Wikipedia pageviews, and GDELT news volume served as general pickleball attention signals, with the Trends index for 'sourdough' as a negative control. Sports and Fitness Industry Association (SFIA) participation estimates supplied a total player denominator. MAIN OUTCOME MEASURES: Annual national injury estimates with design-based 95 percent confidence intervals; injury-to-participation measures; and correlations between total pickleball-related injuries and general pickleball attention signals before and after removing trend and seasonality. RESULTS: Estimated emergency department-treated pickleball injuries rose 17.5-fold, from 1,391 in 2014 (highly unstable) to 24,294 in 2023. 70 percent of adjudicated cases involved adults aged 60 to 79. During 2017-2023, injury estimates rose 4.0-fold and participation rose about 4.4-fold. No temporal trend was detected in the injury-to-participation measure (P=0.59). Search interest looked like an excellent proxy: in annual levels it correlated with total pickleball-related injuries at R=0.96, and Pickleball Wikipedia pageviews at R=0.98. However, so did searches for "sourdough", at R=0.76. Removing trend and seasonality left little (monthly residual R=0.084; year-on-year R=0.28 over 96 months, 2015-2023), and the seasons ran opposite, with injuries peaking in February and searches in July, such that, on 12-month mean profiles, the sourdough negative control fitted the injury season (R=0.96) while pickleball ran against it (R=-0.40). General pickleball search interest and pickleball news coverage remained correlated in year-on-year changes in 2017-2023 (R=0.64), whereas their corresponding correlations with total pickleball-related injuries in 2017-2023 were 0.25 and 0.20. CONCLUSIONS: The absolute burden of emergency department-treated pickleball injury has grown substantially, but the available surveillance data cannot resolve whether the sport has become more hazardous per participant. The observed rise is consistent with growth in exposure alone. The strong correlation between search interest and injury counts was not specific, the association was substantially attenuated after detrending, and the seasonal patterns were opposed. These descriptive results do not establish that search interest can substitute for injury surveillance, and series that rise together should not be assumed to be related.

Background: Male hypogonadism is associated with sexual, physical, and psychological manifestations, and testosterone replacement therapy (TRT) is used to restore testosterone levels and relieve symptoms. Objective: To evaluate the efficacy of TRT in adult men with hypogonadism across erectile function, hypogonadal symptoms, fatigue, body composition, waist circumference, urinary symptoms, and quality of life. Methods: This systematic review and meta-analysis followed PRISMA guidance. PubMed/MEDLINE, Google Scholar, and ScienceDirect were searched. Fourteen studies involving 1,388 participants were included. Effect estimates were synthesized as standardized mean differences using random-effects models, and heterogeneity was assessed with I2, Cochrans Q, and t2. Results: TRT was associated with favorable pooled effects on erectile function, hypogonadal symptoms, fatigue, lean mass, fat mass, waist circumference, and quality of life. No consistent effect was observed for lower urinary tract symptoms. Heterogeneity was high for erectile function, hypogonadal symptoms, waist circumference, and urinary symptoms; moderate for body-composition outcomes; and low for fatigue and quality of life. Randomized trials generally yielded smaller effect estimates than observational studies. Conclusions: TRT was associated with improvement across several clinical and body-composition outcomes in hypogonadal men, although effect magnitude varied substantially by outcome and study design. The high heterogeneity for several outcomes and the larger estimates in observational studies warrant cautious interpretation and support the need for longer, high-quality randomized trials.

Chronic intermittent hypobaric hypoxia is an occupational exposure experienced by workers who alternate between high-altitude worksites and lower-altitude resting locations. Its effects on cardiac autonomic modulation and electrocardiographic parameters remain insufficiently characterized in Andean workers. This study aimed to compare heart rate variability and electrocardiographic parameters between workers exposed to chronic intermittent hypobaric hypoxia and controls working permanently at lower altitude in Arequipa, Peru. An observational cross-sectional study was conducted in 96 male workers aged 20-60 years. The exposed group included 53 workers performing rotational shifts at altitudes [&ge;]3,000 m above sea level with rest periods at <2,500 m, while the control group included 43 workers working permanently at <2,500 m. Heart rate variability was assessed during the morning rest period in Arequipa, at approximately 2,300 25 m above sea level, using a Polar(R) H10 heart rate sensor after 15 minutes of rest. Participants also underwent standard 12-lead electrocardiography. Vital signs were clinically similar between groups. No statistically significant differences were observed in PR interval, corrected QT interval, time-domain heart rate variability parameters, or frequency-domain heart rate variability parameters. In this sample of apparently healthy male workers evaluated during their rest period at moderate altitude, exposure to chronic intermittent hypobaric hypoxia was not associated with significant differences in resting heart rate variability or standard electrocardiographic parameters.

Background: Cardiometabolic disease is a leading cause of death, and most therapies suppress established pathology rather than restore functional capacity. Pulsed electromagnetic field (PEMF) therapy is a non-invasive stimulus touted as a potential complementary approach that may engage adaptive responses, with practical potential for home-based use. We systematically reviewed and meta-analysed PEMF effects on cardiometabolic outcomes. Methods: We searched seven electronic databases and Google Scholar from inception to 31 August 2026 for studies of PEMF in adults, healthy or with cardiometabolic conditions. Between-group differences were rescaled into minimal clinically important difference (MCID) units to facilitate comparison across diverse outcomes. Established anchor-based MCIDs were used where available; otherwise, 0.5 pooled within-arm SD was used. Effects were pooled using multilevel random-effects models with study-clustered robust variance, with subgroup, sensitivity, and exploratory dose-response analyses. The review was registered with PROSPERO (CRD420261404575). Results: Ten studies (353 participants) were included. PEMF was associated with an overall benefit of 0.54 MCID units (95% CI 0.08-1.00). Effects were largest in hypertension (1.24 MCID units, 0.52-1.96), with no observed heterogeneity across two double-blind trials (I2=0%). Exploratory multivariable meta-regression associated greater cumulative exposure and lower frequency with larger effects. Conclusions: PEMF therapy may offer a non-invasive, non-pharmacological adjunct for improving cardiometabolic outcomes, with potential for home-based use. The most compelling signal was observed in hypertension, where the pooled effect exceeded one clinically important difference, although confirmation in larger trials is required.

Introduction: The inability to measure renal sympathetic outflow clinically poses a significant problem for patient identification and intraprocedural feedback for renal denervation. Sympathetic vasomotion is a novel physiologic measure of rhythmic vascular control that reflects renal sympathetic nervous system activity, but previous measurements of sympathetic vasomotion relied on 15-minute data recordings, which may be impractical in many clinical settings. We therefore tested whether shorter data segments can provide reliable sympathetic vasomotion assessment to enhance decision making for renal denervation. Methods: Ten swine that had previously undergone unilateral surgical renal denervation underwent four rounds of catheter-based denervation of the contralateral kidney. Sympathetic vasomotion was quantified from the time-varying arterial pressure-resistive renal blood flow transfer function of recordings obtained before and after each round of ablation. Randomly placed 1- to 14-minute data segments were scored and compared with the corresponding 15-minute sympathetic vasomotion scores across 100 passes using correlation, intraclass correlation, error, and Bland-Altman agreement metrics, and by whether they reproduced the denervation decisions made from the full recordings. Results: Agreement with the 15-minute reference score improved steeply with recording length up to approximately four minutes and slowly thereafter, with the point of diminishing returns at four minutes for every group-level measure. Four-minute data segments showed an intraclass correlation coefficient of 0.94, reproduced the group-level statistical results across ablations, and preserved intraprocedural denervation decisions. Bland-Altman analysis revealed that individual-level precision continued to improve with recording length; the proportion of scores falling within a quarter of the average difference between innervated and denervated kidneys at baseline was 65 percent at four minutes and 96 percent at ten minutes. Discussion: Four-minute data segments provide a feasible minimum recording duration when the question is a group comparison or a paired, within-individual decision, such as intraprocedural confirmation that an innervated kidney has shifted toward a denervated state. When a single score must be interpreted on its own, as in preprocedural patient selection, ten-minute recordings provide greater precision. Further studies are needed to prospectively evaluate sympathetic vasomotion in clinical settings and determine whether this technology can support procedural feedback and inform patient selection.

Background: Intramuscular fat and fibrous tissue deposition increase with ageing, disuse, and disease and contribute to impaired muscle function and reduced 'muscle quality'. Magnetic resonance imaging (MRI) and biopsy provide reference measures of muscle composition, but their cost, invasiveness, and limited accessibility restrict routine use. B-mode ultrasonography has emerged as a practical, low-cost alternative, with ultrasound-derived echo intensity widely interpreted as a surrogate measure (index) of intramuscular fat, fibrosis, and 'muscle quality'. However, such interpretation warrants further scrutiny. Aim: To quantify the relationship between ultrasound-derived echo intensity and reference measures of intramuscular fat and fibrous tissue and determine whether these relationships vary across muscles or according to anatomical and methodological factors. Methods: A systematic search of six databases was conducted (last search: August 2026). Human and animal studies reporting correlations between echo intensity and measures of intramuscular fat or fibrous tissue using MRI, histology, or chemical analysis were synthesised using multilevel random-effects meta-analysis with study-level cluster-robust inference. Correlations were Fisher z-transformed and back-transformed for interpretation. Exploratory analyses examined fat compartment, muscle, muscle architecture, health status, study model, and distance-correction procedures. Results: Twenty-eight studies met the eligibility criteria. For intramuscular fat, 204 effects from 23 independent studies yielded a weak-to-moderate pooled correlation with echo intensity (r=0.54, 95% CI: 0.45-0.61; 95% PI: - 0.02-0.84; P<0.01), with substantial heterogeneity (I^2=74.5%). The wide prediction interval suggests the true correlation could range from negligible to strong. No significant moderation effects were observed for study model (animal vs. human: r=0.46 vs. 0.55; P=0.26), health status (clinical vs. healthy: r=0.64 vs. 0.49; P=0.11), probe-to-muscle distance correction (corrected vs. raw echo intensity: r=0.57 vs. 0.53; P=0.25), or muscle architecture (non-pennate vs. pennate: r=0.63 vs. 0.53; P=0.56), although some categories contained few studies and effects. Model-based inference indicated significant moderation effect of lipid compartment (intramyocellular lipid vs. total intramuscular fat vs. extramyocellular lipid: r=0.10 vs. 0.57 vs. 0.49; P<0.001) but this effect was not significant under cluster-robust inference (P=0.50). For fibrous tissue, six effects from four studies yielded a weak, non-significant pooled correlation (r=0.34, 95% CI -0.39, 0.81], 95% PI [-0.85, 0.96]; P=0.24). Conclusions: Echo intensity is weakly-to-moderately associated with intramuscular fat, and this varied substantially across studies and muscles, whereas evidence for intramuscular fibrous tissue is limited and uncertain. These findings provide limited support for interpreting echo intensity as a surrogate measure or an index of intramuscular fat or fibrosis or, on this basis, as an index of 'muscle quality'.