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The Bergstrom needle and all related supplies were gathered before beginning the procedure (Fig. Bergstrom muscle biopsy needle and accessories fully assembled for use, with cutting trocar inserted through suction-enhancing nipple and in place over outer trocar.
The results of the sampling experiment carried out to test the effectiveness of the SEN are outlined in Fig.3.
Tissue wet weight per sample obtained by using non-suction-enhanced method of Mubarak et al.
Both the growth hormone research and biopsy-technique procedures were approved by the Rhode Island Hospital Institutional Review Board, and all human subjects provided written informed consent documentation. Only two subjects (2.4%) complained of discomfort after the procedure that limited their usual activities. The application of percutaneous muscle biopsies has been a mainstay of research in exercise physiology for nearly two decades (2, 5, 8, 14).
In 1962, Bergstrom (1) described a technique for obtaining skeletal muscle samples with a biopsy needle apparently known to Duchenne in the 1850s. With more than a decade of elite-level training experience and advanced degrees in both exercise science and physical therapy, Dr. John is an internationally recognized coach, speaker, and writer, whose work has been popularized in media outlets such as Testosterone Nation, Mountain Dog Diet, Breaking Muscle, and Muscle and Strength, just to name a few.
John is the owner of John Rusin Fitness Systems, an online fitness platform geared toward synergizing the best of high-performance training and physical therapy to athletes and clients worldwide.
How to Trim the Fat Off Your Warm Up RoutineIt's easy to place too much emphasis on soft-tissue and mobility work as a warm up prior to training - how much time are you wasting on a weekly basis? Shred-telligent Design: How to Ramp Up Your Major LiftsWhen it comes to developing strength and muscle mass, is your warm-up doing more harm than good?
Everything You Need to Know About Supersets for HypertrophyThese simple hypertrophy tips could make the difference between personal records and injuries. Muscle Mass, Strength, and Mobility: Choose 3If you've resolved to pack on more muscle while maintaining your strength and functionality, you've come to the right place. 5 Steps to Safely Train Around Lower Back PainThese tips will have you maintaining your hard-earned muscle armor while letting your lower back recover. This technique, which also has been referred to as a punch biopsy (13) or semiopen biopsy (9), is useful for biochemical, histochemical, and histomorphometric analyses (3, 4, 10, 11, 14) and achieves results similar to those obtained with open muscle biopsy procedures (7, 12).
We used infant nipple, Ross Laboratories, Columbus OH (4 mm) and cross-cut nipple, Mead Johnson no. From a presterilized tray containing most of the equipment outlined above, a small sterile field was prepared on a Mayo stand.
Apparatus shown fromtop tobottom: cutting trocar that is inserted into outer needle with cutting chamber visible atright and clearing rod that can be inserted into cutting trocar to expel samples between passes. The vastus lateralis biopsy site, at a point 25 cm proximal from the tuberositas tibiae and 5 cm lateral from the midline of the femoral course, was prepared with iodophor paint. To directly compare tissue yields obtained with our modified technique with those obtained by using the conventional technique described by Evans et al. Based on our experience with SEN in animal sampling (see below), we used SEN in the conduct of a clinical trial evaluating the effects of growth hormone on muscle. There was a 91% (1.9-fold) increase in the size of the samples obtained with the 4-mm needle when a SEN was used and a 507% (fivefold) increase in tissue yield when 6-mm needles were used. Forty-six subjects (28 men, 18 women), recruited as part of a project on the use of human growth hormone in the frail elderly, underwent 83 quadriceps muscle biopsies. One of these individuals was a 72-yr-old man whose initial sampling was observed to have been accompanied by an immediate return of blood into the suction tubing and to contain both muscle and fat tissue in one cohesive piece. Although a small amount of blood was observed with each sample obtained, the volume of blood did not confound the collection of the samples, which were quickly and easily separated and removed from the window of the needle with smooth forceps.
More recently, clinical application of the technique for the diagnosis and classification of neuromuscular disorders has been enthusiastically endorsed (12). Rusin develops performance, regeneration, and aesthetics programs for some of the world’s best power athletes, NFL and MLB athletes, gold-medal Olympians, competitive powerlifters, and bodybuilders. John Rusin Physical Therapy, a sports performance physical therapy practice, located in Madison, Wisconsin. Fix Your Tracking in the Squat and LungeIf your knees hurt, the true answer is to fix the origin of the problem.


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The addition of suction through the cutting trocar was described in 1982 as a means of enhancing the size of the tissue samples obtained with each insertion of the needle (6). 303367; Becton Dickinson, Franklin Lakes, NJ) (4 mm) and Argyle female luer lock connector (no. Syringe (10 ml) is connected to adapter tubing, which can be secured to the canula adapter. Skin and subcutaneous tissue were infiltrated with 10 ml of 1% Novocain, ensuring that the fascia lata was well infiltrated.
Consecutive samples obtained on a subset of these subjects were weighed to quantify the sample weights of the suction enhanced technique obtained with a 6-mm needle.
12), directly compared with results obtained by using suction-enhancing nipples in an anesthetized pig. In subjects undergoing repeat biopsies (n = 37), the second tissue procedure was performed 6 mo after the first.
He reported pain and swelling in the affected leg for 24 h after the procedure, but a large eccymosis was also evident, which resolved slowly over the next week. Wet weights were measured on tissue obtained on nine passes of the 6-mm needle with SEN from five consecutive subjects (4 men, 1 women) and are outlined in Table 1. In the course of our research, we had the opportunity to implement the needle biopsy technique and have modified the procedure to optimize sample size. Although we obtained nearly double the tissue yield using SEN with a 4-mm needle compared with no suction enhancement, the fivefold increase in weight of muscle sample was more dramatic with a 6-mm Bergstrom needle. His innovative vision and knowledge brings together high-performance strength and hypertrophy programming with a cutting-edge, pain-free training methodology. We provide the technology, tools, and products you need to burn fat, build muscle, and become your best self. The resultant increase in tissue yield made it possible to apply a wider variety of analytic assays to each sample, without increasing discomfort to the patient (6). With the clearing rod fully inserted through the cutting cannula, the blunt end was eased through the opening of a nipple from the outer approach so as to accomplish a positioning of the nipple on the cannula shaft as illustrated in Fig. After ensuring adequate local anesthesia, a stab wound was made in the lateral thigh at the biopsy site directly through the overlying skin, subcutaneous fat, and fascia lata. Results represent 6 passes with each method and a 4-mm needle and 5 passes each with a 6-mm needle.
In most of the other biopsies, there was no evidence of superficial fat or facial tissue included in the samples, which reinforces the importance of operator experience and adequate penetration into the muscle bed. This has allowed the completion of multiple assays on samples obtained at one procedure and minimized the need for repeated sampling.
In the process of standardizing the percutaneous biopsy technique, as most recently described (12), for application in a human protocol, we noted difficulty in obtaining an adequate connection between syringe and cutting cannula that is necessary for optimal suction generation with both 4- and 6-mm Bergstrom needles.
An anesthetized pig was sampled, following an unrelated laparoscopic procedure that had been approved by the animal use committee before planned death of the animal. Most subjects were studied with the 6-mm sampling needle (eight biopsies were performed with the 4-mm needle on five subjects), as initial review of sample sizes with the 4-mm needles indicated that larger volumes of tissue would be required for the array of analyses planned for protocol evaluation.
We instituted several modifications to the technique to ensure reliable connections for both the 4- and 6-mm cutting cannulas, including a gasket system, to further enhance suction. The cannula-nipple assembly was placed on the trocar so that the nipple slides firmly over the open end of the trocar (Fig. 11 blade is sufficient for insertion of the 4-mm trocar directly through the stab wound pathway into the muscle to be biopsied. Multiple needle biopsies were obtained on the lateral thigh musculature in a 5-cm area midway between the proximal and distal femur. Each procedure required ?15 min from initial positioning, shaving, local anesthesia, incision, sampling, and postprocedural closure and occlusion. Most subjects reported no change in their daily routine after the procedure, and many participated in recreational sports such as bowling and golf without reporting a compromise in performance.
In all cases, adequate tissue samples were obtained for histomorphometric and other analysis. Utilizing essentially the same procedures as our protocol except for the SEN, they noted that the size and quality of the muscle samples obtained were sufficient to confirm accurate diagnosis in 98.4% of the patients biopsied.


In our hands, these modifications objectively enhanced sample size up to sixfold, compared with specimens obtained without suction enhancement in our animal model, and resulted in abundant material for our investigations in all human subjects sampled.
When the 6-mm trocar was utilized, the stab wound was extended laterally 2–3 mm to accommodate the larger needle. A total of 25 samples, through three separate stab wounds on each thigh, were obtained with both needle sizes using a 10-ml syringe with and without SEN. Although nine subjects did not participate further in the study for a variety of reasons, none dropped out because of the initial muscle biopsy experience. These inexpensive, readily available nipples enhance the suction by blocking the passage of air between the cutting and outer trocar and, thus, increasing the amount and duration of negative pressure that can be developed. However, it was noted that five to six passes were necessary to obtain sufficient tissue to perform the necessary assays.
Once the trocar has been inserted through the fascia (generally the sensation of overcoming resistance is obvious), it was advanced to ensure that the cutting chamber opening (window) would lie fully within the muscle. The mean wet weight of the muscle samples obtained in our clinical work with the 6-mm needles was ?40% greater than reported for a 5-mm Bergstrom needle (6). We developed a new enhanced-suction technique [suction-enhancing nipples (SEN)] and compared it with techniques currently in practice by assessing biopsy yields on anesthetized pigs.
At this point, the cutting cannula was fully inserted into the trocar to ensure that the thickness of the nipple material being utilized allowed full closure of the cutting chamber. Statistical analysis of data was performed by using t-tests for parametric data and the Mann-Whitney rank sum test for nonparametric data.
In our clinical trial, tissue yield was enhanced further by using a double-sampling technique. We applied the enhanced-suction technique to human subjects participating in a clinical trial. The use of a sterile surgical lubricant further maintains both the seal and the integrity of the nipple opening (by avoiding tearing), especially when working with the 6-mm needle. While the nipple atop the trocar was held as described above, the cutting trocar was withdrawn 2.5 cm. Reference has been made to a double-chop technique (14), which is simple to perform but has not been described in detail. Unfortunately, a direct comparison of tissue yield between the methods in these last two studies and that reported here is not possible as the first report did not specify sample weights (12) and details of the muscle biopsy procedure were not included in the second (11a).
In the pig, there was a mean 91% (1.9-fold) increase in the size of the samples obtained with the 4-mm needle when SEN was used and a mean 507% (fivefold) increase in sample size when the SEN was applied to the 6-mm needles. The lubricant diminishes friction when the trocar is moved within the nipple and prevents tearing of the nipple opening. An assistant immediately applied suction by fully withdrawing the plunger of a 10-ml syringe, thus drawing muscle tissue into the cutting chamber as the cutting trocar was simultaneously advanced, slicing off the sample as the assistant released the suction.
In our experience, we found that after closing the cutting chamber to slice off the first sample the trocar could be rotated 90° clockwise and the sampling procedure repeated before removing the trocar from the muscle. However, it appears that the enhancement of sample size with our method may improve the success rate of the procedure when used clinically and decrease trauma to the patient, as an adequate sample should be obtained with fewer needle passes. The male end of an appropriately sized adapter was inserted into the proximal end of the cutting cannula and attached to a syringe via connecting tubing (Fig. To maximize the amount of muscle sample obtained per insertion, the trocar was rotated 90° in a clockwise fashion, and the procedure was repeated before withdrawal of the trocar from the thigh (double-sample technique).
Adequate tissue samples for histomorphometric and other analyses were obtained in all samples obtained. The percutaneous muscle biopsy performed with enhanced suction using inexpensive, readily available nipples enhances tissue yield two- to fivefold. The syringe plunger was withdrawn to the 3-ml mark before muscle insertion to create a buffer of air for use in removing the sample at a later time (see below).



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