Claudius, C; Garvey, L H; Viby-Mogensen, J
Neuromuscular blocking drugs are designed to bind to the nicotinic receptor at the neuromuscular junction. However, they also interact with other acetylcholine receptors in the body. Binding to these receptors causes adverse effects that vary with the specificity for the cholinergic receptor...... in question. Moreover, all neuromuscular blocking drugs may cause hypersensitivity reactions. Often the symptoms are mild and self-limiting but massive histamine release can cause systematic reactions with circulatory and respiratory symptoms and signs. At the end of anaesthesia, no residual effect...... of a neuromuscular blocking drug should be present. However, the huge variability in response to neuromuscular blocking drugs makes it impossible to predict which patient will suffer postoperative residual curarization. This article discusses the undesirable effects of the currently available neuromuscular blocking...
VANDENBROEK, L; LAMBALK, LM; RICHARDSON, FJ; WIERDA, JMKH
The ED50 and the ED90, the time-course of the neuromuscular block, the intubation conditions, and the cardiovascular effects of Org 9273, a new steroidal nondepolarizing neuromuscular blocking agent, have been evaluated in 41 anesthetized patients. From cumulative dose-response curves the ED50 and
Yasuda, S; Takeda, J; Sekiguchi, H; Fukushima, K
To evaluate the influence of succinylcholine (Scc) on the neuromuscular blocking effect of subsequently administered vecuronium in children, 30 patients aged 2-14 years scheduled for elective surgery were studied after obtaining the informed consent from the parents. Anesthesia was induced with inhalation of sevoflurane, nitrous oxide and oxygen. T1 of the adductor pollicis muscle to ulnar nerve stimulation elicited by train of four stimulation at 2 Hz was monitored continuously by an acceleration transducer. The patients were divided into two groups; group V (16 patients) received vecuronium (0.03 mg.kg-1) and group SV (14 patients) received vecuronium (0.03 mg.kg-1) after 100% recovery of twitch from neuromuscular blockade induced with Scc (1.0 mg.kg-1). Short onset of action and potentiation of maximal block were demonstrated in group SV. After vecuronium administration, a complete suppression of T1 was observed in 8 patients of group SV and only 1 patient of group V. The present study demonstrates that the neuromuscular blockade of vecuronium can be potentiated with the prior administration of Scc in pediatric patients.
Tammisto, T; Salmenperä, M
The characteristics of the myoneural block caused by a new neuromuscular blocking agent, dioxonium (Dx), were evaluated in surgical patients. The force and the corresponding electromyogram (EMG) of the thumb adduction evoked by various modes of ulnar nerve stimuli were measured. Onset, maintenance and disappearance of blockade after sequential administration of Dx were compared with results obtained with d-tubocurarine (dTc) or suxamethonium (Sx). Initially the Dx block was shown to be depolarizing with a negligible fade in the 2 Hz train of four stimuli with a single twitch suppression of 90%. On a weight basis, Dx was found to be about 15 times as potent as dTc in suppressing twitch to the 90% level. During maintenance, the block gained nondepolarizing characteristics with profound fades in the 2 and 50 Hz trains. The transition was associated with tachyphylaxis and with a more pronounced suppression of EMG amplitude than that measured in the twitch force. After a total dose of about 100 microgram/kg of Dx, the sensitivity to Dx again increased and the discrepancy between twitch tension and EMG disappeared. This pattern of changes was also seen with Sx. Spontaneous recovery occurred slightly faster than after dTc blocks of corresponding duration. With neostigmine, reversal was hastened and a full recovery with restitution of prerelaxant twitch and disappearance of fades was reached in about 20 min. Some discrepancy in EMG amplitude and twitch force persisted, however.
ERIKSSON, LI; VANDENBROM, RHG; LENNMARKEN, C; AGOSTON, S
A modification of the isolated arm technique was applied in 10 females under opioid-based i.v. anaesthesia for comparison of the offset of an atracurium-induced neuromuscular block in an isolated arm to an arm with maintained circulation. The neuromuscular blocking effect of a bolus dose of
Viby-Mogensen, J.; Østergaard, D.; Donati, F.
Good Clinical Research Practice (GCRP), neuromuscular blocking agents, pharmacokinetics, pharmacokinetic/pharmacodynamic modeling, population pharmacokinetics, statistics, study design......Good Clinical Research Practice (GCRP), neuromuscular blocking agents, pharmacokinetics, pharmacokinetic/pharmacodynamic modeling, population pharmacokinetics, statistics, study design...
Effects of avoiding neuromuscular blocking agents during maintenance of anaesthesia on recovery characteristics in patients undergoing craniotomy for supratentorial lesions: A randomised controlled study
Ruchi A Jain
Full Text Available Background and Aims: Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used. Methods: Sixty patients with the American Society of Anesthesiologists physical status I or II, aged between 18 and 60 years were included in the study. All patients received anaesthesia including desflurane, dexmedetomidine and scalp block. The patients were randomly allocated to receive no neuromuscular blocking agent (Group A or atracurium infusion to keep train-of-four count 2 (Group B. The two groups were compared with respect to haemodynamic stability, brain relaxation scores and recovery characteristics. Haemodynamic parameters and time taken to achieve Aldrete score >9 and other secondary outcomes were analysed using Student's t-test. Non-parametric data were analysed using the Mann–Whitney test. Results: The mean arterial pressure was comparable between the groups. The intraoperative heart rate was comparable; however, in the post-operative period, it remained higher in Group B for 30 min after extubation (P = 0.02. The brain relaxation scores were comparable among the two groups (P = 0.27. Tracheal extubation time, time taken for orientation and time required to reach Aldrete score ≥9 were comparable among the two groups. Conclusion: The present study suggests that balanced anaesthesia using desflurane, dexmedetomidine and scalp block can preclude the use of neuromuscular blocking agents in patients undergoing supratentorial surgery under intense haemodynamic monitoring.
Efeito da administração do atracúrio sobre a recuperação do bloqueio neuromuscular induzido pelo pancurônio Efecto de la administración del atracúrio sobre la recuperación del bloqueo neuromuscular inducido por el pancuronio Effect of atracurium on pancuronium-induced neuromuscular block recovery
Luís Fernando Rodrigues Maria
complementación con atracúrio no promovió alteración en la recuperación espontanea inicial del bloqueo neuromuscular inducido por el pancuronio y promovió diminución de 20% en el tiempo de recuperación total.BACKGROUND AND OBJECTIVES: Additional neuromuscular blocker doses are in general needed during wall closing after abdominal surgeries. This study aimed at determining during partial pancuronium-induced neuromuscular block recovery, the effect of additional atracurium dose on spontaneous neuromuscular block recovery. METHODS: Participated in this study 30 patients divided in two groups: pancuronium group (n = 14 and atracurium group (n = 16. Neuromuscular function was continuously monitored by accelerometry of abductor pollicis muscle using TOF to supramaximally stimulate ulnar nerve. Anesthesia was induced with propofol, fentanyl and 0.08 mg.kg-1 pancuronium, and was maintained with 60% N2O in oxygen and 0.5% isoflurane expired concentration. When T1 returned to 25% of control, 0.025 mg.kg-1 pancuronium or 0.20 mg.kg-1 atracurium were administered to pancuronium or atracurium group, respectively. Time for spontaneous T1 recovery = 10%, 25%, 75% of recovery index (RI 25-75% and time to T4/T1 equal 0.8 after complementary dose, were recorded. RESULTS: There were no differences between groups on T1 spontaneous recovery to 10% (45.00 ± 15.50 vs. 49.69 ± 9.41, 25% (61.64 ± 18.58 vs. 64.25 ± 12.51 and 75% (94.00 ± 28.52 vs. 84.69 ± 16.50. Recovery index (RI 25-75% and time to T4/T1= 0.8 were shorter in the atracurium group. CONCLUSIONS: In this study, atracurium complementation has made no difference in initial spontaneous recovery of pancuronium-induced neuromuscular block, but has decreased total recovery time in 20%.
Viby-Mogensen, J; Ostergaard, D; Donati, F; Fisher, D; Hunter, J; Kampmann, JP; Kopman, A; Proost, JH; Rasmussen, SN; Skovgaard, LT; Varin, F; Wright, PMC
In September 1997, an international consensus conference on standardization of studies of neuromuscular blocking agents was held in Copenhagen, Denmark. Based on the conference, a set of guidelines fur good clinical research practice (GCRT) in pharmacokinetic studies of neuromuscular blocking agents
Kageyama, Kyoko; Hayakawa, Yuka; Nakajima, Yasufumi; Hashimoto, Satoru
Among all drugs used for general anesthesia, neuromuscular blocking agents (NMBAs) seem to play a predominant role in the incidence of severe adverse reactions. The overall incidence of perioperative anaphylaxis is estimated at 1 in 10,000-20,000 anesthetic procedures, whereas it is estimated at 1 in 6,500 administrations of NMBAs. After anaphylaxis, allergologic assessment is essential to identify the offending agent and to prevent recurrences. The estimated sensitivity of skin tests for muscle relaxants is approximately 94% to 97%. Prick testing is advised for the diagnosis of the NMBAs responsible for an anaphylactic reaction, and intradermal testing is preferred when investing cross-reaction. The choice of the safest possible anesthetic agents should be based on the result of a rigorously performed allergologic assessment.
VANDENBROEK, L; WIERDA, JMKH; PROOST, JH; HOMMES, FDM; AGOSTON, S
The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing neuromuscular blocking agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED(50) and ED(90)
Su, C.; Lee, C. Y.
The inhibitory action of chlorpromazine on skeletal muscle has been studied with isolated preparations. In the nerve-muscle preparations of the frog sartorius and the rat diaphragm, the twitch responses to indirect stimulation are much more strongly depressed by chlorpromazine than those to direct stimulation. The conductivity of the nerve trunk is unaffected. The contractures of the frog rectus abdominis muscle caused by acetylcholine are depressed by chlorpromazine,but the contractures due to KCl are not influenced. Larger doses of chlorpromazine cause contracture by themselves, and this cannot be prevented by tubocurarine. In the sartorius muscle of the toad, the depolarization due to acetylcholine is reduced by chlorpromazine. The paralysing action of chlorpromazine adds to that of tubocurarine, and is antagonized to some extent by eserine or neostigmine. Muscles treated with chlorpromazine do not completely recover on washing. High concentrations of chlorpromazine depress the release of acetylcholine by motor-nerve stimulation, although they do not affect the enzymic synthesis of acetylcholine by acetone-dried powder of guinea-pig brain. The differences between the neuromuscular block produced by chlorpromazine and that by tubocurarine are discussed. PMID:13835490
Lemmens Hendrikus JM
Full Text Available Abstract Background Acetylcholinesterase inhibitors cannot rapidly reverse profound neuromuscular block. Sugammadex, a selective relaxant binding agent, reverses the effects of rocuronium and vecuronium by encapsulation. This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia. Methods Patients aged ≥18 years, American Society of Anesthesiologists class 1-4, scheduled to undergo surgery under general anesthesia were enrolled in this phase III, multicenter, randomized, safety-assessor blinded study. Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation, with maintenance doses of 0.015 mg/kg as required. Patients were randomized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1-2 post-tetanic counts. The primary efficacy variable was time from start of study drug administration to recovery of the train-of-four ratio to 0.9. Safety assessments included physical examination, laboratory data, vital signs, and adverse events. Results Eighty three patients were included in the intent-to-treat population (sugammadex, n = 47; neostigmine, n = 36. Geometric mean time to recovery of the train-of-four ratio to 0.9 was 15-fold faster with sugammadex (4.5 minutes compared with neostigmine (66.2 minutes; p Conclusions Recovery from profound vecuronium-induced block is significantly faster with sugammadex, compared with neostigmine. Neostigmine did not rapidly reverse profound neuromuscular block (Trial registration number: NCT00473694.
Lundstrøm, Lars Hyldborg; Duez, Christophe Hv; Nørskov, Anders Kehlet
. However, no systematic review of randomized trials has evaluated conditions for tracheal intubation, possible adverse effects, and postoperative discomfort. Objectives: To evaluate the effects of avoiding neuromuscular blocking agents (NMBA) versus using NMBA on difficult tracheal intubation (DTI...... and morbidity. Use of neuromuscular blocking agents (NMBA) to facilitate tracheal intubation is a widely accepted practice. However, because of adverse effects, NMBA may be undesirable. Cohort studies have indicated that avoiding NMBA is an independent risk factor for difficult and failed tracheal intubation...... to look for unidentified trials. Selection criteria: We included randomized controlled trials (RCTs) that compared the effects of avoiding versus using NMBA in participants 14 years of age or older. Data collection and analysis: Two review authors extracted data independently. We conducted random...
Claudius, C; Viby-Mogensen, J; Skovgaard, Lene Theil
BACKGROUND: Acceleromyography (AMG) is increasingly being used in neuromuscular research, including in studies establishing the potency of neuromuscular blocking and reversal agents. However, AMG is insufficiently validated for use interchangeably with the gold standard, mechanomyography (MMG......) for this purpose. The aim of this study was to compare AMG and MMG for establishing dose-response relationship and potency, using rocuronium as an example. METHODS: We included 40 adult patients in this randomized-controlled single-dose response study. Anaesthesia was induced and maintained with propofol...... difference between AMG and MMG is so small that it justifies AMG to be used for establishing the potency of neuromuscular blocking agents. However, the wide CIs show that we cannot rule out a 13% higher ED(50) and a 26% higher ED(95) for AMG....
Akkermans, L.M.A.; Bercken, J. van den; Zalm, J.M. van der
The effects of aldrin-transdiol, one of the active metabolites of the insecticide dieldrin, on evoked transmitter release, neuromuscular facilitation and neuromuscular depression have been studied in frog sartorius nerve-muscle preparations. Conventional techniques of intracellular recordings were
Olkkola, K T; Tammisto, T
We have studied the effect of prior administration of suxamethonium on the infusion requirements of atracurium at 50% neuromuscular block in patients undergoing elective general surgery. Anaesthesia was maintained with nitrous oxide in oxygen, propofol and fentanyl. Of 20 patients given atracurium, only 10 were given prior administration of suxamethonium 1 mg kg-1. At the beginning of the infusion, atracurium 0.3 mg kg-1 was given by bolus administration. Interaction between the two drugs was assessed by determining the steady state rate of infusion necessary to produce a constant 50% neuromuscular block. This was accomplished by applying non-linear curve fitting to data on the cumulative dose requirements during anaesthesia. The neuromuscular blocking effect was found to be similar with or without prior administration of suxamethonium. The mean steady-state rate of infusion for atracurium was 0.19 (SD 0.03) mg kg-1 h-1 for patients given suxamethonium and 0.18 (0.09) mg kg-1 h-1 for those who were not given suxamethonium. Thus prior administration of suxamethonium did not affect the infusion requirements of atracurium at 50% neuromuscular block, unlike the situation at constant 90% neuromuscular block.
Ahmed Abdelgawwad Wefki Abdelgawwad Shousha
Full Text Available Duchenne’s muscular dystrophy (DMD is the most common and severe form of myopathy. Patients with DMD are more sensitive to sedative, anesthetic, and neuromuscular blocking agents which may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. In this case report, we describe a 25-year-old male patient admitted for cholecystectomy under general anesthesia. We induced our anesthesia by oxygen, propofol, fentanyl, and rocuronium bromide. Maintenance was done by fentanyl, rocuronium bromide, sevoflurane, and O2. We report in this case the safety use of sugammadex to antagonize the neuromuscular block and rapid recovery in such category of patients.
Recent large use of magnesium in the obstetric population should incite anesthesiologists to control its side effects and drugs interactions. We report a case of a 30-year-old woman, with severe preeclampsia and HELLP syndrome, receiving sulfate magnesium and nicardipine, who underwent a cesarean section under ...
Leutzow, Bianca; Lange, Jörn; Gibb, Andreas; Schroeder, Henry; Nowak, Andreas; Wendt, Michael; Usichenko, Taras I
Transcutaneous vagal nerve stimulation is a promising treatment modality in patients suffering mood disorders and chronic pain, however, the mechanisms are still to be elucidated. A recently developed technique of EEG responses to electrical stimulation of the inner side of the tragus suggests that these responses are far field potentials, generated in the vagal system - Vagal Sensory Evoked Potentials (VSEP). To reproduce the VSEP technique free from myogenic artifacts. Fourteen ASA I-II patients scheduled for elective surgery in standardized Total Intravenous Anesthesia (TIVA) were enrolled. Transcutaneous electrical stimulation was applied to the inner side of the right tragus. Averaged EEG responses were recorded from the electrode positions C4-F4 and T4-O2 before and after induction of TIVA, during the maximal effect of the non-depolarizing muscle relaxing agent, cis-atracurium (C-AR) and after recovery from C-AR under TIVA. Typical response curves with P1, N1 and P2 peaks could be reproduced in all patients before and after anesthesia induction. The response curves disappeared during the C-AR action and re-appeared after recovery from C-AR under TIVA. The disappearance of the scalp responses to electrical tragus stimulation under the neuromuscular block suggests a muscular origin of these potentials. Copyright © 2013 Elsevier Inc. All rights reserved.
Žužek, Monika Cecilija; Grandič, Marjana; Benoit, Evelyne; Frangež, Robert
The effects of natural polymeric alkylpyridinium salt (nPoly-3-APS), a potent acetylcholinesterase inhibitor isolated from the marine sponge Reniera sarai, were studied on isolated mouse phrenic nerve-hemidiaphragm muscle preparations using electrophysiological approaches. nPoly-3-APS inhibited nerve-evoked isometric muscle twitch and tetanic contraction in a concentration-dependent manner (IC50=29.4μM and 18.5μM, respectively) and produced a 30-44% decrease of directly muscle-elicited twitch and tetanus amplitudes at 54.4μM. Additionally, nPoly-3-APS (9.1-27.2μM) markedly decreased the amplitude of miniature endplate potentials, while their frequency was only affected at the highest concentration used. Endplate potentials were also inhibited by nPoly-3-APS in a concentration-dependent manner (IC50=20.1μM), without significant change in the resting membrane potential of muscle fibers (up to 54.4μM). In conclusion, our results show, for the first time, that nPoly-3-APS preferentially blocks the neuromuscular transmission, in vitro, by a non-depolarizing mechanism. This strongly suggests that the in vivo toxicity of nPoly-3-APS mainly occurs through an antagonist action of the compound on nicotinic acetylcholine receptors of skeletal muscles. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available The kinesio taping is a technique that was created in 1979 by Doctor Kenzo Kase I’m looking through it that could generate a new therapeutic option to control pain, improve athletic performance and reduce the impact of musculoskeletal disorders. From the Sydney 2000 Olympic Games, this technique as a therapeutic alternative PTO and is composed of health professionals in the field of sport and physical rehabilitation.Objetive: This article aims to identify theoretical approaches on the bandage neuromuscular. Material and methods: held today, for which conducted a literature search of databases such as como Proquest, Ovid, Cochraine, PEDro, Journal of Orthopedic and Sports Physical, Sciencedirect, Pubmed y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs.The paper proposes a scheme of contextualization of the current landscape of the use and effects of kinesio taping in the management of different pathologies of the musculo-skeletal system in sports. Conclusion: it is concluded that currently many health professionals, and take the neuromuscular bandage a good therapeutic option in the management of diseases affecting the human body is investigated and every day more about the subject, which makes these new therapeutic methods to acquire a scientific value and transcends knowledge.
Narimatsu, Eichi; Niiya, Tomohisa; Takahashi, Kazunobu; Yamauchi, Masanori; Yamakage, Michiaki
The composite effects of organophosphorus (OP)-cholinesterase (ChE) inhibitors and oximes on the actions of nondepolarizing neuromuscular blockers in acute OP-ChE inhibitor intoxication have not been evaluated in detail. We investigated the effects of paraoxon (Pox) (an OP-ChE inhibitor) and pralidoxime (PAM) (an oxime) on the nondepolarizing neuromuscular blocking action of rocuronium. Isometric twitch tensions of rat left phrenic nerve-hemidiaphragm preparations elicited by indirect (phrenic nerve) supramaximal stimulation at 0.1 Hz were evaluated. Analysis of variance with post hoc testing was used for statistical comparison, and P fashion. Paraoxon caused a rightward shift in the rocuronium concentration-twitch tension curve (IC(50), 15.48 [15.24-15.72] μM). The rightward shift was completely inhibited by previous copretreatment (IC(50), 9.98 [9.77-10.20] μM) and partially inhibited by simultaneous copretreatment (IC(50), 11.68 [11.45-11.91] μM) with PAM but was not inhibited by subsequent copretreatment (IC(50), 13.69 [13.39-13.99] μM) with PAM (P influence the rightward shift (P < .01, n = 6). Paraoxon depressed rocuronium-induced neuromuscular block by inhibiting ChEs, and the action of Pox was inhibited by PAM. Pralidoxime acts more intensely when applied earlier. The time-dependent effect of PAM indicates that the preceding presence of PAM in proximity to ChEs before Pox is necessary for definite suppression of the Pox-induced ChE inhibition. Copyright © 2012 Elsevier Inc. All rights reserved.
Tammisto, T; Wirtavuori, K; Linko, K
Three clinical methods, visual, tactile and 'spring', for the assessment of neuromuscular blockade were compared to the EMG recording evoked during enflurane anaesthesia and relaxation with vecuronium in 33 patients. During maintenance of the block, the tactile method, based on the recognition of the strength of movement of the patient's thumb against the observer's fingers, was more accurate than the two other methods. The correlation coefficient compared to the TI of the EMG was 0.77. The tactile method led to over-estimation of muscle strength in only 9-10% of the assessments made by the anaesthetists, while this happened in about one-third of the cases when the visual method was applied. The observers under-estimated the muscle power in about 30% of the assessments made with each of the clinical methods. During the recovery, the mean train-of-four (TOF) ratio of the EMG was less than 40% when the anaesthetists announced that they could detect no fade with the visual or tactile methods. The corresponding value obtained with the spring method (standardized preload with a rubber spring) was significantly higher, 66%. Using the spring, a clinically significant residual fade (TOF less than 0.50) could be detected in nine of the 11 cases. As residual relaxation cannot be ruled out using the clinical methods, quantitative recording of neuromuscular function is recommended in cases where complete recovery from muscle relaxation is of special importance. The spring method is the most reliable clinical method during recovery, while the tactile method is the most accurate during the maintenance of neuromuscular block.
Gray, A T; Krejci, S T; Larson, M D
To test the hypothesis that systemically administered neuromuscular blocking drugs acutely alter resting pupil size or the direct reflex response to light in anesthetized humans. Patients were randomized to receive an intravenous injection of saline (0.15 mL/kg), pancuronium bromide (0.1 mg/kg), or vecuronium bromide (0.15 mg/kg) after induction of general anesthesia and tracheal intubation. The University of California, San Francisco, Moffitt-Long Hospitals. Healthy adults (American Society of Anesthesiologists physical status I or II) of either sex scheduled for elective surgery requiring general anesthesia, tracheal intubation, and muscle relaxation of an anticipated duration of 2 or more hours. Measurements of resting pupil size, direct reflex response to light, and constriction velocity were obtained in double-blinded fashion using infrared pupillometry. Pupillary size, reflex amplitude, and constriction velocity were not altered by the presence of either vecuronium or pancuronium. Tetanic stimuli and concomitant isoflurane administration respectively increased and decreased pupillary light reflex amplitude, indicating that pupillary responses were not fixed. We conclude that systemically administered neuromuscular blocking drugs (vecuronium and pancuronium) do not acutely affect the pupillary light reflex in healthy, anesthetized patients.
Full Text Available Anesthesia can be maintained with propofol or sevoflurane. Volatile anesthetics increase neuromuscular block of muscle relaxants. We tested the hypothesis, that sevoflurane would cause less vocal cord injuries than an intravenous anesthesia with propofol. In this prospective trial, 65 patients were randomized in 2 groups: SEVO group, anesthesia with sevoflurane, and TIVA group, total intravenous anesthesia with propofol. Intubating and extubating conditions were evaluated. Vocal cord injuries were examined by stroboscopy before and 24 and 72 h after surgery; hoarseness and sore throat were assessed up to 72 h after surgery. Hoarseness and sore throat were comparable between both groups (not significant. Similar findings were observed for vocal cord injuries: 9 (SEVO versus 5 (TIVA patients; ; the overall incidence was 24%. Type of vocal cord injuries: 9 erythema and 5 edema of the vocal folds. Neuromuscular block was significantly longer in the SEVO group compared with the TIVA group: 71 (range: 38–148 min versus 52 (range: 21–74 min; . Five patients (TIVA group versus 11 patients (SEVO group needed neostigmine to achieve a TOF ratio of 1.0 . Under anesthesia with propofol laryngeal injuries were not increased; the risk for residual curarization, however, was lower compared with sevoflurane.
Harboe, T; Johansson, S G O; Florvaag, E; Oman, H
Neuromuscular blocking agents (NMBAs) can cause anaphylaxis through immunoglobulin E (IgE) antibodies that bind quaternary ammonium ion epitopes. These epitopes are present in numerous common chemicals and drugs, exposure to which, theoretically, could be of importance in the development and maintenance of the IgE sensitization promoting allergic reactions. Pholcodine is one such drug, which in a recent pilot study was shown to induce a remarkable increase in serum IgE levels in two IgE-sensitized individuals. The present study explores the effect of pholcodine exposure on IgE in a population with previously diagnosed IgE-mediated anaphylaxis towards NMBAs. Seventeen patients were randomized to 1 week's exposure with cough syrup containing either pholcodine or guaifenesin. The primary variables serum IgE and IgE antibodies towards pholcodine, morphine and suxamethonium were measured before and 4 and 8 weeks after start of exposure. Patients exposed to pholcodine had a sharp rise in levels of IgE antibodies towards pholcodine, morphine and suxamethonium, the median proportional increases 4 weeks after exposure reaching 39.0, 38.6 and 93.0 times that of the base levels respectively. Median proportional increase of IgE was 19.0. No changes were observed in the guaifenesin group. Serum levels of IgE antibodies associated with allergy towards NMBAs increase significantly in sensitized patients after exposure to cough syrup containing pholcodine. Availability of pholcodine should be restricted by medical authorities because of the potential risk of future allergic reactions to muscle relaxants.
Videira, Rogerio L R; Vieira, Joaquim E
In anesthesia practice, inadequate antagonism of neuromuscular blocking drugs (NMBD) may lead to frequent prevalence of residual neuromuscular block that is associated with morbidity and death. In this study we analyzed the clinical decision on antagonizing NMBD to generate hypotheses about barriers to the introduction of experts' recommendations into clinical practice. Sequential surveys were conducted among 108 clinical anesthesiologists to elicit the rules of thumb (heuristics) that support their decisions and provide a measurement of the confidence the clinicians have in their own decisions in comparison with their peers' decisions. The 2 most frequently used heuristics for administering reversal were "the interval since the last NMBD dose was short" and "the breathing pattern is inadequate," chosen by 73% and 71% of the clinicians, respectively. Clinicians considered that the prevalence of clinically significant residual block is higher in their colleagues' practices than in their own practice (60% vs 16%, odds ratio=7.8, 95% confidence interval, 3.8 to 16.2, P=0.0001). The clinicians were less likely to use antagonists if >60 minutes had elapsed after a single dose of atracurium (0.5 mg/kg) (31%) in comparison with after rocuronium 0.6 mg/kg (53%) (P=0.0035). In our institution, the clinical decision to antagonize NMBD is mainly based on the pharmacological forecast and a qualitative judgment of the adequacy of the breathing pattern. Clinicians judge themselves as better skilled at avoiding residual block than they do their colleagues, making them overconfident in their capacity to estimate the duration of action of intermediate-acting NMBD. Awareness of these systematic errors related to clinical intuition may facilitate the adoption of experts' recommendations into clinical practice.
Dante J Heredia
Full Text Available The failure to transmit neural action potentials (APs into muscle APs is referred to as neuromuscular transmission failure (NTF. Although synaptic dysfunction occurs in a variety of neuromuscular diseases and impaired neurotransmission contributes to muscle fatigue, direct evaluation of neurotransmission by measurement of successfully transduced muscle APs is difficult due to the subsequent movements produced by muscle. Moreover, the voltage-gated sodium channel inhibitor used to study neurotransmitter release at the adult neuromuscular junction is ineffective in embryonic tissue, making it nearly impossible to precisely measure any aspect of neurotransmission in embryonic lethal mouse mutants. In this study we utilized 3-(N-butylethanimidoyl-4-hydroxy-2H-chromen-2-one (BHC, previously identified in a small-molecule screen of skeletal muscle myosin inhibitors, to suppress movements without affecting membrane currents. In contrast to previously characterized drugs from this screen such as BTS, which inhibit skeletal muscle myosin ATPase activity but also block neurotransmission, BHC selectively blocked nerve-evoked muscle contraction without affecting neurotransmitter release. This feature allowed a detailed characterization of neurotransmission in both embryonic and adult mice. In the presence of BHC, neural APs produced by tonic stimulation of the phrenic nerve at rates up to 20 Hz were successfully transmitted into muscle APs. At higher rates of phrenic nerve stimulation, NTF was observed. NTF was intermittent and characterized by successful muscle APs following failed ones, with the percentage of successfully transmitted muscle APs diminishing over time. Nerve stimulation rates that failed to produce NTF in the presence of BHC similarly failed to produce a loss of peak muscle fiber shortening, which was examined using a novel optical method of muscle fatigue, or a loss of peak cytosolic calcium transient intensity, examined in whole
El-Subbagh, Hussein I; El-Azab, Adel S; Hassan, Ghada S; El-Messery, Shahenda M; Abdel-Aziz, Alaa A-M; El-Taher, Kamal E H
The synthesis, biological evaluation and molecular modeling study of 6,7-dihydro-[1,3,4] thiadiazolo[3,2-a][1,3]diazepine analogues as new class of neuromuscular blocking agents are described. The new compounds act via competitive mechanism with ACh which could be reversed by the anticholinesterase - Physostigmine. Compounds GS-53 (30) and AAH1 (33) induced dose-dependent neuromuscular blockade with onset time of 3 and 10 min, ED50 0.15 and 0.36 mmol/kg i.p., respectively, in rats. Compound 30 proved to be as twice as potent as 33 with rapid onset and shorter duration (P Molecular modeling analysis indicated that hydrogen bonding to Thr120 and Thr124 beside hydrophobic interactions play effective role incorporating the active ligands to nAChR. The obtained model could be useful for further development of new skeletal muscle relaxants. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Kassardjian, Charles D; Murray, Brian J; Kokokyi, Seint; Jewell, Dana; Barnett, Carolina; Bril, Vera; Katzberg, Hans D
The relationship between sleep and neuromuscular fatigue is understood poorly. The goal of this study was to evaluate the effects of napping on quantitative measures of neuromuscular fatigue in patients with myasthenia gravis (MG). Eight patients with mild to moderate MG were recruited. Patients underwent maintenance of wakefulness tests (MWT) and multiple sleep latency tests (MSLT). The Quantitative Myasthenia Gravis Score (QMGS) was measured before nap and after each nap to examine the effects of napping and sleep on neuromuscular weakness. Results showed that QMGS improves only after naps where patients slept more than 5 min but not where patients did not sleep or slept less than 5 min. Daytime napping mitigates neuromuscular fatigue in patients with MG, especially if patients slept for more than 5 min. Copyright © 2013 Wiley Periodicals, Inc.
Bruintjes, M.H.D.; Helden, E.V. van; Braat, A.E.; Dahan, A; Scheffer, G.J.; Laarhoven, C.J.H.M. van; Warle, M.C.
Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority
Aalberse, R. C.; Kleine Budde, I.; Mulder, M.; Stapel, S. O.; Paulij, W.; Leynadier, F.; Hollmann, M. W.
Background. The significance of IgE antibodies to neuromuscular blocking agent (NMBA)-induced anaphylactic reactions during anaesthesia is unclear. We investigated the relevance of IgE to rocuronium using an in vitro technique. Methods. Serum samples from 61 patients with anaphylactic reactions
Mohansundar Sankaravel; Jeffrey Low Fook Lee; Ong Kuan Boon; Sanmuganathan Jeganathan
Background: Proprioceptive deficiency followed by lateral ankle sprain leads to poor balance is not uncommon. It has been linked with increased injury risk among young athletes. Introducing neuromuscular training programs for this have been believed as one of the means of injury prevention. Hence, this study was aimed to determine the effects of six weeks progressive neuromuscular training (PNM Training) on static balance gains among the young athletes with a previous history of ankle sprains...
Lee, Song Joo; Ren, Yupeng; Chang, Alison H.; Geiger, François; Zhang, Li-Qun
Purpose Pivoting neuromuscular control and proprioceptive acuity may play an important role in ACL injuries. The goal of this study was to investigate whether pivoting neuromuscular training on an offaxis elliptical trainer (POINT) could improve pivoting neuromuscular control, proprioceptive acuity, and functional performance. Methods Among 41 subjects, 21 subjects participated in 18 sessions of POINT (3 sessions/week for 6 weeks), and 20 subjects served as controls who did their regular workout. Both groups received pre-, mid-, and post-intervention evaluations. Propensity score analysis with multivariable regression adjustment was used to investigate the effect of training on pivoting neuromuscular control (pivoting instability, leg pivoting stiffness, maximum internal and external pivoting angles), proprioceptive acuity, and functional performance in both groups. Results Compared to the control group, the training group significantly improved pivoting neuromuscular control as reduced pivoting instability, reduced maximum internal and external pivoting angles, increased leg pivoting stiffness, and decreased entropy of time to peak EMG in the gluteus maximus and lateral gastrocnemius under pivoting perturbations. Furthermore, the training group enhanced weight-bearing proprioceptive acuity and improved the single leg hop distance. Conclusion Improvement of pivoting neuromuscular control in functional weight-bearing activities and task performances following POINT may help develop lower limb injury prevention and rehabilitation methods to reduce ACL and other musculoskeletal injuries associated with pivoting sports. PMID:24389517
Lee, Song Joo; Ren, Yupeng; Chang, Alison H; Geiger, François; Zhang, Li-Qun
Pivoting neuromuscular control and proprioceptive acuity may play an important role in anterior cruciate ligament injuries. The goal of this study was to investigate whether pivoting off-axis intensity adjustable neuromuscular control training (POINT) could improve pivoting neuromuscular control, proprioceptive acuity, and functional performance. Among 41 subjects, 21 subjects participated in 18 sessions of POINT (three sessions per week for 6 wk), and 20 subjects served as controls who did their regular workout. Both groups received pre-, mid-, and postintervention evaluations. Propensity score analysis with multivariable regression adjustment was used to investigate the effect of training on pivoting neuromuscular control (pivoting instability, leg pivoting stiffness, maximum internal, and external pivoting angles), proprioceptive acuity, and functional performance in both groups. Compared with the control group, the training group significantly improved pivoting neuromuscular control as reduced pivoting instability, reduced maximum internal and external pivoting angles, increased leg pivoting stiffness, and decreased entropy of time to peak EMG in the gluteus maximus and lateral gastrocnemius under pivoting perturbations. Furthermore, the training group enhanced weight-bearing proprioceptive acuity and improved the single leg hop distance. Improvement of pivoting neuromuscular control in functional weight-bearing activities and task performances after POINT may help develop lower limb injury prevention and rehabilitation methods to reduce anterior cruciate ligament and other musculoskeletal injuries associated with pivoting sports.
Dell-Kuster, Salome; Levano, Soledad; Burkhart, Christoph S; Lelais, Frédéric; Zemp, André; Schobinger, Elektra; Hampl, Karl; Kindler, Christoph; Girard, Thierry
The duration of neuromuscular block (NMB) following succinylcholine administration is characterised by a high interindividual variability. However, this has not yet been quantified in a large sample of surgical patients. The significance of underlying clinical factors is unknown. The objective of this study was to profile the variability in NMB duration following a standard dose of succinylcholine and to investigate contributing clinical and genetic factors. A prospective, observational study. Tertiary referral centre. In a total of 1630 surgical patients undergoing a rapid sequence induction and intubation, clinical risk factors for a prolongation in NMB duration following succinylcholine were assessed. In a subset of 202 patients, additional biochemical and molecular genetic investigations of butyrylcholinesterase were performed. A standard 1 mg kg dose of succinylcholine after administration of an induction drug and an opioid. NMB duration measured as the time between administration of succinylcholine until reappearance of palpable muscular response to supramaximal transcutaneous ulnar nerve stimulation. NMB varied from 80 s to 44 min with a median duration of 7.3 min. Sixteen percent of patients had NMB duration in excess of 10 min. A multivariable survival model identified physical status, sex, age, hepatic disease, pregnancy, history of cancer and use of etomidate or metoclopramide as independent risk factors for a prolonged NMB. Three novel butyrylcholinesterase variants were identified: p.Ile5Thr; p.Val178Ile; and p.Try231Ser. Neuromuscular blockade duration in excess of 10 min occurred in 16% of a general surgical population following a single dose of succinylcholine. The multivariable model of clinical risk factors for prolonged NMB revealed a negative predictive value of 87%, thereby indicating that absence of such risk factors may reliably predict a shorter duration of NMB. In patients with clinical risk factors for a prolonged NMB or with
de Assunção Braga, Angelica de Fátima; Carvalho, Vanessa Henriques; da Silva Braga, Franklin Sarmento; Potério, Gloria Maria Braga; Santos, Filipe Nadir Caparica; Junqueira, Fernando Eduardo Féres
Local anaesthetics are drugs that are widely used in clinical practice. However, the effects of these drugs on the neuromuscular junction and their influence on the blockade produced by non-depolarising neuromuscular blocking drugs are still under investigation. The aim of this study was to evaluate, in vitro, the influence of a 50% enantiomeric excess bupivacaine mixture on neuromuscular transmission and neuromuscular block produced by pancuronium. Rats were distributed into three groups (n = 5) according to the drug studied namely, 50% enantiomeric excess bupivacaine mixture (5 μg/mL); pancuronium (2 μg/mL); 50% enantiomeric excess bupivacaine mixture + pancuronium. The following parameters were evaluated: (1) Effects of a 50% enantiomeric excess bupivacaine mixture on membrane potential (MP) and miniature endplate potentials (MEPPs); (2) amplitude of diaphragmatic response before and 60 min after the addition of a 50% enantiomeric excess bupivacaine mixture; the degree of neuromuscular block with pancuronium and pancuronium combined with a 50% enantiomeric excess bupivacaine mixture. A 50% enantiomeric excess bupivacaine mixture did not alter the amplitude of muscle response (MP) but decreased the frequency and amplitude of MEPP. The block produced by pancuronium was potentiated by a 50% enantiomeric excess bupivacaine mixture. A 50% enantiomeric excess bupivacaine mixture used alone did not affect neuromuscular transmission, but potentiated the neuromuscular block produced by pancuronium. No action was shown on the muscle fibre, and alterations on MEPPs demonstrated a presynaptic action.
Children with cerebral palsy (CP) often demonstrate poor hand function due to spasticity. Thus spasticity in the wrist and finger flexors poses a great deal of functional limitations. This study was therefore designed to compare the effectiveness of Cryotherapy and Neuromuscular Electrical Stimulation (NMES) on spasticity ...
Thevathasan, T; Shih, S L; Safavi, K C; Berger, D L; Burns, S M; Grabitz, S D; Glidden, R S; Zafonte, R D; Eikermann, M; Schneider, J C
We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs. Clinicians used cisatracurium (mean dose [SD] 0.19 mg kg-1 [0.12]), rocuronium (0.83 mg kg-1 [0.53]) and vecuronium (0.14 mg kg-1 [0.07]). Intraoperative administration of NMBAs was dose-dependently associated with higher risk of 30-day hospital readmission (adjusted odds ratio 1.89 [95% Confidence Interval (CI) 1.26-2.84] for 5th quintile vs 1st quintile; P for trend: Psurgery) significantly modified the risk (interaction term: aOR 1.31 [95% CI 1.05-1.63], P=0.02), and the adjusted odds of readmission in patients undergoing ambulatory surgical procedures who received high-dose NMBAs vs low-dose NMBAs amounted to 2.61 [95% CI 1.11-6.17], P for trend: Phigh doses of NMBAs given during abdominal surgery was associated with an increased risk of 30-day readmission, particularly in patients undergoing ambulatory surgery.
Feb 23, 2018 ... with a modified gamma-cyclodextrin structure offers a viable alternative to the traditional decurarization by cholinesterase inhibitors in the context of the use of steroidal neuromuscular blocking agents. Sugammadex shows its effects through encapsulation of the steroidal neuromuscular blockers, its effects ...
Angélica de Fátima Braga
Full Text Available BACKGROUND AND OBJECTIVES: The local anesthetic effects on neuromuscular junction and its influence on blockade produced by nondepolarizing neuromuscular blockers are still under-investigated; however, this interaction has been described in experimental studies and in humans. The aim of this study was to evaluate in vitro the interaction between ropivacaine and pancuronium, the influence on transmission and neuromuscular blockade, and the effectiveness of neostigmine and 4-aminopyridine to reverse the blockade. METHODS: Rats were divided into groups (n = 5 according to the study drug: ropivacaine (5 µg mL-1; pancuronium (2 µg mL-1; ropivacaine + pancuronium. Neostigmine and 4-aminopyridine were used at concentrations of 2 µg mL-1 and 20 µg mL-1, respectively. The effects of ropivacaine on membrane potential and miniature endplate potential, the amplitude of diaphragm responses before and 60 min after the addition of ropivacaine (degree of neuromuscular blockade with pancuronium and with the association of pancuronium-ropivacaine, and the effectiveness of neostigmine and 4-aminopyridine on neuromuscular block reversal were evaluated. RESULTS: Ropivacaine did not alter the amplitude of muscle response (the membrane potential, but decreased the frequency and amplitude of the miniature endplate potential. Pancuronium blockade was potentiated by ropivacaine, and partially and fully reversed by neostigmine and 4-aminopyridine, respectively. CONCLUSIONS: Ropivacaine increased the neuromuscular block produced by pancuronium. The complete antagonism with 4-aminopyridine suggests presynaptic action of ropivacaine.
Casanova, Javier; Piñeiro, Patricia; De La Gala, Francisco; Olmedilla, Luis; Cruz, Patricia; Duque, Patricia; Garutti, Ignacio
Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious. A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along the year of 2013 who required one-lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train-of-four response (intense, deep and moderate blockade) during one-lung ventilation. Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides, compliance and peripheral oxygen saturation were significantly higher in those moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements. Deep neuromuscular blockade attenuates the poor lung mechanics observed during one-lung ventilation. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
William R. Veal
Full Text Available This study examined the effects of a tri-schedule on the academic achievement of students in a high school. The tri-schedule consists of traditional, 4x4 block, and hybrid schedules running at the same time in the same high school. Effectiveness of the schedules was determined from the state mandated test of basic skills in reading, language, and mathematics. Students who were in a particular schedule their freshman year were tested at the beginning of their sophomore year. A statistical ANCOVA test was performed using the schedule types as independent variables and cognitive skill index and GPA as covariates. For reading and language, there was no statistically significant difference in test results. There was a statistical difference mathematics-computation. Block mathematics is an ideal format for obtaining more credits in mathematics, but the block format does little for mathematics achievement and conceptual understanding. The results have content specific implications for schools, administrations, and school boards who are considering block scheduling adoption.
Dong, S; Acouetey, D S; Guéant-Rodriguez, R-M; Zmirou-Navier, D; Rémen, T; Blanca, M; Mertes, P M; Guéant, J-L
Allergic IgE-mediated reactions to neuromuscular blocking agents (NMBAs) are the main cause of immediate hypersensitivity reactions in anaesthesia; their predominant occurrence in the absence of previous exposure to NMBAs suggests a risk related to environmental exposure. To investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France. The study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (n = 128) were compared with baker/pastry makers (n = 108) and 'non-exposed' matched control subjects (n = 379). We observed a 4.6-fold higher frequency of positive IgE against quaternary ammonium ions in hairdressers (HD), compared with baker/pastry makers (BP) and control (C) groups. The competitive inhibition of quaternary ammonium Sepharose radioimmunoassay (QAS-IgE RIA) with succinylcholine was significantly higher in HD, compared with BP and C groups, with inhibition percentage of 66.2 ± 7.4, 39.7 ± 6.0 and 43.8 ± 9.9, respectively (P 100 kU/L were the two significant predictors of IgE-sensitization against quaternary ammonium ions in the multivariate analysis of a model that included age, sex, professional exposure, increased concentration of total IgE (IgE > 100 kU/L) and positive IgE against prevalent allergens (Phadiatop(®) ; P = 0.019 and P = 0.001, respectively). The exposure to hairdressing professional occupational factors increases IgE-sensitization to NMBAs and quaternary ammonium ion compounds used in hairdressing. Besides the pholcodine hypothesis, our study suggests that repetitive exposure to quaternary ammonium compounds used in hairdressing is a risk factor for NMBAs sensitization. © 2013 John Wiley & Sons Ltd.
Jubeau, Marc; Zory, Raphaël; Gondin, Julien; Martin, Alain; Maffiuletti, Nicola A
The aim of this study was to evaluate the effects of neuromuscular electrical stimulation (NMES) training and subsequent detraining on neuromuscular fatigue mechanisms. Ten young healthy men completed one NMES fatigue protocol before and after a NMES training program of 4 weeks and again after 4 weeks of detraining. Muscle fatigue (maximal voluntary torque loss), central fatigue (activation failure), and peripheral fatigue (transmission failure and contractile failure) of the plantar flexor muscles were assessed by using a series of electrically evoked and voluntary contractions with concomitant electromyographic and torque recordings. At baseline, maximal voluntary torque decreased significantly with fatigue (Pmuscle activation after training and detraining was significantly lower compared to baseline values (Ptraining-detraining of the plantar flexor muscles significantly reduced the muscle fatigue associated to one single NMES exercise session. This was mainly attributable to a reduction in activation failure, i.e., lower central fatigue, probably as a result of subject's accommodation to pain and discomfort during NMES.
Nardin, Rachel A; Zarrin, Amy R; Horowitz, Gary L; Tarulli, Andrew W
The objective was to determine the effect of a proposed increase in the upper reference limits of serum creatine kinase (CK) on neuromuscular disease diagnosis. This was a retrospective study of 94 Caucasian subjects (49 women and 45 men) in whom a neuromuscular physician ordered a CK as part of their evaluation. The patients were divided into two groups: those with diagnoses that either should or could elevate serum CK, and those with diagnoses that should not elevate serum CK. Sensitivities and specificities of the manufacturer's and the newly proposed upper reference limits were determined. For women, raising the upper reference limit of CK from 140 IU/L to 201 IU/L reduced the sensitivity of the test from 50% to 29%, while increasing the specificity from 67% to 80%. For men, raising the upper reference limit of CK from 174 IU/L to 322 IU/L reduced the sensitivity from 80% to 60%, while increasing the specificity from 63% to 80%. The newly proposed upper reference limits resulted in a false-negative CK of clinical significance in 7 of 94 subjects. Increasing the upper reference limit for CK reduced the sensitivity and increased the specificity of serum CK for neuromuscular disease diagnosis. Such a change will reduce unnecessary referrals and invasive diagnostic testing in patients with asymptomatic CK elevations. The clinical impact of the loss in sensitivity is small. If these new upper reference limits are adopted, neuromuscular physicians should be aware that a normal CK level does not exclude a diagnosis of myopathy.
Bruintjes, M H; van Helden, E V; Braat, A E; Dahan, A; Scheffer, G J; van Laarhoven, C J; Warlé, M C
Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inception to December 2016. We included randomized trials, crossover studies, and cohort studies. Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions. Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB, with a mean difference of 0.65 (95% confidence interval (CI): 0.47-0.83) on a scale of 1-5, and it facilitates the use of low-pressure pneumoperitoneum. Furthermore, deep NMB reduces postoperative pain scores in the postanaesthesia care unit, with a mean difference of - 0.52 (95% CI: -0.71 to - 0.32). Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: email@example.com.
Insinga, Ralph P; Joyal, Cédric; Goyette, Alexandra; Galarneau, André
The objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada. A discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use. Trials show sugammadex's impact on OR time and RNMB varies by whether full neuromuscular recovery (train-of-four ratio ≥0.9) is verified prior to extubation in the OR. Scenarios were therefore evaluated reflecting varied assumptions for neuromuscular reversal practices. With use of moderate neuromuscular block, when full neuromuscular recovery is verified prior to extubation (93 procedures performed with sugammadex, 91 with neostigmine), use of sugammadex versus neostigmine avoided 2.4 procedural cancellations due to OR time over-run and 33.5 h of paid staff overtime, while saving an average of 62 min per OR day. No difference was observed between comparators for these endpoints in the scenario when full neuromuscular recovery was not verified prior to extubation, however, per procedure risk of RNMB at extubation was reduced from 60% to 4% (reflecting 51 cases prevented), with associated reductions in risks of hypoxemia (12 cases avoided) and upper airway obstruction (23 cases avoided). Sugammadex impact in reversing deep neuromuscular block was evaluated in an exploratory analysis. When it was hypothetically assumed that 30 min of OR time were saved per procedure, the number of paid hours of staff over-time dropped from 84.1 to 32.0, with a 93% reduction in the per patient risk of residual blockade. In clinical
Tammisto, T; Olkkola, K T
We studied the intensity of neuromuscular block that is adequate for surgical relaxation at different end-tidal levels of enflurane during N2O-O2-fentanyl anesthesia in 30 patients undergoing upper abdominal surgery. After induction of anesthesia with thiopental 4-6 mg/kg and vecuronium 0.07 mg/kg intravenously (i.v.), patients were randomly assigned to receive nitrous oxide-oxygen (2:1) and enflurane at 0.3% (Group I), 0.6% (Group II), or 1.2% (Group III) end-tidal level throughout anesthesia. The initial neuromuscular block was allowed to terminate and additional increments of 1 mg vecuronium were given when indicated by clinical signs or by spontaneous electromyography of neck muscles. In Group I additional vecuronium had to be given 62 times and in Groups II and III, 33, and 16 times, respectively. The mean (SD) neuromuscular block at the time of additional vecuronium was 75.9% +/- 20.7%, 62.5% +/- 20.1%, and 39.3% +/- 21.1% in Groups I to III, respectively. We conclude that there was a clear linear relationship between the end-tidal concentration of enflurane and the degree of neuromuscular block necessary to produce adequate surgical muscle relaxation (P < 0.001).
Serpa Neto, Ary; Pereira, Victor Galvão Moura; Espósito, Daniel Crepaldi; Damasceno, Maria Cecília Toledo; Schultz, Marcus J.
Background: Acute respiratory distress syndrome (ARDS) is a potentially fatal disease with high mortality. Our aim was to summarize the current evidence for use of neuromuscular blocking agents (NMBA) in the early phase of ARDS. Methods: Systematic review and meta-analysis of publications between
Influência da lidocaína no bloqueio neuromuscular produzido pelo rocurônio: estudo em preparação nervo frênico-diafragma de rato Influencia de la lidocaína en el bloqueo neuromuscular producido por el rocuronio: estudio en preparación nervio frénico-diafragma de ratón Influence of lidocaine on the neuromuscular block produced by rocuronium: study in rat phrenic-diaphragmatic nerve preparation
Yolanda Christina S. Loyola
el antagonismo parcial de neostigmina.BACKGROUND AND OBJECTIVES: The action mechanism of local anesthetics (LA on neuromuscular junction motivated several studies. When administered at low doses, they do not interfere on neuromuscular transmission. But high doses may compromise neuromuscular transmission and increase the effects of neuromuscular blockers. The objective of this study was to evaluate lidocaine interaction with rocuronium on rat diaphragm through its influence on neuromuscular block degree. METHODS: Rats, weighing between 250 and 300 g, were used. Preparation was set according to the technique described by Bulbring. Groups were formed (n = 5 according to the drug being studied: lidocaine - 20 µg.mL-1 (Group I; rocuronium - 4 µg.mL-1 (Group II, and rocuronium - 4 µg.mL-1 with lidocaine - 20 µg.mL-1 (Group III. The following items were assessed: 1 the extent of diaphragm muscle responses to indirect stimulation, both before and 60 minutes after adding lidocaine and a neuromuscular blocker; 2 membrane potentials (MP and miniature end-plate potentials (MEPP; 3 the effectiveness of neostigmine, and 4 aminopyridine on neuromuscular blockage reversal. RESULTS: When administered separately, lidocaine did not alter the extent of muscular responses. With the previous use of lidocaine, rocuronium neuromuscular blockage was 82.8% ± 1.91%, with a significant difference (p = 0.0079 when compared to the group with isolated rocuronium (57.8% ± 1.9%. Blockage was both partially and fully reverted by neostigmine and 4-aminopyridine, respectively. Lidocaine did not alter membrane potential and caused an initial increase on MEPP, followed by a blockage. CONCLUSIONS: Lidocaine increases the neuromuscular blocking produced by rocuronium. MEPP modifications identify a presynaptic action. The complete antagonism of 4-aminopyridine indicates a presynaptic component. This idea is supported by the partial antagonism through neostigmine.
Full Text Available Background: Proprioceptive deficiency followed by lateral ankle sprain leads to poor balance is not uncommon. It has been linked with increased injury risk among young athletes. Introducing neuromuscular training programs for this have been believed as one of the means of injury prevention. Hence, this study was aimed to determine the effects of six weeks progressive neuromuscular training (PNM Training on static balance gains among the young athletes with a previous history of ankle sprains. Methods: This study was an experimental study design, with pre and post test method to determine the effects of PNM Training on static balance gains. All data were collected at university’s sports rehabilitation lab before and after six weeks of intervention period. There were 20 male and female volunteer young athletes (20.9 ± 0.85 years of age with a previous history of ankle sprain involving various sports were recruited from the University community. All the subjects were participated in a six week PNM Training that included stability, strength and power training. Outcome measures were collected by calculating the errors on balance error scoring system made by the athletes on static balance before and after the six weeks of intervention period. Static balance was tested in firm and foam surfaces and recorded accordingly. Results: The researchers found a significant decrease (2.40 ± 0.82 in total errors among the samples at the post test compared with their pre test (P >0.05. Conclusions: The study demonstrates that a PNM Training can improve the static balance on both the firm and foam surfaces among the young athletes with a previous history of ankle sprains.
Abdulatif, M; Al-Ghamdi, A; Al-Sanabary, M; Abdel-Gaffar, M E
We have studied the time course of recovery after administration of edrophonium during intense mivacurium block in children aged 2-10 yr, using thumb acceleration in response to train-of-four (TOF) stimulation. Forty-three children receiving alfentanil, propofol, nitrous oxide, isoflurane anaesthesia and mivacurium 0.2 mg kg-1 were allocated randomly to one of three groups. Patients in group 1 (n = 15) received edrophonium 1 mg kg-1, 2 min after maximum block (intense block group). At the time of administration of edrophonium in this group, there was no response to TOF stimulation (100% block) and the post-tetanic count was 10.7 (range 0-20). Patients in group 2 received the same dose of edrophonium after 10% recovery of the first twitch (T1) in the TOF (conventional reversal). Patients in group 3 (n = 13) recovered spontaneously. All patients developed complete suppression of twitch height in response to the bolus dose of mivacurium. All recovery times were measured from the point of maximum block after mivacurium. Mean time for 25% recovery of T1 (clinical duration) was 3.8 (SD 1.1) min in the intense block group. This was significantly shorter than the conventional reversal (8.3 (2.4) min) and spontaneous recovery (9.2 (3.5) min) groups (P < 0.001). The times for 75% and 90% recovery of T1 were shorter in the intense block group (9.4 (2.8), 12.3 (4.2) min) compared with the conventional (13.1 (3.8), 17.3 (4.8) min) and spontaneous recovery (14.9 (4.5), 17.9 (5.2) min) groups (P < 0.01). Total recovery time required for 70% recovery of the TOF ratio (T4/T1) was 8.8 (2.4) min in the intense block group. This was significantly shorter than the conventional reversal (11.9 (3.2) min) (P < 0.05) and spontaneous recovery (17.1 (4.0) min) groups (P < 0.001). Conventional reversal was associated with a shorter total recovery time compared with spontaneous recovery (P < 0.01). The recovery index (time interval between T1 25% and 75%) was comparable in groups 1-3 (5.5 (2
Influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo cisatracúrio Influencia del sevoflurano y del isoflurano en la recuperación del bloqueo neuromuscular producido por el cisatracúrio The influence of sevoflurane and isoflurane on the recovery from cisatracurium-induced neuromuscular block
Angélica de Fátima de Assunção Braga
índice de recuperación (T1(25-75% fueron respectivamente: Grupo I (66,2 ± 13,42 min y 23,6 ± 5,02 min, Grupo II (54,4 ± 6,58 min y 14,9 ± 3,82 min y Grupo III (47,2 ± 7,43 y 16,2 ± 2,93. En relación a la duración clínica hubo diferencia significante entre los grupos I y II, I y III, y II y III. Para el índice de recuperación hubo diferencia significante entre el grupo I y los demás grupos. CONCLUSIONES: La recuperación del bloqueo neuromuscular producido por el cisatracúrio fue más lenta durante la anestesia con los agentes volátiles de que con el propofol, siendo el efecto más pronunciado con el sevoflurano.BACKGROUND AND OBJECTIVES: The effects of neuromuscular blockers on the neuromuscular junction are potentiated by volatile anesthetics. This study aimed at evaluating the influence of sevoflurane and isoflurane on the recovery of cisatracurium- induced neuromuscular block. METHODS: Ninety ASA I and II patients undergoing elective surgeries under general anesthesia were included in this study. Patients were allocated in three groups: Group I (sevoflurane, Group II (isoflurane and Group III (propofol. All patients were premedicated with intramuscular midazolam (0.1 mg.kg-1 30 min before surgery. Anesthesia was induced with alfentanil (50 µg.kg-1, propofol (2.5 mg.kg-1 and cisatracurium (0.15 mg.kg-1. Patients were then ventilated under mask with 100% O2 until disappearance of all TOF responses when laryngoscopy and tracheal intubation were performed. Volatile agents for anesthetic maintenance were introduced immediately after tracheal intubation in 2% and 1% concentrations, respectively, for sevoflurane and isoflurane, as well as the propofol continuous infusion (7 to 10 mg.kg-1.h-1 for Group III. All patients received a 50% mixture of O2 and N2O. Neuromuscular function was monitored by adductor pollicis muscle acceleromyography with TOF stimulation at 15-second intervals. Clinical duration of neuromuscular block (T1(25% and recovery index (RI
Kazon, Soráia; Grecco, Luanda A C; Pasini, Hugo; Corrêa, João C F; Christovão, Thaluanna C L; de Carvalho, Paulo de Tarsocamillo; Giannasi, Lilian Chrystiane; Lucareli, Paulo R G; de Oliveira, Luis Vicente Franco; Salgado, Afonso Shiguemi Inoue; Sampaio, Luciana M M; Oliveira, Claudia S
The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT- A. Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale. The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and
Full Text Available Abstract Background The use of botulinum toxin A (BT-A for the treatment of lower limb spasticity is common in children with cerebral palsy (CP. Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist. Neuromuscular electrical stimulation (NMES is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT- A. Methods/Design Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae. The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1 one week prior to the administration of BT-A; 2 one week after the administration of BT-A; and 3 four months after the administration of BT-A (end of intervention. Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale. Discussion The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior
Place, Nicolas; Blum, Yannick; Armand, Stéphane; Maffiuletti, Nicola A; Behm, David G
The inclusion of relatively long bouts of stretching (repeated static stretches of ∼30 seconds) in the warm-up is usually associated with a drop in muscle performance. The purpose of this study was to assess the effect of a novel self-administered proprioceptive neuromuscular facilitation (PNF) paradigm with short periods of stretching and contraction on quadriceps neuromuscular function, vertical jump performance, and articular range of motion (ROM). Twelve healthy men (age: 27.7 ± 7.3 years, height: 178.4 ± 10.4 cm, weight: 73.8 ± 16.9 kg) volunteered to participate in a PNF session and a control session separated by 2-7 days. The PNF stretching lasted 2 minutes and consisted of 4 sets of 5-second isometric hamstring contraction immediately followed by 5 seconds of passive static stretch of the quadriceps immediately followed by 5 seconds isometric quadriceps contraction for each leg. For the control session, the participants were asked to walk at a comfortable speed for 2 minutes. Active ROM of knee flexion, vertical jump performance, and quadriceps neuromuscular function were tested before, immediately after, and 15 minutes after the intervention. The PNF stretching procedure did not affect ROM, squat jump, and countermovement jump performances. Accordingly, we did not observe any change in maximal voluntary contraction force, voluntary activation level, M-wave and twitch contractile properties that could be attributed to PNF stretching. The present self-administered PNF stretching of the quadriceps with short (5-second) stretches is not recommended before sports where flexibility is mandatory for performance.
Influência da nifedipina no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia de la nifedipina en el bloqueo neuromuscular producido por atracurio y cisatracurio: estudio en preparación nervio frénico diafragma de ratón Influence of nifedipine on the neuromuscular block produced by atracurium and cistracurium: study in rat phrenic-diaphragmatic nerve preparation
Silmara Rodrigues de Sousa
neuromuscular del atracurio y del cisatracurio, no cambió el potencial de membrana y produjo el aumento inicial en la frecuencia de los PPTM, seguida de bloqueo. CONCLUSIONES: La nifedipina, en la concentración empleada, potenció el bloqueo neuromuscular que el atracurio e cisatracurio produjeron. Estudios electrofisiológicos demostraron una acción presináptica y la ausencia de acción despolarizante sobre la fibra muscular.BACKGROUND AND OBJECTIVES: Calcium channel blockers may interact with neuromuscular blockers, increasing its effects. Research studies about this interaction display controversial results. In some studies these drugs produced neuromuscular blockage, or contracture, or no effect at all was proved over skeletal neuromuscular response. This study assessed the nifedipine effects over muscular responses and its possible interaction with neuromuscular blockers in rat diaphragm. METHODS: A number of 25 rats were used, weighing between 250 and 300 g and sacrificed under anesthesia with intraperitoneal pentobarbital (40 mg.kg-1. Preparation was mounted according to the technique described by Bulbring. Diaphragm was kept under tension, connected to an isometric transducer and subjected to an indirect stimulation of 0.1 Hz frequency. Diaphragm contractions were registered on a physiograph. In order to evaluate the effect of these drugs on neuromuscular transmission, they were added separately or associated to the preparation, on the following concentrations: nifedipine (4 µg.mL-1; atracurium (20 µg.mL-1; cistracurium (3 µg.mL-1. On phrenic-nerve preparation, the assessed items were: 1 the extent of diaphragm muscle response to indirect stimulation, before and 45 minutes after adding nifedipine and neuromuscular blockers separately and after the association of both drugs; 2 nifedipine effects on membrane potentials (MP and miniature end-plate potentials (MEPP. RESULTS: Employed separately, nifedipine did not alter the extent of muscular responses, but it did
Brueckmann, B; Sasaki, N; Grobara, P
by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual...... measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch® SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], Pcare patients, 2 also had clinical evidence of partial...... paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs 18.6 min respectively; P=0.02). CONCLUSIONS: After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened...
Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho
[Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used t...
Hagau, Natalia; Gherman, Nadia; Cocis, Mihaela; Petrisor, Cristina
Skin tests for neuromuscular blocking agents (NMBAs) are not currently recommended for the general population undergoing general anaesthesia. In a previous study we have reported a high incidence of positive allergy tests for NMBAs in patients with a positive history of non-anaesthetic drug allergy, a larger prospective study being needed to confirm those preliminary results. The objective of this study was to compare the skin tests results for patients with a positive history of antibiotic-induced immediate type hypersensitivity reactions to those of controls without drug allergies. Ninety eight patients with previous antibiotic hypersensitivity and 72 controls were prospectively included. Skin tests were performed for atracurium, pancuronium, rocuronium, and suxamethonium. We found 65 positive skin tests from the 392 tests performed in patients with a positive history of antibiotic hypersensitivity (1 6.58%) and 23 positive skin tests from the 288 performed in controls (7.98%), the two incidences showing significant statistical difference (p = 0.0011). The relative risk for having a positive skin test for NMBAs for patients versus controls was 1.77 (1.15-2.76). For atracurium, skin tests were more often positive in patients with a positive history of antibiotic hypersensitivity versus controls (p = 0.02). For pancuronium, rocuronium and suxamethonium the statistical difference was not attained (p-values 0.08 for pancuronium, 0.23 for rocuronium, and 0.26 for suxamethonium). Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population. Copyright © 2015 The Authors. Production and hosting by Elsevier B.V. All rights reserved.
Wirtavuori, K; Salmenperä, M; Tammisto, T
The effects of variations in carbon dioxide concentration on the antagonism of pancuronium-induced neuromuscular block by neostigmine were studied in 21 patients: normocarbia (PE'CO2 5.4%, PaCO2 4.93 kPa, n = 7), hypocarbia (PE'CO2 3.6%, PaCO2 3.30 kPa, n = 7) and hypercarbia (PE'CO2 7.5%, PaCO2 7.13 kPa, n = 7). Mechanical and electromyographic responses to ulnar nerve stimulation (0.1 Hz and 2 Hz) were recorded. A 90% block during nitrous oxide in oxygen anaesthesia was maintained by incremental single injections of pancuronium and reversed with neostigmine 0.35 mg kg-1 with atropine 0.0175 mg kg-1. The recovery of twitch tension up to 50% was similar in all groups but thereafter slower in the hypercarbia group. The recovery times from 25% to 75% twitch tension correlated with PaCO2 (r = 0.55, P less than 0.05). A residual block of about 10% was seen in hypercarbic patients. However, the recovery of e.m.g. amplitude and train-of-four ratios was similar in all groups. Thus, the impaired recovery of twitch tension seems to be the result of depressed contractility rather than failure of neuromuscular transmission.
Pühringer, F K; Heier, T; Dodgson, M; Erkola, O; Goonetilleke, P; Hofmockel, R; Gaetke, M R; Mortensen, C R; Upadhyaya, B; Eriksson, L I
This study was designed to compare variability in the offset of two neuromuscular blocking agents with different elimination pathways. The spontaneous recovery profiles of cisatracurium and vecuronium were compared in adult (18-64 years) and elderly (> or =65 years) patients receiving N2O/O2/fentanyl/propofol anaesthesia. Patients were randomised to receive an initial bolus dose and maintenance doses of 3xED95, respectively, 0.6xED95 for cisatracurium (0.15 and 0.03 mg.kg-1) or 2xED95, respectively, and 0.4xED95 for vecuronium (0.1 and 0.02 mg.kg(-1)), as recommended in their prescribing information. Administration of the study drugs was double-blinded, and neuromuscular transmission was monitored using mechanomyography of the evoked response of the adductor pollicis, following ulnar nerve stimulation. The clinically effective duration (minutes) of the initial bolus dose, defined as the mean time to 25% T1 recovery (+/-SD), for the adult and elderly patients was 53.5+/-9.8 and 57.3+/-11.5 for cisatracurium, respectively, and 34.1+/-9.0 and 47.5+/-14.4 for vecuronium, respectively. The duration of spontaneous sufficient recovery (SSR), defined as the mean (+/-SD) time interval in minutes from 25% T1 recovery to a T4:T1 ratio > or =0.8 after the last bolus dose, for the adult, respectively, elderly patients was 28.3+/-8.0 and 31.7+/-10.0 for cisatracurium and 38.5+/-13.2 and 60.3+/-26.1 for vecuronium. Whereas both the clinically effective duration and the duration of SSR are comparable between the adult and the elderly patients receiving cisatracurium, they differ substantially between these two age groups for vecuronium. Furthermore, the variability in offset is significantly lower in patients receiving cisatracurium, especially in the elderly, which may be of particular clinical interest.
Balcı, Nilay Comuk; Yuruk, Zeliha Ozlem; Zeybek, Aslican; Gulsen, Mustafa; Tekindal, Mustafa Agah
[Purpose] The aim of our study was to compare the initial effects of scapular proprioceptive neuromuscular facilitation techniques and classic exercise interventions with physiotherapy modalities on pain...
Son, Jongsang; Lee, Dongyeop; Kim, Youngho
Neuromuscular electrical stimulation is well-known as a modality to improve the performance of neuromuscular system, but its clinical value on muscle strengthening remains equivocal. In this study, we designed a system for an involuntary eccentric contraction of biceps brachii muscles using continuous passive movement and commercial neuromuscular electrical stimulation devices. To investigate the effects of involuntary eccentric contraction training by neuromuscular electrical stimulation on the enhancement of muscle strength, seven healthy men between the ages of 24 and 29 years participated in this study. Participants were trained two times per week for 12 weeks. Each exercise session was performed for 30 min with no rest intervals. Isometric elbow flexion torque and biceps brachii muscle thickness were chosen as evaluation indices, and were measured at pre-/post-training. After the 12-week training, the isometric elbow flexion torque of the trained side significantly increased by approximately 23% compared to the initial performance (P<0.01). Meanwhile, the torque of the untrained side showed no significant change (P=0.862). During the 12-week training period, the biceps brachii muscle thickness of the trained side significantly increased by around 8% at rest and 16% at maximum voluntary contraction (P<0.01). The developed system and the technique show promising results, suggesting that it has the potential to be used to increase the muscle strength in patients with neuromuscular disease and to be implemented in design rehabilitative protocols. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT scores, 2 Star Excursion Balance Test (SEBT reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.
Abstract Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed\\/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT) scores, 2 Star Excursion Balance Test (SEBT) reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs) during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.
Clark, Heather; Lazarus, Cathy; Arvedson, Joan; Schooling, Tracy; Frymark, Tobi
Purpose: To systematically review the literature examining the effects of neuromuscular electrical stimulation (NMES) on swallowing and neural activation. The review was conducted as part of a series examining the effects of oral motor exercises (OMEs) on speech, swallowing, and neural activation. Method: A systematic search was conducted to…
Rathleff, Michael S.; Samani, Afshin; Olesen, Jens L.
BACKGROUND: Female adolescents with patellofemoral pain are characterized by altered neuromuscular knee control and reduced maximal quadriceps torque. The purpose of this study is to investigate whether exercise therapy and patient education are associated with larger improvements in neuromuscular...... knee control and maximal quadriceps torque compared with patient education alone. METHODS: This is an ancillary analysis of a cluster randomized controlled trial investigating the effect of patient education and exercise therapy on self-reported recovery in 121 adolescents with patellofemoral pain...... flexion/extension kinematics and maximal quadriceps torque. FINDINGS: There was an 8-15% greater decrease in the complexity of surface electromyography suggesting an improvement in neuromuscular knee control among those randomized to exercise therapy (0.08
Stratone, Ana; Stratone, Carmen; Chiruţă, Roxana; Zaharia, D; Căruntu, Lidia; Diaconu, Mariana; Stefancu, Oana; Topoliceanu, Fl
The important physiological role of calcium and magnesium ions is all over recognised, about a lot of enzymatic reactions. Magnesium deficit produce neuromuscular hyper-reactivity, psychic reactions, functional hypoparathyroidism, increase of K+ channels membranes permeability, while hypermagnesemia decrease Ach release from neuromuscular synapsis, with post-synaptic excitability decreasing. Using BEROCCA (Hoffman la Roche) 1 cp/day, 30 days at the teenagers with behaviour troubles and at a goup of pregnant women (trimester I-III) with paresthesia, irritability, sleeplessness, we observed an improve of clinical signs, increasing plasma Ca2+ and Mg2+. EEG and EMG prove the beneficial effects of pharmaceutical product BEROCCA.
Braga, Angélica de Fátima de Assunção; Carvalho, Vanessa Henriques; Braga, Franklin Sarmento da Silva; Rodrigues-Simioni, Léa; Loyola, Yolanda Christina S; Potério, Glória Braga
The effects of local anesthetics (LA) on neuromuscular transmission and their influence on the neuromuscular blockade produced by competitive neuromuscular blockers have not been fully investigated. The objective of this study was to evaluate, in vitro, the effects of lidocaine and 50% enantiomeric excess bupivacaine (S75-R25) on the neuromuscular blockade produced by rocuronium. The rats were divided in five groups (n = 5) according to the drug used: isolated lidocaine, bupivacaine (S75-R25), or rocuronium (groups I, II, and II); and rocuronium in preparations previously exposed to LAs (groups IV and V). The concentrations used were as follows: 20 microg x mL(-1), 5 microg x mL(-1), and 4 microg x mL(-1) of lidocaine, bupivacaine (S75-R25), and rocuronium, respectively. The following parameters were evaluated: 1) the strength of muscular contraction of the diaphragm to indirect electrical stimulations, before and 60 minutes after the isolated addition of the LAs and rocuronium, and the association AL-rocuronium; and 2) the effects of LAs on membrane potential (MP) and miniature end-plate potentials (MEPP). The effect of LAs on muscle contraction in response to acetylcholine was evaluated in chick biventer cervicis preparations. Isolated lidocaine and bupivacaine (S75-R25) did not change the muscular response and the levels of MPs. In preparations exposed to LAs, rocuroniuminduced blockade was significantly greater than that produced by rocuronium alone. In chick biventer cervicis preparations, lidocaine and bupivacaine (S75R25) decreased contraction in response to acetylcholine. Lidocaine increased the frequency of MEPPs, which was followed by the blockade; bupivacaine (S75R25) caused a reduction in MEPPs followed by blockade. Local anesthetics caused a potentiation of the neuromuscular blockade produced by rocuronium. The results showed pre- and post-synaptic effects.
Magalh?es, Francisco Elezier Xavier; Junior, Arlindo Rodrigues de Mesquita; Meneses, Harnold?s Tyson de Sousa; Moreira dos Santos, Rayele Pricila; Rodrigues, Ezaine Costa; Gouveia, Samara Sousa Vasconcelos; Gouveia, Guilherme Pertinni de Morais; Orsini, Marco; Bastos, Victor Hugo do Vale; Machado, Dionis de Castro Dutra
[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the ...
Ermilov, Leonid G.; Pulido, Juan N.; Atchison, Fawn W.; Zhan, Wen-Zhi; Ereth, Mark H.; Sieck, Gary C.
Cardiopulmonary bypass (CPB) is associated with significant postoperative morbidity, but its effects on the neuromuscular system are unclear. Recent studies indicate that even relatively short periods of mechanical ventilation result in significant neuromuscular effects. Carbon monoxide (CO) has gained recent attention as therapy to reduce the deleterious effects of CPB. We hypothesized that 1) CPB results in impaired neuromuscular transmission and reduced diaphragm force generation; and 2) CO treatment during CPB will mitigate these effects. In adult male Sprague-Dawley rats, diaphragm muscle-specific force and neuromuscular transmission properties were measured 90 min after weaning from normothermic CPB (1 h). During CPB, either low-dose inhaled CO (250 ppm) or air was administered. The short period of mechanical ventilation used in the present study (∼3 h) did not adversely affect diaphragm muscle contractile properties or neuromuscular transmission. CPB elicited a significant decrease in isometric diaphragm muscle-specific force compared with time-matched, mechanically ventilated rats (∼25% decline in both twitch and tetanic force). Diaphragm muscle fatigability to 40-Hz repetitive stimulation did not change significantly. Neuromuscular transmission failure during repetitive activation was 60 ± 2% in CPB animals compared with 76 ± 4% in mechanically ventilated rats (P < 0.05). CO treatment during CPB abrogated the neuromuscular effects of CPB, such that diaphragm isometric twitch force and neuromuscular transmission were no longer significantly different from mechanically ventilated rats. Thus, CPB has important detrimental effects on diaphragm muscle contractility and neuromuscular transmission that are largely mitigated by CO treatment. Further studies are needed to ascertain the underlying mechanisms of CPB-induced neuromuscular dysfunction and to establish the potential role of CO therapy. PMID:20089713
Marek, Sarah M; Cramer, Joel T; Fincher, A Louise; Massey, Laurie L; Dangelmaier, Suzanne M; Purkayastha, Sushmita; Fitz, Kristi A; Culbertson, Julie Y
Context: Stretching is commonly used as a technique for injury prevention in the clinical setting. Our findings may improve the understanding of the neuromuscular responses to stretching and help clinicians make decisions for rehabilitation progression and return to play.Objective: To examine the short-term effects of static and proprioceptive neuromuscular facilitation stretching on peak torque (PT), mean power output (MP), active range of motion (AROM), passive range of motion (PROM), electromyographic (EMG) amplitude, and mechanomyographic (MMG) amplitude of the vastus lateralis and rectus femoris muscles during voluntary maximal concentric isokinetic leg extensions at 60 and 300 degrees .s.Design: A randomized, counterbalanced, cross-sectional, repeated-measures design.Setting: A university human research laboratory.Patients or Other Participants: Ten female (age, 23 +/- 3 years) and 9 male (age, 21 +/- 3 years) apparently healthy and recreationally active volunteers.Intervention(s): Four static or proprioceptive neuromuscular facilitation stretching exercises to stretch the leg extensor muscles of the dominant limb during 2 separate, randomly ordered laboratory visits.Main Outcome Measure(s): The PT and MP were measured at 60 and 300 degrees .s, EMG and MMG signals were recorded, and AROM and PROM were measured at the knee joint before and after the stretching exercises.Results: Static and proprioceptive neuromuscular facilitation stretching reduced PT (P = .051), MP (P = .041), and EMG amplitude (P = .013) from prestretching to poststretching at 60 and 300 degrees .s (P static and proprioceptive neuromuscular facilitation stretching. The MMG amplitude increased in the rectus femoris muscle in response to the static stretching at 60 degrees .s (P = .031), but no other changes in MMG amplitude were observed (P > .05).Conclusions: Both static and proprioceptive neuromuscular facilitation stretching caused similar deficits in strength, power output, and muscle
Kazon, Soráia; Grecco, Luanda A C; Pasini, Hugo; Corrêa, João C F; Christovão, Thaluanna C L; de Carvalho, Paulo de Tarsocamillo; Giannasi, Lilian Chrystiane; Lucareli, Paulo R G; de Oliveira, Luis Vicente Franco; Salgado, Afonso Shiguemi Inoue; Sampaio, Luciana M M; Oliveira, Claudia S
.... The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children...
Cadore, Eduardo Lusa; Izquierdo, Mikel; Pinto, Stephanie Santana; Alberton, Cristine Lima; Pinto, Ronei Silveira; Baroni, Bruno Manfredini; Vaz, Marco Aurélio; Lanferdini, Fábio Juner; Radaelli, Régis; González-Izal, Miriam; Bottaro, Martim; Kruel, Luiz Fernando Martins
The aim of this study was investigate the effects of different intrasession exercise orders in the neuromuscular adaptations induced by concurrent training in elderly. Twenty-six healthy elderly men (64.7 ± 4.1 years), were placed into two concurrent training groups: strength prior to (SE, n = 13) or after (ES, n = 13) endurance training. Subjects trained strength and endurance training during 12 weeks, three times per week performing both exercise types in the same training session. Upper and lower body one maximum repetition test (1RM) and lower-body isometric peak torque (PTiso) and rate of force development were evaluated as strength parameters. Upper and lower body muscle thickness (MT) was determined by ultrasonography. Lower-body maximal surface electromyographic activity of vastus lateralis and rectus femoris muscles (maximal electromyographic (EMG) amplitude) and neuromuscular economy (normalized EMG at 50 % of pretraining PTiso) were determined. Both SE and ES groups increased the upper- and lower-body 1RM, but the lower-body 1RM increases observed in the SE was higher than ES (35.1 ± 12.8 vs. 21.9 ± 10.6 %, respectively; P muscles evaluated, with no differences between groups. In addition, there were increases in the maximal EMG and neuromuscular economy of vastus lateralis in both SE and ES, but the neuromuscular economy of rectus femoris was improved only in SE (P strength prior to endurance exercise during concurrent training resulted in greater lower-body strength gains as well as greater changes in the neuromuscular economy (rectus femoris) in elderly.
Chappell, Jonathan D; Limpisvasti, Orr
Altered motor control strategies are a proposed cause of the female athlete's increased risk for noncontact anterior cruciate ligament injury. Injury prevention programs have shown promising results in decreasing the incidence of anterior cruciate ligament injury. To evaluate the effect of the Kerlan-Jobe Orthopaedic Clinic Modified Neuromuscular Training Program on the biomechanics of select jumping tasks in the female collegiate athlete. Controlled laboratory study. Thirty female National Collegiate Athletic Association Division I soccer and basketball players performed vertical jump, hopping tests, and 2 jumping tasks (drop jump and stop jump). All subjects completed a 6-week neuromuscular training program with core strengthening and plyometric training. Three-dimensional motion analysis and force plate data were used to compare the kinetics and kinematics of jumping tasks before and after training. Dynamic knee valgus moment during the stance phase of stop jump tasks decreased after completion of the neuromuscular training program (P = .04), but differences were not observed for the drop jump. Initial knee flexion (P = .003) and maximum knee flexion (P = .006) angles increased during the stance phase of drop jumps after training, but differences were not observed for the stop jump. The athletes showed improved performance in vertical jump (P < .001), right 1-legged hop (P < .001), and left 1-legged hop (P < .001). Completion of a 6-week neuromuscular training program improved select athletic performance measures and changed movement patterns during jumping tasks in the subject population. The use of this neuromuscular training program could potentially modify the collegiate athlete's motion strategies, improve performance, and lower the athlete's risk for injury.
Huckstorf, B. L.; Slocum, G. R.; Bain, J. L.; Reiser, P. M.; Sedlak, F. R.; Wong-Riley, M. T.; Riley, D. A.
We hypothesized that hindlimb suspension unloading of 8-day-old neonatal rats would disrupt the normal development of muscle fiber types and the motor innervation of the antigravity (weightbearing) soleus muscles but not extensor digitorum longus (EDL) muscles. Five rats were suspended 4.5 h and returned 1.5 h to the dam for nursing on a 24 h cycle for 9 days. To control for isolation from the dam, the remaining five littermates were removed on the same schedule but not suspended. Another litter of 10 rats housed in the same room provided a vivarium control. Fibers were typed by myofibrillar ATPase histochemistry and immunostaining for embryonic, slow, fast IIA and fast IIB isomyosins. The percentage of multiple innervation and the complexity of singly-innervated motor terminal endings were assessed in silver/cholinesterase stained sections. Unique to the soleus, unloading accelerated production of fast IIA myosin, delayed expression of slow myosin and retarded increases in standardized muscle weight and fiber size. Loss of multiple innervation was not delayed. However, fewer than normal motor nerve endings achieved complexity. Suspended rats continued unloaded hindlimb movements. These findings suggest that motor neurons resolve multiple innervation through nerve impulse activity, whereas the postsynaptic element (muscle fiber) controls endplate size, which regulates motor terminal arborization. Unexpectedly, in the EDL of unloaded rats, transition from embryonic to fast myosin expression was retarded. Suspension-related foot drop, which stretches and chronically loads EDL, may have prevented fast fiber differentiation. These results demonstrate that neuromuscular development of both weightbearing and non-weightbearing muscles in rats is dependent upon and modulated by hindlimb loading.
Fukushima, Akihiro; Chazono, Kaori; Hashimoto, Yuichi; Iwajima, Yui; Yamamoto, Shohei; Maeda, Yasuhiro; Ohsawa, Masahiro; Ono, Hideki
Oseltamivir, an anti-influenza virus drug, induces marked hypothermia in normal mice. We have proposed that the hypothermic effect arises from inhibition of the nicotinic acetylcholine receptor function of sympathetic ganglion neurons which innervate the brown adipose tissue (a heat generator). It has been reported that local anesthetics inhibit nicotinic acetylcholine receptor function by acting on its ionic channels, and that bupropion, a nicotinic antagonist, induces hypothermia. In this study, we compared the effects of oseltamivir, procaine and bupropion on body temperature, cardiovascular function and neuromuscular transmission. Intraperitoneal administration of oseltamivir (100mg/kg), procaine (86.6mg/kg) and bupropion (86.7mg/kg) lowered the core body temperature of normal mice. At lower doses (10-30mg/kg oseltamivir, 8.7-26mg/kg procaine and bupropion), when administered subcutaneously, the three drugs antagonized the hypothermia induced by intraperitoneal injection of nicotine (1mg/kg). In anesthetized rats, intravenous oseltamivir (30-100mg/kg), procaine (10mg/kg) and bupropion (10mg/kg) induced hypotension and bradycardia. Oseltamivir alone (100mg/kg) did not inhibit neuromuscular twitch contraction of rats, but at 3-30mg/kg it augmented the muscle-relaxing effect of d-tubocurarine. Similar effects were observed when lower doses of procaine (10-30mg/kg) and bupropion (3-10mg/kg) were administered, suggesting that systemic administration of oseltamivir inhibits muscular nicotinic acetylcholine receptors. These results support the idea that the hypothermic effect of oseltamivir is due to its effects on sympathetic ganglia which innervate the brown adipose tissue, and suggest that oseltamivir may exert non-selective ion channel blocking effects like those of ester-type local anesthetics. Copyright © 2015 Elsevier B.V. All rights reserved.
Background: The versatility of military physical therapist practice enables them not only to diagnose knee injuries but also to provide a wide range of definitive care and rehabilitation, reducing the need for costly evacuation. The aim this study was to evaluate the effectiveness of interventions by Neuromuscular Electrical Stimulation (NMES) in the functional knee rehabilitation in soldiers and describe the main predictors and determinants in each intervention. Methods: A systematic search ...
Cronin, Gaye W; Steenerson, Ronald Leif
The study goal was to present the effectiveness of neuromuscular facial retraining techniques used in combination with electromyography for improving facial function even in cases of longstanding paralysis. We conducted a retrospective case review in a tertiary neurotology clinic. Twenty-four patients with facial paralysis received neuromuscular facial retraining between April 1999 and April 2001. The patient sample included 6 males and 18 females, with an average age of 44 years. A control group consisted of 6 patients (4 females and 2 males). All patient groups made significant improvements in function with improved symmetry in dual-channel electromyographic readings and increased facial movement percentages. Some of the percentages of posttreatment facial function were as follows: acoustic neuromas, 93%; Bell's palsy/Ramsay Hunt syndrome, 80%; and facial nerve anastomosis, 71%. Synkinesis was reduced by at least 2 levels in patients who initially demonstrated synkinesis. Neuromuscular facial retraining exercises and electromyography are effective for improving facial movements. Facial retraining is an excellent example of the plasticity of the central nervous system to reorganize, even in cases of longstanding paralysis.
VANDENBROEK, L; WIERDA, JMKH; SMEULERS, NJ; PROOST, JH
We have evaluated in 10 anaesthetized patients the time course of action, infusion requirements, reversibility and pharmacokinetics of Org 9487. Org 9487 was administered as a bolus dose of 1.5 mg kg(-1), followed by an infusion to maintain a block of 75-85 % for 60 min. After recovery from the
Judd, Dana L; Winters, Joshua D; Stevens-Lapsley, Jennifer E; Christiansen, Cory L
Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty. Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison. Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes. Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.
Yıldızgören, Mustafa Turgut; Nakipoğlu Yüzer, Güldal Funda; Ekiz, Timur; Özgirgin, Neşe
To evaluate the effects of neuromuscular electrical stimulation on wrist range of motion, wrist and finger flexor spasticity, and hand functions in patients with unilateral cerebral palsy. Twenty-four children with unilateral spastic cerebral palsy (14 boys and 10 girls) between the ages of 5 and 14 years were randomized into neuromuscular electrical stimulation and control groups. Conventional exercises were applied, and static volar wrist-hand orthosis was administered to all patients 5 days a week for 6 weeks. Additionally, 30-minute neuromuscular electrical stimulation sessions were applied to the wrist extensor muscles in the neuromuscular electrical stimulation group. Patients were evaluated by Zancolli Classification System, Manual Ability Classification System, and Abilhand-Kids Test. Compared with baseline, a significant increase was evident in active wrist extension angle at the fourth and sixth weeks in both groups (all P spasticity values in the neuromuscular electrical stimulation group at the fourth and sixth weeks (P = 0.002 and P = 0.001, respectively) and in the control group only at the sixth week (P = 0.008). Abilhand-Kids values improved only in the neuromuscular electrical stimulation group (P spasticity, and hand functions in cerebral palsy. Copyright © 2014 Elsevier Inc. All rights reserved.
Zouari, N; Choyakh, F
Two patients were bitten by tunisian cobras (Naja haje haje). A few hours after the bite they developed generalized paralysis which progressed to respiratory paralysis. Electrophysiological features are similar to those of myasthenia gravis and exhibit decremental pattern after stimulation at a frequency of three per second. It is probable that cobra neurotoxins act postsynaptically. The neuromuscular blocking activity of snake-venom can be reversed by intravenous neostigmine.
Cadore, Eduardo Lusa; Izquierdo, Mikel; Pinto, Stephanie Santana; Alberton, Cristine Lima; Pinto, Ronei Silveira; Baroni, Bruno Manfredini; Vaz, Marco Aurélio; Lanferdini, Fábio Juner; Radaelli, Régis; González-Izal, Miriam; Bottaro, Martim; Kruel, Luiz Fernando Martins
The aim of this study was investigate the effects of different intrasession exercise orders in the neuromuscular adaptations induced by concurrent training in elderly. Twenty-six healthy elderly men (64.7 ± 4.1 years), were placed into two concurrent training groups: strength prior to (SE, n = 13) or after (ES, n = 13) endurance training. Subjects trained strength and endurance training during 12 weeks, three times per week performing both exercise types in the same training session. Upper an...
Influência dos Hipnóticos no bloqueio neuromuscular produzido pelo cisatracúrio: emprego da aceleromiografia Influencia de los hipnóticos en el bloqueo neuromuscular producido por el cisatracurio: uso de la aceleromiografía Influence of hypnotics on cisatracurium-induced neuromuscular block: use of acceleromyograhpy
Angélica de Fátima de Assunção Braga
ésica, la inducción fue con propofol (2,5 mg.kg-1 o etomidato (0,3 mg.kg-1 precedido de fentanilo (250 µg y seguido de cisatracurio (0,1 mg.kg-1. Los pacientes fueron ventilados con oxígeno al 100% hasta la obtención de la reducción de un 95% o más en la amplitud de la respuesta del aductor del pulgar cuando se hizo la laringoscopia y la intubación traqueal. La función neuromuscular fue monitorizada con aceleromiografía. Se evaluaron el inicio de acción del cisatracurio, las condiciones de intubación traqueal y las repercusiones hemodinámicas. RESULTADOS: Los tiempos promedios y las desviaciones estándar para el inicio de acción del cisatracurio fueron: GI (86,6 ± 14,3" y GII (116,9 ± 11,6", con una diferencia significativa (p BACKGROUND AND OBJECTIVE: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB. The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. METHOD: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol and GII (etomidate. Patients received intramuscular (IM midazolam (0.1 mg.kg-1 as premedication and we performed induction with propofol (2.5 mg.kg-1 or etomidate (0.3 mg.kg-1, preceded by fentanyl (250 mg and followed by cisatracurium (0.1 mg.kg-1. The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. RESULTS: The mean time and standard deviations of cisatracurium onset were: GI (86.6 ± 14.3 s and GII (116.9 ± 11.6 s, with a significant difference (p < 0, 0001
Zanetti, Giulia; Sikorra, Stefan; Rummel, Andreas; Krez, Nadja; Duregotti, Elisa; Negro, Samuele; Henke, Tina; Rossetto, Ornella; Binz, Thomas; Pirazzini, Marco
Botulinum neurotoxin serotype C (BoNT/C) is a neuroparalytic toxin associated with outbreaks of animal botulism, particularly in birds, and is the only BoNT known to cleave two different SNARE proteins, SNAP-25 and syntaxin. BoNT/C was shown to be a good substitute for BoNT/A1 in human dystonia therapy because of its long lasting effects and absence of neuromuscular damage. Two triple mutants of BoNT/C, namely BoNT/C S51T/R52N/N53P (BoNT/C α-51) and BoNT/C L200W/M221W/I226W (BoNT/C α-3W), were recently reported to selectively cleave syntaxin and have been used here to evaluate the individual contribution of SNAP-25 and syntaxin cleavage to the effect of BoNT/C in vivo. Although BoNT/C α-51 and BoNT/C α-3W toxins cleave syntaxin with similar efficiency, we unexpectedly found also cleavage of SNAP-25, although to a lesser extent than wild type BoNT/C. Interestingly, the BoNT/C mutants exhibit reduced lethality compared to wild type toxin, a result that correlated with their residual activity against SNAP-25. In spite of this, a local injection of BoNT/C α-51 persistently impairs neuromuscular junction activity. This is due to an initial phase in which SNAP-25 cleavage causes a complete blockade of neurotransmission, and to a second phase of incomplete impairment ascribable to syntaxin cleavage. Together, these results indicate that neuroparalysis of BoNT/C at the neuromuscular junction is due to SNAP-25 cleavage, while the proteolysis of syntaxin provides a substantial, but incomplete, neuromuscular impairment. In light of this evidence, we discuss a possible clinical use of BoNT/C α-51 as a botulinum neurotoxin endowed with a wide safety margin and a long lasting effect.
João Fernando Lourenço de Almeida
Full Text Available Neuromuscular blocking agents (NMBAs have been widely used to control patients who need to be immobilized for some kind of medical intervention, such as an invasive procedure or synchronism with mechanical ventilation. The purpose of this monograph is to review the pharmacology of the NMBAs, to compare the main differences between the neuromuscular junction in neonates, infants, toddlers and adults, and moreover to discuss their indications in critically ill pediatric patients. Continuous improvement of knowledge about NMBAs pharmacology, adverse effects, and the many other remaining unanswered questions about neuromuscular junction and neuromuscular blockade in children is essential for the correct use of these drugs. Therefore, the indication of these agents in pediatrics is determined with extreme judiciousness. Computorized (Medline 1990-2000 and active search of articles were the mechanisms used in this review.Os bloqueadores neuromusculares têm sido amplamente utilizados para controlar pacientes que necessitem imobilidade para algum tipo de intervenção médica, desde a realização de procedimentos invasivos até a obtenção de sincronismo com a ventilação mecânica. O objetivo básico desta monografia é revisar a farmacologia dos principais bloqueadores neuromusculares, analisar as diferenças existentes na junção neuromuscular de neonatos, lactentes, pré-escolares e adultos, além de discutir suas indicações em pacientes criticamente enfermos internados em unidade de terapia intensiva pediátrica. Revisão computadorizada da literatura (Medline 1990-2000 associado a busca ativa de artigos compuseram o mecanismo de busca dos dados desta revisão.
Duvaldestin, Philippe; Kuizenga, Karel; Saldien, Vera
Sugammadex is the first of a new class of selective muscle relaxant binding drugs developed for the rapid and complete reversal of neuromuscular blockade induced by rocuronium and vecuronium. Many studies have demonstrated a dose-response relationship with sugammadex for reversal of neuromuscular...... blockade in patients induced and maintained under propofol anesthesia. However, sevoflurane anesthesia, unlike propofol, can prolong the effect of neuromuscular blocking drugs (NMBDs) such as rocuronium and vecuronium....
Métézeau, P; Bourneau, R; Mambrini, J; Tazieff-Depierre, F
ATX II is a toxin extracted from tentacles of Anemonia sulcata. It was known that this protein displays neurotoxic effects on frog isolated neuromuscular preparation (Fig. 1, 2) and that muscular contractures observed with ATX II are blocked by d-tubocurarine (Fig. 3) or on a 40-days-denervated gastrocnemius (Fig. 4). Part of these experiments has already appeared. 1. These effects of ATX II depend on calcium concentration in the bathing medium, as is the case for transmitter release. The same results were observed when we substituted strontium to calcium. 2. On an intact sciatic sartorius preparation, ATX II does not act on the amplitude of the miniature endplate potentials (mepps, Fig. 6). The muscular action potential is not modified by this toxin. 3. ATX II increases the frequency of the mepps (Fig. 5). The evoked transmitter release (quantal content) after ATX II is also largely increased (Fig. 7). 4. In conclusion, it is suggested that ATX II acts indirectly on the muscle through an increase in acetylcholine release from the motor nerve terminals.
Colson, Serge S; Benchortane, Michaël; Tanant, Véronique; Faghan, Jean-Paul; Fournier-Mehouas, Manuela; Benaïm, Charles; Desnuelle, Claude; Sacconi, Sabrina
To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) strength training in facioscapulohumeral muscular dystrophy (FSHD) patients. Uncontrolled before-after trial. Neuromuscular disease center in a university hospital and a private-practice physical therapy office. FSHD patients (N=9; 3 women, 6 men; age 55.2+/-10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness. Patients underwent 5 months of strength training with NMES bilaterally applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week. Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities. NMES strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved. In FSHD, NMES strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities.
de Jesus Reis Rosa, Luana; Silva, Gleidy Ana Araujo; Filho, Jorge Amaral; Silva, Magali Glauzer; Groppo, Francisco Carlos; Oshima-Franco, Yoko
In geographically isolated populations where intensive medical care or serum therapy is not easily accessible snake envenomation is a major cause for concern. The aim of the present study was to test Camellia sinensis extracts, theaflavin and epigallocatechin (two of the main C. sinensis components) against the irreversible neuromuscular blockade induced by Crotalus durissus terrificus venom in mouse phrenic-nerve diaphragm preparations. A quantitative histological study was also performed. The venom (20µg/ml) completely decreased twitch tension after 70min and 5µg/ml venom abolished 50% of twitch amplitude after 60min. C. sinensis extract induced intense facilitatory effect in the preparation activity at 0.2mg/ml and slightly facilitatory effect at 0.05mg/ml. Both 0.05mg/ml C. sinensis extract and 0.05mg/ml commercial theaflavin maintained partial muscular activity in presence of 5µg/ml venom. The histological data confirms that Cs is able to protect the muscle from the myotoxic activity of the venom. Commercial epigallocatechin gallate did not show pre-synaptic nor post-synaptic activities. C. sinensis extract was able to protect the mouse phrenic-nerve diaphragm against the irreversible neuromuscular blockade induced by C. durissus terrificus venom. PMID:21544176
Full Text Available Approximately 60% of perioperative anaphylactic reactions are thought to be immunoglobulin IgE mediated, whereas 40% are thought to be non-IgE mediated hypersensitivity reactions (both considered non-dose-related type B adverse drug reactions. In both cases, symptoms are elicited by mast cell degranulation. Also, pharmacological reactions to drugs (type A, dose-related may sometimes mimic symptoms triggered by mast cell degranulation. In case of hypotension, bronchospasm, or urticarial rash due to mast cell degranulation, identification of the responsible mechanism is complicated. However, determination of the type of the underlying adverse drug reaction is of paramount interest for the decision of whether the culprit drug may be re-administered. Neuromuscular blocking agents (NMBA are among the most frequent cause of perioperative anaphylaxis. Recently, it has been shown that NMBA may activate mast cells independently from IgE antibodies via the human Mas-related G-protein-coupled receptor member X2 (MRGPRX2. In light of this new insight into the patho-mechanism of pseudo-allergic adverse drug reactions, in which as drug-receptor interaction results in anaphylaxis like symptoms, we critically reviewed the literature on NMBA-induced perioperative anaphylaxis. We challenge the dogma that NMBA mainly cause IgE-mediated anaphylaxis via an IgE-mediated mechanism, which is based on studies that consider positive skin test to be specific for IgE-mediated hypersensitivity. Finally, we discuss the question whether MRGPRX2 mediated pseudo-allergic reactions should be re-classified as type A adverse reactions.
Juchler, Isabelle; Blasimann, Angela; Baur, Heiner; Radlinger, Lorenz
Functional ankle instability is the result of sensorimotor or structural deficits. The commonly used kinesio tape (KT) is supposed to have a positive influence on sensorimotor functions. Eight women and two men (mean ± SD, age 24.4 ± 3.3 years) with functional ankle instability with recurrent ankle sprains ran downhill on a treadmill (3.3 m/s and a negative slope of 5°). The first trial was without KT, the second with KT on the peroneus longus (PL) muscle. Neuromuscular activity was measured using surface electromyography for 15 seconds. Sensation of giving way was assessed with a visual analog scale (VAS). Comparisons were made between measurements with and without KT using the Wilcoxon rank sum test. The level of significance was set at P ≤ 0.05. None of the chosen parameters for preactivation, reflex activation, or total activation showed statistically significant differences between the two trials (P > 0.05). The mean values for the sensation of giving way were lower with KT (VAS, median 1.2, range 0-2.8) than without (VAS, median 1.8, range 0-3.9), but did not reach statistical significance (P = 0.102) or clinical relevance. KT in participants with functional ankle instability (FAI) seems to have no effect on the neuromuscular activity of PL and sensation of giving way during downhill running.
Toussaint, Michel; Boitano, Louis J; Gathot, Vincent; Steens, Marc; Soudon, Philippe
Manual and mechanical cough-augmentation techniques can improve peak cough flow (PCF) in patients with respiratory insufficiency caused by neuromuscular disease. We studied cough-augmentation techniques in 179 clinically stable patients with various neuromuscular diseases. We measured vital capacity (VC), maximum expiratory pressure (MEP), and PCF, with and without 3 cough-augmentation techniques: manually assisted cough (MAC); breath-stacking (in a subgroup of 60 patients receiving noninvasive mechanical ventilation); and breath-stacking in combination with MAC (also in the 60-patient subgroup). We analyzed the data with the receiver operating characteristic (ROC), to predict the lower limits (assisted PCF > or = 180 L/min) and upper limits (assisted PCF techniques. The lower limit of effective assisted cough with MAC, breath-stacking, and breath-stacking plus MAC was best predicted by VC > 1,030 mL (ROC 0.86, P 558 mL (ROC 0.92, P 340 mL (ROC 0.90, P 34 cm H(2)O (ROC 0.89, P techniques the benefits decreased linearly with increasing MEP and VC (P techniques can be predicted with measurements of maximum respiratory capacity. Patients with VC > 340 mL and MEP manually assisted cough to improve PCF to > 180 L/min.
Minshull, Claire; Eston, Roger; Bailey, Andrea; Rees, David; Gleeson, Nigel
The effects of flexibility conditioning on neuromuscular and sensorimotor performance were assessed near to full knee extension (25°). Eighteen males who were randomly assigned into two groups underwent eight weeks (three-times per week) of flexibility conditioning (hip region/knee flexor musculature; dominant limb) involving either proprioceptive neuromuscular facilitation (PNF) (n=9) or passive stretching (PASS) (n=9). Both modes of flexibility conditioning are popular within contemporary exercise and clinical settings and have demonstrated efficacy in improving range of motion. The contralateral limb and a prior 'no exercise' condition were used as controls. The PNF and PASS modes of conditioning improved passive hip flexibility to a similar extent (mean 19.3% vs. baseline, intervention limb, pPNF (PASS: 10.8% and 16.9% lengthening of EMDV and EMDE, respectively vs. PNF: 3.2% and 6.2%, pPNF conditioning suggests a preserved capability for rapid muscle activation, which is important in the maintenance of dynamic joint stability. That PNF was also equally efficacious in flexibility conditioning would suggest that this mode of flexibility training should be used over passive to help preserve dynamic joint stability capabilities at this extended and vulnerable joint position.
Giandolini, M; Horvais, N; Rossi, J; Millet, G Y; Morin, J-B; Samozino, P
Minimizing musculo-skeletal damage and fatigue is considered paramount for performance in trail running. Our purposes were to investigate the effects of the foot strike pattern and its variability on (a) muscle activity during a downhill trail run and (b) immediate and delayed neuromuscular fatigue. Twenty-three runners performed a 6.5-km run (1264 m of negative elevation change). Electromyographic activity of lower-limb muscles was recorded continuously. Heel and metatarsal accelerations were recorded to identify the running technique. Peripheral and central fatigue was assessed in knee extensors (KE) and plantar flexors (PF) at Pre-, Post-, and 2 days post downhill run (Post2d). Anterior patterns were associated with (a) higher gastrocnemius lateralis activity and lower tibialis anterior and vastus lateralis activity during the run and (b) larger decreases in KE high-frequency stimulus-evoked torque Post and larger decrements in KE MVC Post2d. High patterns variability during the run was associated with (a) smaller decreases in KE Db100 Post and MVC Post2d and (b) smaller decreases in PF MVC Post and Post2d. Anterior patterns increase the severity of KE peripheral fatigue. However, high foot strike pattern variability during the run reduced acute and delayed neuromuscular fatigue in KE and PF. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Kosek, E; Roos, Ewa M.; Ageberg, E
To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters.......To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters....
Wang, Shao-Jun; Xu, Dong-Qing; Li, Jing-Xian
This study examined the effects of regular Tai Chi practice and jogging on the neuromuscular activity of the trunk, hip, and ankle joint muscles of older people during lateral postural perturbation. A total of 42 older people participated in the study and formed the Tai Chi, jogging, and sedentary control groups. Electromyography signals were collected from the peroneus longus, anterior tibialis, gluteus medius, and erector spinae during unpredictable mediolateral perturbation. The Tai Chi group exhibited significantly faster latencies of the tibialis anterior and erector spinae than the control group. The jogging group showed a significantly shorter neuromuscular reaction time of the erector spinae than the control group. No significant difference was observed between the Tai Chi and jogging groups. Long-term regular Tai Chi practice enhanced the neuromuscular reaction of the erector spinae and tibialis anterior to lateral perturbation and will help timely posture correction when lateral postural distributions occur.
Yu, S P; Van der Kloot, W
The rate of non-quantal acetylcholine (ACh) release was estimated at the mouse neuromuscular junction by observing the effect of (+)-tubocurarine on endplate membrane potential or current in preparations pretreated with an irreversible anti-acetylcholinesterase (anti-AChE). Voltage clamping was an effective method for measuring non-quantal release. Non-quantal release was markedly inhibited by 10 microM aconitine. Non-quantal release was not significantly increased by 10 microM dihyroouabain (DHO). (It has been reported that ouabain increases the leak). Non-quantal release was roughly doubled following exposure to hypertonic solution or to elevated K(+)-solution. This is in accord with the hypothesis that the leak is by way of ACh transporters incorporated into the terminal membrane following exocytosis, but other interpretations remain to be tested.
Reed, Umbertina C.
Objetivo: apresentar os dados essenciais para o diagnóstico diferencial entre as principais doenças neuromusculares, denominação genérica sob a qual agrupam-se diferentes afecções, decorrentes do acometimento primário da unidade motora (motoneurônio medular, raiz nervosa, nervo periférico, junção mioneural e músculo). Fontes dos dados: os aspectos clínicos fundamentais para estabelecer o diagnóstico diferencial entre as diferentes doenças neuromusculares, bem como entre estas e as causas de h...
Balcı, Nilay Comuk; Yuruk, Zeliha Ozlem; Zeybek, Aslican; Gulsen, Mustafa; Tekindal, Mustafa Agah
[Purpose] The aim of our study was to compare the initial effects of scapular proprioceptive neuromuscular facilitation techniques and classic exercise interventions with physiotherapy modalities on pain, scapular dyskinesis, range of motion, and function in adhesive capsulitis. [Subjects and Methods] Fifty-three subjects were allocated to 3 groups: scapular proprioceptive neuromuscular facilitation exercies and physiotherapy modalities, classic exercise and physiotherapy modalities, and only physiotherapy modalities. The intervention was applied in a single session. The Visual Analog Scale, Lateral Scapular Slide Test, range of motion and Simple Shoulder Test were evaluated before and just after the one-hour intervention in the same session (all in one session). [Results] All of the groups showed significant differences in shoulder flexion and abduction range of motion and Simple Shoulder Test scores. There were statistically significant differences in Visual Analog Scale scores in the proprioceptive neuromuscular facilitation and control groups, and no treatment method had significant effect on the Lateral Scapular Slide Test results. There were no statistically significant differences between the groups before and after the intervention. [Conclusion] Proprioceptive neuromuscular facilitation, classic exercise, and physiotherapy modalities had immediate effects on adhesive capsulitis in our study. However, there was no additional benefit of exercises in one session over physiotherapy modalities. Also, an effective treatment regimen for shoulder rehabilitation of adhesive capsulitis patients should include scapular exercises.
Burke, Jeanmarie R
The purpose of this research was to determine the effects of footwear comfort perception on the gain of the gastrocnemius H-reflex response during single leg balance tasks. Subjects performed single leg balance tasks while wearing aerobic sneakers with two different pairs of shoe insoles that were subjectively rated for comfort using a reliable 150 mm visual analog scale. The primary outcome was the consistency of decreasing the gain of the gastrocnemius H-reflex with increasing balance task complexity as a function of footwear comfort perception. Among the asymptomatic subjects (n = 11), H-reflex gain significantly decreased by 19% and 10% from balancing on a stable surface to an unstable surface for the shoe-brand and replacement insoles, respectively (p comfort perception may negatively impact the attenuation of gastrocnemius H-reflex gain that contributes to the neuromuscular control of challenging balance tasks.
Ellman, Lauren M; Schetter, Christine Dunkel; Hobel, Calvin J; Chicz-Demet, Aleksandra; Glynn, Laura M; Sandman, Curt A
The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among males (even after controlling for length of gestation). Results also suggested that increases in maternal cortisol at 31 weeks were associated with increases in infant maturation among females, although these results were not significant after controlling for length of gestation. Findings suggest that stress hormones have effects on human fetal neurodevelopment that are independent of birth outcome.
Ayala, Francisco; Pomares-Noguera, Carlos; Robles-Palazón, Francisco Javier; Del Pilar García-Vaquero, Maria; Ruiz-Pérez, Ignacio; Hernández-Sánchez, Sergio; De Ste Croix, Mark
The main purpose of this study was to analyse the training effects of the FIFA 11+ and Harmoknee on several parameters of physical performance measures in youth amateur football players. 41 adolescent players were randomised within each team into 2 groups (team 1: control vs. FIFA 11+; team 2: control vs. Harmoknee). The FIFA 11+ and Harmoknee groups performed the program 3 times a week for 4 weeks; the control groups completed their usual warm-up routines. 13 physical performance measures (joint range of motion, dynamic postural control, single legged hop limb symmetry, sprint time, jumping height and agility) were assessed. All physical performance parameters were compared via a magnitude-based inference analysis. Significant between-group differences (in favour of the FIFA 11+ players) were found for dynamic postural control (anterior [2.5%] and posteromedial [7.2%] distances), single legged hop limb symmetry (side-to-side symmetry during a triple hop test [8.3%]), 10 (8.4%) and 20 (1.8%) m sprint times and jumping height (9.1%) neuromuscular outcomes. For the Harmoknee, significant differences (in comparison to its paired control group) were found only for 10 (2.7%) and 20 (2.9%) m sprint times and jumping height (9.7%). Therefore, the main findings of this study suggest exchanging traditional warm-up programmes for the FIFA 11+ in male youth soccer players based on its superior effects on some neuromuscular parameters (sprinting, jumping and stability) of physical performance. © Georg Thieme Verlag KG Stuttgart · New York.
... to the optimal care of patients with spinal deformity Patients and Families Professionals About SRS Türkçe español ... unable to maintain appropriate balance / alignment of the spine and trunk. Neuromuscular curves are often associated with ...
Valizadeh, Leila; Sanaeefar, Mahnaz; Hosseini, Mohammad Bager; Asgari Jafarabadi, Mohammad; Shamili, Aryan
Introduction: Although the survival rate of infants born preterm has increased, the prevalence of developmental problems and motor disorders among this population of infants remains the same. This study investigated the effect of physical activity programs in and out of water on motor performance and neuromuscular development of infants born preterm and had induced immobility by mechanical ventilation. Methods: This study was carried out in Al-Zahra hospital, Tabriz. 76 premature infants were randomly assigned into four groups. One group received daily passive range of motion to all extremities based on the Moyer-Mileur protocol. Hydrotherapy group received exercises for shoulders and pelvic area in water every other day. A combination group received physical activity programs in and out of water on alternating days. Infants in a containment group were held in a fetal position. Duration of study was two weeks 'from 32 through 33 weeks post menstrual age (PMA). Motor outcomes were measured by the Test of Infant Motor Performance. Neuromuscular developmental was assessed by New Ballard scale and leg recoil and Ankle dorsiflexion items from Dubowitz scale. Data were analyzed using SPSS version 13. Results: TIMP and neuromuscular scores improved in all groups. Motor performance did not differ between groups at 34 weeks PMA. Postural tone of leg recoil was significantly higher in physical activity groups post intervention. Conclusion: Physical activities and containment didn't have different effects on motor performance in infants born preterm. Leg recoil of neuromuscular development items was affected by physical activity programs.
Full Text Available Objectives: This study aimed to evaluatethe the effect of eight weeks whole body vibration training (WBVT and detraining periods on neuromuscular performance male healthy older people. Methods & Materials: Thirty male subjects (70±9.6 years old were randomly allocated into two groups of WBVT and control (n=15 per group. Timed Up & Go and 5-Chair stand tests, as indicators of neuromuscular performance in older subjects, were taken as pretest and posttest and also after four, six, and eight weeks of detraining. Results: Results of Repeated-measure ANOVA and one-way ANOVA showed that neuromuscular performance improved significantly in WBVT group (P<0.05. There were also significant differences between posttest and six and eight weeks of detraining periods in WBVTgroup (P<0.05. Conclusion: WBVT could affect neuromuscular performance in healthy subjects and reduce the probability of falling among them. However, the effects of this training are not persistent, goes back to the early levels after six weeks of detraining. Hence, it is possible that WBVT can be recommended as a safe balance training to older people.
Pinto, Stephanie S; Alberton, Cristine L; Bagatini, Natália C; Zaffari, Paula; Cadore, Eduardo L; Radaelli, Régis; Baroni, Bruno M; Lanferdini, Fábio J; Ferrari, Rodrigo; Kanitz, Ana Carolina; Pinto, Ronei S; Vaz, Marco Aurélio; Kruel, Luiz Fernando M
This study investigated the effects of different exercise sequences on the neuromuscular adaptations induced by water-based concurrent training in postmenopausal women. Twenty-one healthy postmenopausal women (57.14 ± 2.43 years) were randomly placed into two water-based concurrent training groups: resistance training prior to (RA, n = 10) or after (AR, n = 11) aerobic training. Subjects performed resistance and aerobic training twice a week over 12 weeks, performing both exercise types in the same training session. Upper (elbow flexors) and lower-body (knee extensors) one-repetition maximal test (1RM) and peak torque (PT) (knee extensors) were evaluated. The muscle thickness (MT) of upper (biceps brachii) and lower-body (vastus lateralis) was determined by ultrasonography. Moreover, the maximal and submaximal (neuromuscular economy) electromyographic activity (EMG) of lower-body (vastus lateralis and rectus femoris) was measured. Both RA and AR groups increased the upper- and lower-body 1RM and PT, while the lower-body 1RM increases observed in the RA was greater than AR (34.62 ± 13.51 vs. 14.16 ± 13.68 %). RA and AR showed similar MT increases in upper- and lower-body muscles evaluated. In addition, significant improvements in the maximal and submaximal EMG of lower-body muscles in both RA and AR were found, with no differences between groups. Both exercise sequences in water-based concurrent training presented relevant improvements to promote health and physical fitness in postmenopausal women. However, the exercise sequence resistance-aerobic optimizes the strength gains in lower limbs.
Gulick, Dawn T; Castel, John C; Palermo, Francis X; Draper, David O
Patterned electrical neuromuscular stimulation (PENS) uses the electrical stimulation of sensory and motor nerves to achieve a skeletal muscle contraction using an electromyogram-derived functional pattern. PENS is used extensively for neuromuscular reeducation and treatment of muscle disuse atrophy. To explore the effectiveness of PENS as applied to the quadriceps muscles on the vertical jump of an athletic population. Experimental with control and repeated measures over time. Healthy college athletes (54 women, 75 men) were divided into 3 groups (control, n = 30; jump, n = 33; and jump with PENS, n = 63). There was no difference among groups' height and weight. Athletes performed a baseline standing vertical jump using a vertical jump system. The control group continued its normal daily activities with no jumping tasks included. The jump groups performed 3 sets of 12 repetitions with a 2-minute rest between sets at a frequency of 3 times per week. The PENS group did the jumping with the coordination of an electrical stimulation system. Vertical jump was retested after 6 weeks of intervention and 2 weeks after cessation. A 3-way repeated measures analysis of variance for time (control, jump alone, jump with PENS) revealed a significant difference (P jump group from posttest to follow-up jump. There was no significant difference between groups for the baseline vertical jump. This study demonstrated that 6 weeks of vertical jump training coordinated with PENS resulted in a greater increase than jumping only or control. This pattern of stimulation with PENS in combination with jump training may positively affect jumping.
Erxleben, C; Rathmayer, W
Effects of anemone toxin II (ATX II) have been analysed on the neuromuscular junction of the frog and different twitch muscles. Amplitudes of evoked endplate potentials and endplate currents are increased by ATX II, without effects on the amplitudes of miniature endplate potentials and endplate currents resulting from ionophoretically applied transmitter. The increase in evoked transmitter release is due to an increase in quantal content caused by an effect of the toxin on the presynaptic action potentials. ATX II is also effective on muscle fibers. The action potentials of frog twitch muscles are reversibly prolonged by ATX II. Their rate of rise and amplitudes are increased, while there is no effect on resting membrane potential. Similarly, action potentials of fast twitch muscle (extensor digitorum longus, EDL) of the mouse are reversibly prolonged by ATX II. In slow twitch muscle (soleus, SOL) of the mouse the toxin induces repetitive action potentials following the generation of a single action potential. Tetrodotoxin resistant action potentials of both denervated EDL and SOL are greatly and irreversibly prolonged by ATX II. The effects on muscle are due to a Na+ channel specific action of ATX II. Na+ current inactivation is slowed with the time constant tau h increasing towards positive membrane potentials. The steady state inactivation curve hoo was shifted to more positive potentials and its slope reduced.
Hindle, Kayla B; Whitcomb, Tyler J; Briggs, Wyatt O; Hong, Junggi
Proprioceptive neuromuscular facilitation (PNF) is common practice for increasing range of motion, though little research has been done to evaluate theories behind it. The purpose of this study was to review possible mechanisms, proposed theories, and physiological changes that occur due to proprioceptive neuromuscular facilitation techniques. Four theoretical mechanisms were identified: autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory. The studies suggest that a combination of these four mechanisms enhance range of motion. When completed prior to exercise, proprioceptive neuromuscular facilitation decreases performance in maximal effort exercises. When this stretching technique is performed consistently and post exercise, it increases athletic performance, along with range of motion. Little investigation has been done regarding the theoretical mechanisms of proprioceptive neuromuscular facilitation, though four mechanisms were identified from the literature. As stated, the main goal of proprioceptive neuromuscular facilitation is to increase range of motion and performance. Studies found both of these to be true when completed under the correct conditions. These mechanisms were found to be plausible; however, further investigation needs to be conducted. All four mechanisms behind the stretching technique explain the reasoning behind the increase in range of motion, as well as in strength and athletic performance. Proprioceptive neuromuscular facilitation shows potential benefits if performed correctly and consistently.
Efeitos neuromusculares e cardiovasculares do pipecurônio: estudo comparativo entre diferentes doses Efectos neuromusculares y cardiovasculares del pipecuronio: estudio comparativo entre diferentes dosis Neuromuscular and cardiovascular effects of pipecuronium: a comparative study between different dose
Angélica de Fátima de Assunção Braga
del pancuronio, pero desprovisto de efectos cardiovasculares. Se evaluaron los efectos neuromusculares, condiciones de intubación traqueal y las repercusiones hemodinámicas de de los diferentes dosis de pipecuronio. MÉTODO: Los pacientes fueron distribuidos en de los grupos de acuerdo a la dosis de pipecuronio: Grupo I (0,04 mg.kg-1 y Grupo II (0,05 mg.kg-1. La medicación preanestésica consistió en midazolam (0,1 mg.kg-1 por vía muscular, 30 minutos antes de la operación. La inducción anestésica se obtuvo con propofol (2,5 mg.kg-1 precedido del fentanil (5 µg.kg-1 y del pipecuronio en las dosis de 0,04 y 0,05 mg.kg-1 para los Grupos I y II, respectivamente. Los pacientes se ventilaron con O2 a 100% bajo máscara hasta la reducción de un 75% de la amplitud de la respuesta al estímulo aislado (1 Hz, cuando fueron realizadas la laringoscopía y la intubación traqueal. El isoflurano (0,5 a 1% en mezcla de O2 y N(20 a un 50% para el mantenimiento de la anestesia, fue introducido a continuación de la intubación traqueal. Los pacientes fueron ventilados mecánicamente para mantener el P ET CO2 entre 32 y 36 mmHg. La farmacodinámica del pipecuronio se evaluó por aceleromiografía. RESULTADOS: Los tiempos promedios y desviaciones estándar para el inicio de acción, duración clínica (T1(25% e índice de recuperación (T1(25-75% fueron los siguientes: Grupo I (122,10 ± 4,18 seg, 49,63 ± 9,54 min y 48,21 ± 6,72 min y Grupo II (95,78 ± 8,91 seg, 64,84 ± 13,13 min y 48,52 ± 4,95 min. El inicio de acción, la duración clínica y las condiciones de intubación traqueal fueron significativamente diferentes entre los grupos. CONCLUSIONES: El pipecuronio, en la dosis 0,05 mg.kg-1 puede ser usado en procedimientos de larga duración donde se desee evitar alteraciones cardiocirculatorias.BACKGROUND AND OBJECTIVES: Pipecuronium is a non-depolarizing neuromuscular blocker with similar properties to pancuronium, but without cardiovascular effects. Neuromuscular
Kyung-Jin Ha; Sang-Yeol Lee; Hojun Lee; Seung-Jun Choi
Purpose: Manual lymphatic drainage (MLD) and proprioceptive neuromuscular facilitation (PNF) are potential therapeutic strategies to reduce mastectomy-induced edema. The purpose of this study was to investigate whether the combination of these therapies would induce synergistic effects to treat lymphedema-related complications and to analyze a possible physiological mechanism involved in the observed effects.Methods: A total of 55 patients diagnosed with mastectomy-induced lymphedema were rec...
Guillermo Peña García-Orea
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n6p722 Physical training with the use of instability generator devices has become popular in the health area, in sport training and clinical practice (mainly in the prevention and treatment of injuries. To understand how the process of using these devices occurs and the results of their acute effects is important to guide professionals in choosing the appropriate device. The aim of this review was to present the main features of instability devices and analyze their acute effects on core muscle activation, neuromuscular performance and activation of lower and upper limbs. Studies have shown that the main acute effects of exercises performed with these devices are: 1 increased activation / muscular recruitment (especially in the middle zone or core; 2 greater co-activation of antagonist muscles (trunk, upper and lower limbs, with increased stiffness and joint stability; 3 lower force output, power and speed in extremities.
Wageck, B; Nunes, G S; Silva, F L; Damasceno, M C P; de Noronha, M
To investigate the applications and effects of neuromuscular electrical stimulation (NMES) in critically ill patients in ICU by means of a systematic review. Electronic searches were conducted in the databases Medline, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Embase, ProQuest Health and Medical Complete, AMED, and PEDro. The PEDro score was used to assess the methodological quality of the eligible studies. The search yielded a total of 9759 titles and nine articles satisfied the eligibility criteria. These studies showed that NMES can maintain or increase muscle mass, strength and volume, reduce time in mechanical ventilation and weaning time, and increase muscle degradation in critically ill patients in ICU. Two studies allowed a meta-analysis of the effects of NMES on quadriceps femoris strength and it showed a significant effect in favor of NMES in the Medical Research Council (MRC) Scale (standardized mean difference 0.77 points; p=0.02; 95% CI: 0.13-1.40). The selected studies showed that NMES has good results when used for the maintenance of muscle mass and strength in critically ill patients in ICU. Future studies with high methodological quality should be conducted to provide more evidence for the use of NMES in an ICU setting. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Qi, Ya-Chao; Niu, Xiao-Li; Gao, Ya-Ran; Wang, He-Bo; Hu, Ming; Dong, Li-Peng; Li, Ya-Zhou
The aims of this study were to investigate the effect of neuromuscular electrical stimulation (NMES) combined with strengthening exercise on movement in children with spastic cerebral palsy (CP). One hundred children with spastic CP were randomly divided into a treatment group (NMES and strengthening exercise, n = 50) and a control group (only NMES, n = 50). We compared the Comprehensive Spasticity Scale (CSS) score, Gross Motor Function Measure (GMFM) score, and walking speed before treatment and 6 weeks and 3 months after treatment between the 2 groups. There was no difference in CSS score between the treatment and control groups before the therapy (12.0 ± 3.4 vs 12.3 ± 3.6), which decreased much more in the treatment group after 6 weeks (7.6 ± 3.0 vs 9.5 ± 2.8) and 3 months (7.4 ± 2.4 vs 9.4 ± 2.6) with significant differences ( P strengthening exercise was more effective than NMES alone in the recovery of spastic CP.
Olędzka, Marianna; Jaczewska-Bogacka, Joanna
[b]Background.[/b] Subacromial impingement syndrome is a condition of the shoulder girdle which limits daily activities. It is worth seeking fast and effective treatment options. The aim of this study was to assess the impact of single-session proprioceptive neuromuscular facilitation (PNF) therapy on the shoulder range of motion and pain level in patients with subacromial impingement syndrome.[b]Materials and methods. [/b]The experimental group consisted of 11 patients with subacromial impingement syndrome who had undergone therapy based on the PNF concept. A control group consisted of 12 patients with subacromial impingement syndrome who had undergone laser therapy, magnetic field therapy and local cryotherapy. Both before and after the therapeutic interventions, the painless passive and active ranges of abduction, flexion, and external and internal rotation of the shoulder joint were measured on the same day with the use of a goniometer and measuring tape. Patients also evaluated their pain levels. They were asked to fill in DASH questionnaires in order to evaluate their baseline functional status. Nonparametric tests were used for the statistical analysis.[b]Results:[/b] After single-session PNF therapy, the mean shoulder range of motion increased by 15° (active) and 14° (passive). Active abduction improved by 13° and passive abduction by 18°. The ranges of active and passive external rotation increased by 8° and 7°, respectively. Active and passive internal rotation increased by 4°. 73% of patients who underwent the therapy stated that their pain had decreased. The magnetic field therapy, laser therapy and cryotherapy alone did not contribute to increased ranges of motion.[b]Conclusions.[/b] 1. Subacromial impingement syndrome significantly limits function in daily life. 2. Single-session therapy with the use of the techniques and patterns of proprioceptive neuromuscular facilitation can improve both the active and passive range of shoulder movement. 3
Sharma, Vishal; Kaur, Jaskirat
The purpose of this study was to evaluate the effects of core strengthening combined with pelvic proprioceptive neuromuscular facilitation (PNF) on trunk impairment, balance, gait, and functional ability of chronic stroke patients. Twenty-three participants with chronic stroke were recruited and randomly allocated to one of the two groups: core strengthening combined with pelvic PNF (group 1, n=13), and pelvic PNF with trunk flexibility exercises (group 2, n=10). Intervention was given to bot...
Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V
healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated...... into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block...... and the abdominal muscle-relaxing effect. RESULTS: The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6...
Full Text Available Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES at different intensities on energy expenditure (oxygen and calories in healthy adults. The secondary aim was to develop a generalized linear regression (GEE model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1, motor threshold (E2, and maximal intensity comfortably tolerated (E3. Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject’s demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.
Lesinski, M; Prieske, O; Demps, M; Granacher, U
It has previously been shown that fatigue and unstable surfaces affect jump performance. However, the combination thereof is unresolved. Thus, the purpose of this study was to examine the effects of fatigue and surface instability on jump performance and leg muscle activity. Twenty elite volleyball players (18 ± 2 years) performed repetitive vertical double-leg box jumps until failure. Before and after a fatigue protocol, jump performance (i.e., jump height) and electromyographic activity of selected lower limb muscles were recorded during drop jumps (DJs) and countermovement jumps (CMJs) on a force plate on stable and unstable surfaces (i.e., balance pad on top of force plate). Jump performance (3-7%; P jump performance: 8%; P volleyball players, whereas surface instability affects neuromuscular DJ performance only. Absent fatigue × surface interactions indicate that fatigue-induced changes in jump performance are similar on stable and unstable surfaces in jump-trained athletes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Miriéle Cristina Ferraz
Full Text Available We confirmed the ability of the triterpenoid betulin to protect against neurotoxicity caused by Bothrops jararacussu snake venom in vitro in mouse isolated phrenic nerve-diaphragm (PND preparations and examined its capability of in vivo protection using the rat external popliteal/sciatic nerve-tibialis anterior (EPSTA preparation. Venom caused complete, irreversible blockade in PND (40 μg/mL, but only partial blockade (~30% in EPSTA (3.6 mg/kg, i.m. after 120 min. In PND, preincubation of venom with commercial bothropic antivenom (CBA attenuated the venom-induced blockade, and, in EPSTA, CBA given i.v. 15 min after venom also attenuated the blockade (by ~70% in both preparations. Preincubation of venom with betulin (200 μg/mL markedly attenuated the venom-induced blockade in PND; similarly, a single dose of betulin (20 mg, i.p., 15 min after venom virtually abolished the venom-induced decrease in contractility. Plasma creatine kinase activity was significantly elevated 120 min after venom injection in the EPSTA but was attenuated by CBA and betulin. These results indicate that betulin given i.p. has a similar efficacy as CBA given i.v. in attenuating the neuromuscular effects of B. jararacussu venom in vivo and could be a useful complementary measure to antivenom therapy for treating snakebite.
Ferraz, Miriéle Cristina; de Oliveira, Jhones Luiz; de Oliveira Junior, Joel Reis; Cogo, José Carlos; dos Santos, Márcio Galdino; Franco, Luiz Madaleno; Puebla, Pilar; Ferraz, Helena Onishi; Ferraz, Humberto Gomes; da Rocha, Marisa Maria Teixeira; Hyslop, Stephen
We confirmed the ability of the triterpenoid betulin to protect against neurotoxicity caused by Bothrops jararacussu snake venom in vitro in mouse isolated phrenic nerve-diaphragm (PND) preparations and examined its capability of in vivo protection using the rat external popliteal/sciatic nerve-tibialis anterior (EPSTA) preparation. Venom caused complete, irreversible blockade in PND (40 μg/mL), but only partial blockade (~30%) in EPSTA (3.6 mg/kg, i.m.) after 120 min. In PND, preincubation of venom with commercial bothropic antivenom (CBA) attenuated the venom-induced blockade, and, in EPSTA, CBA given i.v. 15 min after venom also attenuated the blockade (by ~70% in both preparations). Preincubation of venom with betulin (200 μg/mL) markedly attenuated the venom-induced blockade in PND; similarly, a single dose of betulin (20 mg, i.p., 15 min after venom) virtually abolished the venom-induced decrease in contractility. Plasma creatine kinase activity was significantly elevated 120 min after venom injection in the EPSTA but was attenuated by CBA and betulin. These results indicate that betulin given i.p. has a similar efficacy as CBA given i.v. in attenuating the neuromuscular effects of B. jararacussu venom in vivo and could be a useful complementary measure to antivenom therapy for treating snakebite. PMID:26633987
Magalhães, Francisco Elezier Xavier; Junior, Arlindo Rodrigues de Mesquita; Meneses, Harnold’s Tyson de Sousa; Moreira dos Santos, Rayele Pricila; Rodrigues, Ezaine Costa; Gouveia, Samara Sousa Vasconcelos; Gouveia, Guilherme Pertinni de Morais; Orsini, Marco; Bastos, Victor Hugo do Vale; Machado, Dionis de Castro Dutra
[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care. PMID:26157261
Magalhães, Francisco Elezier Xavier; Junior, Arlindo Rodrigues de Mesquita; Meneses, Harnold's Tyson de Sousa; Moreira Dos Santos, Rayele Pricila; Rodrigues, Ezaine Costa; Gouveia, Samara Sousa Vasconcelos; Gouveia, Guilherme Pertinni de Morais; Orsini, Marco; Bastos, Victor Hugo do Vale; Machado, Dionis de Castro Dutra
[Purpose] Stretching using proprioceptive neuromuscular facilitation involve physiological reflex mechanisms through submaximal contraction of agonists which activate Golgi organ, promoting the relaxation reflex. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation alone and with prior application of cryotherapy and thermotherapy on hamstring stretching. [Subjects and Methods] The sample comprised of 32 young subjects with hamstring retraction of the right limb. The subjects were randomly allocated to four groups: the control, flexibility PNF, flexibility PNF associated with cryotherapy, flexibility PNF in association with ultrasound therapy. [Results] After 12 stretching sessions, experimental groups showed significant improvements compared to the control group. Moreover, we did not find any significant differences among the experimental groups indicating PNF stretching alone elicits similar results to PNF stretching with prior administration of cryotherapy or thermotherapy. [Conclusion] PNF without other therapy may be a more practical and less expensive choice for clinical care.
Influência dos Hipnóticos no bloqueio neuromuscular produzido pelo cisatracúrio: emprego da aceleromiografia Influencia de los hipnóticos en el bloqueo neuromuscular producido por el cisatracurio: uso de la aceleromiografía Influence of hypnotics on cisatracurium-induced neuromuscular block: use of acceleromyograhpy
Angélica de Fátima de Assunção Braga; Franklin Sarmento da Silva Braga; Glória Maria Braga Potério; José Aristeu Fachini Frias; Fernanda Maria Silva Pedro; Derli Conceição Munhoz
JUSTIFICATIVA E OBJETIVOS: Os efeitos farmacodinâmicos dos bloqueadores neuromusculares (BNM) podem ser influenciados por diferentes drogas, entre elas os hipnóticos. O objetivo deste estudo foi avaliar a influência do propofol e do etomidato sobre o bloqueio neuromuscular produzido pelo cisatracúrio. MÉTODO: Foram incluídos 60 pacientes, ASA I e II, submetidos a cirurgias eletivas sob anestesia geral, distribuídos aleatoriamente em dois grupos de acordo com o hipnótico empregado: GI (propofo...
Moghaddas, Azadeh; Dashti-Khavidaki, Simin
Ischemia-reperfusion (I/R) injury plays important role in morbidity and mortality in several pathologies, including myocardial infarction, ischemic stroke, acute kidney injury, trauma, and circulatory arrest. An imbalance in metabolic supply and tissue's demand during ischemia results in profound tissue hypoxia and microvascular dysfunction. Subsequently, reperfusion further results in activation of immune responses and cell death programs. l-carnitine and its derivatives have been administered to improve tolerance against I/R injury in various tissues. Anti-ischemic properties of l-carnitine and its derivative in neuromuscular organs will be reviewed here at the light of pertinent results from basic and clinical researches. All available in vitro and in vivo studies, patents, clinical trials, and meeting abstracts in English language that examined the protective effects of l-carnitine against I/R induced injury in neuromuscular organs were reviewed. Materials were obtained by searching ELSEVIER, web of knowledge, PubMed, Scopus, clinical trials, and Cochrane database of systematic reviews. Although animal studies on central nervous system and some human studies on muscular system were in favors of effects of l-carnitine against I/R injury, however, more clinical trials are needed to clarify the clinical importance of l-carnitine as a treatment option to manage I/R-induced injury of neuromuscular system. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Frank R. Noyes
Full Text Available While many anterior cruciate ligament (ACL prevention programs have been published, few have achieved significant reductions in injury rates and improvements in athletic performance indices; both of which may increase compliance and motivation of athletes to participate. A supervised neuromuscular retraining program (18 sessions was developed, aimed at achieving both of these objectives. The changes in neuromuscular indices were measured after training in 1000 female athletes aged 13–18 years, and the noncontact ACL injury rate in 700 of these trained athletes was compared with that of 1120 control athletes. There were significant improvements in the drop-jump test, (p < 0.0001, effect size [ES] 0.97, the single-leg triple crossover hop (p < 0.0001, ES 0.47, the t-test (p < 0.0001, ES 0.64, the multi-stage fitness test (p < 0.0001, ES 0.57, hamstring strength (p < 0.0001, and quadriceps strength (p < 0.01. The trained athletes had a significant reduction in the noncontact ACL injury incidence rate compared with the controls (1 ACL injury in 36,724 athlete-exposures [0.03] and 13 ACL injuries in 61,244 exposures [0.21], respectively, p = 0.03. The neuromuscular retraining program was effective in reducing noncontact ACL injury rate and improving athletic performance indicators.
Full Text Available Introduction: Although the survival rate of infants born preterm has increased, the prevalence of developmental problems and motor disorders among this population of infants remains the same. This study investigated the effect of physical activity programs in and out of water on motor performance and neuromuscular development of infants born preterm and had induced immobility by mechanical ventilation.Methods: This study was carried out in Al-Zahra hospital, Tabriz. 76 premature infants were randomly assigned into four groups. One group received daily passive range of motion to all extremities based on the Moyer-Mileur protocol. Hydrotherapy group received exercises for shoulders and pelvic area in water every other day. A combination group received physical activity programs in and out of water on alternating days. Infants in a containment group were held in a fetal position. Duration of study was two weeks ‘from 32 through 33 weeks post menstrual age (PMA. Motor outcomes were measured by the Test of Infant Motor Performance. Neuromuscular developmental was assessed by New Ballard scale and leg recoil and Ankle dorsiflexion items from Dubowitz scale. Data were analyzed using SPSS version 13.Results: TIMP and neuromuscular scores improved in all groups. Motor performance did not differ between groups at 34 weeks PMA. Postural tone of leg recoil was significantly higher in physical activity groups post intervention.Conclusion: Physical activities and containment didn’t have different effects on motor performance in infants born preterm. Leg recoil of neuromuscular development items was affected by physical activity programs.
Loubser, P G; Cardus, D; Pickard, L R; McTaggart, W G
The effects of unilateral, low-frequency, neuromuscular stimulation on the circulation in skin of the lower extremities were studied in eight subjects with peripheral vascular disease and eight control subjects with normal peripheral vasculature. Sixty minutes of stimulation (at 2 Hz), of sufficient intensity to produce visible contraction of musculature, was applied through cutaneous electrodes placed over the common peroneal nerve and dorsum of the foot. Systolic and diastolic blood pressure, heart rate, bilateral great-toe photoplethysmographic waveform, and bilateral pedal skin temperature were recorded at 30-min intervals during stimulation and 30 min after stimulation. Mean differences in recordings before and after stimulation were then calculated for each parameter, showing in subjects with peripheral vascular disease significant increases of 5.3 +/- 2.1 mm and 0.5 +/- 0.1 degree C for ipsilateral photoplethysmographic waveform amplitude and pedal skin temperature, respectively. Mean differences for the remaining parameters were not significant. Recorded parameters in the control group did not change after stimulation. These results demonstrate that low-frequency, neuromuscular stimulation produces regional cutaneous vasodilation in subjects with peripheral vascular disease. No evidence of generalized vasodilation after neuromuscular stimulation was found.
Caio A. A. Lins
Full Text Available ABSTRACT Background Kinesio Taping (KT is an elastic bandage that aims to improve neuromuscular performance, although there is no consensus as to its benefits. Objective To analyze the immediate and delayed effects of KT on the neuromuscular performance of the femoral quadriceps, on balance, and lower limb function in healthy subjects. Method This is a randomized controlled trial. Thirty-six women with a mean age of 22.2±3.6 years and BMI of 22.5±2.3 Kg/m2 were divided into three groups: control, with ten minutes of rest (control, n=12, application of Kinesio Taping without tension (placebo, n=12 and with tension (KT, n=12 on the quadriceps. The primary outcome was isokinetic performance, while secondary outcomes were the single-hop test, one-footed static balance, and electromyographic activity. The evaluations were carried out in five stages: 1 before application of KT, 2 immediately after the application of KT, 3 after 24h, 4 after 48h, and 5 after 72h. Mixed ANOVA was used to determine differences between groups. Results There was no change in one-footed static balance, electromyographic activity of the VL in the lower limb function, nor in isokinetic performance between groups. Conclusion KT promotes neither immediate nor delayed changes in neuromuscular performance of the femoral quadriceps in healthy women.
Lins, Caio A A; Borges, Daniel T; Macedo, Liane B; Costa, Karinna S A; Brasileiro, Jamilson S
Kinesio Taping (KT) is an elastic bandage that aims to improve neuromuscular performance, although there is no consensus as to its benefits. To analyze the immediate and delayed effects of KT on the neuromuscular performance of the femoral quadriceps, on balance, and lower limb function in healthy subjects. This is a randomized controlled trial. Thirty-six women with a mean age of 22.2±3.6 years and BMI of 22.5±2.3 Kg/m2 were divided into three groups: control, with ten minutes of rest (control, n=12), application of Kinesio Taping without tension (placebo, n=12) and with tension (KT, n=12) on the quadriceps. The primary outcome was isokinetic performance, while secondary outcomes were the single-hop test, one-footed static balance, and electromyographic activity. The evaluations were carried out in five stages: 1) before application of KT, 2) immediately after the application of KT, 3) after 24h, 4) after 48h, and 5) after 72h. Mixed ANOVA was used to determine differences between groups. There was no change in one-footed static balance, electromyographic activity of the VL in the lower limb function, nor in isokinetic performance between groups. KT promotes neither immediate nor delayed changes in neuromuscular performance of the femoral quadriceps in healthy women.
Mariangela Salles Pereira Nassar
Full Text Available The Lucia jig is a technique that promotes neuromuscular reprogramming of the masticatory system and allows the stabilization of the mandible without the interference of dental contacts, maintaining the mandible position in harmonic condition with the musculature in normal subjects or in patients with temporomandibular dysfunction (TMD. This study aimed to electromyographically analyze the activity (RMS of the masseter and temporal muscles in normal subjects (control group during the use of an anterior programming device, the Lucia jig, in place for 0, 5, 10, 20 and 30 minutes to demonstrate its effect on the stomatognathic system. Forty-two healthy dentate individuals (aged 21 to 40 years with normal occlusion and without parafunctional habits or temporomandibular dysfunction (RDC/TMD were evaluated on the basis of the electromyographic activity of the masseter and temporal muscles before placement of a neuromuscular re-programming device, the Lucia jig, on the upper central incisors. There were no statistically significant differences (p < 0.05 in the electromyographic activity of the masticatory muscles in the different time periods. The Lucia jig changed the electromyographic activity by promoting a neuromuscular reprogramming. In most of the time periods, it decreased the activation of the masticatory muscles, showing that this device has wide applicability in dentistry. The use of a Lucia jig over 0, 5, 10, 15, 20 and 30 minutes did not promote any statistically significant increase in muscle activity despite differences in the data, thus showing that this intra-oral device can be used in dentistry.
Valenzuela Pedro L.
Full Text Available The aim of this study was to analyze the effects of high-frequency neuromuscular electrical stimulation training (NMES on the structure, function and oxidative capacity of the skeletal muscle using a mice model (C57BL/6J strain, n=8. The left tibialis anterior muscle in mice was electro-stimulated (ST whereas the right muscle was maintained as an internal control (CT. The ST limb was submitted to eight surface (100 Hz NMES sessions in two weeks, with a minimum gap of 24 h between sessions. NMES training increased muscle mass (42.0±3.3 vs. 36.1±5.4 mg, p<0.05, effect size [ES] r=0.55, the mean fiber cross-sectional area (FCSA (3318±333 vs. 2577±405 μ2, p<0.001, ES=0.71, maximal force (224.7±13.8 vs. 184.5±30.9 mN, p<0.01, ES=0.64, and the rate of force development (1.63±0.14 vs. 1.34±0.20 mN/ms, p<0.05, ES=0.64, with no effects on the muscle oxidative profile. These results demonstrate that surface NMES induced muscle hypertrophy and instigated an improvement in the contractile properties of the TA muscle in mice. Therefore, this animal model appears to be suitable for the study of hypertrophic processes as it enables better control of the stimulus properties (intensity, duration, frequency, etc. than other traditionally used animal models and does not require negative reinforcements or surgical procedures.
William R. Holcomb
Full Text Available Neuromuscular electrical stimulation (NMES may be used to prevent strength loss associated with post-surgical immobilization. Most studies testing the effectiveness of NMES have trained the knee extensors. The purpose of this investigation was to test the effectiveness of NMES when training the elbow flexors. Twenty-four students were randomly assigned to one of three groups: NMES training, isometric training or control. Testing and training were completed using a Biodex™ dynamometer. After a standard warm-up, subjects were positioned on the Biodex™ with left shoulder in anatomical neutral, elbow flexed to 90o and forearm supinated. Subjects performed three maximum isometric contractions of 5 seconds duration, with 1 min rest between repetitions. Average peak torque during three repetitions was calculated. Subjects trained on three days per week for four weeks. Training included 15 maximum contractions of 15 seconds duration with 45 seconds recovery between repetitions. Russian current was delivered by a Forte™ 400 Combo via electrodes placed over ends of biceps brachii. A maximum tolerable ramped intensity was delivered with frequency of 90 bps and duty cycle of 15:45. After training, subjects were post-tested in a manner identical to pretest. Mean normalized strength data were analyzed using a 3 (Group x 2 (Test ANOVA. The Group x Test interaction was significant. Post-hoc analyses revealed that the voluntary training group (normalized means of 0.49 to 0.71 for the pretest and post-test, respectively had a significantly greater increase than the other two groups, which were not significantly different from each other. The lack of significant strength gains with NMES was likely due to low average training intensity, which was only 20.4% of MVIC. Based on these results, NMES training may not be an effective alternative to voluntary training in healthy subjects
Donath, Lars; Roth, Ralf; Hohn, Yannick; Zahner, Lukas; Faude, Oliver
The present study examined the effects of Zumba training (group fitness based on salsa and aerobics) on endurance, trunk strength, balance, flexibility, jumping performance and quality of life (QoL) in female college students. Thirty female participants were randomly assigned (strata: age, BMI and physical activity) to an intervention (INT, n = 15: age: 21.0 ± 2.3 years; BMI: 21.8 ± 3.0 kg/m(2); physical activity (PA): 7.6 ± 4.6 h/week) or control group (CON, n = 14: age: 21.0 ± 2.8 years; BMI: 21.0 ± 2.1 kg/m(2); PA: 7.3 ± 3.6 h/week). Instructed Zumba training was provided twice a week for 8 weeks (training attendance: 100%). QoL was assessed using the WHO-QoL-BREF questionnaire. Endurance was measured with the 6-min walking test (6MWT). Trunk flexibility was assessed with the stand-and-reach-test and lower-extremity strength with the jump-and-reach-test. The star excursion balance test (SEBT) was employed to assess dynamic balance. Trunk strength endurance was examined using the Swiss global trunk strength test in prone and lateral (left, right) positions. All testings were performed before and after the training period. We observed large statistically significant between-group effects of total QoL score (INT: +9.8%, CON: +0.4%, p 0.05). Instructed Zumba training can be applied to improve well-being, aerobic fitness and neuromuscular function in female college students.
Pantović, Milan; Popović, Boris; Madić, Dejan; Obradović, Jelena
Neuromuscular electrical stimulation (NMES) has recently drawn a lot of attention as means for strengthening of voluntary muscle contraction both in sport and rehabilitation. NMES training increases maximal voluntary contraction (MVC) force output through neural adaptations. On the other hand, positive effects of resistance training (RT) on muscle strength are well known. The aim of this study was to investigate effects of a 5-week program of NMES compared to RT program of same duration. Sample of 15 students' of faculty of sport and physical education (age 22 ± 2) were randomized in two groups: NMES (N = 7) and RT (N = 8). NMES group performed NMES superimposed over voluntary muscle contraction, RT group performed resistance training with submaximal loads. Subjects were evaluated for knee isokinetic dynamometry on both sides (60° and 180° s). After intervention no significant difference between groups were observed in isokinetic dynamometry (p = 0.177). However, applying pair sample t test within each group revealed that peak torque increased in NMES-group (p = 0.002 for right knee extensors muscles, p = 0.003 for left, respectively, at 60° and p = 0.004 for left knee extensors muscles, at angular velocity 180°). In RT group (p = 0.033 for right knee extensors muscles, p = 0.029 for right knee flexor muscles, at angular velocity 60°). Our results indicate that NMES has equal potential if not in some way better than classical RT having in mind that overload on locomotor apparatus during NMES is minimal and force of muscle contraction is equal on both sides, for enhancement of knee muscles concentric peak torque.
Mikkola, Jussi; Vesterinen, Ville; Taipale, Ritva; Capostagno, Benoit; Häkkinen, Keijo; Nummela, Ari
The purpose of this study was to assess the effects of heavy resistance, explosive resistance, and muscle endurance training on neuromuscular, endurance, and high-intensity running performance in recreational endurance runners. Twenty-seven male runners were divided into one of three groups: heavy resistance, explosive resistance or muscle endurance training. After 6 weeks of preparatory training, the groups underwent an 8-week resistance training programme as a supplement to endurance training. Before and after the 8-week training period, maximal strength (one-repetition maximum), electromyographic activity of the leg extensors, countermovement jump height, maximal speed in the maximal anaerobic running test, maximal endurance performance, maximal oxygen uptake ([V·]O(₂max)), and running economy were assessed. Maximal strength improved in the heavy (P = 0.034, effect size ES = 0.38) and explosive resistance training groups (P = 0.003, ES = 0.67) with increases in leg muscle activation (heavy: P = 0.032, ES = 0.38; explosive: P = 0.002, ES = 0.77). Only the heavy resistance training group improved maximal running speed in the maximal anaerobic running test (P = 0.012, ES = 0.52) and jump height (P = 0.006, ES = 0.59). Maximal endurance running performance was improved in all groups (heavy: P = 0.005, ES = 0.56; explosive: P = 0.034, ES = 0.39; muscle endurance: P = 0.001, ES = 0.94), with small though not statistically significant improvements in [V·]O(₂max) (heavy: ES = 0.08; explosive: ES = 0.29; muscle endurance: ES = 0.65) and running economy (ES in all groups runners should include heavy resistance training in their training programmes to enhance endurance performance, such as improving sprinting ability at the end of a race.
Huber, Erika O; Roos, Ewa M.; Meichtry, André
baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. METHODS: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3...
Full Text Available We studied the effects of self-administered neuromuscular electrical stimulation (NMES on changes in strength, endurance, selected anthropometric measures, and subject's perceived shape and satisfaction of the abdominal wall. Twenty-four adults (experimental group stimulated their abdominals 5 days per week (20-40 minutes per session for 8 weeks and refrained from engaging in any additional exercise during the study. A control group (N=16 refrained from exercising the abdominals or engaging in any other exercise training during the study. Subjects were tested at the beginning, mid-point, and end of the study. Isometric strength of the abdominal muscles was tested using a isokinetic dynamometer, endurance was measured using the ACSM curl-up test, abdominal circumference was measured using a steel tape measure, and body shape and satisfaction were assessed via questionnaire. The stimulation group had a 58% increase in abdominal strength, whereas the control group did not change. The stimulation group also had a 100% increase in abdominal endurance versus a 28% increase in the control group. Waist circumference decreased by of 3.5 cm in the stimulation group compared to no significant change in the control group. All 24 subjects in the stimulation group felt that their midsections were more "toned" and "firmed" and 13/24 (54% felt that their posture had improved as a result of the stimulation. None of the control group subjects reported changes in these parameters. There were no significant differences in body weight, BMI, or skinfold thickness over the course of the study in either group. NMES, as used in the current study, resulted in significant improvements in the muscular strength and endurance of the abdominal region, as well as subject's perceived shape and satisfaction of the mid-section.
Leonardo Coelho Rabello de Lima
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2015v17n5p539 Eccentric exercise training using low intensity-high volume approach has been performed to improve maximal muscle strength and power. The aim of this study was to compare the effects of short-term downhill walking and level walking training on lower limb strength and maximal oxygen uptake of active individuals. Eighteen young adults were divided into level walking group (n = 9 or downhill walking training group (n = 9. Both groups performed a four-week training program. The level walking group performed seven level walking sessions per week, while the downhill walking group walked downhill (-16% in the same weekly frequency. One week before and one week after the training protocol, maximal oxygen uptake, muscle-bone cross-sectional area and isometric peak torque of knee extensors and plantar flexors were assessed for both groups. A significant group vs. time interaction was found only for cross sectional area of plantar flexors (PF, showing increases for the downhill walking group (112.6 ± 28.9 cm2 vs. 115.9 ± 29 cm2 but not for the level walking group (94.9 ± 23.3 cm2vs. 94.6 ± 228 cm2. Maximal oxygen uptake remained unaltered after training for both groups and IPT was increased after training for both groups. It was concluded that short-term downhill walking training does not seem to be efficient in promoting improvements in cardiorrespiratory fitness of young adults. However, it seems to promote gains in some variables related to neuromuscular fitness
Full Text Available The purpose of this study was to examine the effectiveness of 12-week plyometric training on vertical jump performance (Vj, maximal surface EMG, M-wave amplitude, Mwave latency, and nerve conduction velocity (NCV in men volleyball player. Thirty junior high school volleyball players' volunteers (age: 17.53 0.74; Height: 177.67 3.14; Weight: 61.31 5.32 were divided into plyometric training [PT] (n=15 and control group[c] (n=15. PT group trained so.w' but C group didn't participate in this training. Both groups were pre- and post tested in EMG, M-wave parameters, NCV and Vj test. Tow way ANOVA (group*time interaction and Bonferroni post hoes test demonstrated significant differences (P<0.05 in PT group of pre to post test in VJ performance (9.67 % and in M-wave latency 16.55 % t ; nerve conduction velocity 14.19 % t ; there is no significant differences in IEMG (4.6 5 % J, and M-wave amplitude (20.91 % t , but there is no significant improvement during this period in control group. Comparison between groups after 12wk showed that there was a significant improvement in Latency (16.74 % J, and NCV (19.10% t in PT group during the course of the study than C group (P<0.05. based on the results of this study, it is possible to conclude that coaches and trainers consider PT as a strategy for increasing volleyball players' explosive performance that this may have taken place in neuromuscular responses such as; optimizing motor unites (MU pattern, optimizing MUs recruitment, augmentation in nerve conduction velocity, decrement in reflex excitability of the motor pool.
Leonardo Coelho Rabello de Lima
Full Text Available Eccentric exercise training using low intensity-high volume approach has been performed to improve maximal muscle strength and power. The aim of this study was to compare the effects of short-term downhill walking and level walking training on lower limb strength and maximal oxygen uptake of active individuals. Eighteen young adults were divided into level walking group (n = 9 or downhill walking training group (n = 9. Both groups performed a four-week training program. The level walking group performed seven level walking sessions per week, while the downhill walking group walked downhill (-16% in the same weekly frequency. One week before and one week after the training protocol, maximal oxygen uptake, muscle-bone cross-sectional area and isometric peak torque of knee extensors and plantar flexors were assessed for both groups. A significant group vs. time interaction was found only for cross sectional area of plantar flexors (PF, showing increases for the downhill walking group (112.6 ± 28.9 cm2 vs. 115.9 ± 29 cm2 but not for the level walking group (94.9 ± 23.3 cm2vs. 94.6 ± 228 cm2. Maximal oxygen uptake remained unaltered after training for both groups and IPT was increased after training for both groups. It was concluded that short-term downhill walking training does not seem to be efficient in promoting improvements in cardiorrespiratory fitness of young adults. However, it seems to promote gains in some variables related to neuromuscular fitness.
Lundstrøm, L H; Møller, A M; Rosenstock, Charlotte Vallentin
BACKGROUND: Previous studies indicate that avoiding neuromuscular blocking agents (NMBAs) may be a risk factor for difficult tracheal intubation (DTI). We investigated whether avoiding NMBA was associated with DTI. METHODS: A cohort of 103,812 consecutive patients planned for tracheal intubation...... by direct laryngoscopy was retrieved from the Danish Anaesthesia Database. We used an intubation score based upon the number of attempts, change from direct laryngoscopy to a more advanced technique, or intubation by a different operator. We retrieved data on age, sex, ASA physical status classification......, priority of surgery, time of surgery, previous DTI, modified Mallampati score, BMI, and the use of NMBA. Using logistic regression, we assessed whether avoiding NMBA was associated with DTI. RESULTS: The frequency of DTI was 5.1 [95% confidence interval (CI): 5.0-5.3]%. In a univariate analysis, avoiding...
Craig, Lauren H; Svircev, Anna; Haber, Michael; Juncos, Jorge L
The objectives of this study is to examine the effects of neuromuscular therapy (NMT) on motor and nonmotor symptoms in Parkinson's disease (PD). Thirty-six subjects with PD were randomly assigned to NMT or music relaxation (MR, or active control). Subjects received treatment twice a week for 4 weeks. Testing was conducted at baseline, after final treatment, and 8 days after final treatment. Primary outcome measures were the Motor subscale of the United Parkinson Disease Rating Scale (UPDRS) and the Clinical Global Impression scale (CGI-Change). Secondary outcome measures included a PD-specific quality of life scale (PDQ-39), quantitative measures of motor function, and severity scales for anxiety and depression symptoms. NMT resulted in a significant and sustained improvement in the Motor subscale of the UPDRS (P < or = 0.0001), most notable in the tremor scores. Also improved 1 week after the last treatment were the CGI scores (P = 0.007) and the finger-tapping speed (P = 0.001). The MR active control group had a slight improvement in tremor but evidenced no other change in motor function. Both groups exhibited a modest improvement in quality of life immediately after the last treatment. This effect was sustained for 8 days only in the MR group. In the nonmotor domains, the MR group evidenced improvements in mood (P = 0.001) and anxiety (P = 0.002), whereas NMT had no effect on mood (P = 0.09), and its initial effect on anxiety (P = 0.0009) dissipated after 8 days (P = 0.40). Group differences for UPDRS motor score and patient CGI-Change were superior in the NMT compared to the MR group. There was no group difference in PDQ-39 scores or in nonmotor measures. The findings suggest that NMT can improve motor and selected nonmotor symptoms in PD and that this effect is more durable for the motor symptoms. The results of this pilot study warrant larger controlled studies to examine dose range, durability, and mechanisms of NMT in PD function. Copyright 2006 Movement
Cavalcante, Walter Luís Garrido; Ponce-Soto, Luis Alberto; Marangoni, Sérgio; Gallacci, Márcia
A myographic study was performed to compare the neuromuscular effects of venoms and crotoxin-like proteins from Crotalus durissus ruruima and Crotalus durissus cumanensis in mice phrenic-diaphragm preparation. It was concluded that both venoms present neurotoxic activity as a consequence of their crotoxin content. Furthermore, crotoxin from C.d. cumanensis is more potent than that from C.d. ruruima venom. At the concentration range in which both venoms express neurotoxic activity, only C.d. cumanensis venom also manifest a direct myotoxic effect that probably involves the synergic participation of other components than crotoxin. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Background: Poor balance ability is a predictor of injuries of the lower extremity. Multi-intervention proprioception preventive programs, comprising balance training, strength, plyometric, agility, running, and stretching exercises, are effective in improving balance ability and reducing the risk of lower extremity injuries in athletes.Objective: The aim of the study was to examine the effect of a 20-week in-season multi-intervention proprioceptive neuromuscular training program on postural stability in male youth basketball players.Methods: Twenty-one elite male youth basketball players were divided into an intervention group (n = 10, age 17.3 ± 1.3 years and a control group (n = 11, age 16.5 ± 1.8 years. During the in-season period (20 weeks, the intervention group followed a proprioceptive and neuromuscular training program, three times per week and 20 minutes per session. Balance was tested in a quiet unipedal stance (on both the dominant and non-dominant leg on a foam mat with eyes open, before and after a 20-week period in both groups. The mean velocities in the medial-lateral and anterior-posterior directions and the mean total velocity of the centre of pressure (COP displacement were obtained with a force platform.Results: The combined effect (pre-post test × group showed that intervention resulted in significant improvement in the mean COP velocity for both the dominant and non-dominant limb in the anterior-posterior direction (p = .013 and p < .001, respectively and in the medial-lateral direction (p = .007 and p < .001, respectively as well as in the total COP velocity (p = .009 and p < .001, respectively. Conclusions: The specific proprioceptive and neuromuscular training had a positive effect on postural stability for both the dominant and non-dominant limb in basketball players.
Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders
). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured......OBJECTIVE: To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. METHODS: In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA...... on the activities of daily living (ADL) subscale in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires for patients with hip and knee OA, respectively. Primary endpoint was 3 months after surgery. RESULTS: 165 patients randomised...
Pillastrini, Paolo; Rocchi, Giulia; Deserri, Deborah; Foschi, Paola; Mardegan, Michele; Naldi, Maria Teresa; Villafañe, Jorge Hugo; Bertozzi, Lucia
The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). We conducted a randomised clinical trial. The study included 32 people, 31% female (mean ± SD age: 66 ± 9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks. The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p shoulder flexion (95% CI: 37.3-22.7) at 4 weeks and by 24.8° (95% CI: 32.1-17.6) at 8 weeks as well as in abduction by 30.6° (95% CI: 37.5-23.7) at 4 weeks and 25.1° (95% CI: 33.8-16.3) at 8 weeks. Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke. Implications for Rehabilitation Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention. Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems. This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping. Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.
Ritzmann, Ramona; Freyler, Kathrin; Krause, Anne; Gollhofer, Albert
Scopolamine is used to counteract motion sickness in parabolic flight (PF) experiments. Although the drug's anticholinergic properties effectively impede vomiting, recent studies document other sensory side-effects in the central nervous system that may considerably influence sensorimotor performance. This study aimed to quantify such effects in order to determine if they are of methodological and operational significance for sensorimotor control. Ten subjects of a PF campaign received a weight-sex-based dose of a subcutaneous scopolamine injection. Sensorimotor performance was recorded before medication, 20min, 2h and 4h after injection in four space-relevant paradigms: balance control in one-leg stance with eyes open (protocol 1) and closed as well as force-generating capacity in countermovement jumps and hops (protocol 2). Postural sway, forces and joint angles were recorded. Neuromuscular control was assessed by electromyography and peripheral nerve stimulation; H-reflexes and M-waves were used to monitor spinal excitability of the Ia afferent reflex circuitry and maximal motor output. (1) H-reflex amplitudes, latencies and functional reflexes remained unchanged after scopolamine injection. (2) M-waves, neuromuscular activation intensities and antagonistic muscle coordination did not change with scopolamine administration. (3) Balance performance and force-generating capacity were not impeded by scopolamine. We found no evidence for changes in sensorimotor control in response to scopolamine injection. Sensory processing of daily relevant reflexes, spinal excitability, maximal motor output and performance parameters were not sensitive to the medication. We conclude that scopolamine administration can be used to counteract motion sickness in PF without methodological and operational concerns or interference regarding sensorimotor skills associated with neuromuscular control.
Bistolfi, Alessandro; Zanovello, Jessica; Ferracini, Riccardo; Allisiardi, Fabrizio; Lioce, Elisa; Magistroni, Ernesta; Berchialla, Paola; Da Rold, Ilaria; Massazza, Giuseppe
to evaluate the efficacy of the use of the neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA). a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using PICOS approach to formulate the research question, Controlled terms and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data and loans received. out of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control-group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (NMES-group). Patients of NMES-groups got the best scores (Timed Up and Go Test, Stair-Climbing Test and Walk Test). NMES benefits were strong in the first postoperative weeks/months and gradually diminished. NMES allows a slightly better functional recovery following TKA, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.
Barrio, Javier; Errando, Carlos L; San Miguel, Guillermo; Salas, Boris I; Raga, Juan; Carrión, José L; García-Ramón, Jaime; Gallego, Juan
To evaluate the effect of neuromuscular blockade (NMB) upon the abdominal space during pneumoperitoneum establishment in laparoscopic surgery, comparing moderate NMB and deep NMB. Prospective, randomized, crossover clinical trial. Operating room. Seventy-six American Society of Anesthesiologists 1 to 2 patients scheduled for elective laparoscopic surgery. Two independent evaluations were performed at the establishment of pneumoperitoneum for a preset intraabdominal pressures (IAPs) of 8 and 12 mm Hg, both during moderate NMB (train-of-four count, 1-3) and deep NMB (posttetanic count, <5). Rocuronium was used to induce NMB, and sugammadex was used for reversal. We evaluated (i) the volume of CO2 introduced in 41 patients and (ii) the skin-sacral promontory distance in 35 patients, at pneumoperitoneum establishment. Compared to moderate NMB, deep NMB increased, in a significant manner, both the intraabdominal volume of CO2 insufflated (mean [SD], 2.24 [1.10] vs 2.81 [1.13] L at 8 mm Hg IAP, P<.001, and 3.52 [1.31] vs 4.09 [1.31] L at 12 mm Hg IAP, P<.001) and the skin-sacral promontory distance (11.78 [1.52] vs 12.16 [1.51] cm at 8 mm Hg IAP, P=.002, and 13.34 [1.87] vs 13.80 [1.81] cm at 12 mm Hg IAP, P<.001). Increase in intraabdominal volume after inducing deep NMB was observed in 88% and 81.7% of patients at 8 and 12 mm Hg pneumoperitoneum, with a volume increase of mean of 36.8% (95% confidence interval [CI], 22.8-50.8) and 25% (95% CI, 13.7-36.4), respectively (P=.003). Increase in distance was observed in 61% and 82% of patients at 8 and 12 mm Hg pneumoperitoneum, with a mean distance increase of 3.3% (95% CI, 1.3-5.4) and 3.6% (95% CI, 1.9-5.2), respectively (P=.840). Deep NMB, in comparison to moderate NMB, increased in a significant manner the abdominal space at pneumoperitoneum establishment. However, the effective increase in the abdominal cavity dimensions could be low, the increase showed a great interindividual variability, and it was not observed in
Abboud, Jacques; Lardon, Arnaud; Boivin, Frédéric; Dugas, Claude; Descarreaux, Martin
Introduction: Trunk neuromuscular responses have been shown to adapt under the influence of muscle fatigue, as well as spinal tissue creep or even with the presence of low back pain (LBP). Despite a large number of studies exploring how these external perturbations affect the spinal stability, characteristics of such adaptations remains unclear. Aim: The purpose of this systematic review was to assess the quality of evidence of studies investigating trunk neuromuscular responses to unexpected trunk perturbation. More specifically, the targeted neuromuscular responses were trunk muscle activity reflex and trunk kinematics under the influence of muscle fatigue, spinal creep, and musculoskeletal pain. Methods: A research of the literature was conducted in Pubmed, Embase, and Sport-Discus databases using terms related to trunk neuromuscular reflex responses, measured by electromyography (baseline activity, reflex latency, and reflex amplitude) and/or trunk kinematic, in context of unexpected external perturbation. Moreover, independent variables must be either trunk muscle fatigue or spinal tissue creep or LBP. All included articles were scored for their electromyography methodology based on the "Surface Electromyography for the Non-Invasive Assessment of Muscles (SENIAM)" and the "International Society of Electrophysiology and Kinesiology (ISEK)" recommendations whereas overall quality of articles was scored using a specific quality checklist modified from the Quality Index. Meta-analysis was performed on reflex latency variable. Results: A final set of 29 articles underwent quality assessments. The mean quality score was 79%. No effect of muscle fatigue on erector spinae reflex latency following an unexpected perturbation, nor any other distinctive effects was found for back muscle fatigue and reflex parameters. As for spinal tissue creep effects, no alteration was found for any of the trunk reflex variables. Finally, the meta-analysis revealed an increased erector
Influência da freqüência de estímulos na instalação do bloqueio neuromuscular produzido pelo rocurônio e pancurônio: avaliação pelo método acelerográfico Influencia de la frecuencia de estímulos en la instalación del bloqueo neuromuscular producido por el rocuronio y pancuronio: evaluación por el método acelerográfico Influence of stimulation frequency on rocuronium and pancuronium-induced neuromuscular block onset: acceleromyography evaluation
Derli da Conceição Munhóz
condiciones de intubación traqueal. RESULTADOS: Los tiempos medios (segundos para el inicio de acción e instalación de bloqueo neuromuscular total producido por el pancuronio fueron: Grupo I (159,33 ± 35,22 y 222 ± 46,56 y Grupo II (77,83 ± 9,52 y 105,96 ± 15,58; para el rocuronio: Grupo I (83 ± 17,25 y 125,33 ± 20,12 y Grupo II (48,96 ± 10,16 y 59,83 ± 10,36 con diferencia significativa entre los grupos. Las condiciones de intubación traqueal fueron satisfactorias en 117 pacientes (97,5% e insatisfactorias en 3 (2,5%. CONCLUSIONES: El inicio de acción y el tiempo para la obtención del bloqueo neuromuscular total en el músculo aductor del pulgar, producidos por el rocuronio y por el pancuronio, son más cortos cuando hay empleo de mayores frecuencias de estímulos.BACKGROUND AND OBJECTIVES: Factors associated to patients and neuromuscular blockers (NMB, as well as others inherent to neuromuscular function monitoring, may affect neuromuscular block onset. This study aimed at the influence of two different stimulation frequencies on rocuronium and pancuronium-induced neuromuscular block. METHODS: Participated in this study 120 patients, physical status ASA I and II, submitted to elective procedures under general anesthesia, who were randomly allocated in two groups, according to the stimulation frequency employed to monitor neuromuscular block: Group I - 0.1 Hz (n = 60 and Group II - 1 Hz (n = 60. Two subgroups were formed within each group (n = 30, according to the neuromuscular blocker: Subgroup P (pancuronium and Subgroup R (rocuronium. Patients were premedicated with muscular midazolam (0.1 mg.kg-1, 30 minutes before surgery. Anesthesia was induced with propofol (2.5 mg.kg-1 preceded by alfentanil (50 µg.kg-1 and followed by pancuronium or rocuronium. Patients were ventilated under mask with 100% oxygen until 75% or more decrease in adductor pollicis muscle response, when laryngoscopy and tracheal intubation were performed. Neuromuscular function was
Aslan, Goksen Kuran; Gurses, H Nilgun; Issever, Halim; Kiyan, Esen
To investigate the effects of inspiratory and expiratory muscle training on pulmonary functions in patients with slowly progressive neuromuscular disease. Prospective randomized controlled double-blinded study. Chest diseases clinic of university hospital. Twenty-six patients with slowly progressive neuromuscular disease followed for respiratory problems were included in the study. Patients were randomly divided into two groups; experimental (n = 14; age 31.6 ±12.3 years) and sham (n = 12; age 26.5 ±8.6 years) groups. Spirometry, peak cough flow, maximal inspiratory pressure, maximal expiratory pressure, and sniff nasal inspiratory pressure were measured before the eighth week of study, and subsequently at end of it. Respiratory muscle training was performed by inspiratory (Threshold Inspiratory Muscle Trainer) and expiratory (Threshold Positive Expiratory Pressure) threshold loading methods. Training intensities were increased according to maximal inspiratory and expiratory pressures in the experimental group, while the lowest loads were used for training in the sham group. Patients performed 15 minutes inspiratory muscle training and 15 minutes expiratory muscle training, twice a day, five days/week, for a total of eight weeks at home. Training intensity was adjusted in the training group once a week. Maximal inspiratory and expiratory pressures (cmH2O, % predicted) (respectively p = 0.002, p = 0.003, p = 0.04, p = 0.03) and sniff nasal inspiratory pressure (p = 0.04) were improved in the experimental group when compared with the sham group. However, there was no improvement in spirometric measurements when groups were compared (p > 0.05). As a conclusion of our study, we found that respiratory muscle strength improved by inspiratory and expiratory muscle training in patients with slowly progressive neuromuscular disease. © The Author(s) 2013.
Mirbagheri, Mehdi M; Niu, Xun; Kindig, Matt; Varoqui, Deborah
We studied the effects of robotic-assisted locomotor (LOKOMAT) training on neuromuscular abnormality associated with spasticity in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week for 4 weeks, with up to 45 minutes of training per session. Subjects were evaluated before and after 1, 2, and 4 weeks of training, and the effects of training on the intrinsic (muscular) and reflexive components of the neuromuscular properties were quantified over the ankle range-of-motion. A linear (slope&intercept) regression was fit to the stiffness-angle curve. "Growth mixture" modeling was used to identify recovery classes for these parameters over the training period. Two distinct classes were observed. Class 1 subjects had initially higher reflex stiffness parameters (i.e., intercept and slope vs. ankle position) and reduced significantly over the training period. Class 2 subjects initially had lower reflex stiffness parameters and experienced non-significant reductions. Similar results were observed for the intrinsic stiffness intercept; however, intrinsic slope showed no significant improvement over training for either class. These findings demonstrate that LOKOMAT training is effective in reducing reflex and intrinsic stiffness (which abnormally increase in SCI) and improving the abnormal modulation of reflexes over the ankle range-of-motion.
Thomas, Abbey C; Lepley, Lindsey K; Wojtys, Edward M; McLean, Scott G; Palmieri-Smith, Riann M
Laboratory-based experiment using a pretest/posttest design. To determine the effects of neuromuscular fatigue on quadriceps strength and activation and sagittal and frontal plane knee biomechanics during dynamic landing following anterior cruciate ligament reconstruction (ACLR). Impaired quadriceps central activation occurs post-ACLR, likely altering lower extremity biomechanics. Neuromuscular fatigue similarly reduces volitional muscle activation and impairs neuromuscular control. Upon return to full activity post-ACLR, individuals likely concurrently experience quadriceps central activation deficits and neuromuscular fatigue, though the effects of fatigue on muscle strength and activation and biomechanics post-ACLR are unknown. Seventeen individuals 7 to 10 months post-ACLR and 16 controls participated. Quadriceps strength and central activation ratio were recorded prefatigue and postfatigue, which was induced via sets of double-leg squats. Knee biomechanics were recorded during a dynamic landing activity prefatigue and postfatigue. Both groups demonstrated smaller knee flexion (initial contact, P = .017; peak, P = .004) and abduction (initial contact, P = .005; peak, P = .009) angles postfatigue. The ACLR group had smaller peak knee flexion angles (Pbiomechanics were present postfatigue in both groups, suggesting that neuromuscular fatigue may increase noncontact ACL injury risk. However, these changes were not exaggerated in those post-ACLR, likely because they already demonstrated a stiff-legged landing strategy prefatigue.
Anjum, Hadeya; Amjad, Imran; Malik, Arshad Nawaz
To determine the effects of proprioceptive neuromuscular facilitation (PNF) techniques as compared with the traditional prosthetic strength training (TPT), in improving ambulatory function in subjects with transtibial amputation. Randomized control trial. Artificial Limb Centre of Fauji Foundation Hospital, Rawalpindi, from July to December 2014. Patients with lower-limb amputation was selected through purposive sampling and randomly assigned into PNF group (n=31) and traditional group (n=32). The baseline and follow-up of 04 weeks treatment session was provided and measurement was noted through the locomotor capabilities index. The locomotor capabilities index abilities had significant difference in both groups. The mean index was 23.93 for PNF and 18.18 for TPT(p > 0.05), and the knee muscle strength was also significantly different (p > 0.05). There was no significant difference in gait parameters. Proprioceptive neuromuscular facilitation technique is better in improving the locomotor abilities and knee muscle strength as compared to traditional training. The basic gait parameters have same effect in both groups.
Maselli, Ricardo A; Books, Wendy; Dunne, Vanessa
Synaptotagmins are abundant synaptic proteins that represent the best candidate for the calcium sensor at the nerve terminal. The pore-forming, voltage-sensing transmembrane alpha-1 subunit of the P/Q voltage-gated calcium channel (or Ca(v)2.1) encoded by the CACNA1A gene is another major component of the process of action potential-evoked exocytosis at the adult mammalian neuromuscular junction. Defects of these proteins, in nonhuman species, result in severe disruption of rapid synaptic transmission. This paper investigates the molecular bases of inherited presynaptic deficits of neuromuscular transmission in humans. Patients with congenital presynaptic failure, including two patients with episodic ataxia type 2 (EA-2) due to CACNA1A mutations, were studied with muscle biopsy, microelectrode studies, electron microscopy, DNA amplification, and sequencing. All patients, including EA-2 patients, showed selective failure of the action potential-dependent release without reduction of the spontaneous release of neurotransmitter. In addition, patients with EA-2 showed partial blockade of neuromuscular transmission with the N-type blocker omega-conotoxin not seen in controls. The EM showed a varied degree of increased complexity of postsynaptic folds. Mutational analysis in candidate genes, including human synaptotagmin II, syntaxin 1A, synaptobrevin I, SNAP 25, CACNA1A, CACNB2, and Rab3A, was unrevealing. Although no mutations in candidate genes were found in patients with inborn presynaptic failure, functional and structural similarities between this group and patients with EA-2 due to CACNA1A mutations suggest a common pathogenic mechanism.
Smith, C M; Housh, T J; Hill, E C; Cochrane, K C; Jenkins, N Dm; Schmidt, R J; Johnson, G O
To determine the effects of constant versus alternating applications of torque during fatiguing, intermittent isometric muscle actions of the leg extensors on maximal voluntary isometric contraction (MVIC) torque and neuromuscular responses. Sixteen subjects performed two protocols, each consisting of 50 intermittent isometric muscle actions of the leg extensors with equal average load at a constant 60% MVIC or alternating 40 then 80% (40/80%) MVIC with a work-to-rest ratio of 6-s on and 2-s off. MVIC torque as well as electromyographic signals from the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) and mechanomyographic signals from the VL were recorded pretest, immediately posttest, and 5-min posttest. The results indicated that there were no time-related differences between the 60% MVIC and 40/80% MVIC protocols. The MVIC torque decreased posttest (22 to 26%) and remained depressed 5-min posttest (9%). There were decreases in electromyographic frequency (14 to 19%) and mechanomyographic frequency (23 to 24%) posttest that returned to pretest levels 5-min posttest. There were no changes in electromyographic amplitude and mechanomyogrpahic amplitude. These findings suggested that these neuromuscular parameters did not track the fatigue-induced changes in MVIC torque after 5-min of recovery.
Smirmaul, Bruno P C; de Moraes, Antonio Carlos; Angius, Luca; Marcora, Samuele M
To investigate the effects of caffeine on performance, neuromuscular fatigue and perception of effort during high-intensity cycling exercise in moderate hypoxia. Seven adult male participants firstly underwent an incremental exercise test on a cycle ergometer in conditions of acute normobaric hypoxia (fraction inspired oxygen = 0.15) to establish peak power output (PPO). In the following two visits, they performed a time to exhaustion test (78 ± 3% PPO) in the same hypoxic conditions after caffeine ingestion (4 mg kg -1 ) and one after placebo ingestion in a double-blind, randomized, counterbalanced cross-over design. Caffeine significantly improved time to exhaustion by 12%. A significant decrease in subjective fatigue was found after caffeine consumption. Perception of effort and surface electromyographic signal amplitude of the vastus lateralis were lower and heart rate was higher in the caffeine condition when compared to placebo. However, caffeine did not reduce the peripheral and central fatigue induced by high-intensity cycling exercise in moderate hypoxia. The caffeine-induced improvement in time to exhaustion during high-intensity cycling exercise in moderate hypoxia seems to be mediated by a reduction in perception of effort, which occurs despite no reduction in neuromuscular fatigue.
Miyagishi, A; Nakahara, H; Hara, Y
In isolated tissues and anesthetized animals, beta- and alpha-adrenoceptor blocking properties of arotinolol were studied in comparison with those of other typical adrenoceptor antagonists. The following order of beta-adrenoceptor blocking activities were obtained in isolated tissues: arotinolol = pindolol greater than propranolol = oxprenolol = alprenolol greater than or equal to labetalol for beta 1-adrenoceptors (guinea-pig right atrium) and pindolol = oxprenolol = arotinolol greater than propranolol greater than labetalol for beta 2-adrenoceptors (guinea-pig trachea). In anesthetized cats, arotinolol was about 9 and 25 times more potent than propranolol, about 30 and 100 times more potent than labetalol in blocking beta 1- and beta 2-adrenoceptors, respectively. Furthermore arotinolol showed a competitive antagonistic effect on phenylephrine-induced contraction of isolated rat aortic strips. The relative order of alpha 1-adrenoceptor blocking potencies was as follows: prazosin greater than phentolamine greater than labetalol greater than arotinolol = yohimbine. Presynaptic alpha 2-adrenoceptor blocking action of arotinolol was also assessed in isolated rat vas deferens and arotinolol was revealed to be a much weaker presynaptic alpha 2-adrenoceptor antagonist. In anesthetized rats arotinolol was 4-5 times less potent than labetalol and about 26 times less potent than phentolamine in blocking alpha 1-adrenoceptors. Thus, as for the selectivity for 2 subtypes of alpha-adrenoceptors, arotinolol showed a selectivity for alpha 1-adrenoceptors over presynaptic alpha 2-adrenoceptors.
Dello Iacono, A; Eliakim, A; Padulo, J; Laver, L; Ben-Zaken, S; Meckel, Y
The aim of this study was to investigate the influence of physical contact on neuromuscular impairments and inflammatory response during handball small-sided games. Using a counterbalanced design, 12 elite male junior handball players were divided into two groups: contact (C-SSG) and no-contact (NC-SSG), performing both contact and no-contact small-sided games, in reverse order on two training sessions separated by 5 days. The methodology and rules were identical for the two SSG regimens, with the only difference being the inclusion or prohibition of upper body use for physical contacts. Upper and lower body neuromuscular performances and blood concentrations of inflammatory cytokine IL-6 were assessed before and immediately after the games. During small-sided games, video analysis was used to establish the physical contact counts. Significant differences were found in most upper and lower limbs muscles kinetic variables and in the physical contact events (all P handball players. These outcomes outline the specific physiological profile of C-SSG that, in turn, might be used by practitioners and coaches as a practical approach to strategically select exercises in athlete's overall training program. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Ageberg, Eva; Nilsdotter, Anna; Kosek, Eva
The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled...... before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee....
Nakahara, H; Nakazawa, M; Takeda, K; Imai, S
Acute hypotensive effects and the mechanisms of three beta-adrenergic blocking drugs with alpha-blocking activity were studied in comparison with those of prazosin, propranolol and hydralazine in the conscious spontaneously hypertensive rat (SHR). Prazosin lowered the blood pressure dose-dependently and inhibited the pressor response to phenylephrine. Three beta-adrenergic blocking drugs with alpha-blocking activity, labetalol (30 mg/kg), arotinolol (100 mg/kg) and nipradilol (100 mg/kg) also lowered the blood pressure to the same extent as prazosin (0.3 mg/kg), but the inhibition of the pressor response to phenylephrine produced by them was disproportionately slight. Propranolol (100 mg/kg) did not lower the blood pressure. These results suggest that the acute hypotensive effects of three beta-adrenergic blocking drugs with alpha-blocking activity were attributable only partially to the alpha-adrenergic blocking effect; a mechanism or mechanisms other than the alpha-adrenergic blocking effect must be invoked to explain the acute hypotensive effect produced by lower doses of these drugs in the conscious SHR.
Compressive strength, water absorption, split tensile strength tests were carried out on the various samples. The results show that the addition of polythene fibre to sandcrete blocks has very little effect on the compressive strength, although at 0.5% fibre content, the tensile strength increased. Heating the blocks at 100oC for ...
Cools, F; Offringa, M
Ventilated newborn infants breathing in asynchrony with the ventilator are at risk for complications during mechanical ventilation, such as pneumothorax or intraventricular hemorrhage, and are exposed to more severe barotrauma, which consequently could impair their clinical outcome. Neuromuscular paralysis, which eliminates spontaneous breathing efforts of the infant, has potential advantages in this respect. However, a number of complications have been reported with muscle relaxation in infants, so that concerns exist regarding the safety of prolonged neuromuscular paralysis in newborn infants. To determine whether routine neuromuscular paralysis of newborn infants receiving mechanical ventilation compared with no routine paralysis results in clinically important benefits or harms. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004), MEDLINE (from 1966 to April 2004) and EMBASE (from 1988 to April 2004) were searched. References of review articles were hand searched. Language restriction was not imposed. All trials using random or quasi-random patient allocation, in which the routine use of neuromuscular blocking agents during mechanical ventilation was compared to no paralysis or selective paralysis in newborn infants. Methodological quality was assessed blindly and independently by the two authors. Data were abstracted using standard methods of the Cochrane Collaboration and its Neonatal Review Group, with independent evaluation of trial quality, and abstraction and synthesis of data by both authors. Treatment effect was analysed using relative risk, risk difference and weighted mean difference. Ten possibly eligible trials were identified, of which six were included in the review. All the included trials studied preterm infants ventilated for respiratory distress syndrome, and used pancuronium as the neuromuscular blocking agent. In the analysis of the results of all trials, no significant difference was found in
Andersen, Lars L; Zeeman, Peter; Jørgensen, Jørgen R
Hemiparesis-disability and muscle weakness of 1 side of the body-is a common consequence of stroke. High-intensity strength training may be beneficial to regain function, but strength coaches in the field of rehabilitation need evidence-based guidelines. The purpose of this study was to evaluate...... consisting of isokinetic muscle strength, neuromuscular activation measured with electromyography (EMG), electrically evoked muscle twitch contractile properties, and gait performance (10-m Walk Test and 6-min Walk Test). After the 12-week conditioning program, knee extensor and flexor strength increased...... during all contraction modes and velocities in the paretic leg. Significant increases were observed for agonist EMG amplitude at slow concentric and slow eccentric contraction. Twitch torque increased, whereas twitch time-to-peak tension remained unchanged. By contrast, no significant changes were...
Hu, X L; Tong, K Y; Li, R; Xue, J J; Ho, S K; Chen, P
An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (Probot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions. Copyright © 2011 Elsevier Ltd. All rights reserved.
Zebis, Mette K; Bencke, Jesper; Andersen, Lars
and knee, and ground reaction forces were recorded during a sidecutting maneuver. Neuromuscular activity in the prelanding phase was obtained 10 and 50 ms before foot strike on a force plate and at 10 and 50 ms after foot strike on a force plate. RESULTS: Neuromuscular training markedly increased before...
Zebis, Mette K; Bencke, Jesper; Andersen, Lars L; Døssing, Simon; Alkjaer, Tine; Magnusson, S Peter; Kjaer, Michael; Aagaard, Per
The project aimed to implement neuromuscular training during a full soccer and handball league season and to experimentally analyze the neuromuscular adaptation mechanisms elicited by this training during a standardized sidecutting maneuver known to be associated with non-contact anterior cruciate ligament (ACL) injury. The players were tested before and after 1 season without implementation of the prophylactic training and subsequently before and after a full season with the implementation of prophylactic training. A total of 12 female elite soccer players and 8 female elite team handball players aged 26 +/- 3 years at the start of the study. The subjects participated in a specific neuromuscular training program previously shown to reduce non-contact ACL injury. Neuromuscular activity at the knee joint, joint angles at the hip and knee, and ground reaction forces were recorded during a sidecutting maneuver. Neuromuscular activity in the prelanding phase was obtained 10 and 50 ms before foot strike on a force plate and at 10 and 50 ms after foot strike on a force plate. Neuromuscular training markedly increased before activity and landing activity electromyography (EMG) of the semitendinosus (P < 0.05), while quadriceps EMG activity remained unchanged. Neuromuscular training increased EMG activity for the medial hamstring muscles, thereby decreasing the risk of dynamic valgus. This observed neuromuscular adaptation during sidecutting could potentially reduce the risk for non-contact ACL injury.
Renzenbrink, Gerbert J.; IJzerman, Maarten Joost
Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teaching
Yoo, Jae Ho; Lim, Bee Oh; Ha, Mina; Lee, Soo Won; Oh, Soo Jin; Lee, Yong Seuk; Kim, Jin Goo
Female athletes are more prone to anterior cruciate ligament (ACL) injury than their male counterparts, presumably because of anatomical, hormonal, and neuromuscular differences. Of these three, only the neuromuscular component can be modified by preventive exercise. We aimed to evaluate the effect of a neuromuscular protocol on the prevention of ACL injury by performing meta-analysis, and to identify essential factors by subgroup analysis. An extensive literature review was conducted to identify relevant studies, and eventually, only seven randomized controlled trials or prospective cohort studies were included in the analysis. The odds ratios (OR) and the confidence interval (CI) for the overall effects of training and of potentially contributory factors were estimated. The OR and the 95% CI for the overall effect of the preventive training were 0.40 and [0.27, 0.60], respectively. Subgroup analysis revealed that an age under 18, soccer rather than handball, pre- and in-season training rather than either pre- or in-season training, and the plyometrics and strengthening components rather than balancing were significant. Meta-analysis showed that pre- and in-season neuromuscular training with an emphasis on plyometrics and strengthening exercises was effective at preventing ACL injury in female athletes, especially in those under 18 years of age. Further study is required to develop a relevant training program protocol of appropriate intensity.
Holsgaard-Larsen, A; Christensen, R; Clausen, B
OBJECTIVE: To test long-term effectiveness of neuromuscular exercise (NEMEX) with instructions in optimized pharmacological treatment (PHARMA) on activities of daily living (ADL) in patients with early knee osteoarthritis. DESIGN: 12-months follow-up from a randomized controlled trial. Participants...
Madsen, Matias Vested; Donatsky, Anders Meller; Jensen, Bente Rona
endotracheally intubated, mechanically ventilated, anesthetized with propofol and fentanyl, and randomized into two groups in a cross-over assessor-blinded design. Neuromuscular block was established with rocuronium. Artificial laparotomy for ileus was performed. We investigated the influence of intense......PURPOSE: Intense neuromuscular block may improve surgical conditions in ileus laparotomies; however, it is difficult to evaluate. The aim of this study was to investigate if neuromuscular block improved surgical conditions in pigs with artificial ileus laparotomy. METHODS: Six pigs were...... neuromuscular block on surgical conditions with a subjective rating scale, force needed to close the fascia, incidences of abdominal contractions while suctioning the lungs, width of the wound diastase and operating time as outcome parameters. RESULTS: In all six pigs no abdominal contractions occurred while...
Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Erdem, Ali Fuat; Palabıyık, Onur
Thoracic paravertebral block (TPVB) can be performed with or without general anaesthesia for various surgical procedures. TPVB is a popular anaesthetic technique due to its low side effect profile and high analgesic potency. We used 20 mL of 0.5% levobupivacaine for a single injection of unilateral TPVB at the T7 level with neurostimulator in a 63 year old patient with co-morbid disease who underwent cholecystectomy. Following the application patient lost consciousness, and was intubated. Haemodynamic instability was normalised with rapid volume replacement and vasopressors. Anaesthetic drugs were stopped at the end of the surgery and muscle relaxant was antagonised. Return of mucle strenght was shown with neuromuscular block monitoring. Approximately three hours after TPVB, spontaneous breathing started and consciousness returned. A total spinal block is a rare and life-threatening complication. A total spinal block is a complication of spinal anaesthesia, and it can also occur after peripheral blocks. Clinical presentation is characterised by hypotension, bradicardia, apnea, and cardiac arrest. An early diagnosis and appropriate treatment is life saving. In this case report, we want to present total spinal block after TPVB.
Toglia, M P; Hinman, P J; Dayton, B S; Catalano, J F
Picture and word recall was examined in conjunction with list organization. 60 subjects studied a list of 30 items, either words or their pictorial equivalents. The 30 words/pictures, members of five conceptual categories, each represented by six exemplars, were presented either blocked by category or in a random order. While pictures were recalled better than words and a standard blocked-random effect was observed, the interaction indicated that the recall advantage of a blocked presentation was restricted to the word lists. A similar pattern emerged for clustering. These findings are discussed in terms of limitations upon the pictorial superiority effect.
Thomsen, Jakob Louis Demant; Mathiesen, Ole; Hägi-Pedersen, Daniel; Skovgaard, Lene Theil; Østergaard, Doris; Engbaek, Jens; Gätke, Mona Ring
Muscle relaxants facilitate endotracheal intubation under general anesthesia and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and an increased risk of respiratory complications. Use of an objective neuromuscular monitoring device may prevent residual block. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time consuming and require the presence of expert personnel. A neuromuscular monitoring e-learning module might support consistent use of neuromuscular monitoring devices. The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on anesthesia staff's use of objective neuromuscular monitoring and the incidence of residual neuromuscular blockade in surgical patients at 6 Danish teaching hospitals. In this interrupted time series study, we are collecting data repeatedly, in consecutive 3-week periods, before and after the intervention, and we will analyze the effect using segmented regression analysis. Anesthesia departments in the Zealand Region of Denmark are included, and data from all patients receiving a muscle relaxant are collected from the anesthesia information management system MetaVision. We will assess the effect of the module on all levels of potential effect: staff's knowledge and skills, patient care practice, and patient outcomes. The primary outcome is use of neuromuscular monitoring in patients according to the type of muscle relaxant received. Secondary outcomes include last recorded train-of-four value, administration of reversal agents, and time to discharge from the postanesthesia care unit as well as a multiple-choice test to assess knowledge. The e-learning module was developed based on a needs assessment process, including focus group interviews, surveys, and expert opinions. The e
Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W
The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.
Yoo, Ji Won; Lee, Dong Ryul; Cha, Young Joo; You, Sung Hyun
The purpose of the present study was to compare therapeutic effects of an electromyography (EMG) biofeedback augmented by virtual reality (VR) and EMG biofeedback alone on the triceps and biceps (T:B) muscle activity imbalance and elbow joint movement coordination during a reaching motor taskOBJECTIVE: To compare therapeutic effects of an electromyography (EMG) biofeedback augmented by virtual reality (VR) and EMG biofeedback alone on the triceps and biceps muscle activity imbalance and elbow joint movement coordination during a reaching motor task in normal children and children with spastic cerebral palsy (CP). 18 children with spastic CP (2 females; mean±standard deviation = 9.5 ± 1.96 years) and 8 normal children (3 females; mean ± standard deviation = 9.75 ± 2.55 years) were recruited from a local community center. All children with CP first underwent one intensive session of EMG feedback (30 minutes), followed by one session of the EMG-VR feedback (30 minutes) after a 1-week washout period. Clinical tests included elbow extension range of motion (ROM), biceps muscle strength, and box and block test. EMG triceps and biceps (T:B) muscle activity imbalance and reaching movement acceleration coordination were concurrently determined by EMG and 3-axis accelerometer measurements respectively. Independent t-test and one-way repeated analysis of variance (ANOVA) were performed at p EMG biofeedback when augmented by virtual reality exercise games in children with spastic CP. The augmented EMG and VR feedback produced better neuromuscular balance control in the elbow joint than the EMG biofeedback alone.
Amasyali, Saliha Y; Yaliman, Ayşe
To determine the effectiveness of mirror therapy and electromyography (EMG)-triggered neuromuscular stimulation on improvement of functions of the upper extremity in patients with subacute stroke in comparison with conventional therapy as well as to evaluate the advantage of each treatment over another, we conducted a prospective, randomized, and controlled trial involving 24 patients with ischemic stroke. The mean age and mean time since stroke of the patients were 58.79±11.49 years and 5.25±2.25 months. Patients were assigned randomly to a mirror therapy group (MT group, n=9), which consisted of therapy with a mirror box 5 days/week, 30 min/day, for 3 weeks, an electrostimulation group (ES group, n=7), which consisted of therapy with EMG-triggered stimulation (EMG-stim) of similar duration and frequency of treatment as the MT group, and a control group (n=8). All the groups received conventional physiotherapy for the same period as the MT group. Patients in the MT group practiced their therapy at home after supervised sessions. The Fugl-Meyer scores of the upper extremity, grip force, wrist extension, and Box and Block Test were evaluated at baseline, after treatment, and at 3 months after the treatment. All of these measures were evaluated by a blinded researcher. We found that there was no significant improvement in wrist extension range and grip force in control group. The MT and EMG-stim were effective in increasing the Fugl-Meyer motor scale for upper extremity (MT group: PTest (MT group and ES group PEMG-stim. We assume that this difference might be related to the feasibility of maintenance of MT at home.
Efeito do priming na redução da latência do pipecurônio, novo bloqueador neuromuscular não-despolarizante Efecto del priming en la reducción de la latencia del pipecuronio, nuevo bloqueador neuromuscular no despolarizante Effect of priming in shortening onset of pipecuronium, a new nondepolarizing neuromuscular blocker
José Carlos Canga
adultos sometidos a cirugías electivas bajo anestesia general. MÉTODO: Fueron estudiados 32 pacientes adultos de ambos sexos, con edad entre 20 y 65 años, estado físico ASA I ó II, a ser sometidos a cirugías electivas bajo anestesia general. Fueron excluidos del estudio pacientes con insuficiencia renal o hepática, neuromiopatia, uso concomitante de drogas que influencien la farmacocinética de la droga o pacientes con histórico familiar de hipertermia maligna. Fueron divididos en dos grupos: Grupo 1 donde fue utilizada el priming con 0,01 mg.kg-1 3 minutos después de completada la dosis de 0,08 mg.kg-1 y el Grupo 2, sin dosis priming (Grupo Control. El relajamiento neuromuscular fue controlado por la aceleromiografía (Aparato TOF-Guard y en el momento en que T1 BACKGROUND AND OBJECTIVES: One of the most important neuromuscular blockers property is short onset, allowing early tracheal intubation. Low nondepolarizing blocker dose before the full dose is known to decrease the onset of most neuromuscular blockers. Pipecuronium bromide is a long-lasting aminosteroid with major cardiovascular stability, however, with late onset. This study aimed at evaluating pipecuronium priming effect in adult patients submitted to elective surgeries under general anesthesia. METHODS: Participated in this study 33 adult patients of both genders, aged 20 to 65 years, physical status ASA I or II, to be submitted to elective surgeries under general anesthesia. Exclusion criteria were patients with kidney or liver failure, neuromuscular diseases, in concurrent use of drugs influencing pipecuronium pharmacokinetics, and patients with family history of malignant hyperthermia. Patients were divided in 2 groups: Group 1 = priming with 0.01 mg.kg-1 and 3 minutes later the remaining 0.07 mg.kg-1 (total 0.08 mg.kg-1; Group 2 = no priming dose (group control. Neuromuscular relaxation was controlled by acceleromyography (TOF-Guard device and laryngoscopy was accomplished when T1 < 10%. T test
Sun, Fenghua; Wang, Li-Juan; Wang, Lin
Childhood obesity is one of the most critical public health problems in the world. It is associated with low neuromuscular function and postural deformities. Whether weight loss can improve postural stability and neuromuscular control, benefit daily activities, or prevent injury is unknown. Therefore, this study attempts to investigate the effect of a 6 month weight management program on postural stability and neuromuscular control among obese children. We will conduct a prospective, single-blind, randomized controlled trial with 120 prepubescent obese children. Participants will be randomly assigned to a weight management group or a control group. The weight management group will participate in a dietary and exercise program. The control group will receive health education. After the intervention, participants will be followed for 6 months with no active intervention. The primary and secondary outcomes will be assessed at the baseline, and after 6 months and 12 months. Primary outcome measures will include body weight, body height, body mass index, waist circumference, hip circumference, and body fat percentage. Secondary outcome measures will include three-dimensional functional biomechanics in different tasks, proprioception tests of the knee and ankle, neuromuscular response of the leg muscles, and muscle strength tests of the knee and ankle. Furthermore, adverse events will be recorded and analyzed. An intention-to-treat analysis will be performed if any participants withdraw from the trial. The important features of this trial include the randomization procedures and large sample size. This study attempts to estimate the effect of weight loss intervention on outcomes, including daily life function, postural stability, and neuromuscular control in prepubescent obese children. Therefore, our results can be useful for obese children, medical staff, and healthcare decision makers. Chinese Clinical Trial Registry ChiCTR-IOB-15005874.
Shields, Richard K; Dudley-Javoroski, Shauna
Maintaining the physiologic integrity of paralyzed limbs may be critical for those with spinal cord injury (SCI) to be viable candidates for a future cure. No long-term intervention has been tested to attempt to prevent the severe musculoskeletal deterioration that occurs after SCI. The purposes of this study were to determine whether a long-term neuromuscular electrical stimulation training program can preserve the physiological properties of the plantar flexor muscles (peak torque, fatigue index, torque-time integral, and contractile speed) as well as influence distal tibia trabecular bone mineral density (BMD). Subjects began unilateral plantar flexion electrical stimulation training within 6 wk after SCI while the untrained leg served as a control. Mean compliance for the 2-yr training program was 83%. Mean estimated compressive loads delivered to the tibia were approximately 1-1.5 times body weight. The training protocol yielded significant trained versus untrained limb differences for torque (+24%), torque-time integral (+27%), fatigue index (+50%), torque rise time (+45%), and between-twitch fusion (+15%). These between-limb differences were even greater when measured at the end of a repetitive stimulation protocol (125 contractions). Peripheral quantitative computed tomography revealed 31% higher distal tibia trabecular BMD in trained limbs than in untrained limbs. The intervention used in this study was sufficient to limit many of the deleterious muscular and skeletal adaptations that normally occur after SCI. Importantly, this method of load delivery was feasible and may serve as the basis for an intervention to preserve the musculoskeletal properties of individuals with SCI.
Barber-Westin, Sue D; Noyes, Frank R
Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics. First, to determine if fatigue uniformly alters lower limb biomechanics during athletic tasks that are associated with noncontact ACL injuries. Second, to determine if changes should be made in ACL injury prevention training programs to alter the deleterious effects of fatigue on lower limb kinetics and kinematics. Systematic review; Level of evidence, 4. A systematic review of the literature using MEDLINE was performed. Key terms were fatigue, neuromuscular, exercise, hop test, and single-legged function tests. Inclusion criteria were original research studies involving healthy participants, use of a fatigue protocol, study of at least 1 lower limb task that involved landing from a hop or jump or cutting, and analysis of at least 1 biomechanical variable. Thirty-seven studies involving 806 athletes (485 female, 321 male; mean age, 22.7 years) met the inclusion criteria. General fatigue protocols were used in 20 investigations, peripheral protocols were used in 17 studies, and 21 different athletic tasks were studied (13 single-legged, 8 double-legged). There was no consistency among investigations regarding the effects of fatigue on hip, knee, or ankle joint angles and moments or surface electromyography muscle activation patterns. The fatigue protocols typically did not produce statistically significant changes in ground-reaction forces. Published fatigue protocols did not uniformly produce alterations in lower limb neuromuscular
McGRATH, Ryan P; Whitehead, James R; Caine, Dennis J
Until recently, the scientific community believed that post-exercise stretching could reduce delayed onset muscle soreness (DOMS), but recent reviews of studies on the topic have concluded that pre- or post-exercise static stretching has no effect on mitigating DOMS. However, the effect of proprioceptive neuromuscular facilitation (PNF) post-exercise stretching on preventing DOMS has not been adequately studied. The purpose of this study was to determine the effect of post-exercise PNF stretching on DOMS. Young adult participants (N=57) were randomly assigned to a PNF stretching group (n=19), a static stretching group (n=20), and to a no-stretching control group (n=18). All participants completed exercise designed to induce DOMS prior to post-exercise experimental stretching protocols. Participants rated their soreness level on a pain scale 24 and 48 hours post-exercise. A 3 × 2 mixed ANOVA showed there was an effect for time (pPNF and control groups, but not for the static stretching group. Other analyses revealed a significant correlation (r=.61, pPNF group. Consistent with the results of previous research on post-exercise static stretching, these results indicate that post-exercise PNF stretching also does not prevent DOMS. However, the correlation analysis suggests it is possible the pre-stretch muscle contractions of the post-exercise PNF protocol may have placed a load on an already damaged muscle causing more DOMS for some participants.
Wośko, Jarosław; Sawulski, Sławomir; Dabrowski, Wojciech; Nestorowicz, Andrzej
Carotid endarterectomy is a preventative operation to reduce the incidence of embolic stroke. The prime concern during surgery is the protection of the brain during carotid artery cross-clamping. Since blood flow to the brain is provided via the non-affected carotid artery and collateral circulation, it is essential to maintain consciousness in the patient during surgery, in order to assess the effects of cross-clamping. Regional anaesthesia has therefore been regarded as the method of choice for this kind of surgery. Cervical plexus analgesia can be achieved at two levels: superficial--when skin branches of the plexus are blocked, and deep--when short and long nerves are blocked. Successful block of the cervical plexus depends of effective analgesia achieved at both levels. This can be achieved by a single injection as described by Winnie, or multiple injection at C2, C3 and C4 as described by Moore. Among possible complications, the most common is transient phrenic nerve block with diaphragm dysfunction. We have compared the effects of cervical plexus block performed according to Winnie (group W), or Moore (group M) on spirometry, arterial oxygen saturation and carbon dioxide tension, in seventy-five patients scheduled for endarterectomy. Group W consisted of 44 patients, and group M--of 31 patients. VC, FVC, FEV1 and PIF decreased in all patients. There were no statistically significant differences between the groups. Transient paralysis of the diaphragm, confirmed by chest x-ray, occurred in 8 (19.5%) patients of group W, and in 4 (14.3%) patients of group M. Gas exchange remained unchanged. We proved that cervical plexus block is associated with moderate depression of respiratory function without impairment of gas exchange. The block may be complicated by transient unilateral diaphragm paralysis.
Langeard, Antoine; Bigot, Lucile; Chastan, Nathalie; Gauthier, Antoine
The lower limb muscle functions of the elderly are known to be preferentially altered by ageing. Traditional training effectively counteracts some of these functional declines but is not always accessible due to its cost and to the accessibility of the training centers and to the incapacities of some seniors to practice some exercises. Neuromuscular electrical stimulation (NMES) could provide an interesting alternative muscle training technique because it is inexpensive and transportable. The aim of this systematic review was to summarize the current evidence on the effect of the use of lower limb NMES as a training technique for healthy elderly rehabilitation. Electronic databases were searched for trials occurring between 1971 (first occurrence of NMES training) and November 2016. Ten published articles were retrieved. Training programs either used NMES alone, or NMES associated with voluntary muscle contraction (NMES+). They either targeted calves or thigh muscles and their training length and intensity were heterogeneous but all studies noted positive effects of NMES on the elderly's functional status. Indeed, NMES efficiently improved functional and molecular muscle physiology, and, depending on the studies, could lead to better gait and balance performances especially among less active elderly. Given the association between gait, balance and the risk of falls among the elderly, future research should focus on the efficiency of NMES to reduce the high fall rate among this population. Copyright © 2017 Elsevier Inc. All rights reserved.
Guilherme P. T. Areas
Full Text Available BACKGROUND: Elastic resistance bands (ERB combined with proprioceptive neuromuscular facilitation (PNF are often used in resistance muscle training programs, which have potential effects on peripheral muscle strength. However, the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation. OBJECTIVES: The assessment of the effects of PNF combined with ERB on respiratory muscle strength. METHOD: Twenty healthy, right-handed females were included. Subjects were randomized to either the resistance training program group (TG, n=10 or the control group (CG, n=10. Maximal expiratory pressure (MEP and inspiratory pressure (MIP were measured before and after four weeks of an upper extremity resistance training program. The training protocol consisted of upper extremity PNF combined with ERB, with resistance selected from 1 repetition maximum protocol. RESULTS: PNF combined with ERB showed significant increases in MIP and MEP (p<0.05. In addition, there were significant differences between the TG and CG regarding ∆MIP (p=0.01 and ∆MEP (p=0.04. CONCLUSIONS: PNF combined with ERB can have a positive impact on respiratory muscle strength. These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength.
Klockars, Alan J.; Potter, Nina Salcedo
The type I error control and power of a number of analysis of covariance (ANCOVA) and randomized block (RB) designs with curvilinear data were studied for tests of the additive treatment effect and interaction. For tests of additive effects, the analysis was also conducted using systematic assignment to treatments and using random assignment with…
Jamilson Simões Brasileiro
Full Text Available The Patellofemoral pain syndrome (PFPS is described as an anterior or retropatellar knee pain in the absence of other associated diseases, and has often been associated with dysfunction of the vastus medialis oblique muscle (VMO. However, several studies have demonstrated the impossibility of selectively activating this muscle with exercises. The aim of the present study was to analyze the immediate effect of neuromuscular electrical stimulation of VMO muscle by means of monitoring the electromyographic activity of the vastus medialis oblique (VMO and vastus lateralis (VL muscles. Eighteen healthy women with a mean age of 23.2 years and mean BMI of 20 Kg/m2 were evaluated. The study protocol included electromyographic analysis of VMO and VL muscles, before and immediately after neuromuscular electrical stimulation of the VMO muscle. During the electromyographic analysis, the volunteers performed maximal voluntary isometric contraction in a 60° knee extension on an isokinetic dynamometer. “Russian current” apparatus was used for electrical stimulation. Results: The data analysis demonstrated a signifi cant increase in VMO activation intensity immediately after it had been electrically stimulated (p=0.0125, whereas VL activation intensity exhibited no signifi cant increase (p=0.924. Moreover, a significant increase in the VMO/VL ratio was also detected (p=0.048. In this study it was observed that electrical stimulation modifiedthe VMO/VL ratio, which suggests electrical stimulation has a benefi cial effect on VMO muscle strength. Resumo A Síndrome da dor patelofemoral (SDPF é descrita como dor anterior ou retro-patelar do joelho na ausência de outras patologias associadas, sendo freqüentemente associada à disfunção do Vasto Medial Oblíquo (VMO. Entretanto, diversos estudos têm demonstrado a impossibilidade de ativar seletivamente este músculo através de exercícios. O objetivo do presente estudo foi analisar o efeito imediato da
Full Text Available Rong-chang Chen,1,* Xiao-ying Li,1,* Li-li Guan,1 Bing-peng Guo,1 Wei-liang Wu,1 Zi-qing Zhou,1 Ya-ting Huo,1 Xin Chen,2 Lu-qian Zhou1 1State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 2Zhujiang Hospital of Southern Medical University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Purpose: Patients with COPD often experience skeletal muscle dysfunction. For those who are unable or unwilling to undertake physical training, neuromuscular electrical stimulation (NMES may provide an alternative method of rehabilitation. The purpose of this meta-analysis was to investigate the controversial topic of whether this therapy is effective in patients with moderate-to-severe COPD. Patients and methods: We pooled data from nine trials published between January 9, 2002 and January 4, 2016 across PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, and relevant websites for randomized controlled trials. In these trials, patients with moderate-to-severe COPD were randomly allocated to receive NMES. Primary outcomes were quadricep strength and exercise capacity. The secondary outcome was health-related quality of life. Results: We extracted data from 276 patients. NMES contributed to statistically improved quadricep strength (standardized mean difference 1.12, 95% confidence interval [CI] 0.64–1.59, I2=54%; P>0.00001 and exercise capacity, including longer exercise distance (weighted mean difference 51.53, 95% CI 20.13–82.93, I2=90%; P=0.001, and longer exercise endurance (standardized mean difference 1.11, 95% CI 0.14–2.08, I2=85%; P=0.02. There was no significant difference in St George’s Respiratory Questionnaire scores (weighted mean difference -0.07, 95% CI -2.44 to 2.30, I2=56%; P=0.95. Conclusion: NMES appears an effectual means of enhancing quadricep strength and exercise
Godges, Joseph J; Mattson-Bell, Melodie; Thorpe, Donna; Shah, Drashti
Randomized controlled 2-group. pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders. The purpose of this study was to evaluate the immediate effect of soft tissue mobilization (STM) with proprioceptive neuromuscular facilitation (PNF) to increase glenohumeral external rotation at 45 degrees of shoulder abduction and overhead reach. It is postulated that limitation in glenohumeral external rotation, when measured at 45 degrees of shoulder abduction, represents subscapularis muscle flexibility deficits and is associated with the inability to fully reach overhead. No research, however, is available to demonstrate whether intervention strategies intended to improve subscapularis flexibility and glenohumeral external rotation range of motion at 45 degrees of shoulder abduction will improve a patient's ability to reach overhead. Twenty patients (10 males, 10 females; age range, 21-83 years) with limited glenohumeral external rotation and overhead reach of 1 year duration or less served as subjects. The subjects were randomly assigned to a treatment group, which consisted of soft tissue mobilization to the subscapularis and proprioceptive neuromuscular facilitation to the shoulder rotators, or a control group. Goniometric measurements of glenohumeral external rotation at 45 degrees abduction and overhead reach were taken preintervention and immediately postintervention for the treatment group or at prerest and postrest periods for the control group. The treatment group improved by a mean of 16.4 degrees (95% confidence interval [CI, 12.5 degrees-20.3 degrees) of glenohumeral external rotation, as compared to less than a 1 degree gain (95% CI, -0.2 degrees-2.0 degrees) in the control group (P < .0005). Overhead reach in the treatment group improved by a mean of 9.6 cm (95% CI, 5.2-14.0 cm) in comparison to a mean gain of 2.4 cm (95% CI, -0.8-5.6 cm) for the control group (P = .009). These findings suggest that a single intervention
Wilcox, A L; Bao, Y T; Loeppky, R N
The ability of 10 pyrroles to block the acidic nitrosation of morpholine has been determined by using an assay that measures their effectiveness in the presence of a 10-fold excess of amine. The log (% N-nitrosomorpholine) formed is a linear function of blocking agent concentrations ranging from 0.0 to 1.5 times the equivalents of initial nitrite. The negative slopes of these plots allow a ranking of the effectiveness of the blocking agent. Several of the pyrroles have been found to be much more effective than established blocking agents such as ascorbic acid. The following order of blocking ability has been determined: 2,5-dimethylpyrrole = 1-benzyl-2,5-dimethylpyrrole much greater than 4-methylcatechol greater than ascorbic acid = 1,2-phenylenediamine = pyrrole greater than 1,2,5-tribenzylpyrrole = 1-benzylpyrrole = octamethylporphine much greater than ammonium sulfamate = hydrazine = 2,5-diphenylpyrrole much much greater than beta-nicotyrine greater than 2-pyrrolecarboxylic acid. Pyrroles give complex mixtures devoid of N-nitroso compounds upon nitrosation.
Toosizadeh, Nima; Bazrgari, Babak; Hendershot, Brad; Muslim, Khoirul; Nussbaum, Maury A; Madigan, Michael L
Repetitive lifting is associated with an increased risk of occupational low back disorders, yet potential adverse effects of such exposure on trunk mechanical and neuromuscular behaviours were not well described. Here, 12 participants, gender balanced, completed 40 min of repetitive lifting in all combinations of three flexion angles (33, 66, and 100% of each participant's full flexion angle) and two lift rates (2 and 4 lifts/min). Trunk behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness and reflexive responses were compromised after lifting exposures, with larger decreases in stiffness and reflexive force caused by larger flexion angles, which also delayed reflexive responses. Consistent effects of lift rate were not found. Except for reflex delay no measures returned to pre-exposure values after 20 min of recovery. Simultaneous changes in both trunk stiffness and neuromuscular behaviours may impose an increased risk of trunk instability and low back injury. An elevated risk of low back disorders is attributed to repetitive lifting. Here, the effects of flexion angle and lift rate on trunk mechanical and neuromuscular behaviours were investigated. Increasing flexion angle had adverse effects on these outcomes, although lift rate had inconsistent effects and recovery time was more than 20 min.
Full Text Available Background: Upper trapezius trigger points is a common cause for neck pain, decreased cervical range of motion and functional activities. The purpose of the study was to evaluate the effectiveness of integrated neuromuscular inhibitory technique (INIT along with specific strength training exercises in reducing pain, improving ROM and functional activities in subjects with upper trapezius trigger point. Methods: Thirty subjects were diagnosed with upper trapezius trigger points were included in the study. These patients were randomly allocated to intervention group (n=15, which underwent a 4- weeks training program of INIT along with specific strength training & control group (n=15 that received INIT alone. The outcome measures were taken before and after treatment. Outcomes were measured by visual analogue scale, cervical range of motion and neck disability index. Within the groups VAS, NDI, and cervical lateral flexion and rotation showed significant change in the mean value. The comparison of pre and post VAS in experimental group and control group showed a significant change in the experimental group .Paired sample t- test was used to analyze changes from before and after intervention programmed. Results: There is a statistically significant (p<0.00 improvement in both variables from baseline to 4th week in experimental group and control group but compared to control group, experimental group shows highly significant values in all parameters. Conclusion: INIT along with specific strength training is proved to be effective in reducing pain, decreasing disability and improving range of motion in individuals with upper trapezius trigger points.
Keese, Felipe; Farinatti, Paulo; Massaferri, Renato; Matos-Santos, Lenifran; Silva, Nadia; Monteiro, Walace
It has been proposed that fatigue during strength exercise is negatively influenced by prior proprioceptive neuromuscular facilitation (PNF) stretching. However, it is possible that the effects of PNF on muscle endurance are affected by stretching duration. This study investigated the influence of PNF on the number of repetitions of the leg curl exercise performed with multiple sets and submaximal load. Nineteen men (age 25 ± 1 years, weight 75.8 ± 4.2 kg, height 178.1 ± 3.8 cm, 10-repetition maximum [RM] 78.3 ± 6.9 kg) performed 4 sets of leg curl with 10RM load with and without previous PNF (3 sets of hip flexion either with knees extended or flexed, duration ~2.5 minutes). The total number of repetitions decreased along sets in both situations (38.6% in control and 41.0% in PNF sessions, p PNF was detected for the number of repetitions in each set (first set, p = 0.330; second set, p = 0.072; third set, p = 0.061; fourth set, p = 0.150). In conclusion, the number of repetitions performed in multiple sets of the leg curl was not decreased by prior PNF stretching. Therefore, it appears that a moderate level of PNF could be used before resistance exercise with a minimal negative effect.
Kaymaz, Dicle; Ergün, Pınar; Demirci, Ebru; Demir, Neşe
In severely disabled patients who are not capable of following formal pulmonary rehabilitation (PR) and/or tolerating higher training intensities, neuromuscular electrical stimulation (NMES) has been successfully utilized as a localized training method. In this non-randomized controlled observational study 50 patients with severe chronic obstructive pulmonary disease (COPD), who were allocated into two groups. Endurance training group (ET) (n= 27) and NMES group (n= 23). To compare the effects of NMES and ET on health-related quality of life (HRQOL), exercise capacity, muscle strength, dyspnea, psychological status, and body composition in patients with severe COPD. Before and after PR program, the study parameters were assessed using the Medical Research Council (MRC) scale, incremental and endurance shuttle walking tests (ISWT, ESWT), manual muscle testing (MMT), the St. George's Respiratory Questionnaire (SGRQ), bioelectrical impedance analysis, and the Hospital Anxiety and Depression Scale (HADS). After the PR program, walking distance and endurance time significantly increased in both groups (p 0.05) and HADS (p> 0.05) scores, body-mass index (BMI) (p= 0.49), fat-free mass (FFM) (p= 0.50) and fat-free mass index (FFMI) (p= 0.94). NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD.
Full Text Available Abstract Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home
Grimpe, Christoph; Hussinger, Katrin
In recent years, firms have increasingly contributed to and been confronted with a patent landscape characterized by numerous but marginal inventions, overlapping claims and patent fences. As a result, firms risk to be blocked in their patent applications or to be infringed upon by rivals. While...... both aspects constitute major challenges for the appropriation of returns to inventive activity, extant literature suggests that participation in the market for technology might actually resolve or at least alleviate these problems. In this paper, we investigate the effect of patent blocking...... and infringement on firms’ engagement in in- and cross-licensing. Based on a sample of more than 1000 German manufacturing firms our results show that firms engage in in-licensing as a reaction to patent blocking and in both in- and cross-licensing if their protected IP was infringed upon. However, these effects...
Tavares, Francisco; Healey, Phil; Smith, Tiaki B; Driller, Matthew
In the elite Rugby setting, it is critical to understand the effects of training load on the levels of fatigue, soreness and readiness of the athletes. The training load, wellness, neuromuscular markers of fatigue and various perceptual measures of soreness of 16 elite Rugby athletes were monitored during a training week. Training load was obtained for field training sessions, extra conditioning and gym-based sessions. Perceptual fatigue was obtained every morning from a 5-item wellness questionnaire and a questionnaire on the muscle soreness of 9 different muscle sites from each side of the body. Neuromuscular performance was obtained from a countermovement jump. Although the training performed on day 4 had a significantly (pload in comparison to training days 1 and 2, muscle soreness and neuromuscular performance were more adversely effected after the cumulative workloads of days 1 and 2. Moreover, the effect of training load on muscle soreness was only evident in the lower body muscles. Data from the present study also suggest that two days off training are adequate for complete recovery from a high load training week in elite Rugby athletes. There were no significant differences in soreness ratings between left and right sides for any of the 9 muscles sites. There was a clear effect of training load on soreness and neuromuscular fatigue, with greater fatigue following two training days in a row when compared to a single training day. Monitoring soreness from different lower body muscle sites may provide important information that relates to the fatigue levels of Rugby athletes and therefore it is recommended to be included as part of the training load monitoring protocol.
Karaku?, Sinem; Gelecek, Nihal; Ye?ilyaprak, Sevgi Sevi
Objectives: The purpose of the study was to investigate the effects of Proprioceptif Neuromuscular Facilitation (PNF) and Mulligan concepts on the pain, functional level and quality of life in the patients with subacromial impingement syndrome (SIS). Methods: This study was carried out on 40 patients (26 females, 14 males), mean age 50,3?1,13 years, who had been diagnosed as SIS admitted to the physical therapy and rehabilitation clinic. Before the beginning measurements all the patients were...
Full Text Available The presents study investigated the effects of between-set interventions on neuromuscular function of the knee extensors during six sets of 10 isokinetic (120°·s-1 maximal concentric contractions separated by three minutes. Twelve healthy men (age: 23.9 ± 2.4 yrs were tested for four different between-set recovery conditions applied during two minutes: passive recovery, active recovery (cycling, electromyostimulation and stretching, in a randomized, crossover design. Before, during and at the end of the isokinetic session, torque and thigh muscles electromyographic activity were measured during maximal voluntary contractions and electrically-evoked doublets. Activation level was calculated using the twitch interpolation technique. While quadriceps electromyographic activity and activation level were significantly decreased at the end of the isokinetic session (-5.5 ± 14.2 % and -2.7 ± 4.8 %; p < 0.05, significant decreases in maximal voluntary contractions and doublets were observed after the third set (respectively -0.8 ± 12.1% and -5.9 ± 9.9%; p < 0.05. Whatever the recovery modality applied, torque was back to initial values after each recovery period. The present results showed that fatigue appeared progressively during the isokinetic session with peripheral alterations occurring first followed by central ones. Recovery interventions between sets did not modify fatigue time course as compared with passive recovery. It appears that the interval between sets (3 min was long enough to provide recovery regardless of the interventions
Elbasan, Bulent; Akaya, Kamile Uzun; Akyuz, Mufit; Oskay, Deran
Neurodevelopmental treatment (NDT), neuromuscular electrical stimulation (NMES), and Kinesio Taping (KT) applications are separately used to improve postural control and sitting balance in children with cerebral palsy (CP). The aim of this study is to examine the combined effect of NDT, NMES and KT applications on postural control and sitting balance in children with CP. Forty five children, in 3 groups, between the ages 5-12 years were included in the study. Group 1 received NDT; group 2 received NDT + NMES; and the group 3 received NDT + NMES + KT for 6 weeks. Sitting function evaluated by the sitting section of the gross motor function measure (GMFM), and postural control assessed with the seated postural control measurement (SPCM). Seating section of GMFM was improved significantly in all the groups; however, increases in the group 3 were higher than groups 1 and 2 (p= 0.001). While significant differences were observed in all groups in the SPCM posture (pNDT improve the sitting posture, postural control, seating function, and gross motor function in children with CP.
Full Text Available Shortened hamstrings are likely to restrict the anterior pelvic tilt and induce a slumped posture due to the posterior pelvic tilt. This study was conducted to compare the effects of proprioceptive neuromuscular facilitation (PNF stretching and modified anterior pelvic tilt taping (APTT on hamstring shortness-associated pelvic compensation while executing seated double-knee extension. Male college students (28 healthy young adults; mean age: 21.4 ± 2.1 years with hamstring shortness were recruited as study subjects and randomly assigned to either the PNF stretching group (control group or the APTT group (experimental group. In all the subjects, changes in the movement distance of the centre of gluteal pressure (COGP as well as rectus abdominis (RA and semitendinosus (SEM muscle activities were measured during seated double-knee extension while the respective intervention method was applied. Both groups showed significant decreases in COGP distance and RA muscle activity compared with their respective baseline values (p < 0.05, however, no significant changes were observed in SEM muscle activity. We can infer that not only a direct intervention on the hamstring, such as PNF stretching, but also a modified APTT-mediated pelvic intervention may be used as a method for reducing pelvic compensation induced by hamstring shortness.
Lee, Seung-Woong; Lee, Jung-Hoon
Shortened hamstrings are likely to restrict the anterior pelvic tilt and induce a slumped posture due to the posterior pelvic tilt. This study was conducted to compare the effects of proprioceptive neuromuscular facilitation (PNF) stretching and modified anterior pelvic tilt taping (APTT) on hamstring shortness-associated pelvic compensation while executing seated double-knee extension. Male college students (28 healthy young adults; mean age: 21.4 ± 2.1 years) with hamstring shortness were recruited as study subjects and randomly assigned to either the PNF stretching group (control group) or the APTT group (experimental group). In all the subjects, changes in the movement distance of the centre of gluteal pressure (COGP) as well as rectus abdominis (RA) and semitendinosus (SEM) muscle activities were measured during seated double-knee extension while the respective intervention method was applied. Both groups showed significant decreases in COGP distance and RA muscle activity compared with their respective baseline values (p < 0.05), however, no significant changes were observed in SEM muscle activity. We can infer that not only a direct intervention on the hamstring, such as PNF stretching, but also a modified APTT-mediated pelvic intervention may be used as a method for reducing pelvic compensation induced by hamstring shortness.
Bruce-Brand, Robert A; Walls, Raymond J; Ong, Joshua C; Emerson, Barry S; O'Byrne, John M; Moyna, Niall M
Quadriceps femoris muscle (QFM) weakness is a feature of knee osteoarthritis (OA) and exercise programs that strengthen this muscle group can improve function, disability and pain. Traditional supervised resistance exercise is however resource intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA. Because of the limitations of traditional exercise programs, interest has been shown in the use of neuromuscular electrical stimulation (NMES) to strengthen the QFM. We conducted a single-blind, prospective randomized controlled study to compare the effects of home-based resistance training (RT) and NMES on patients with moderate to severe knee OA. 41 patients aged 55 to 75 years were randomised to 6 week programs of RT, NMES or a control group receiving standard care. The primary outcome was functional capacity measured using a walk test, stair climb test and chair rise test. Additional outcomes were self-reported disability, quadriceps strength and cross-sectional area. Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention (weeks 1, 8 and 14 respectively). There were similar, significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 (p ≤ 0.001) and compared to the control group (p knee OA, producing similar improvements in functional capacity. Current Controlled Trials ISRCTN85231954.
Dr. Khyati Kothary
Full Text Available Background: Pulmonary Tuberculosis (PTB leads to many physical impairements which can affect the daily physical tasks. Giving neuromuscular electrical stimulation (NMES to quadriceps muscle can improve the functional status without causing fatigue and compromising oxygen status. The aim of the study was to study the effect of NMES on quadriceps muscle strength and six minute walk distance in Pulmonary tuberculosis. Method: This was an interventional based study conducted in K.J.Somaiya Medical Hospital. 26 patients suffering from pulmunary tuberculosis were taken in the study. Strength assessment of quadriceps muscle was assessed by 1RM and six minute walk distance was assessed by six minute walk test. NMES is given to quadriceps muscles bilaterally for continuous 10 sessions in 11 days. Result: Wilcoxon signed rank test, ‘t' test and mann whitney test were done to analyse the data. There was significant increase in 1RM (1.808kgs->2.885kgs and 6MWD (405.23m->493.65m post NMES training. Conclusion: Therefore the study performed suggest that NMES training performed prior to endurance training is useful for strengthening peripheral muscles, which in turn may augment gains in body weight and improves quality of life, further reductions in ventilation requirements during exercise. Despite the ability to cure tuberculosis, there remains a significant impact on the patient’s health status in physical, psychological and social aspects. The study showed significant improvement by giving NMES in 6MWD and 1RM.
Kay, Anthony D; Blazevich, Anthony J
The effects of isometric contractions and passive stretching on muscle-tendon mechanics and muscle activity were studied in 16 healthy human volunteers. First, peak concentric and passive ankle joint moment data were recorded on an isokinetic dynamometer with electromyographic monitoring of the triceps surae; real-time motion analysis of the lower leg and ultrasound imaging of the Achilles-medial gastrocnemius muscle-tendon junction were simultaneously conducted. Second, the subjects performed six 8-s maximal voluntary isometric contractions (MVICs) before repeating the passive and active trials. Although there was no decrease in isometric joint moment after MVICs, peak concentric moment was significantly reduced (11.5%, P static plantar flexor stretches before being retested 2 and 30 min after stretch. The stretch protocol caused no significant change in any measure. At 30 min after stretching, significant recovery in concentric moment and muscle activity was detected at dorsiflexed joint angles, while Achilles tendon stiffness and passive joint moment remained significantly reduced. These data show that the performance of MVICs interrupts the normal stretch-induced losses in active and passive plantar flexor joint moment and neuromuscular activity, largely because concentric strength and tendon properties were already affected. Importantly, the decrease in Achilles tendon stiffness remained 30 min later, which may be an important etiological factor for muscle-tendon strain injury risk.
Full Text Available The purpose of this study was to examine the effect of low-frequency neuromuscular electrical stimulation (NMES on glucose profile in persons with type 2 diabetes mellitus (T2DM. Eight persons with T2DM (41 to 65 years completed a glucose tolerance test with and without NMES delivered to the knee extensors for a 1-hour period at 8 Hz. Three blood samples were collected: at rest, and then 60 and 120 minutes after consumption of a glucose load on the NMES and control days. In NMES groups glucose concentrations were significantly lower (P<0.01 than in the control conditions. Moreover, a significant positive correlation (r=0.9, P<0.01 was obtained between the intensity of stimulation and changes in blood glucose. Our results suggest that low-frequency stimulation seem suitable to induce enhance glucose uptake in persons with T2DM. Moreover, the intensity of stimulation reflecting the motor contraction should be considered during NMES procedure.
Higgins Averill, Orla; Baker, Diana; Rinaldi, Claudia
Many schools have adopted schoolwide intervention blocks as a component of response-to-intervention (RTI) implementation to ensure that students who need intervention are receiving it. However, virtually no peer-reviewed guidance exists for helping teachers manage this time effectively. This article presents a blueprint for organizing intervention…
Tholang T. Mokhele
South African Journal of Geomatics, Vol. 6. No. 2, Geomatics Indaba 2017 Special Edition, August 2017. 155. Effects of different building blocks designs on the statistical characteristics of Automated. Zone-design Tool output areas. Mokhele Ta1, Mutanga Ob and Ahmed Fc. aResearch Methodology and Data Centre, ...
Purpose: To investigate effects of neurolytic celiac plexus block (NCPB) on stress and inflammation in rats with partial hepatectomy (PH). Methods: A model of PH rat was established, and serum C-reactive protein (CRP); corticosterone (GC); adrenocorticotropin (ACTH); noradrenaline (NA); adrenalin (AD); aspartate ...
The effect of urea-molasses-multinutrient blocks (UMMB) as an energy and protein supplement on reproductive performance and milk yield of dairy cows was investigated in 18 crossbred cows from eight smallholder farms. In treatment 1 nine, cows were fed a maximum of 1 kg (UMMB per cow per day in addition to the ...
Andersen, S; Dickenson, A H; Kohn, M
There are clinical observations that neurogenic pain can respond well to the opioid ketobemidone, in contrast to pethidine and morphine. This has led us to the hypothesis that the analgesic effect of ketobemidone in neurogenic pain may be due to both opioid as well as additional non-opioid effects...... with a Ki value of 26 microM. Therefore, ketobemidone appears to possess both mu opioid agonist as well as NMDA blocking effects....
Full Text Available Background: Back pain is a prevalent and expensive problem in society. 60-80% of people will suffer at least one episode of low back pain sometime in their lives and 30-40% of these will experience low back pain each year. Therefore the need of the following study is to see the effect of proprioceptive neuromuscular facilitation on back muscle strength, pain and QOL in subjects with Chronic Low Back Pain. Methods: Ethical approval was taken before study. Forty patients with chronic low back pain (28 male, 12 female were included in the study and divided into two groups each containing 20 subjects. All the participants were signed written consent after being informed in detail about the study. Group A has been given the proprioceptive neuromuscular facilitation exercises including Rhythmic Stabilization (RST and Combination of Isotonics (COI and Conventional back exercises. Group B was given conventional back exercises only. Outcome measures were taken at the end of one month i.e. after the treatment protocol. VAS, SF-36Questionnaire and Core stability gradation were taken in both groups. Results: There is significant improvement in VAS score in both groups but Group A was having more significant improvement than Group B. Also there is significant improvement in core stability grading and SF 36 score in Group A. Conclusion: It is concluded that proprioceptive neuromuscular facilitation exercises on back is effective in reducing pain and improving core muscle strength in subjects with Chronic Low Back Pain.
Kunigo, Tatsuya; Murouchi, Takeshi; Yamamoto, Shuji; Yamakage, Michiaki
Serratus plane block is performed for analgesia of the anterior chest wall. However, there has been no study concerning the appropriate volume for this block. This prospective randomized controlled study assesses the dermatomal spread and analgesic effects of serratus plane block. Ultrasound-guided serratus plane block was performed for breast cancer surgery. The patients were randomly assigned to receive 20 or 40 mL of 0.375% ropivacaine. The primary end point was the number of affected dermatomes as assessed by cold test and pinprick test 20 minutes after the block procedure. Secondary end points were the time until the first postoperative analgesic rescue, adverse effects, and complications. The number of affected dermatomes assessed by the cold test for patients receiving 40 mL of 0.375% ropivacaine was significantly larger than that for patients receiving 20 mL (P = 0.002; 6 [5-7] vs 4 [3-4] dermatomes). Similarly, with the pinprick test, the affected area was larger for the 40 mL group than for the 20 mL group (P = 0.009; 4 [2-6] vs 2 [1-3] dermatomes). There were no differences between the 2 groups in secondary end points. Ultrasound-guided serratus plane block spread in the craniocaudal direction is more widespread with 40 mL than with 20 mL of 0.375% ropivacaine. The time until the first postoperative analgesic rescue dose was not extended by a larger volume of injection. UMIN Clinical Trials Registry (identifier UMIN000016549).
Umbertina C. Reed
Full Text Available Objetivo: apresentar os dados essenciais para o diagnóstico diferencial entre as principais doenças neuromusculares, denominação genérica sob a qual agrupam-se diferentes afecções, decorrentes do acometimento primário da unidade motora (motoneurônio medular, raiz nervosa, nervo periférico, junção mioneural e músculo. Fontes dos dados: os aspectos clínicos fundamentais para estabelecer o diagnóstico diferencial entre as diferentes doenças neuromusculares, bem como entre estas e as causas de hipotonia muscular secundária ao comprometimento do sistema nervoso central ou a doenças sistêmicas não-neurológicas, são enfatizados, com base na experiência clínica vinda do atendimento a crianças com doenças neuromusculares durante os últimos 12 anos, no ambulatório de doenças neuromusculares do Hospital das Clínicas da Faculdade de Medicina, da Universidade de São Paulo. A revisão bibliográfica foi efetuada através do Medline e do periódico Neuromuscular Disorders, publicação oficial da World Muscle Society. Síntese dos dados: nas crianças, a maior parte destas afecções é geneticamente determinada, sendo as mais comuns a distrofia muscular progressiva ligada ao sexo, de Duchenne, a amiotrofia espinal infantil, a distrofia muscular congênita, a distrofia miotônica de Steinert, e as miopatias congênitas, estruturais e não estruturais. Polineuropatias hereditárias, síndrome miastênica congênita e miopatias metabólicas são menos comuns, porém mostram correlação geno-fenotípica cada vez mais precisa. Conclusões: na década passada, inúmeros avanços da genética molecular facilitaram imensamente o diagnóstico e o aconselhamento genético das doenças neuromusculares mais comuns das crianças, inclusive possibilitando diagnóstico fetal e, adicionalmente, vieram permitir melhor caracterização fenotípica e classificação mais objetiva.Objective: to discuss the most important aspects for performing a
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Full Text Available There have been great advancements in cardiac surgery over the last two decades; the widespread use of off-pump aortocoronary bypass surgery, minimally invasive cardiac surgery, and robotic surgery have also changed the face of cardiac anaesthesia. The concept of "Fast-track anaesthesia" demands the use of nondepolarising neuromuscular blocking drugs with short duration of action, combining the ability to provide (if necessary sufficiently profound neuromuscular blockade during surgery and immediate re-establishment of normal neuromuscular transmission at the end of surgery. Postoperative residual muscle paralysis is one of the major hurdles for immediate or early extubation after cardiac surgery. Nondepolarising neuromuscular blocking drugs for cardiac surgery should therefore be easy to titrate, of rapid onset and short duration of action with a pathway of elimination independent from hepatic or renal dysfunction, and should equally not affect haemodynamic stability. The difference between repetitive bolus application and continuous infusion is outlined in this review, with the pharmacodynamic and pharmacokinetic characteristics of vecuronium, pancuronium, rocuronium, and cisatracurium. Kinemyography and acceleromyography are the most important currently used neuromuscular monitoring methods. Whereas monitoring at the adductor pollicis muscle is appropriate at the end of surgery, monitoring of the corrugator supercilii muscle better reflects neuromuscular blockade at more central, profound muscles, such as the diaphragm, larynx, or thoraco-abdominal muscles. In conclusion, cisatracurium or rocuronium is recommended for neuromuscular blockade in modern cardiac surgery.
Creaser, Janet I; Edwards, Christopher J; Morris, Nichole L; Donath, Max
Distracted driving is a significant concern for novice teen drivers. Although cellular phone bans are applied in many jurisdictions to restrict cellular phone use, teen drivers often report making calls and texts while driving. The Minnesota Teen Driver Study incorporated cellular phone blocking functions via a software application for 182 novice teen drivers in two treatment conditions. The first condition included 92 teens who ran a driver support application on a smartphone that also blocked phone usage. The second condition included 90 teens who ran the same application with phone blocking but which also reported back to parents about monitored risky behaviors (e.g., speeding). A third control group consisting of 92 novice teen drivers had the application and phone-based software installed on the phones to record cellular phone (but not block it) use while driving. The two treatment groups made significantly fewer calls and texts per mile driven compared to the control group. The control group data also demonstrated a higher propensity to text while driving rather than making calls. Software that blocks cellular phone use (except 911) while driving can be effective at mitigating calling and texting for novice teen drivers. However, subjective data indicates that some teens were motivated to find ways around the software, as well as to use another teen's phone while driving when they were unable to use theirs. Cellular phone bans for calling and texting are the first step to changing behaviors associated with texting and driving, particularly among novice teen drivers. Blocking software has the additional potential to reduce impulsive calling and texting while driving among novice teen drivers who might logically know the risks, but for whom it is difficult to ignore calling or texting while driving. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.
Full Text Available Background. Tai Chi is a traditional Chinese medicine exercise used for improving neuromuscular function. This study aimed to investigate the effects of Tai Chi versus proprioception exercise program on neuromuscular function of the ankle in elderly people. Methods. Sixty elderly subjects were randomly allocated into three groups of 20 subjects per group. For 16 consecutive weeks, subjects participated in Tai Chi, proprioception exercise, or no structured exercise. Primary outcome measures included joint position sense and muscle strength of ankle. Subjects completed a satisfaction questionnaire upon study completion in Tai Chi and proprioception groups. Results. (1 Both Tai Chi group and proprioception exercise group were significantly better than control group in joint position sense of ankle, and there were no significant differences in joint position sense of ankle between TC group and PE group. (2 There were no significant differences in muscle strength of ankle among groups. (3 Subjects expressed more satisfaction with Tai Chi than with proprioception exercise program. Conclusions. None of the outcome measures on neuromuscular function at the ankle showed significant change posttraining in the two structured exercise groups. However, the subjects expressed more interest in and satisfaction with Tai Chi than proprioception exercise.
Khalid, Abdul Jabbar; Harris, Sujae Ian; Michael, Loke; Joseph, Hamill; Qu, Xingda
This study investigated whether neuromuscular fatigue affects the neuromuscular control of an athlete within a sports context setting and whether these effects were more pronounced in the females. Lower limb joint kinetics of 6 male and 6 female inter-varsity soccer players performing side-stepping tasks in non-fatigue versus fatigue and anticipated versus unanticipated conditions were quantified using 10 Motion Analysis Corporation cameras and a Kistler(™) force platform. The Yo-Yo intermittent recovery Level 1 fatigue protocol was employed. Stance foot initial contact and peak forces, and peak joint knee moments of the lower limb were submitted to a 3-way mixed-model repeated measure ANOVA. The results suggested that males tend to elicit significantly higher knee joint loadings when fatigued. In addition, males elicited significantly higher peak proximal tibia anterior/posterior shear force, vertical ground reaction force at initial contact and peak internal rotational moments than females. These findings suggested that males were at greater overall injury risk than females, especially in the sagittal plane. Neuromuscular control-based training programmes/interventions that are designed to reduce the risk of the non-contact ACL injury need to be customised for the different genders.
Bremner, Cody B; Holcomb, William R; Brown, Christopher D; Perreault, Melanie E
Clinical Scenario: Orthopedic knee conditions are regularly treated in sports-medicine clinics. Rehabilitation protocols for these conditions are often designed to address the associated quadriceps strength deficits. Despite these efforts, patients with orthopedic knee conditions often fail to completely regain their quadriceps strength. Disinhibitory modalities have recently been suggested as a clinical tool that can be used to counteract the negative effects of arthrogenic muscle inhibition, which is believed to limit the effectiveness of therapeutic exercise. Neuromuscular electrical stimulation (NMES) is commonly accepted as a strengthening modality, but its ability to simultaneously serve as a disinhibitory treatment is not as well established. Does NMES effectively enhance quadriceps voluntary activation in patients with orthopedic knee conditions? Summary of Key Findings: Four randomized controlled trials (RCTs) met the inclusion criteria and were included. Of those, 1 reported statistically significant improvements in quadriceps voluntary activation in the intervention group relative to a comparison group, but the statistical significance was not true for another study consisting of the same sample of participants with a different follow-up period. One study reported a trend in the NMES group, but the between-groups differences were not statistically significant in 3 of the 4 RCTs. Clinical Bottom Line: Current evidence does not support the use of NMES for the purpose of enhancing quadriceps voluntary activation in patients with orthopedic knee conditions. Strength of Recommendation: There is level B evidence that the use of NMES alone or in conjunction with therapeutic exercise does not enhance quadriceps voluntary activation in patients with orthopedic knee conditions (eg, anterior cruciate ligament injuries, osteoarthritis, total knee arthroplasty).
Lepley, Lindsey K; Lepley, Adam S; Onate, James A; Grooms, Dustin R
Neuromuscular alterations are a major causal factor of primary and secondary injuries. Though injury prevention programs have experienced some success, rates of injuries have not declined, and after injury, individuals often return to activity with functionality below clinical recommendations. Considering alternative therapies to the conventional concentric exercise approach, such as one that can target neuromuscular injury risk and postinjury alterations, may provide for more effective injury prevention and rehabilitation protocols. Peer-reviewed sources available on the Web of Science and MEDLINE databases from 2000 through 2016 were gathered using searches associated with the keywords eccentric exercise, injury prevention, and neuromuscular control. Eccentric exercise will reduce injury risk by targeting specific neural and morphologic alterations that precipitate neuromuscular dysfunction. Clinical review. Level 4. Neuromuscular control is influenced by alterations in muscle morphology and neural activity. Eccentric exercise beneficially modifies several underlying factors of muscle morphology (fiber typing, cross-sectional area, working range, and pennation angle), and emerging evidence indicates that eccentric exercise is also beneficial to peripheral and central neural activity (alpha motorneuron recruitment/firing, sarcolemma activity, corticospinal excitability, and brain activation). There is mounting evidence that eccentric exercise is not only a therapeutic intervention influencing muscle morphology but also targets unique alterations in neuromuscular control, influencing injury risk.
Walls, Raymond J
Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.
Lytle, Tyer; Radhakrishna, Mithun; Sing, Charles
Two oppositely charged polymers can undergo associative phase separation in a salt solution in a process known as \\x98complex coacervation. Recent work has used this as a motif to control the self-assembly behavior of a mixture of oppositely-charged block copolymers which form nanoscale structures. The materials formed from these complex coacervate-block copolymers (BCPs) have potential use as drug delivery systems, gels, and sensors. We have developed a hybrid Monte Carlo-Single Chain in a Mean Field (MC-SCMF) simulation method that is able to determine morphological phase diagrams for BCPs. This technique is an efficient way to calculate morphological phase diagrams and provides a clear link between molecular level features and self-assembly behaviors. Morphological phase diagrams showing the effects of polymer concentration, salt concentration, chain length, and charge-block fraction at large charge densities on self-assembly behavior have been determined. An unexpected phase transition from disorder to hexagonal packing at large salt concentrations has been observed for charge-block fractions equal to and larger than 0.5. This is attributed to the salt filling space stabilizing the morphology of the BCP.
Cometti, Carole; Deley, Gaelle; Babault, Nicolas
The presents study investigated the effects of between-set interventions on neuromuscular function of the knee extensors during six sets of 10 isokinetic (120°·s(-1)) maximal concentric contractions separated by three minutes. Twelve healthy men (age: 23.9 ± 2.4 yrs) were tested for four different between-set recovery conditions applied during two minutes: passive recovery, active recovery (cycling), electromyostimulation and stretching, in a randomized, crossover design. Before, during and at the end of the isokinetic session, torque and thigh muscles electromyographic activity were measured during maximal voluntary contractions and electrically-evoked doublets. Activation level was calculated using the twitch interpolation technique. While quadriceps electromyographic activity and activation level were significantly decreased at the end of the isokinetic session (-5.5 ± 14.2 % and -2.7 ± 4.8 %; p < 0.05), significant decreases in maximal voluntary contractions and doublets were observed after the third set (respectively -0.8 ± 12.1% and -5.9 ± 9.9%; p < 0.05). Whatever the recovery modality applied, torque was back to initial values after each recovery period. The present results showed that fatigue appeared progressively during the isokinetic session with peripheral alterations occurring first followed by central ones. Recovery interventions between sets did not modify fatigue time course as compared with passive recovery. It appears that the interval between sets (3 min) was long enough to provide recovery regardless of the interventions. Key pointsAllowing three minutes of recovery between sets of 10 maximal concentric contractions would help the subjects to recover from the peripheral fatigue induced by each set and therefore to start each new set with a high intensity.During this type of session, with three minutes between sets, passive recovery is sufficient; there is no need to apply complicated recovery interventions.
Schlingermann, Brenagh E; Lodge, Clare A; Gissane, Conor; Rankin, Paula M
The purpose of this Observational Analytical Cohort Study was to assess the effectiveness of an injury prevention programme (IPP) - GAA15 (Gaelic Athletic Association 15) - on the incidence of injury in collegiate Gaelic games. 131 Gaelic games players (mean age 20.5 years ± SD 3.0) were used for analysis in this study. Participants completed preseason and postseason testing which involved performance of the Y Balance test. The GAA15 was employed for the intervention group; coaches were instructed to implement the programme before every training session and match throughout the collegiate GAA (Gaelic Athletic Association) season. The control group adopted their normal warm up procedures for the season. Player's injuries were documented on a weekly basis by allied health care professionals working with the teams using an online database system. Results showed significant improvements in composite Y balance scores in favour of the intervention group (Adjusted mean difference Right: 1.8 % Normalised Mean Reach Distance (%NMRD) [p= 0.007] / Left: 2.3 %NMRD [p= 0.001]). Injury rates in the intervention group (2.62 injuries per 1000h) were reduced by 66% (p=0.001) in comparison to an age matched control group (7.62 per 1000h). Training injuries, hamstring injuries, non-contact injuries and severe injuries were also reduced as a result of the implementation of the GAA15 (Injury Rate Ratio (IRR): 0.20, 0.59, 0.39, and 0.45 respectively). Implementation of an IPP such as the GAA15 can reduce the risk of injury in Gaelic games and influence player's neuromuscular performance assessed through the Y Balance test.
Cometti, Carole; Deley, Gaelle; Babault, Nicolas
The presents study investigated the effects of between-set interventions on neuromuscular function of the knee extensors during six sets of 10 isokinetic (120°·s-1) maximal concentric contractions separated by three minutes. Twelve healthy men (age: 23.9 ± 2.4 yrs) were tested for four different between-set recovery conditions applied during two minutes: passive recovery, active recovery (cycling), electromyostimulation and stretching, in a randomized, crossover design. Before, during and at the end of the isokinetic session, torque and thigh muscles electromyographic activity were measured during maximal voluntary contractions and electrically-evoked doublets. Activation level was calculated using the twitch interpolation technique. While quadriceps electromyographic activity and activation level were significantly decreased at the end of the isokinetic session (-5.5 ± 14.2 % and -2.7 ± 4.8 %; p < 0.05), significant decreases in maximal voluntary contractions and doublets were observed after the third set (respectively -0.8 ± 12.1% and -5.9 ± 9.9%; p < 0.05). Whatever the recovery modality applied, torque was back to initial values after each recovery period. The present results showed that fatigue appeared progressively during the isokinetic session with peripheral alterations occurring first followed by central ones. Recovery interventions between sets did not modify fatigue time course as compared with passive recovery. It appears that the interval between sets (3 min) was long enough to provide recovery regardless of the interventions. Key points Allowing three minutes of recovery between sets of 10 maximal concentric contractions would help the subjects to recover from the peripheral fatigue induced by each set and therefore to start each new set with a high intensity. During this type of session, with three minutes between sets, passive recovery is sufficient; there is no need to apply complicated recovery interventions. PMID:24149550
This study is a preliminary investigation of the possible toxic effects of flyash particles from an experimental fluidized-bed combustion process at the Morgantown Energy Research Center. Emphasis has been placed on the action of trace metals present on the surface and in the matrix of the particulates emissions, since these elements may be toxic in low dosages. It is well established that external calcium (Ca/sup 2 +/) is essential for neuromuscular transmission. In the absence of Ca/sup 2 +/ from the external medium, nerve impulses continue to invade the terminal but do not evoke transmitter release. Many of the di- and trivalent metal ions have been tested for their ability to substitute for Ca/sup 2 +/ and have been shown to affect evoked and spontaneous transmitter release. Many of these ions cause a decrease in amplitude of the evoked end-plate potential (e.p.p.), but raise the frequency of spontaneously occurring miniature end-plate potentials (m.e.p.p.s). Several investigators have found that the effective concentration necessary to cause an increase in m.e.p.p. frequency is far greater than that which decreases the e.p.p. amplitude. The neuromuscular junction of the frog was selected to test the effects of flyash particles and pure metal ions, since its general characteristics are well documented and its sensitivity to metal ions is well known. Cadmium (Cd/sup 2 +/) was chosen for our investigation because it had previously been reported to be a highly potent inhibitor of evoked release, yet having no significant effect on spontaneous release even at high concentrations. In this report it was shown that the effective concentrations necessary to increase m.e.p.p. frequency are in the same range as those which decrease e.p.p. amplitude.
Costa, Ana Claudia; Composto, Russell J.; Vlcek, Petr; Geoghehan, Mark; Creton, Costantino
We have addressed the effect of non-adsorbing block length of block copolymers on their interfacial properties. To this goal, a low volume fraction (5 vol.styrene-b-methylmethacrylate) (dPS-b-MMA) having a nearly constant adsorbing block length (NMMA 40) was added to a PS matrix, which represents a nearly neutral environment for the dPS block. Films with varying non-adsorbing block lengths (NdPS 90-940) were spin coated on silicon oxide surfaces. Neutron reflectivity and forward recoil spectrometry were used to measure the dPS-b-MMA interfacial excess (z*) and width (w). The results show that z* and w increases with NdPS. These results are interpreted using a self-consistent mean field model. Probe tack tests indicate that adhesion improves with NdPS and suggests that the entanglements across the matrix/adsorbed layer interface are partially responsible for enhanced thin film adhesion.
Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.
Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral
Efeito de um programa de treinamento de facilitação neuromuscular proprioceptiva sobre a mobilidade torácica Effect of a training program based on proprioceptive neuromuscular facilitation onto thoracic mobility
Marlene Aparecida Moreno
Full Text Available A proposta deste estudo foi analisar o efeito de um programa de treinamento de membros superiores baseado nas técnicas de facilitação neuromuscular proprioceptiva (FNP sobre a mobilidade torácica. Foram estudadas 24 voluntárias sedentárias, idade 22,9 ± 2,9 anos, divididas em grupo controle (GC, que não participou do treinamento, e grupo treinado (GT. O protocolo de treinamento físico foi constituído por um programa de exercícios de FNP, realizado três vezes por semana, durante quatro semanas. Os dois grupos foram submetidos à avaliação da mobilidade torácica por meio de cirtometria, antes e após o período de treinamento. Os dados colhidos foram analisados estatisticamente, com nível de significância α = 5%. Os valores da cirtometria axilar e xifoideana do GC antes e após o período de intervenção não apresentaram alterações significativas (p>0,05. No GT os valores das variáveis foram significantemente maiores após a intervenção (pThe purpose of this study was to analyse the effect of an upper limb training program based on proprioceptive neuromuscular facilitation (PNF techniques on thoracic mobility. The study was carried out with 24 sedentary female volunteers, aged 22.9±2.9 years. Participants were divided into a control group (CG, who did not perform any exercise, and a trained group (TG, submitted to training. The physical training protocol consisted of a PNF exercise program, three times a week for four weeks. The two groups were assessed as to thoracic mobility by means of cirtometry before and after the training period. Data were statistically analysed and significance level set at α=5%. In CG, initial axillary and xiphoid cirtometry values showed no significant differences when compared to data obtained on the final evaluation (p>0.05. TG measures, in turn, were significantly higher after the training program (p<0.05. The PNF protocol here proposed seems hence to be an efficient exercise program to
Costa, Ana Claudia; Composto, Russell J.; Vlcek, Petr; Satija, Sushil; Ivkov, Robert
Block copolymer adsorption to polar substrates is investigated using neutron reflectivity and forward recoil spectrometry. The adhesion promoter is poly (deuterated styrene-block-methylmethacrylate) (dPS-b-MMA) having a short and nearly constant MMA block, which adsorbs to the substrate. The non-adsorbing dPS block length, NdPS, is systematically varied from below to above the entanglement degree of polymerization (Ne). The dPS-b-MMA is blended with a PS matrix, which represents a nearly neutral environment for the dPS block. The substrates are silicon oxide and an organic monolayer of an amino terminated silane. Dewetting studies show that film stability increases as NdPS approaches Ne and as the substrate becomes more hydrophobic. These macroscopic results suggest that entanglements across the matrix/adsorbed layer interface and a strong MMA-substrate interaction can greatly improve thin film stability.
Lee, Jung-Ho; Park, Soo-Jin; Na, Sang-Su
[Purpose] The present study examined the effects of treatment using PNF extension techniques on the pain, pressure pain, and neck and shoulder functions of the upper trapezius muscles of myofascial pain syndrome (MPS) patients. [Subjects...
Truong, Alexander D; Kho, Michelle E; Brower, Roy G; Feldman, Dorianne R; Colantuoni, Elizabeth; Needham, Dale M
The effect of exercise on cytokines may improve muscle strength. Neuromuscular electrical stimulation (NMES) is a muscle-preserving therapy that benefits patients unable to participate in active exercise. How NMES alters cytokines is unclear. The aim of this study was to study the effects of 1 NMES session on cytokines associated with protein metabolism during exercise. We evaluated the effects of NMES on IL-1, IL-6, IL-10 and TNF-α levels in peripheral blood. Participants received NMES to bilateral lower extremity muscles (quadriceps, tibialis anterior, gastrocnemius) for 30 min. Blood samples immediately pre- and post-NMES were drawn at 15-min intervals to 2-h follow-up, and the mean values of pre-NMES levels were compared to peak and trough post-NMES levels. For cytokines with significant changes, we conducted a repeated-measures linear regression analysis. We also measured post-NMES lactate and creatine kinase levels. We enrolled nine eligible participants. There was a significant increase in peak IL-6 from the mean pre-NMES value [0·65 (0·89) to 1·04 (0·89) pg ml -1 , P = 0·001] and a significant decrease in trough IL-1 [0·08 (0·07) to 0·02 (0·02) pg ml -1 , P = 0·041] and TNF-α [2·42 (0·54) to 2·16 (0·59) pg ml -1 , P = 0·021]. In repeated-measures regression analysis, we identified significantly higher mean IL-6 values throughout the full 120 min post-NMES period, and a significantly higher mean IL-1 value at 30 min post-NMES. There were no significant differences in peak IL-10, trough IL-6, lactate, or creatine kinase values. In nine healthy humans, 30 min of NMES was temporally associated with changes in cytokines similar to the effects of active exercise and may mediate NMES' observed effects on reducing muscle weakness. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
Lohse, Keith R; Sherwood, David E
Although the effects of attention on movement execution are well documented behaviorally, much less research has been done on the neurophysiological changes that underlie attentional focus effects. This study presents two experiments exploring effects of attention during an isometric plantar-flexion task using surface electromyography (sEMG). Participants' attention was directed either externally (towards the force plate they were pushing against) or internally (towards their own leg, specifically the agonist muscle). Experiment 1 tested the effects of attention on accuracy and efficiency of force produced at three target forces (30, 60, and 100% of the maximum voluntary contraction; MVC). An internal focus of attention reduced the accuracy of force being produced and increased cocontraction of the antagonist muscle. Error on a given trial was positively correlated with the magnitude of cocontraction on that trial. Experiment 2 tested the effects of attention on muscular fatigue at 30, 60 and 100%MVC. An internal focus of attention led to less efficient intermuscular coordination, especially early in the contraction. These results suggest that an internal focus of attention disrupts efficient motor control in force production resulting in increased cocontraction, which potentially explains other neuromechanical findings (e.g. reduced functional variability with an internal focus). Copyright © 2012 Elsevier B.V. All rights reserved.
Aguilar, María Bravo; Abián-Vicén, Javier; Halstead, Jill; Gijon-Nogueron, Gabriel
To determine the effect kinesiotaping (KT) versus sham kinesiotaping (sham KT) in the repositioning of pronated feet after a short running. Prospective, randomised, double-blinded, using a repeated-measures design with no cross-over. 116 amateur runners were screened by assessing the post-run (45min duration) foot posture to identify pronated foot types (defined by Foot Posture Index [FPI] score of ≥6). Seventy-three runners met the inclusion criteria and were allocated into two treatment groups, KT (n=49) and sham KT (n=24). After applying either the KT or sham KT and completing 45min of running (mean speed of 12km/h), outcome measures were collected (FPI and walking Pedobarography). FPI was reduced in both groups, more so in the KT group (mean FPI between group difference=0.9, CI 0.1-1.9), with a score closer to neutral. There were statistically significant differences between KT and sham KT (p<.05 and p<.01) in pressure time integral, suggesting that sham KT had a greater effect. KT may be of some assistant to clinicians in correction of pronated foot posture in a short-term. There was no effect of KT, however on pressure variables at heel strike or toe-off following a short duration of running, the sham KT technique had a greater effect. Therapy, level 1b. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Full Text Available Purpose: Manual lymphatic drainage (MLD and proprioceptive neuromuscular facilitation (PNF are potential therapeutic strategies to reduce mastectomy-induced edema. The purpose of this study was to investigate whether the combination of these therapies would induce synergistic effects to treat lymphedema-related complications and to analyze a possible physiological mechanism involved in the observed effects.Methods: A total of 55 patients diagnosed with mastectomy-induced lymphedema were recruited and randomized into three experimental groups: PNF group (n = 17, MLD group (n = 20, and PNF + MLD group (n = 18. They were subjected to designated rehabilitation program three times a week for 16 weeks. ROM (flexion of the shoulder joint, edema size, arterial blood flow velocity, and degree of pain and depression were measured every 4 weeks over experimental period.Results: Lymphedema volume, VAS pain scale, and Beck depression scale were decreased in PNF and MLD groups for 16 weeks in a time-dependent manner. In combination, a greater reduction of these variables was observed over 16 weeks compared to each PNF and MLD. While axillary arterial blood circulation rate in the affected extremity was increased in both PNF and PNF + MLD groups over 16 weeks, this value was not increased in MLD group throughout the experimental period. A greater reduction of scales of VAS pain and Beck Depression Inventory (BDI was observed in PNF + MLD group after the 16 week-treatment, as compared to each PNF and MLD group. Pearson's coefficients test demonstrated that there are significant correlation of depression against pain (r = 0.616, p < 0.01, ROM (r = −0.478, p < 0.01, and lymphedema size (r = 0.492, p < 0.01.Conclusion: The combination of MLD and PNF induces potent synergistic effects on edema volume, shoulder range of motion (ROM, pain, and depression in patients with lymphedema. In addition, an increased rate of axillary arterial blood flow in PNF
Oezsarlak, O. E-mail: firstname.lastname@example.org; Schepens, E.; Parizel, P.M.; Goethem, J.W. van; Vanhoenacker, F.; Schepper, A.M. de; Martin, J.J
This article presents the actual classification of neuromuscular diseases based on present expansion of our knowledge and understanding due to genetic developments. It summarizes the genetic and clinical presentations of each disorder together with CT findings, which we studied in a large group of patients with neuromuscular diseases. The muscular dystrophies as the largest and most common group of hereditary muscle diseases will be highlighted by giving detailed information about the role of CT and MRI in the differential diagnosis. The radiological features of neuromuscular diseases are atrophy, hypertrophy, pseudohypertrophy and fatty infiltration of muscles on a selective basis. Although the patterns and distribution of involvement are characteristic in some of the diseases, the definition of the type of disease based on CT scan only is not always possible.
Southwell, Daniel J; Hills, Nicole F; McLean, Linda; Graham, Ryan B
Targeted activation of the transversus abdominis (TrA) muscle through the abdominal drawing-in maneuver (ADIM) is a frequently prescribed exercise for the prevention and rehabilitation of low back pain. However, there is still debate over the role the ADIM plays in maintaining a stable spine during movement. Thus, a single cohort pre/post-intervention protocol was used to examine whether 5 min of ADIM training prior to a dynamic movement task alters dynamic spine stability and control. Thirteen healthy participants performed a repetitive spine flexion task twice, once before and once after they received biofeedback training on how to correctly perform the ADIM in standing. Abdominal and back muscle activation (indwelling and surface electromyography, EMG) and 3D kinematic data were recorded during all trials. EMG activation (percent maximum) and local dynamic stability of spine movement [maximum finite-time Lyapunov exponent (λmax)] were compared before and after the training using Friedman's rank test and repeated-measures ANOVA, respectively. To assess the moderating effects of absolute changes in EMG (∆EMG) of each muscle after training on changes in stability, the ∆EMG (peak and mean) were added to the ANOVA as separate covariates (ANCOVA). Following ADIM training, there were greater peak and mean levels of activation in all tested abdominal muscles, including TrA, (p back muscles. The ANOVA showed no significant change in λmax following training (p = 0.633). However, after considering the moderating effects of the ∆EMG seen in each muscle with training, it was found that only changes in TrA EMG significantly influenced stability. The ANCOVA revealed a significant main effect of training on stability as well as a significant interaction effect between training and ∆EMG recorded from TrA (p < 0.05); those with larger increases in TrA activation demonstrated larger improvements in stability. As a group, 5 min of ADIM training did not change
Full Text Available The aim of this study was to analyze the music effects on physiological and psychophysiological responses, as well as on the maximum power output attained during an incremental test. A sample of 10 healthy individuals (20.8 ± 1.4 years, 77.0 ± 12.0 kg, 179.2 ± 6.3 cm participated in this study. It was recorded the electromyographic activity (muscles Rectus Femoris − RF and Vastus Lateralis − VL, heart rate (HR, rating of perceived exertion (RPE, ratings of perceived time (RPT and the maximum power output attained (PMax during music (WM and without music (WTM conditions. The individuals completed four maximal incremental tests (MIT ramp-like on a cycle simulator with initial load of 100 W and increments of 10 W•min-1. The mean values of PMax between conditions WTM (260.5 ± 27.7 W and WM (263.2 ± 17.2 W were not statistically different. The comparison between the rates of increase of the values expressed in root-mean-square (RMS and median frequency (MF for both muscles (RF and VL also showed no statistical difference, as well as HR, RPE and RPT. It is concluded that the use of the electronic music during an incremental test to exhaustion showed no effect on the analyzed variables for the investigated group.
Allahyar, Razia; Akbar, Atif; Iqbal, Furhan
Research findings made over the last few years have highlighted the important role of creatine (Cr) in health and disease. However, limited information is available regarding the effect of Cr supplementation on cognation. Present study was designed to determine the effect of variable doses of Cr (1% and 3%) on selected parameters of female albino mice behaviour. Following weaning, on 20th postnatal day, female albino mice were divided into three groups on the basis of dietary supplementation. Control group were was fed with normal rodent diet, whereas treated groups received diet supplemented with 1% and 3% Creatine monohydrate (Ssniff, Germany) for 10 weeks. Morris water maze (MWM), Rota rod and open field (OF) tests were carried out at the end of diet supplementation for neurofunctional assessment in all the groups. Data analysis showed that Cr supplementation did not affect the muscular activity and during rota rod test as well as locomotor and exploratory behaviour during OF test. Results of MWM probe trial indicated that mice supplemented with 3% Cr had significantly more entries in platform area than other two treatments (p=0.03) indicating improved spatial memory. Body weight remained unaffected (p>0.05) when compared between three experimental treatments. Female mice supplemented with 3% Cr showed improved spatial memory than mice fed on 1% Cr-supplemented diet and mice on normal rodent diet.
Bruno de Paula Caraça Smirmaul
Full Text Available The aim of this study was to analyze the music effects on physiological and psychophysiological responses, as well as on the maximum power output attained during an incremental test. A sample of 10 healthy individuals (20.8 ± 1.4 years, 77.0 ± 12.0 kg, 179.2 ± 6.3 cm participated in this study. It was recorded the electromyographic activity (muscles Rectus Femoris − RF and Vastus Lateralis − VL, heart rate (HR, rating of perceived exertion (RPE, ratings of perceived time (RPT and the maximum power output attained (PMax during music (WM and without music (WTM conditions. The individuals completed four maximal incremental tests (MIT ramp-like on a cycle simulator with initial load of 100 W and increments of 10 W·min-1. The mean values of PMax between conditions WTM (260.5 ± 27.7 W and WM (263.2 ± 17.2 W were not statistically different. The comparison between the rates of increase of the values expressed in root-mean-square (RMS and median frequency (MF for both muscles (RF and VL also showed no statistical difference, as well as HR, RPE and RPT. It is concluded that the use of the electronic music during an incremental test to exhaustion showed no effect on the analyzed variables for the investigated group.
Full Text Available The purpose of this study was to examine the effectiveness of 12-week plyometric training on vertical jump performance (Vj, maximal surface EMG, M-wave amplitude, M�wave latency, and nerve conduction velocity (NCV in men volleyball player. Thirty junior high school volleyball players' volunteers (age: 17.53� 0.74; Height: 177.67� 3.14; Weight: 61.31 � 5.32 were divided into plyometric training [PT] (n=15 and control group[c] (n=15. PT group trained so.w' but C group didn't participate in this training. Both groups were pre- and post tested in EMG, M-wave parameters, NCV and Vj test. Tow way ANOVA (group*time interaction and Bonferroni post hoes test demonstrated significant differences (P
Dinh, Ngoc-Duy; Luo, Rongcong; Christine, Maria Tankeh Asuncion; Lin, Weikang Nicholas; Shih, Wei-Chuan; Goh, James Cho-Hong; Chen, Chia-Hung
Light-directed forces have been widely used to pattern micro/nanoscale objects with precise control, forming functional assemblies. However, a substantial laser intensity is required to generate sufficient optical gradient forces to move a small object in a certain direction, causing limited throughput for applications. A high-throughput light-directed assembly is demonstrated as a printing technology by introducing gold nanorods to induce thermal convection flows that move microparticles (diameter = 40 µm to several hundreds of micrometers) to specific light-guided locations, forming desired patterns. With the advantage of effective light-directed assembly, the microfluidic-fabricated monodispersed biocompatible microparticles are used as building blocks to construct a structured assembly (≈10 cm scale) in ≈2 min. The control with microscale precision is approached by changing the size of the laser light spot. After crosslinking assembly of building blocks, a novel soft material with wanted pattern is approached. To demonstrate its application, the mesenchymal stem-cell-seeded hydrogel microparticles are prepared as functional building blocks to construct scaffold-free tissues with desired structures. This light-directed fabrication method can be applied to integrate different building units, enabling the bottom-up formation of materials with precise control over their internal structure for bioprinting, tissue engineering, and advanced manufacturing. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Bochkezanian, Vanesa; Newton, Robert U; Trajano, Gabriel S; Vieira, Amilton; Pulverenti, Timothy S; Blazevich, Anthony J
Neuromuscular electrical stimulation (NMES) is commonly used to activate skeletal muscles and reverse muscle atrophy in clinical populations. Clinical recommendations for NMES suggest the use of short pulse widths (100-200 μs) and low-to-moderate pulse frequencies (30-50 Hz). However, this type of NMES causes rapid muscle fatigue due to the (non-physiological) high stimulation intensities and non-orderly recruitment of motor units. The use of both wide pulse widths (1000 μs) and tendon vibration might optimize motor unit activation through spinal reflex pathways and thus delay the onset of muscle fatigue, increasing muscle force and mass. Thus, the objective of this study was to examine the acute effects of patellar tendon vibration superimposed onto wide-pulse width (1000 μs) knee extensor electrical stimulation (NMES, 30 Hz) on peak muscle force, total impulse before "muscle fatigue", and the post-exercise recovery of muscle function. Tendon vibration (Vib), NMES (STIM) or NMES superimposed onto vibration (STIM + Vib) were applied in separate sessions to 16 healthy adults. Total torque-time integral (TTI), maximal voluntary contraction torque (MVIC) and indirect measures of muscle damage were tested before, immediately after, 1 h and 48 h after each stimulus. TTI increased (145.0 ± 127.7%) in STIM only for "positive responders" to the tendon vibration (8/16 subjects), but decreased in "negative responders" (-43.5 ± 25.7%). MVIC (-8.7%) and rectus femoris electromyography (RF EMG) (-16.7%) decreased after STIM (group effect) for at least 1 h, but not after STIM + Vib. No changes were detected in indirect markers of muscle damage in any condition. Tendon vibration superimposed onto wide-pulse width NMES increased TTI only in 8 of 16 subjects, but reduced voluntary force loss (fatigue) ubiquitously. Negative responders to tendon vibration may derive greater benefit from wide-pulse width NMES alone.
H. R. Sadeghipour
Full Text Available It has been reported that cither lithium or verapamil can potentiate the neuromuscular blocking activity of certain neuromuscular blockers. In the present investigation, possible interaction of verapamil with lithium has been described. The dose ■ response effects of verapamil and lithium on diaphragmatic contractility were assessed in vitro. Mechanical responses of the muscle to indirect (nerve and direct (muscle electrical stimulation were recorded. Verapamil depressed rat diaphragm twitch tensions induced by nerve stimulation in a dose - dependent manner with the 50 percent depression of the original twitch tensions (ICSQ by 5.6 xlO^mmol/l."nThe IC50 of verapamil for direct stimulation of the muscle was LI x W'5 mmol II. Partial replacement of sodium chloride by lithium chloride (0.5, 1.5 and 5 mmol /1 in the medium did not change the depressant effect of verapamil on muscle twitches induced by direct (muscle or indirect (nerve electrical stimulation.
Asadi, Abbas; Saez de Villarreal, Eduardo; Arazi, Hamid
Anterior cruciate ligament injuries are common in basketball athletes; common preventive programs for decreasing these injures may be enhancing postural control (PC) or balance with plyometric training. This study investigated the efficiency of plyometric training program within basketball practice to improve PC performance in young basketball players. Sixteen players were recruited and assigned either to a plyometric + basketball training group (PT) or basketball training group (BT). All players trained twice per week, but the PT + BT followed a 6-week plyometric program implemented within basketball practice, whereas the BT followed regular practice. The star excursion balance test (SEBT) at 8 directions (anterior, A; anteromedial, AM; anterolateral, AL; medial, M; lateral, L; posterior, P; posteromedial, PM; and posterolateral, PL) was measured before and after the 6-week period. The PT group induced significant improvement (p ≤ 0.05) and small to moderate effect size in the SEBT (A = 0.95, AM = 0.62, AL = 0.61, M = 0.36, L = 0.47, P = 0.27, PM = 0.25, PL = 0.24). No significant improvements were found in the BT group. Also, there were significant differences between groups in all directions except PM and PL. An integrated plyometric program within the regular basketball practice can lead to significant improvements in SEBT and consequently PC. It can be recommended that strength and conditioning professionals use PT to enhance the athletes' joint awareness and PC to reduce possible future injuries in the lower extremity.
MS Yıldırım; S Ozyurek; OÇ Tosun; Uzer, S; Gelecek, N.
The aim of this study was to compare the effects of static stretching, proprioceptive neuromuscular facilitation (PNF) stretching and Mulligan technique on hip flexion range of motion (ROM) in subjects with bilateral hamstring tightness. A total of 40 students (mean age: 21.5±1.3 years, mean body height: 172.8±8.2 cm, mean body mass index: 21.9±3.0 kg • m-2) with bilateral hamstring tightness were enrolled in this randomized trial, of whom 26 completed the study. Subjects were divided into 4 ...
Hall, Michelle; Hinman, Rana S; Wrigley, Tim V
Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential...... to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have...
Holsgaard-Larsen, A; Clausen, B; Søndergaard, J
OBJECTIVE: To investigate the effect of a NEuro-Muscular EXercise (NEMEX) therapy program compared with instructions in optimized analgesics and anti-inflammatory drug use (PHARMA), on measures of knee-joint load in people with mild to moderate knee osteoarthritis. We hypothesized that knee joint...... loading during walking would be reduced by NEMEX and potentially increased by PHARMA. DESIGN: Single-blind, RCT comparing NEMEX therapy twice a week with PHARMA. Participants with mild-to-moderate medial tibiofemoral knee osteoarthritis were randomly allocated (1:1) to one of two 8-week treatments...
Jacobson, B H; Edwards, S W
To determine the effect of two doses of caffeine on a caudal (monosynaptic) reflex in humans, 30 subjects were randomly assigned to one of three groups. The groups received one of the following doses of caffeine per kilogram body weight using a double blind, placebo controlled design: 6 mg/kg, 3 mg/kg or a placebo. All of the subjects were similarly caffeine naive and were instructed to fast eight hours, refrain from caffeine for 96 hours, and avoid strenuous exercise 48 hours prior to testing. At the pre-test and post-test all subjects were given three trials of the patellar ligament reflex. Following pre-testing, subjects ingested either the caffeine solutions or an inert solution. After a one hour absorption period, subjects were post-tested. Gain scores were analyzed using a one-way ANOVA among the three groups, and a Newman-Keuls multiple range test was used to compare the three groups. The analysis revealed a significant difference in the gain score of the 6 mg/kg group. The control group had a mean gain of 4.3 msec, the 3 mg/kg group had a mean gain of 11.5 msec, and the 6 mg/kg group had a mean gain of 23.8 msec. Although the 6 mg/kg group was significantly different than the other two groups, a visible but nonsignificant difference was found between the 6 mg and 3 mg groups and the 3 mg and 0 mg groups. It was concluded that a 6 mg/kg dose of caffeine significantly lengthens reflex time in college age students.
Thomsen, Jakob Louis Demant; Mathiesen, Ole; Hägi-Pedersen, Daniel
. A neuromuscular monitoring e-learning module might support consistent use of neuromuscular monitoring devices. OBJECTIVE: The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on anesthesia staff's use of objective neuromuscular monitoring and the incidence of residual...... as well as a multiple-choice test to assess knowledge. The e-learning module was developed based on a needs assessment process, including focus group interviews, surveys, and expert opinions. RESULTS: The e-learning module was implemented in 6 anesthesia departments on 21 November 2016. Currently, we...... are collecting postintervention data. The final dataset will include data from more than 10,000 anesthesia procedures. We expect to publish the results in late 2017 or early 2018. CONCLUSIONS: With a dataset consisting of thousands of general anesthesia procedures, the INVERT study will assess whether an e-learning...
Madsen, M V; Staehr-Rye, A K; Gätke, M R
BACKGROUND: The level of neuromuscular blockade (NMB) that provides optimal surgical conditions during abdominal surgery has not been well established. The aim of this systematic review was to evaluate current evidence on the use of neuromuscular blocking agents in order to optimise surgical...
Boer, H.D. de; Egmond, J. van; Driessen, J.J.; Booij, L.H.D.J.
A neuromuscular blocking drug (NMBD) induced neuromuscular blockade (NMB) in patients with myasthenia gravis usually dissipates either spontaneously or by administration of neostigmine. We administered sugammadex to a patient with myasthenia gravis to reverse a rocuronium-induced profound NMB. NMBDs
Andersen, S; Dickenson, A H; Kohn, M
. The present study was therefore made to evaluate the effects of ketobemidone. The study consists of two parts. (1) Single unit recordings were made from dorsal horn neurones in the halothane-anaesthetised rat. Neurones were activated by transcutaneous electrical stimulation of their receptive fields at C......There are clinical observations that neurogenic pain can respond well to the opioid ketobemidone, in contrast to pethidine and morphine. This has led us to the hypothesis that the analgesic effect of ketobemidone in neurogenic pain may be due to both opioid as well as additional non-opioid effects......, dose-dependently and selectively reduced C-fibre evoked responses. Ketobemidone was also found to block wind-up more effectively than morphine at equieffective doses, but unlike morphine in a non-naloxone-reversible manner. (2) In a binding study ketobemidone was shown to inhibit [3H]MK-801 binding...
Kim, Eunkuk; Choi, Hokyung; Cha, Jung-Hoon; Park, Jong-Chul; Kim, Taegyu
The aims of this study were to investigate the ankle position, the changes and persistence of ankle kinematics after neuromuscular training in athletes with chronic ankle instability (CAI). A total of 21 national women’s field hockey players participated (CAI = 12, control = 9). Ankle position at heel strike (HS), midstance (MS), and toe touch (TT) in the frontal plane during walking, running and landing were measured using 3D motion analysis. A 6-week neuromuscular training program was undertaken by the CAI group. Measurements of kinematic data for both groups were measured at baseline and the changes in kinematic data for CAI group were measured at 6 and 24 weeks. The kinematic data at HS during walking and running demonstrated that the magnitude of the eversion in the CAI group (−5.00° and −4.21°) was less than in the control group (−13.45°and −9.62°). The kinematic data at MS also exhibited less ankle eversion in the CAI group (−9.36° and −8.18°) than in the control group (−18.52° and −15.88°). Ankle positions at TT during landing were comparable between groups. Following the 6-week training, the CAI participants demonstrated a less everted ankle at HS during walking and running (−1.77° and −1.76°) compared to the previous positions. They also showed less ankle eversion at MS (−5.14° and −4.19°). Ankle orientation at TT changed significantly to an inverted ankle position (from −0.26° to 4.11°). The ankle kinematics were restored back to the previous positions at 24 weeks except for landing. It appeared that athletes with unstable ankle had a relatively inverted ankle position, and that 6-week neuromuscular training had an immediate effect on changing ankle orientation toward a less everted direction. The changed ankle kinematics seemed to persist during landing but not during walking and running. Key points Athletes with unstable ankles had a relatively inverted ankle position during the initial contact and midstance
Full Text Available The present study investigated whether neuromuscular electrical stimulation for 20 min twice a day with an electrode placed over the soleus muscle and nutritional supplementation with 19 g of protein rich lupin seeds can reduce the loss in volume and strength of the human calf musculature during long term unloading by wearing an orthotic unloading device.Thirteen healthy male subjects (age of 26.4 ± 3.7 years wore a Hephaistos orthosis one leg for 60 days during all habitual activities. The leg side was randomly chosen for every subject. Six subjects only wore the orthosis as control group, and 7 subjects additionally received the countermeasure consisting of neuromuscular electrical stimulation of the soleus and lateral gastrocnemius muscles and lupin protein supplementation. Twenty-eight days before and on the penultimate day of the intervention cross-sectional images of the calf muscles were taken by magnetic resonance imaging (controls n = 5, and maximum voluntary torque (controls n = 6 of foot plantar flexion was estimated under isometric (extended knee, 90° knee flexion and isokinetic conditions (extended knee, respectively.After 58 days of wearing the orthosis the percentage loss of volume in the entire triceps surae muscle of the control subjects (-11.9 ± 4.4%, mean ± standard deviation was reduced by the countermeasure (-3.5 ± 7.2%, p = 0.032. Wearing the orthosis generally reduced plantar flexion torques values, however, only when testing isometric contraction at 90° knee ankle the countermeasure effected a significantly lower percentage decrease of torque (-9.7 ± 7.2%, mean ± SD in comparison with controls (-22.3 ± 11.2%, p = 0.032.Unloading of calf musculature by an orthotic device resulted in the expected loss of muscle volume and maximum of plantar flexion torque. Neuromuscular electrical muscle stimulation and lupin protein supplementation could significantly reduce the process of atrophy.ClinicalTrials.gov, identifier
Zange, Jochen; Schopen, Kathrin; Albracht, Kirsten; Gerlach, Darius A; Frings-Meuthen, Petra; Maffiuletti, Nicola A; Bloch, Wilhelm; Rittweger, Jörn
The present study investigated whether neuromuscular electrical stimulation for 20 min twice a day with an electrode placed over the soleus muscle and nutritional supplementation with 19 g of protein rich lupin seeds can reduce the loss in volume and strength of the human calf musculature during long term unloading by wearing an orthotic unloading device. Thirteen healthy male subjects (age of 26.4 ± 3.7 years) wore a Hephaistos orthosis one leg for 60 days during all habitual activities. The leg side was randomly chosen for every subject. Six subjects only wore the orthosis as control group, and 7 subjects additionally received the countermeasure consisting of neuromuscular electrical stimulation of the soleus and lateral gastrocnemius muscles and lupin protein supplementation. Twenty-eight days before and on the penultimate day of the intervention cross-sectional images of the calf muscles were taken by magnetic resonance imaging (controls n = 5), and maximum voluntary torque (controls n = 6) of foot plantar flexion was estimated under isometric (extended knee, 90° knee flexion) and isokinetic conditions (extended knee), respectively. After 58 days of wearing the orthosis the percentage loss of volume in the entire triceps surae muscle of the control subjects (-11.9 ± 4.4%, mean ± standard deviation) was reduced by the countermeasure (-3.5 ± 7.2%, p = 0.032). Wearing the orthosis generally reduced plantar flexion torques values, however, only when testing isometric contraction at 90° knee ankle the countermeasure effected a significantly lower percentage decrease of torque (-9.7 ± 7.2%, mean ± SD) in comparison with controls (-22.3 ± 11.2%, p = 0.032). Unloading of calf musculature by an orthotic device resulted in the expected loss of muscle volume and maximum of plantar flexion torque. Neuromuscular electrical muscle stimulation and lupin protein supplementation could significantly reduce the process of atrophy. ClinicalTrials.gov, identifier NCT
Carvalho, Vanessa Henriques; Braga, Angélica de Fátima de Assunção; Braga, Franklin Sarmento da Silva; Potério, Gloria Maria Braga; Santos, Filipe Nadir Caparica; Junqueira, Fernando Eduardo Féres
To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro. Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - levobupivacaine (5 µg.mL-1); Group II - pancuronium (2 µg.mL-1); Group III - pancuronium (2 µg.mL-1) + levobupivacaine (5µg.mL-1). The following parameters were evaluated: 1) amplitude of diaphragmatic response to indirect stimulation, before and 60 minutes after the addition of levobupivacaine and pancuronium alone, and after the addition of levobupivacaine combined with pancuronium; 2) membrane potentials (MP) and miniature endplate potentials (MEPP). Levobupivacaine alone did not alter the amplitude of muscle response and MP. In preparations previoulsy exposed to levobupivacaine, the block with pancuronium was significantly denser (90.2 ± 15.2%), showing a significant difference (p=0.031) in comparison to the block produced by pancuronium alone (48.9% ± 9.8%). There was a decrease in the frequency and amplitude of MEPPs. Levobupivacaine potentiated the neuromuscular blockade produced by pancuronium, confirming a presynaptic action by a decrease in miniature endplate potentials.
Molgó, J; Mallart, A
The effect of Anemonia sulcata toxin II (ATX-II) on the amount of transmitter released by nerve impulses was investigated in motor end-plates of the mouse. ATX-II (80 nM) caused repetitive end-plate potentials in response to a single nerve stimulus and a 3- to 4-fold increase in the quantal content of the phasic end-plate potential. This increase is less than what would be expected if ATX-II induced plateau action potentials at the motor endings. To solve this discrepancy presynaptic currents were recorded by focal extracellular electrodes. It was found that the K current present at the endings is strong enough to prevent the development of presynaptic plateau action potentials, in contrast to what has been observed in other excitable membranes (unmyelinated axons, nodes of Ranvier and skeletal muscle fibres). By using tetraethylammonium and 3,4-diaminopyridine to block K channels and Co2+ to block Ca channels, ATX-II allowed the development of prolonged plateau responses at the endings upon motor nerve stimulation. These results suggest that the mouse motor endings are endowed with a relatively powerful K channel system, which effectively controls the amount of presynaptic depolarization.
Maner, Jon K; Gailliot, Matthew T; Menzel, Andrew J; Kunstman, Jonathan W
A growing body of research demonstrates that power promotes a fundamental orientation toward approach and agency. The current studies suggest that this tendency is moderated by dispositional anxiety. In two experiments, high levels of dispositional anxiety blocked the psychological effects of power. Although people low in anxiety responded to a power prime with greater willingness to take risks, those high in anxiety did not (Experiment 1). Similarly, whereas those low in social anxiety responded to power with increased sexual attraction toward a confederate, individuals high in social anxiety failed to show the same effect (Experiment 2). In both studies, the interaction between power and anxiety was statistically mediated by perceptions of reward. Although power enhanced people's perceptions of reward, this effect was eliminated by high levels of dispositional anxiety. This research provides insight into how, and in whom, power promotes approach and agentic behavior.
Gallistel, C R; Boytim, M; Gomita, Y; Klebanoff, L
The neuroleptic pimozide produces an extinction-like decline in the runway and Skinner box performance of rats rewarded with electrical stimulation of the medial forebrain bundle (MFB) in the lateral and posterior hypothalamus. The required dose is an order of magnitude less than the dose that incapacitates. The extinction-like decline is seen even when the drug treated rats run and receive brain stimulation in a running wheel prior to runway testing. The decline is also task-specific: after extinguishing in the Skinner box, rats readily perform in the runway, but soon show extinction in this task, too. The characteristics of pimozide's effects on rewarded behavior imply that the drug, whatever other effects it may have, does block the reinforcing effect of the brain stimulation reward.
Jong, Wybren de; McLeod, Stuart M.
Cardiovascular effects of Octapressin were studied in anesthetized male albino rats. The effect of pretreatment with the following blocking agents was evaluated: atropine, phenoxybenzamine, propranolol, hexamethonium and chlorpromazine. A decrease in blood pressure and in heart rate was induced by
Burger, M; Dreyer, D; Fisher, R L; Foot, D; O'connor, D H; Galante, M; Zalgaonkir, S
Ankle sprains are common musculoskeletal injuries in which the ligaments of the ankle partially or completely tear due to sudden stretching. To critically appraise, evaluate and establish the best available evidence to determine the effectiveness of proprioceptive and neuromuscular training (PNT) compared to bracing in reducing the recurrence rate of ankle sprains in athletes. The following seven databases were searched in June 2017: PubMed, Cochrane Library, PEDro, ScienceDirect, Scopus, SPORTDiscus, EBSCO Host: CINAHL. The main search terms used were "ankle sprains", "proprioceptive training", "neuromuscular training" and "bracing". The quality of the trials were critically appraised according to the PEDro scale. The RevMan 5© software was used to pool results. Three studies met the inclusion criteria and the quality according to the PEDro scale ranged from 4/10-7/10. The pooled data showed no difference between PNT and bracing in reducing the recurrence rate of ankle sprains in athletes at 12 months after initiation of the study. This systematic review of the overall effect suggested that current evidence (Level II) does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains. Physiotherapists are advised to use either PNT or bracing according to the patients preference and their own expertise.
Balachandar, Vivek; Marciniak, Jan-Luigi; Wall, Owen; Balachandar, Chandrika
Anterior cruciate ligament (ACL) injury has a devastating impact on physical and psychological disability. Rates of ACL rupture are significantly greater in females than males during the same sports. Hormonal mechanisms have been proposed but are complex and poorly understood. This systematic review evaluates the effects of menstrual cycle on: 1) lower-limb biomechanics, 2) neuromuscular control, and 3) ACL injury risk. The MEDLINE, CINAHL, SPORTSDiscus, Web of Science, and Google Scholar databases were searched from inception to August 2016 for studies investigating the effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and ACL injury risk in females. Three independent reviewers assessed each paper for inclusion and two assessed for quality. Seventeen studies were identified. There is strong evidence that: 1) greatest risk of ACL injury is within the pre-ovulatory phase of the menstrual cycle, and 2) females with greater ACL laxity in the pre-ovulatory phase experience greater knee valgus and greater tibial external rotation during functional activity. Females are at greatest risk of ACL injury during the pre-ovulatory phase of the menstrual cycle through a combination of greater ACL laxity, greater knee valgus, and greater tibial external rotation during functional activity. Ib.
Boba, Katarzyna; Bianchi, Matteo; McCombe, Greg; Gatt, Ruben; Griffin, Anselm C; Richardson, Robert M; Scarpa, Fabrizio; Hamerton, Ian; Grima, Joseph N
We describe a new class of negative Poisson's ratio (NPR) open cell PU-PE foams produced by blocking the shape memory effect in the polymer. Contrary to classical NPR open cell thermoset and thermoplastic foams that return to their auxetic phase after reheating (and therefore limit their use in technological applications), this new class of cellular solids has a permanent negative Poisson's ratio behavior, generated through multiple shape memory (mSM) treatments that lead to a fixity of the topology of the cell foam. The mSM-NPR foams have Poisson's ratio values similar to the auxetic foams prior their return to the conventional phase, but compressive stress-strain curves similar to the ones of conventional foams. The results show that by manipulating the shape memory effect in polymer microstructures it is possible to obtain new classes of materials with unusual deformation mechanisms.
Chumillas, M J; Cortés, V
Electrophysiological studies are of recognized use in the confirmation of alterations of neuromuscular transmission in further determining their physiopathological characteristics, helping to differentiate them from other conditions with secondary effects on their function. In our study we review the physiopathology of these disorders which compromise the safety factor of the neuromuscular junction, by presynaptic or postsynaptic alterations, and forms the basis of the results of electrophysiological studies. We describe the techniques currently most used: repetitive stimulation and single fibre electromyography complemented by conventional electromyography. Their application and findings in the commonest syndromes are discussed. Finally, their sensitivity, specificity and difficulties are considered.
Liew, Bernard X W; Morris, Susan; Keogh, Justin W L; Appleby, Brendyn; Netto, Kevin
In recent years, athletes have ventured into ultra-endurance and adventure racing events, which tests their ability to race, navigate, and survive. These events often require race participants to carry some form of load, to bear equipment for navigation and survival purposes. Previous studies have reported specific alterations in biomechanics when running with load which potentially influence running performance and injury risk. We hypothesize that a biomechanically informed neuromuscular training program would optimize running mechanics during load carriage to a greater extent than a generic strength training program. This will be a two group, parallel randomized controlled trial design, with single assessor blinding. Thirty healthy runners will be recruited to participate in a six weeks neuromuscular training program. Participants will be randomized into either a generic training group, or a biomechanically informed training group. Primary outcomes include self-determined running velocity with a 20 % body weight load, jump power, hopping leg stiffness, knee extensor and triceps-surae strength. Secondary outcomes include running kinetics and kinematics. Assessments will occur at baseline and post-training. To our knowledge, no training programs are available that specifically targets a runner's ability to carry load while running. This will provide sport scientists and coaches with a foundation to base their exercise prescription on. ANZCTR ( ACTRN12616000023459 ) (14 Jan 2016).
Teiriä, H; Rautoma, P; Yli-Hankala, A
We have compared the potency of vecuronium given to 12 smokers and 12 non-smokers during propofol-alfentanil-nitrous oxide anaesthesia. After obtaining individual dose-response curves, bolus doses of vecuronium were given to maintain neuromuscular block at 90-98% for 60 min. Adductor pollicis EMG was used to monitor neuromuscular block. Mean ED95 values were 61.38 micrograms kg-1 and 47.49 micrograms kg-1 for smokers and non-smokers, respectively (P < 0.01). The dose of vecuronium to maintain 90-98% neuromuscular block was 25% higher in smokers than in non-smokers (96.80 vs 72.11 micrograms kg-1 h-1; P < 0.01). These data reflect the effects of smoking on neuromuscular block induced by vecuronium. The effect may be at the receptor level, although possible increased metabolism of vecuronium in smokers cannot be excluded.
Chen, Ming-Quan; Chen, Chun; Li, Lin
BACKGROUND The median effective dose (ED50) of a drug gives the amount or dose of drug needed to produce effective therapeutic response or desired effect in at least 50% of the population taking it. Our study focused on determining the ED50 required for effective motor block using hyperbaric and plain bupivacaine, and evaluated the influence of baricity on the ED50 required for motor block. MATERIAL AND METHODS A total of 38 patients were randomly assigned into 2 groups according to the baricity of bupivacaine: group P received plain bupivacaine and group H received hyperbaric bupivacaine. The patients were administered 0.5% plain or hyperbaric bupivacaine intrathecally. The dosage of anesthetics in each patient was calculated according to the standard up-down sequential allocation method of Dixon. The first patient in each group received a dose of 7.5 mg bupivacaine, and a dose of 1.0 mg was used as the testing interval. The dose was increased or decreased by 1.0 mg for each patient according to the estimated score of motor block. RESULTS The ED50 required for effective motor block in spinal anesthesia was 7.20 and 10.05 mg in groups H and P, respectively. Their relative motor blocking potency ratio was found to be 0.72. CONCLUSIONS The ED50 for motor block was significantly decreased using hyperbaric bupivacaine intrathecally compared with plain bupivacaine, and the baricity of bupivacaine obviously affected the ED50 for the motor block.
Full Text Available ABSTRACTBACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n = 20, patients did not receive sub-Tenon's anesthesia. In group 2 (n = 20, following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p > 0.05. Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p < 0.05. Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p < 0.05.CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
Tuzcu, Kasim; Coskun, Mesut; Tuzcu, Esra Ayhan; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Aydın, Suzan; Turhanoglu, Selim
Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05). In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Tuzcu, Kasim; Coskun, Mesut; Tuzcu, Esra Ayhan; Karcioglu, Murat; Davarci, Isil; Hakimoglu, Sedat; Aydın, Suzan; Turhanoglu, Selim
Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting. Forty patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups. There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05). In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Putzier, M; Groß, C; Zahn, R K; Pumberger, M; Strube, P
Usually, neuromuscular scolioses become clinically symptomatic relatively early and are rapidly progressive even after the end of growth. Without sufficient treatment they lead to a severe reduction of quality of life, to a loss of the ability of walking, standing or sitting as well as to an impairment of the cardiopulmonary system resulting in an increased mortality. Therefore, an intensive interdisciplinary treatment by physio- and ergotherapists, internists, pediatricians, orthotists, and orthopedists is indispensable. In contrast to idiopathic scoliosis the treatment of patients with neuromuscular scoliosis with orthosis is controversially discussed, whereas physiotherapy is established and essential to prevent contractures and to maintain the residual sensorimotor function.Frequently, the surgical treatment of the scoliosis is indicated. It should be noted that only long-segment posterior correction and fusion of the whole deformity leads to a significant improvement of the quality of life as well as to a prevention of a progression of the scoliosis and the development of junctional problems. The surgical intervention is usually performed before the end of growth. A prolonged delay of surgical intervention does not result in an increased height but only in a deformity progression and is therefore not justifiable. In early onset neuromuscular scolioses guided-growth implants are used to guarantee the adequat development. Because of the high complication rates, further optimization of these implant systems with regard to efficiency and safety have to be addressed in future research.
Jade A. Winfield
Full Text Available This experiment tested the effect of enrichment-block shape on oro-nasal contact by young pigs, and possible habituation to the blocks. Nineteen litters (197 piglets were randomly allocated to one of three block-shape treatments: Cube, Brick, or Wedge. Oro-nasal contact with blocks was infrequent before 25 days of age. Thereafter, contact steadily increased, suggesting enrichment blocks may not need to be provided until week 4 of lactation. Brick-shaped blocks attracted more oro-nasal contact than the cube and wedge shapes (p = 0.002. Oro-nasal contact was more frequent (p < 0.001 during the first 24 h after block introduction than when blocks were four days old. From 25 to 60 days of age, oro-nasal bouts were longer (p = 0.014 during the first 30 min of exposure to a fresh block, than for the remainder of the 24 h, or on day 4 after block replacement. Therefore, habituation to blocks may have occurred by 24 h after block introduction. Brick-shaped blocks may present a wider surface for oro-nasal contact, where multiple pigs could simultaneously interact with the block. We speculate that simultaneous interaction with brick-shaped blocks may be similar to a litter co-operatively massaging the sow’s udder prior to suckling bouts.
Winfield, Jade A; Macnamara, Greg F; Macnamara, Ben L F; Hall, Evelyn J S; Ralph, Cameron R; O'Shea, Cormac J; Cronin, Greg M
This experiment tested the effect of enrichment-block shape on oro-nasal contact by young pigs, and possible habituation to the blocks. Nineteen litters (197 piglets) were randomly allocated to one of three block-shape treatments: Cube, Brick, or Wedge. Oro-nasal contact with blocks was infrequent before 25 days of age. Thereafter, contact steadily increased, suggesting enrichment blocks may not need to be provided until week 4 of lactation. Brick-shaped blocks attracted more oro-nasal contact than the cube and wedge shapes (p = 0.002). Oro-nasal contact was more frequent (p < 0.001) during the first 24 h after block introduction than when blocks were four days old. From 25 to 60 days of age, oro-nasal bouts were longer (p = 0.014) during the first 30 min of exposure to a fresh block, than for the remainder of the 24 h, or on day 4 after block replacement. Therefore, habituation to blocks may have occurred by 24 h after block introduction. Brick-shaped blocks may present a wider surface for oro-nasal contact, where multiple pigs could simultaneously interact with the block. We speculate that simultaneous interaction with brick-shaped blocks may be similar to a litter co-operatively massaging the sow's udder prior to suckling bouts.
Full Text Available Abstract Background Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens. In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective. Methods Seven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention. The quality of each included study was evaluated using a modified version of the van Tulder scale. Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy. Results Nine studies were identified including six randomized controlled trials (RCT and three controlled clinical trials (CCT. Heterogeneity in study design and warm-up strategies prevented pooling of results. Two studies investigated male and female participants, while the remaining seven investigated women only. Risk Ratio (RR statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 0.67, confidence interval (CI 0.54 to 0.84 and overuse (RR 0.45, CI 0.28 to 0.71 lower limb injuries as well as knee (RR 0.48, CI 0.32 to 0.72 injuries among young amateur female footballers. The 'Knee Injury Prevention Program' (KIPP significantly reduced the risk of noncontact lower limb (RR 0.5, CI 0.33 to 0.76 and overuse (RR 0.44, CI 0.22 to 0.86 injuries in young amateur female football and basketball players. The 'Prevent Injury and Enhance Performance' (PEP strategy reduces the incidence of anterior cruciate ligament (ACL injuries (RR 0.18, CI 0.08 to 0.42. The 'HarmoKnee' programme reduces the risk of knee injuries (RR 0.22, CI 0.06 to 0.76 in teenage female footballers. The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP significantly reduces the incidence of anterior
Influência de anestésicos locais sobre o bloqueio neuromuscular produzido pelo rocurônio: ação da lidocaína e da mistura enantiomérica em excesso de 50% de bupivacaína na junção neuromuscular Influencia de anestésicos locales sobre el bloqueo neuromuscular producido por el rocuronio: acción de la lidocaína y de la mezcla enantiomérica en exceso de 50% de bupivacaína en la junción neuromuscular Influence of local anesthetics on the neuromuscular blockade produced by rocuronium: effects of lidocaine and 50% enantiomeric excess bupivacaine on the neuromuscular junction
Angélica de Fátima de Assunção Braga
acción presináptica y postsináptica.BACKGROUND AND OBJECTIVES: The effects of local anesthetics (LA on neuromuscular transmission and their influence on the neuromuscular blockade produced by competitive neuromuscular blockers have not been fully investigated. The objective of this study was to evaluate, in vitro, the effects of lidocaine and 50% enantiomeric excess bupivacaine (S75-R25 on the neuromuscular blockade produced by rocuronium. METHODS: The rats were divided in five groups (n = 5 according to the drug used: isolated lidocaine, bupivacaine (S75-R25, or rocuronium (groups I, II, and II; and rocuronium in preparations previously exposed to LAs (groups IV and V. The concentrations used were as follows: 20 µg.mL-1, 5 µg.mL-1, and 4 µg.mL-1 of lidocaine, bupivacaine (S75-R25, and rocuronium, respectively. The following parameters were evaluated: 1 the strength of muscular contraction of the diaphragm to indirect electrical stimulations, before and 60 minutes after the isolated addition of the LAs and rocuronium, and the association AL-rocuronium; and 2 the effects of LAs on membrane potential (MP and miniature end-plate potentials (MEPP. The effect of LAs on muscle contraction in response to acetylcholine was evaluated in chick biventer cervicis preparations. RESULTS: Isolated lidocaine and bupivacaine (S75-R25 did not change the muscular response and the levels of MPs. In preparations exposed to LAs, rocuroniuminduced blockade was significantly greater than that produced by rocuronium alone. In chick biventer cervicis preparations, lidocaine and bupivacaine (S75R25 decreased contraction in response to acetylcholine. Lidocaine increased the frequency of MEPPs, which was followed by the blockade; bupivacaine (S75R25 caused a reduction in MEPPs followed by blockade. CONCLUSIONS: Local anesthetics caused a potentiation of the neuromuscular blockade produced by rocuronium. The results showed pre- and post-synaptic effects.
In cases where they are not used for census release, they are normally used as building blocks for developing output areas or they are aggregated to higher spatial levels in an effort to preserve privacy or confidentiality. Buildings blocks are therefore, of significant importance towards results that could be drawn from either ...
Mitchell, Anja Ulrike; Torup, Henrik; Hansen, Egon G
. Sensory assessment of a TAP block may guide the decision on the extent of the block. The purpose of this study was to investigate if the dermatomal extent of sensory blockade after injection of 20 ml 0.5% ropivacaine bilaterally into the TAP can be assessed using cold and pinprick sensation....
Mitchell, Anja Ulrike; Torup, Henrik; Hansen, Egon G; Petersen, Pernille Lykke; Mathiesen, Ole; Dahl, Jørgen B; Rosenberg, Jacob; Møller, Ann Merete
The ultrasound-guided transversus abdominis plane (TAP) block is used to treat postoperative pain after abdominal surgery. Abdominal wall sensory nerves are anaesthetised by injecting local anaesthetics into the neurofascial plane between the internal oblique and the transversus abdominis muscles. Sensory assessment of a TAP block may guide the decision on the extent of the block. The purpose of this study was to investigate if the dermatomal extent of sensory blockade after injection of 20 ml 0.5% ropivacaine bilaterally into the TAP can be assessed using cold and pinprick sensation. Subcostal TAP block was performed bilaterally in 20 awake patients scheduled for elective abdominal surgery. Sensory change in dermatomes T4-L4 was tested with pinprick using a blunt needle and cold disinfectant swabs after 10, 20 and 30 minutes. Data from 20 patients (40 blocks) were analysed. Eighteen patients registered sensory change after subcostal TAP block, and dermatomes T10-T12 were blocked after 30 minutes in all of these patients. Spread of sensory change to dermatomes T5-L3 was variable. This study confirmed that the dermatomal extent of a sensory blockade after a single-shot subcostal TAP block can be assessed using cold and pinprick sensation. not relevant. The study was registered at clinicaltrials.gov with the registration number NCT01024868.
Lee, Song Joo; Ren, Yupeng; Press, Joel M; Lee, Jungwha; Zhang, Li-Qun
Knee injuries are usually associated with offaxis loadings in the transverse and frontal planes. Thus, improvement of lower limb offaxis neuromuscular control is important in knee injury prevention and post-injury rehabilitation. The goal of this paper was to investigate the effects of six-week pivoting offaxis intensity adjustable neuromuscular control training (POINT) using a custom-made offaxis elliptical trainer on lower limb offaxis neuromuscular control performance in trained and untrained functional tasks under slippery conditions. Twenty-six subjects participated in 18 sessions of POINT (three sessions per week for six weeks) and 25 subjects served as controls who did a regular workout. Offaxis neuromuscular control performance measures in terms of pivoting instability, sliding instability, and time-to-peak offaxis EMG entropy were evaluated on both groups under slippery conditions including a trained free pivoting task and untrained free sliding task and free pivoting and sliding task. Compared with the control group, the training group significantly decreased pivoting instability and the time-to-peak offaxis EMG entropy in lower limb muscles, indicating improvement in offaxis neuromuscular control performance. Furthermore, the training group showed reduced pivoting instability and sliding instability during the untrained free pivoting and sliding task. This paper may help us develop more focused and effective offaxis training programs to reduce knee injuries associated with offaxis loadings.
Effects of neuromuscular electrical stimulation and low-level laser therapy on the muscle architecture and functional capacity in elderly patients with knee osteoarthritis: a randomized controlled trial.
Melo, Mônica de Oliveira; Pompeo, Klauber Dalcero; Brodt, Guilherme Auler; Baroni, Bruno Manfredini; da Silva Junior, Danton Pereira; Vaz, Marco Aurélio
To determine the effects of low-level laser therapy in combination with neuromuscular electrical stimulation on the muscle architecture and functional capacity of elderly patients with knee osteoarthritis. A randomized, evaluator-blinded clinical trial with sequential allocation of patients to three different treatment groups. Exercise Research Laboratory. A total of 45 elderly females with knee osteoarthritis, 2-4 osteoarthritis degrees, aged 66-75 years. Participants were randomized into one of the following three intervention groups: electrical stimulation group (18-32 minutes of pulsed current, stimulation frequency of 80 Hz, pulse duration of 200 μs and stimulation intensity fixed near the maximal tolerated), laser group (low-level laser therapy dose of 4-6 J per point, six points at the knee joint) or combined group (electrical stimulation and low-level laser therapy). All groups underwent a four-week control period (without intervention) followed by an eight-week intervention period. The muscle thickness, pennation angle and fascicle length were assessed by ultrasonography, and the functional capacity was assessed using the 6-minute walk test and the Timed Up and Go Test. After intervention, only the electrical stimulation and combined groups exhibited significant increases in the muscle thickness (27%-29%) and pennation angle (24%-34%) values. The three groups exhibited increased performance on the walk test (5%-9%). However, no significant differences in terms of functional improvements were observed between the groups. Neuromuscular electrical stimulation reduced the deleterious effects of osteoarthritis on the quadriceps structure. Low-level laser therapy did not potentiate the effects of electrical stimulation on the evaluated parameters. © The Author(s) 2014.
Khamwong, Peanchai; Pirunsan, Ubon; Paungmali, Aatit
Stretching with proprioceptive neuromuscular facilitation (PNF) is frequently used before exercise. The prophylactic effect of PNF on symptoms of muscle damage induced by eccentric exercise of the wrist extensors was examined in this study. Twenty-eight healthy males were randomly divided into the PNF group (n = 14) and the control group (n = 14). PNF was used before eccentric exercise induction in the wrist extensors. All subjects were tested to examine muscle damage characteristics including sensory-motor functions at baseline, immediately, and from 1st to 8th days after the exercise-induced muscle damage (EIMD). The results demonstrated that the PNF group showed a lesser deficit in some sensory-motor functions (p PNF stretching application could be useful for attenuating the signs and symptoms of muscle damage after eccentric exercise. Copyright © 2010 Elsevier Ltd. All rights reserved.
Kitoh, Takeshi; Kobayashi, Koichi; Ina, Hiroaki; Ofusa, Yukihiro; Otagiri, Tetsutaro; Tanaka, Satoshi; Ono, Koichi
A 59-year-old man with amyotrophic lateral sclerosis (ALS) received lumbar epidural and sympathetic ganglion blocks to increase regional blood flow and improve his clinical symptoms. After a lumbar epidural block (0.5% mepivacaine), the skin temperature of his affected lower extremities rose by 7.0 degrees C and became close to that of the intact side, and the distance he was able to walk with his cane increased from 2 to 8 m. The clinical effects produced by the lumbar sympathetic ganglion block (99.5% alcohol) were sustained for approximately 8 weeks after the first block and for approximately 6 weeks after the second block. There were no particular adverse effects or complications associated with these nerve block procedures. Epidural and sympathetic ganglion blocks for an ALS patient, albeit their effects are of a transient nature, may improve related clinical symptoms, and were thought to play a contributory role in improving our patient's quality of life.
Hübscher, Markus; Zech, Astrid; Pfeifer, Klaus; Hänsel, Frank; Vogt, Lutz; Banzer, Winfried
The aim of this systematic review was to assess the effectiveness of proprioceptive/neuromuscular training in preventing sports injuries by using the best available evidence from methodologically well...
Henchoz, Yves; Tétreau, Charles; Abboud, Jacques; Piché, Mathieu; Descarreaux, Martin
Alterations of the neuromuscular control of the lumbar spine have been reported in patients with chronic low back pain (LBP). During trunk flexion and extension tasks, the reduced myoelectric activity of the low back extensor musculature observed during full trunk flexion is typically absent in patients with chronic LBP. To determine whether pain expectations could modulate neuromuscular responses to experimental LBP to a higher extent in patients with chronic LBP compared with controls. A cross-sectional, case-control study. Twenty-two patients with nonspecific chronic LBP and 22 age- and sex-matched control participants. Trunk flexion-extension tasks were performed under three experimental conditions: innocuous heat, noxious stimulation with low pain expectation, and noxious stimulation with high pain expectation. Noxious stimulations were delivered using a contact heat thermode applied on the skin of the lumbar region (L4-L5), whereas low or high pain expectations were induced by verbal and visual instructions. Surface electromyography of erector spinae at L2-L3 and L4-L5, as well as lumbopelvic kinematic variables were collected during the tasks. Pain was evaluated using a numerical rating scale. Pain catastrophizing, disability, anxiety, and fear-avoidance beliefs were measured using validated questionnaires. Two-way mixed analysis of variance revealed that pain was significantly different among the three experimental conditions (F2,84=317.5; plow back extensor musculature during full trunk flexion was observed in the high compared with low pain expectations condition at the L2-L3 level (F2,84=9.5; ppain catastrophizing in patients with chronic LBP (r=0.54; p=.012). Repeated exposure to pain appears to generate rigid and less variable patterns of muscle activation in patients with chronic LBP, which attenuate their response to pain expectations. Patients with high levels of pain catastrophizing show higher myoelectric activity of lumbar muscles in full flexion
Zebis, Mette K; Andersen, Lars L; Brandt, Mikkel; Myklebust, Grethe; Bencke, Jesper; Lauridsen, Hanne Bloch; Bandholm, Thomas; Thorborg, Kristian; Hölmich, Per; Aagaard, Per
Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries. This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical risk factors for non-contact ACL injury. 40 adolescent female football and handball players (15-16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated: (1) EMG amplitude from vastus lateralis (VL), semitendinosus (ST) and biceps femoris 10 ms prior to initial contact (IC) normalised to peak EMG amplitude recorded during maximal voluntary isometric contraction and (2) VL-ST EMG preactivity difference during the 10 ms prior to foot contact (primary outcome). We measured maximal knee joint valgus moment and knee valgus angle at IC. There was a difference between groups at follow-up in VL-ST preactivity (43% between-group difference; 95% CI 32% to 55%). No between-group differences were observed for kinematic and kinetic variables. A 12-week injury prevention programme in addition to training and match play in adolescent females altered the pattern of agonist-antagonist muscle preactivity during side cutting. This may represent a more ACL-protective motor strategy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Efeitos neuromusculares in vitro e in vivo do atracúrio e do rocurônio em ratos submetidos a tratamento de sete dias com carbamazepina Efectos neuromusculares in vitro e in vivo del atracurio y del rocuronio en ratones sometidos a tratamiento de siete días con carbamazepina In vitro and in vivo neuromuscular effects of atracurium and rocuronium in rats treated with carbamazepine for seven days
Caroline Coutinho de Barcelos
the concentration of cytochrome P450 and b5 reductase in hepatic microsomes. METHODS: Rats were treated with carbamazepine (CBZ - 40 mg.kg-1 by gavage and sacrificed on the eighth day under anesthesia with urethane. In vitro and in vivo preparations followed the techniques of Bulbring and Leeuwin and Wolters, respectively. Concentrations and doses of the neuromuscular blockers used in in vitro and in vivo preparations were, respectively, 20 µg.mL-1 and 0.5 mg.kg-1 for atracurium (ATC; and 4 µg.kg-1 and 0.6 mg.kg-1 for rocuronium (ROC. Each protocol had an n = 5 and the response was observed for 60 minutes. The effects of ATC and ROC were evaluated in the preparations of rats treated with carbamazepine (CBZt and compared to those of non-treated rats (CBZst. The concentration of cytochrome P450 and b5 reductase were determined in hepatic chromosomes of rats treated with carbamazepine (CBZt and non-treated rats (CBZst. RESULTS: Carbamazepine did not change the amplitude of neuromuscular response; differences in the neuromuscular blockade produced by atracurium in CBZ1 preparations were not observed, in vitro or in vivo, when compared with CBZst; the neuromuscular blockade produced by rocuronium in CBZt preparations was potentiated in vitro. Carbamazepine did not change the concentrations of cytochrome P450 and b5. CONCLUSIONS: Seven-day treatment with carbamazepine did not change the neuromuscular blockade produce by atracurium, but altered the in vitro effects of rocuronium. The duration of the treatment was not enough to cause enzymatic induction and decrease the sensitivity to rocuronium.
Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study.
Karabay, İlkay; Öztürk, Gökhan Tuna; Malas, Fevziye Ünsal; Kara, Murat; Tiftik, Tülay; Ersöz, Murat; Özçakar, Levent
The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. Cross-sectional area values of tibialis anterior (238.7 ± 61.5 vs. 282.0 ± 67.1 mm) and gastrocnemius (207.9 ± 48.0 vs. 229.5 ± 52.4 mm) (P muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 ± 64.7 vs. 239.7 ± 60.0 mm) after treatment in group B (P muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.
Smith, Martin H.
Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…
Røjskjaer, Jesper O; Gade, Erik; Kiel, Louise B
OBJECTIVE: To assess the effect of bilateral ultrasound-guided transversus abdominis plane block with ropivacaine compared with placebo as part of a multimodal analgesic regimen. DESIGN: A randomized, double-blind, placebo-controlled trial following the CONSORT criteria. SETTING: Hvidovre...... an ultrasound-guided transversus abdominis plane block in women undergoing total abdominal hysterectomy. As part of a multimodal regimen the transversus abdominis plane block showed some effect on pain scores at rest only in the early postoperative period....
Ostinelli, A; Gelosa, S; Frigerio, M; Monti, A F
Shaped fields are widely used in radiotherapy to protect critical organs and to avoid unnecessary normal tissue irradiation. The most common system for photon beam shaping consists in a low melting point alloy. We studied the air bubbles which can occur during alloy cooling with both new and remelted alloys and when different cooling techniques are chosen. Forty cone samples (18 of remelted alloy and 22 of new alloy) were prepared to evaluate the frequence of air bubble recurrence, with reproducible geometric sizes (height = 70 mm, major base surface diameter = 60 mm, minor base surface diameter = 40 mm). Air bubble sizes and dose inhomogeneity were evaluated by reproducing 60Co radiograph of each sample (two orthogonal projections: 6 x 7 cm). The samples were cooled at a constant temperature, following three different modalities: high (25 degrees C), medium (5 degrees C), low (-20 degrees C) temperature. Owing to the small geometrical magnification, air bubble sizes were determined by measuring their surface on samples lateral projections, taking into account the sight detectable bubble edges. Up to 300 mm2 lateral surface bubbles are always present in all castings. Casting inhomogeneities can produce a film-density inhomogeneity ranging from 9% to 40%. The spatial distribution of bubbles seems to be random. Bubble recurrence is independent of both the metal alloy (repeatedly used castings) and the different block cooling modalities. The effect of air bubbles on the shielded areas dose inhomogeneity is generally of no relevant importance. However, these inhomogeneities can produce hot spots which must be taken into accurate consideration only in the particular treatments where critical small size organ dose sparing represents a basic issue (i.e. the shielding of eye lens).
Wilsterman, Marlon E. F.; de Jager, Pauline; Blokpoel, Robert; Frerichs, Inez; Dijkstra, Sandra K.; Albers, Marcel J. I. J.; Burgerhof, Johannes G. M.; Markhorst, Dick G.; Kneijber, Martin
Background: Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous
Full Text Available Neuroimaging studies have shown neuromuscular electrical stimulation (NMES-evoked movements activate regions of the cortical sensorimotor network, including the primary sensorimotor cortex (SMC, premotor cortex (PMC, supplementary motor area (SMA, and secondary somatosensory area (S2, as well as regions of the prefrontal cortex (PFC known to be involved in pain processing. The aim of this study, on nine healthy subjects, was to compare the cortical network activation profile and pain ratings during NMES of the right forearm wrist extensor muscles at increasing current intensities up to and slightly over the individual maximal tolerated intensity (MTI, and with reference to voluntary (VOL wrist extension movements. By exploiting the capability of the multi-channel time domain functional near-infrared spectroscopy technique to relate depth information to the photon time-of-flight, the cortical and superficial oxygenated (O2Hb and deoxygenated (HHb hemoglobin concentrations were estimated. The O2Hb and HHb maps obtained using the General Linear Model (NIRS-SPM analysis method, showed that the VOL and NMES-evoked movements significantly increased activation (i.e., increase in O2Hb and corresponding decrease in HHb in the cortical layer of the contralateral sensorimotor network (SMC, PMC/SMA, and S2. However, the level and area of contralateral sensorimotor network (including PFC activation was significantly greater for NMES than VOL. Furthermore, there was greater bilateral sensorimotor network activation with the high NMES current intensities which corresponded with increased pain ratings. In conclusion, our findings suggest that greater bilateral sensorimotor network activation profile with high NMES current intensities could be in part attributable to increased attentional/pain processing and to increased bilateral sensorimotor integration in these cortical regions.
Loo, Whitney; Maslyn, Jacqueline; Oh, Hee Jeung; Balsara, Nitash
Block copolymer electrolytes are promising for applications in lithium metal solid-state batteries. Due to their ability to microphase separate into distinct morphologies, their ion transport and mechanical properties can be decoupled. The addition of lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) salt to poly(styrene)-block-poly(ethylene oxide) (SEO) has been shown to increase microphase separation in symmetric block copolymer systems due to an increase in the effective interaction parameter (χeff) ; however the effect of block copolymer compositional asymmetry is not well-understood. The effect of compositional asymmetry on polymer morphology was investigated through small and wide angle X-ray scattering (SAXS/WAXS). The effective Flory-Huggins interaction parameter was extracted from the scattering profiles in order to construct a phase diagram to demonstrate the effect of salt and compositional asymmetry on block copolymer morphology.
Larkindale, Jane; Porter, John D
Although the neuromuscular field has seen accelerated approval of a drug for Duchenne muscular dystrophy (DMD) and full approval of one for spinal muscular atrophy, these experiences have shown that objective data and an adequate level of effect are essential for drug approval and reimbursement. The appropriateness and validity of biomarkers and clinically meaningful endpoints and an understanding of disease progression rates all played essential roles in the levels of evidence for these drugs. Such tools are best developed through integration of clinical data. The siloing of clinical data for rare neuromuscular diseases represents a considerable barrier to achieving better care and novel therapies for patients living with neuromuscular diseases. We discuss a data-sharing model implemented for DMD and urge cultural changes in the ways natural history and clinical trial data are collected and shared across all neuromuscular diseases in order to benefit the primary stakeholder, the patient. Muscle Nerve 57: 16-19, 2018. © 2017 Wiley Periodicals, Inc.
Rong, Wei; Tong, Kai Yu; Hu, Xiao Ling; Ho, Sze Kit
An electromyography-driven robot system integrated with neuromuscular electrical stimulation (NMES) was developed to investigate its effectiveness on post-stroke rehabilitation. The performance of this system in assisting finger flexion/extension with different assistance combinations was evaluated in five stroke subjects. Then, a pilot study with 20-sessions training was conducted to evaluate the training's effectiveness. The results showed that combined assistance from the NMES-robot could improve finger movement accuracy, encourage muscle activation of the finger muscles and suppress excessive muscular activities in the elbow joint. When assistances from both NMES and the robot were 50% of their maximum assistances, finger-tracking performance had the best results, with the lowest root mean square error, greater range of motion, higher voluntary muscle activations of the finger joints and lower muscle co-contraction in the finger and elbow joints. Upper limb function improved after the 20-session training, indicated by the increased clinical scores of Fugl-Meyer Assessment, Action Research Arm Test and Wolf Motor Function Test. Muscle co-contraction was reduced in the finger and elbow joints reflected by the Modified Ashworth Scale. The findings demonstrated that an electromyography-driven NMES-robot used for chronic stroke improved hand function and tracking performance. Further research is warranted to validate the method on a larger scale. Implications for Rehabilitation The hand robotics and neuromuscular electrical stimulation (NMES) techniques are still separate systems in current post-stroke hand rehabilitation. This is the first study to investigate the combined effects of the NMES and robot on hand rehabilitation. The finger tracking performance was improved with the combined assistance from the EMG-driven NMES-robot hand system. The assistance from the robot could improve the finger movement accuracy and the assistance from the NMES could reduce the
Shin, Soo-Young; Park, Soo-Hyun
In this paper, the Selective Multiple Acknowledgement (SMA) method, based on Multiple Acknowledgement (MA), is proposed to efficiently reduce the amount of data transmission by redesigning the transmission frame structure and taking into consideration underwater transmission characteristics. The method is suited to integrated underwater system models, as the proposed method can handle the same amount of data in a much more compact frame structure without any appreciable loss of reliability. Herein, the performance of the proposed SMA method was analyzed and compared to those of the conventional Automatic Repeat-reQuest (ARQ), Block Acknowledgement (BA), block response, and MA methods. The efficiency of the underwater sensor network, which forms a large cluster and mostly contains uplink data, is expected to be improved by the proposed method.
Full Text Available In this paper, the Selective Multiple Acknowledgement (SMA method, based on Multiple Acknowledgement (MA, is proposed to efficiently reduce the amount of data transmission by redesigning the transmission frame structure and taking into consideration underwater transmission characteristics. The method is suited to integrated underwater system models, as the proposed method can handle the same amount of data in a much more compact frame structure without any appreciable loss of reliability. Herein, the performance of the proposed SMA method was analyzed and compared to those of the conventional Automatic Repeat-reQuest (ARQ, Block Acknowledgement (BA, block response, and MA methods. The efficiency of the underwater sensor network, which forms a large cluster and mostly contains uplink data, is expected to be improved by the proposed method.
Distracted driving is a significant concern for novice teen drivers. Although cellular phone bans are applied in many jurisdictions to restrict cellular phone use, teen drivers often report making calls and texts while driving. Method The Minnesota Teen Driver Study incorporated cellular phone blocking functions via a software application for 182 novice teen drivers in two treatment conditions. The first condition included 92 teens who ran a driver support application on a smartphone that als...
von Stengel, S; Kemmler, W; Engelke, K; Kalender, W A
We examined whether the effect of multipurpose exercise can be enhanced by whole-body vibration (WBV). One hundred and fifty-one post-menopausal women (68.5 ± 3.1 years) were randomly assigned to three groups: (1) a training group (TG); (2) training including vibration (VTG); and (3) a wellness control group (CG). TG and VTG performed the same training program twice weekly (60 min), consisting of aerobic and strength exercises, with the only difference that leg strength exercises (15 min) were performed with (VTG) or without (TG) vibration. CG performed a low-intensity "wellness" program. At baseline and after 18 months, body composition was determined using dual-X-ray-absorptiometry. Maximum isometric strength was determined for the legs and the trunk region. Leg power was measured by countermovement jumps using a force-measuring plate. In the TG lean body mass, total body fat, and abdominal fat were favorably affected, but no additive effects were generated by the vibration stimulus. However, concerning muscle strength and power, there was a tendency in favor of the VTG. Only vibration training resulted in a significant increase of leg and trunk flexion strength compared with CG. In summary, WBV embedded in a multipurpose exercise program showed minor additive effects on body composition and neuromuscular performance. © 2010 John Wiley & Sons A/S.
Bazrgari, Babak; Hendershot, Brad; Muslim, Khoirul; Toosizadeh, Nima; Nussbaum, Maury A; Madigan, Michael L
Trunk flexion results in adverse mechanical effects on the spine and is associated with a higher incidence of low back pain. To examine the effects of creep deformation on trunk behaviours, participants were exposed to full trunk flexion in several combinations of exposure duration and external load. Trunk mechanical and neuromuscular behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness decreased with increasing flexion duration and in the presence of the external load. Recovery of intrinsic stiffness required more time than the exposure duration and was influenced by exposure duration. Reflexive trunk responses increased immediately following exposure but recovered quickly (∼2.5 min). Alterations in reflexive trunk behaviour following creep deformation exposures may not provide adequate compensation to allow for complete recovery of concurrent reductions in intrinsic stiffness, which may increase the risk of injury due to spinal instability. STATEMENT OF RELEVANCE: An increased risk of low back injury may result from flexion-induced disturbances to trunk behaviours. Such effects, however, appear to depend on the type of flexion exposure, and have implications for the design of work involving trunk flexion.
.... The neuromuscular junction (NMJ) is the site of a number of different autoimmune and genetic disorders, and it is also the target of many neurotoxins from venomous snakes, spiders, scorpions and other species...
Anton, D; Rosecrance, J C; Gerr, F; Merlino, L A; Cook, T M
Work-related musculoskeletal disorders (MSDs) are common among construction workers, such as masons. Few interventions are available to reduce masons' exposure to heavy lifting, a risk factor for MSDs. The purpose of this study was to determine whether one such intervention, the use of light-weight concrete blocks (LWBs), reduces physiological loads compared to standard-weight blocks (SWBs). Using a repeated measures design, 21 masons each constructed two 32-block walls, seven courses (rows) high, entirely of either SWBs or LWBs. Surface electromyography (EMG), from arm and back muscles, and heart rate was sampled. For certain muscles, EMG amplitudes were slightly lower when masons were laying LWBs compared to SWBs. Upper back and forearm extensor EMG amplitudes were greater for the higher wall courses for both block weights. There were no significant differences in heart rate between the two blocks. Interventions that address block weight and course height may be effective for masons.
Imani, Farnad; Hemati, Karim; Rahimzadeh, Poupak; Kazemi, Mohamad Reza; Hejazian, Kokab
Stellate Ganglion Block (SGB) is an effective technique which may be used to manage upper extremities pain due to Chronic Regional Pain Syndrome (CRPS), in this study we tried to evaluate the effectiveness of this procedure under two different guidance for management of this syndrome. The purpose of this study was to evaluate the effectiveness of ultrsound guide SGB by comparing it with the furoscopy guided SGB in upper extermities CRPS patients in reducing pain & dysfuction of the affected link. Fourteen patients with sympathetic CRPS in upper extremities in a randomized method with block randomization divided in two equal groups (with ultrasound or fluoroscopic guidance). First group was blocked under fluoroscopic guidance and second group blocked under ultrasound guidance. After correct positioning of the needle, a mixture of 5 ml bupivacaine 0.25% and 1 mL of triamcinolone was injected. These data represent no meaningful statistical difference between the two groups in terms of the number of pain attacks before the blocks, a borderline correlation between two groups one week and one month after the block and a significant statistical correlation between two groups three month after the block. These data represent no meaningful statistical difference between the patients of any group in terms of the pain intensity (from one week to six months after block), p-value = 0.61. These data represent a meaningful statistical difference among patients of any group and between the two groups in terms of the pain intensity (before the block until six months after block), p-values were 0.001, 0.031 respectively. According the above mentioned data, in comparison with fluoroscopic guidance, stellate ganglion block under ultrasound guidance is a safe and effective method with lower complication and better improvement in patient's disability indexes.
Medici, Roar; Madsen, Matias V; Asadzadeh, Sami
's rating of surgical conditions during suturing, duration of surgery and duration of the suturing of the hernia. CONCLUSION: This randomised cross-over study investigated a potential effect on the surgical workspace in laparoscopic ventral herniotomy using deep NMB compared with no NMB. The study may......INTRODUCTION: Laparoscopic herniotomy is the preferred technique for some ventral hernias. Several factors may influence the surgical conditions, one being the depth of neuromuscular blockade (NMB) applied. We hypothesised that deep neuromuscular blockade defined as a post-tetanic count below eight...... would provide a better surgical workspace. METHODS: This was an investigator-initiated, assessor- and patient-blinded randomised cross-over study. A total of 34 patients with planned laparoscopic umbilical, incisional and linea alba herniotomy were studied. Patients would be randomised to receive deep...
Medici, Roar; Madsen, Matias V; Asadzadeh, Sami
INTRODUCTION: Laparoscopic herniotomy is the preferred technique for some ventral hernias. Several factors may influence the surgical conditions, one being the depth of neuromuscular blockade (NMB) applied. We hypothesised that deep neuromuscular blockade defined as a post-tetanic count below eight......'s rating of surgical conditions during suturing, duration of surgery and duration of the suturing of the hernia. CONCLUSION: This randomised cross-over study investigated a potential effect on the surgical workspace in laparoscopic ventral herniotomy using deep NMB compared with no NMB. The study may...... provide knowledge relevant to other laparoscopic techniques. FUNDING: The study is funded by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. TRIAL REGISTRATION: NCT02247466....
de Paula Oliveira, Lucas; Palucci Vieira, Luiz Henrique; Aquino, Rodrigo; Vieira Manechini, João Paulo; Pereira Santiago, Paulo Roberto; Puggina, Enrico Fuini
The aim of the present study was to compare the acute effects of active (AC), ballistic (BA), passive (PA), proprioceptive neuromuscular facilitation stretching (PNF) methods on performance in vertical jumping, sit and reach, and sprinting in young soccer players. Twelve trained soccer players (17.67 ± 0.87 years) participated in the study. The jump height (H), peak power (PP), and relative power (RP) in the squat jump (SJ) and countermovement jump (CMJ), the range of motion (ROM), the rate of perceived exertion (RPE), and time (s) in 10-20-30 m sprints were evaluated. Significant differences (p PNF with CO and BA, and in the PP between the PNF and CO, AC, and BA, as well as in the RP between the PNF and BA. Significant increases in ROM were found in the AC, BA, PA, and PNF, compared to the CO. In relation to RPE, higher scores were reported in the PA and PNF conditions compared to the AC and BA. No significant differences were found in 10-20-30 m sprints. Therefore, the AC and BA methods can be used prior to vertical jump and sprint activities, with the aim of increasing flexibility. However, the PA and PNF methods should be avoided, due to subsequent negative effects on vertical jump performance.
Edgerton, V. R.; Roy, R. R.
The chronic "unloading" of the neuromuscular system during spaceflight has detrimental functional and morphological effects. Changes in the metabolic and mechanical properties of the musculature can be attributed largely to the loss of muscle protein and the alteration in the relative proportion of the proteins in skeletal muscle, particularly in the muscles that have an antigravity function under normal loading conditions. These adaptations could result in decrements in the performance of routine or specialized motor tasks, both of which may be critical for survival in an altered gravitational field, i.e., during spaceflight and during return to 1 G. For example, the loss in extensor muscle mass requires a higher percentage of recruitment of the motor pools for any specific motor task. Thus, a faster rate of fatigue will occur in the activated muscles. These consequences emphasize the importance of developing techniques for minimizing muscle loss during spaceflight, at least in preparation for the return to 1 G after spaceflight. New insights into the complexity and the interactive elements that contribute to the neuromuscular adaptations to space have been gained from studies of the role of exercise and/or growth factors as countermeasures of atrophy. The present chapter illustrates the inevitable interactive effects of neural and muscular systems in adapting to space. It also describes the considerable progress that has been made toward the goal of minimizing the functional impact of the stimuli that induce the neuromuscular adaptations to space.
Full Text Available Efforts to improve the quality of in vitro matured oocytes by blocking germinal vesicle breakdown (GVBD and allowing more time for ooplasmic maturation have achieved little due to a lack of knowledge on the molecular events during GVBD blocking. Such knowledge is also important for studies aimed at regulating gene expression in maturing oocytes prior to GVBD. We studied species difference and signaling pathways leading to the carrying-over effect of GVBD blocking on post-blocking meiotic progression (PBMP. Overall, GVBD-blocking with roscovitine decelerated PBMP of mouse oocytes but accelerated that of pig oocytes. During blocking culture, whereas cyclin B of pig oocytes increased continuously, that of mouse oocytes declined first and then increased slowly. In both species, (a whereas active CDC2A showed a dynamics similar to cyclin B, inactive CDC2A decreased continuously; (b when oocytes were blocked in blocking medium containing cycloheximide, PBMP was decelerated significantly while cyclin B and active CDC2A decreasing to the lowest level; (c whereas sodium vanadate in blocking medium reduced PBMP, epidermal growth factor (EGF in blocking medium accelerated PBMP significantly with no effect on cyclin B levels. In conclusion, the EGF signaling cascade accelerated PBMP by promoting the pre-MPF (M-phase-promoting factor to MPF conversion during GVBD blocking with roscovitine. The significant difference in PBMP observed between mouse and pig oocytes was caused by species difference in cyclin B dynamics during blocking culture as no species difference was observed in either pre-MPF to MPF conversion or the EGF signaling activity.
Shen, Kuan-Hsuan; Hall, Lisa
It is well known that block copolymers can microphase separate into ordered structures such as lamellae, hexagonally packed cylinders, or the bicontinuous double gyroid phase. Understanding the dynamics of the chains themselves and of added selective small molecule penetrants is relevant to the design of polymeric systems for transport applications. We expect that chain and penetrant dynamics are strongly dependent on morphology, while chain dynamics are also significantly impacted by individual polymer conformations within the morphology. For instance, in prior work on tapered polymers with a midblock of various concentration profiles, chains that fold back and forth across the lamellar interface were shown to have significantly decreased diffusion. Here we use coarse-grained molecular dynamics simulations to study how chain and penetrant dynamics depend on domain spacing, polymer conformations, and microphase morphology. We initialize systems of various fractions of A monomers in lamellar, cylinder, or gyroid microphases by growing polymers in a constrained random walk such that the two blocks are placed on opposite sides of the interface. We include, for comparison, systems with the same fraction of A that are initialized (and kinetically trapped) in different microphases, and show how this impacts polymer relaxation. How the dependence of penetrant diffusion on morphology relates to that of polymer chains will also be discussed. This material is based upon work supported by the National Science Foundation under Grant 1454343.
Sáez, Aurora; Acha, Begoña; Montero-Sánchez, Adoración; Rivas, Eloy; Escudero, Luis M.; Serrano, Carmen
Diagnosis of neuromuscular diseases is based on subjective visual assessment of biopsies from patients by the pathologist specialist. A system for objective analysis and classification of muscular dystrophies and neurogenic atrophies through muscle biopsy images of fluorescence microscopy is presented. The procedure starts with an accurate segmentation of the muscle fibers using mathematical morphology and a watershed transform. A feature extraction step is carried out in two parts: 24 features that pathologists take into account to diagnose the diseases and 58 structural features that the human eye cannot see, based on the assumption that the biopsy is considered as a graph, where the nodes are represented by each fiber, and two nodes are connected if two fibers are adjacent. A feature selection using sequential forward selection and sequential backward selection methods, a classification using a Fuzzy ARTMAP neural network, and a study of grading the severity are performed on these two sets of features. A database consisting of 91 images was used: 71 images for the training step and 20 as the test. A classification error of 0% was obtained. It is concluded that the addition of features undetectable by the human visual inspection improves the categorization of atrophic patterns.
Si, Zhihua; Hu, Ke; Wang, Congcong; Jia, Likun; Zhang, Xiuqing; Wang, Aihua
This study was to investigate the effect of proprioceptive neuromuscular facilitation techniques (NFT) on osteoporosis and serum leptin level in cerebral infarction patients or rats. Forty cerebral infarction rats were randomly grouped into control, sham operation, conventional treatment (CT) group and CT+NFT group. Fifty-two stroke patients with hemiplegia were included in this study. The bone mineral densities (BMD) of proximal hemiplegia limbs and serum ALP, BALP, BGP, IL-6 and leptin levels were detected using commercial kits. In cerebral infarction rats, the BMD, BGP, BALP, ALP and leptin concentrations in the CT+NFT group was higher compared with the control and CT group, while serum IL-6 level was more reduced by CT+NFT than control and CT. In cerebral infarction patients, both CT and CT+NFT increased the BMD, ALP, BGP and leptin levels. In addition, compared with CT, the BMD, ALP, BGP and leptin levels were markedly increased by CT+NFT. C Conclusion: NFC elevated the BMD of hemiplegia limbs, serum ALP, BGP, IL-6 and leptin levels and, thus, alleviated osteoporosis in rats and patients with cerebral infarction.
Yıldırım, M S; Ozyurek, S; Tosun, Oç; Uzer, S; Gelecek, N
The aim of this study was to compare the effects of static stretching, proprioceptive neuromuscular facilitation (PNF) stretching and Mulligan technique on hip flexion range of motion (ROM) in subjects with bilateral hamstring tightness. A total of 40 students (mean age: 21.5±1.3 years, mean body height: 172.8±8.2 cm, mean body mass index: 21.9±3.0 kg · m(-2)) with bilateral hamstring tightness were enrolled in this randomized trial, of whom 26 completed the study. Subjects were divided into 4 groups performing (I) typical static stretching, (II) PNF stretching, (III) Mulligan traction straight leg raise (TSLR) technique, (IV) no intervention. Hip flexion ROM was measured using a digital goniometer with the passive straight leg raise test before and after 4 weeks by two physiotherapists blinded to the groups. 52 extremities of 26 subjects were analyzed. Hip flexion ROM increased in all three intervention groups (pstatic stretching (p=0.016 and p=0.02, respectively). No significant difference was found between Mulligan TSLR technique and PNF stretching (p=0.920). The initial-final assessment difference of hip flexion ROM was similar in typical static stretching and no intervention (p=0.491). A 4-week stretching intervention is beneficial for increasing hip flexion ROM in bilateral hamstring tightness. However, PNF stretching and Mulligan TSLR technique are superior to typical static stretching. These two interventions can be alternatively used for stretching in hamstring tightness.
Camerota, Filippo; Galli, Manuela; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio
Objective: In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type (JHS/EDS-HT). Methods: A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). Results: At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Conclusions: Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms. PMID:25649985
Kim, So Yeon; Kim, Jin Hyun; Jung, Gil Su; Baek, Seung Ok; Jones, Rodney; Ahn, Sang Ho
[Purpose] To investigate the effectiveness of three different neuromuscular electrical stimulation (NMES) protocols for the deep lumbar stabilizing muscles of patients with lumbar degenerative kyphosis (LDK). [Subjects and Methods] Twenty patients with LDK were recruited. Three stimulation protocols were investigated: stimulation of the abdominal muscles (protocol A); stimulation of the lumbar muscles (protocol B); and simultaneous stimulation of the abdominal and lumbar muscles (protocol A+B). Images of the obliquus externus (OE), obliquus internus (OI), transversus abdominis (TrA), and lumbar multifidus (LM) muscles were captured by real-time ultrasound imaging (RUSI). [Results] The thickness of LM was significantly greater during stimulation than at rest for all three protocols. Thicknesses of the abdominal muscles (TrA, OI, and OE) were significantly greater during stimulation than at rest for protocols A and A+B. Thickness increases in LM were significantly greater during protocols B and A+B, but not during protocol A. Thickness increases in the abdominal muscles (TrA, OI, and OE) were significantly greater during protocols A and A+B, but not during protocol B. [Conclusion] NMES can significantly activate the deep lumbar stabilizing muscles of patients with LDK. Protocol A+B of NMES is recommended to aid postural correction and low back pain (LBP) in patients with LDK.
Young, Kim Jin; Je, Choi Won; Hwa, Seo Tae
[Purpose] The purpose of this study was to determine the effects of proprioceptive neuromuscular facilitation integration pattern (PIP) and Swiss ball training on balance and pain in elderly patients with chronic low back pain. [Subjects] Participants were randomly assigned to a PIP training (n=24) and a Swiss ball training group (n=24). [Methods] The training was performed for 30 minutes per day, three times a week for 6 weeks. Outcome measures included the mean velocity in the X and Y directions using the Good Balance System(®), functional reach test, timed up and go test, and visual analogue scale. [Results] After completion of training, mean velocity in the X and Y direction, and the functional reach test, timed up and go test, and visual analogue scale results showed statistically significant improvements in the PIP and Swiss ball training groups. However, there was no significant difference in the functional reach test, timed up and go test, and visual analogue scale results between the two groups. [Conclusion] This study indicated that PIP training improved the balance ability of elderly patients with chronic low back pain.
Petersen, Pernille Lykke; Mathiesen, Ole; Stjernholm, Pia
was evaluated versus placebo and versus an active comparator (ilioinguinal block and wound infiltration). DESIGN: Randomised controlled trial. SETTING: Single centre trial. Study period from June 2010 to November 2011. PATIENTS: Adults (18 to 75 years) with American Society of Anesthesiologists' status 1......CONTEXT: The analgesic effect of transversus abdominis plane (TAP) block after inguinal hernia repair is unclear. OBJECTIVE: The aim of this randomised and double-blind study was to evaluate the analgesic effect of a TAP block in patients scheduled for primary inguinal hernia repair. The TAP block......-3 scheduled for primary inguinal hernia repair as day case surgery were included in the study. INTERVENTIONS: Ninety patients were allocated to one of three groups: group TAP, group infiltration (ilioinguinal nerve block and wound infiltration) and group placebo. MAIN OUTCOME MEASURES: The primary outcome...
Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses
Sugimoto, Dai; Myer, Gregory D.; McKeon, Jennifer M.; Hewett, Timothy E.
Since previous numbers-needed-to-treat (NNT) and relative risk reduction (RRR) report, a few studies were published to evaluate prophylactic effectiveness of neuromuscular training for anterior cruciate ligament (ACL) injury in female athletes. The purpose of the current analyses was to determine the effectiveness of neuromuscular training interventions in reducing both non-contact and overall ACL injury risk in female athletes through RRR and NNT. The keywords ‘knee’, ‘anterior cruciate ligament’, ‘ACL’, ‘prospective’, ‘neuromuscular’, ‘training’, ‘female’ and ‘prevention’ were searched to find studies published from 1995 to 2011 in PubMed and EBSCO (CINAHL, Health source, MEDLINE and SPORT Discus). Inclusion criteria required that relevant studies: recruited physically active young girls as subjects, documented the number of ACL injuries, employed a neuromuscular training intervention, and used a prospective controlled study design. The numbers of non-contact and overall ACL injuries, subjects and observation time period were used to calculate RRR and NNT for each study. A total of 12 studies met the inclusion criteria. There was a 73.4% (95% CI 62.5% to 81.1%) and 43.8% (95% CI 28.9% to 55.5%) of RRR for non-contact and overall ACL injuries. From the NNT analysis, it was determined that, respectively, 108 (95% CI 86 to 150) and 120 (95% CI 74 to 316) individuals would need to be trained to prevent one non-contact or one overall ACL injury over the course of one competitive season. Although the RRR analysis indicated prophylactic benefits of neuromuscular training, the relatively large NNT indicated that many athletes are needed to prevent one ACL injury. A future direction to reduce NNT and improve the efficiency of ACL injury-prevention strategies is to develop a screening system for identifying at-risk athletes. PMID:22745221
Forrester, S E; Allen, S J; Presswood, R G; Toy, A C; Pain, M T G
This study aimed to measure neuromuscular function for the masticatory muscles under a range of occlusal conditions in healthy, dentate adults. Forty-one subjects conducted maximum voluntary clenches under nine different occlusal loading conditions encompassing bilateral posterior teeth contacts with the mandible in different positions, anterior teeth contacts and unilateral posterior teeth contacts. Surface electromyography was recorded bilaterally from the anterior temporalis, superficial masseter, sternocleidomastoid, anterior digastric and trapezius muscles. Clench condition had a significant effect on muscle function (P = 0.0000) with the maximum function obtained for occlusions with bilateral posterior contacts and the mandible in a stable centric position. The remaining contact points and moving the mandible to a protruded position, whilst keeping posterior contacts, resulted in significantly lower muscle activities. Clench condition also had a significant effect on the per cent overlap, anterior-posterior and torque coefficients (P = 0.0000-0.0024), which describe the degree of symmetry in these muscle activities. Bilateral posterior contact conditions had significantly greater symmetry in muscle activities than anterior contact conditions. Activity in the sternocleidomastoid, anterior digastric and trapezius was consistently low for all clench conditions, i.e. centric position, whilst with anterior teeth contacts, both the muscle activity and the degree of symmetry in muscle activity are significantly reduced.
Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial
Full Text Available Abstract Background Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP, given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm and LED (= 660 nm irradiation in CP patients. Methods/design 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. Discussion This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS Descriptors Cerebral Palsy
Zhang, Zheng; Lai, Yuxiao; Yu, Lin; Ding, Jiandong
This paper examines the effects of immobilizing sites of a bioactive ligand on its biological efficacy in a self assembly biomaterial. We synthesized an amphiphilic block copolymer PCLA-PEG-PCLA (PCLA: poly(epsilon-caprolactone-co-lactide), PEG: poly(ethylene glycol)), and then achieved immobilization of arginine-glycine-aspartate (RGD) peptides into either hydrophobic PCLA blocks or hydrophilic PEG blocks. The block copolymers could self assemble into hydrogels composed of percolated micelle network in water, and the sol-gel transition temperature was adjusted between room and body temperatures. In vitro examinations of chondrocyte viability were performed. We found that immobilization of RGD in hydrophilic blocks enhanced cell adhesion on the corresponding hydrogel surface much more significantly than that in hydrophobic blocks. The difference might come from that RGD ligands in hydrophilic blocks are exposed on the micellar surface in water more than those in hydrophobic blocks. The present research highlights the importance of the immobilizing sites of RGD peptides in amphiphilic polymers on the eventual cell-binding efficacy, and is thus meaningful for guiding the molecular design of bioactive materials. Copyright 2010 Elsevier Ltd. All rights reserved.
Wu, Jia-Xuan; Fan, Ru-Jun; Song, Wen-Xue; Chen, Ping
To observe the therapeutic effect of cervical paravertebral block plus acupuncture treatment for cervicogenic headache. Sixty cases of cervicogenic headache were randomly and equally divided into cervical paravertebral block (control) group and acupuncture plus cervical paravertebral block (acupuncture) group. Paravertebral block was performed by injection of 5 mL of 0.3% lidocaine solution containing triamcinolone (10 mg) into the 2nd cervical paravertebral tissue from the cross point between the posterior border of the sternomastoid muscle and the angle of jaw, once every week for three weeks. Manual acupuncture stimulation was applied to Baihui (GV 20), unilateral Fengchi (GB 20) and Jiaosun (SJ 20), once daily for 3 weeks. The patients' headache severity was assessed by visual analogue scale (VAS) and their cervical vertebral activity assessed by range of motion (ROM) before and after the treatment. Compared with pre-treatment in the same one group, the scores of both VAS and ROM at time points of one, two and three weeks after the treatment were significantly decreased in the control and acupuncture groups (P block for cervicogenic headache. Acupuncture combined with cervical paravertebral block is effective in relieving cervicogenic headache and improving cervical vertebral activity in cervicogenic headache patients, and can strengthen the therapeutic effect of simple paravertebral block.
Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan
The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1–54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55–114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491
Sillen, Maurice J H; Speksnijder, Caroline M; Eterman, Rose-Miek A; Janssen, Paul P; Wagers, Scott S; Wouters, Emiel F M; Uszko-Lencer, Nicole H M K; Spruit, Martijn A
Despite optimal drug treatment, many patients with congestive heart failure (CHF) or COPD still experience disabling dyspnea, fatigue, and exercise intolerance. They also exhibit significant changes in body composition. Attempts to rehabilitate these patients are often futile because conventional exercise-training modalities are limited by the severity of exertional dyspnea. Therefore, there is substantial interest in new training modalities that do not evoke dyspnea, such as transcutaneous neuromuscular electrical stimulation (NMES). In this article, we systematically review the literature that addresses the effects of NMES applied to the muscles of ambulation. We focused on the effects of NMES on strength, exercise capacity, and disease-specific health status in patients with CHF or COPD. We also address the methodological quality of the reported studies as well as the safety of NMES. Manuscripts published prior to December 2007 were identified by searching the Medline/PubMed, Embase, Cochrane Controlled Trials Register, CINAHL, and Physiotherapy Evidence Database (PEDro) databases. Fourteen trials were identified (nine trials that examined NMES in CHF patients, and five in COPD patients). PEDro scores for methodological quality of the trials were generally moderate to good. Many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. Nonetheless, the limited number of studies, the disparity in patient populations, and the variability in NMES methodology prohibit the use of metaanalysis. Yet, from the viewpoint of a systematic review, NMES looks promising as a means of rehabilitating patients with CHF and COPD. There is at least sufficient evidence to warrant more large prospective, randomized, controlled trials.
Smith, Brent I; Docherty, Carrie L; Curtis, Denice
Deficits in ankle and hip strength and lower extremity postural control are associated with chronic ankle instability (CAI). Following strength training, muscle groups demonstrate increased strength. This change is partially credited to improved neuromuscular control and many studies have investigated ankle protocols for subjects with CAI. The effects of isolating hip musculature in strength training protocols in this population is not well understood. Examine the effects of hip strengthening on clinical and self-reported outcomes in patients with CAI. Prospective randomized controlled clinical trial. Athletic Training facility. Twenty-six participants with CAI (12 males and 14 females, 20.9±1.5 years, 170.0±12.7 cm, 77.5±17.5 kg) were randomly assigned to training or control groups. The participants completed either four weeks of supervised hip strengthening (resistance bands 3x/week) or no intervention. Participants were assessed on four clinical measures (Star Excursion Balance Test (SEBT) in the anterior, posteromedial and posterolateral directions, Balance Error Scoring System (BESS), hip external rotation strength, hip abduction strength) and a patient reported measure (the Foot and Ankle Ability Measure (FAAM) activities of daily living and sports subscales) before and after the four-week training period. The training group displayed significantly improved post-test measures compared with the control group for: hip abduction strength (training 446.3±77.4 N, control 314.7±49.6 N, p control 169.4±34.6 N, p control 90.2±7.9%, p control 88.0±8.8 %, p control 86.6±9.6%, p control 21.2±6.3 errors, p control 84.8±10.9, p <.01). Improved clinical and patient-reported outcomes in the training group suggest hip strengthening is beneficial in the management and prevention of recurrent symptoms associated with CAI.
Igor de Barcellos Zanon
Full Text Available Objective : Compare the interlaminar blocking technique with the transforaminal blocking, with regard to pain and the presence or absence of complications. Methods : Prospective, descriptive and comparative, double-blind, randomized study, with 40 patients of both sex suffering from sciatic pain due to central-lateral or foraminal disc herniation, who did not respond to 20 physiotherapy sessions and had no instability diagnosed on examination of dynamic radiography. The type of blocking, transforaminal or interlaminar, to be performed was determined by draw. Results : We evaluated 40 patients, 17 males, mean age 49 years, average VAS pre-blocking of 8.85, average values in transforaminal technique in 24 hours, 7, 21, and 90 days of 0.71, 1.04, 2.33 and 3.84, respectively; the average VAS post-blocking for interlaminar technique was 0.89, 1.52, 3.63 and 4.88. The techniques differ only in the post-blocking period of 21 days and overall post-blocking, with significance of p=0.022 and p=0.027, respectively. Conclusion : Both techniques are effective in relieving pain and present low complication rate, and the transforaminal technique proved to be the most effective.
Tawfik, Eman A; Walker, Francis O; Cartwright, Michael S
Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.
Objetivo: apresentar os dados essenciais para o diagnóstico diferencial entre as principais doenças neuromusculares, denominação genérica sob a qual agrupam-se diferentes afecções, decorrentes do acometimento primário da unidade motora (motoneurônio medular, raiz nervosa, nervo periférico, junção mioneural e músculo). Fontes dos dados: os aspectos clínicos fundamentais para estabelecer o diagnóstico diferencial entre as diferentes doenças neuromusculares, bem como entre estas e as causas de h...
Neuromuscular diseases are inherited, chronic, degenerative and progressive. The main characteristics of neuromuscular diseases are: muscular weakness, contractures, scoliosis, respiratory insufficiency, cardiac affection, nutrition disturbances, dependence on the help of others, possible social isolation and physiological problems. Appropriate rehabilitation programs should influence all mentioned characteristics. A special unit for rehabilitation of patients with neuromuscular diseases with...
Holsgaard-Larsen, A; Clausen, B; Søndergaard, J; Christensen, R; Andriacchi, T P; Roos, E M
To investigate the effect of a neuro-muscular exercise (NEMEX) therapy program compared with instructions in optimized analgesics and anti-inflammatory drug use (PHARMA), on measures of knee-joint load in people with mild to moderate knee osteoarthritis (OA). We hypothesized that knee joint loading during walking would be reduced by NEMEX and potentially increased by PHARMA. Single-blind, randomized controlled trial (RCT) comparing NEMEX therapy twice a week with PHARMA. Participants with mild-to-moderate medial tibiofemoral knee OA were randomly allocated (1:1) to one of two 8-week treatments. Primary outcome was change in knee load during walking (Knee Index, a composite score from all three planes based on 3D movement analysis) after 8 weeks of intervention. Secondary outcomes were frontal plane peak knee adduction moment (KAM), Knee Injury and Osteoarthritis Outcome Scores (KOOS) and functional performance tests. Ninety three participants (57% women, 58 ± 8 years with a body mass index [BMI] of 27 ± 4 kg/m2 (mean ± standard deviation [SD])) were randomized to NEMEX group (n = 47) or PHARMA (n = 46); data from 44 (94%) and 41 (89%) participants respectively, were available at follow-up. 49% of the participants in NEMEX and only 7% in PHARMA demonstrated good compliance. We found no difference in the primary outcome as evaluated by the Knee Index -0.07 [-0.17; 0.04] Nm/%BW HT. Secondary outcomes largely supported this finding. We found no difference in the primary outcome; knee joint load change during walking from a NEMEX program vs information on the recommended use of analgesics and anti-inflammatory drugs. ClinicalTrials.gov Identifier: NCT01638962 (July 3, 2012). Ethical Committee: S-20110153. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
Akbulut, Taner; Agopyan, Ani
The aim of this study was to determine the effect of the 8-week proprioceptive neuromuscular facilitation (PNF) exercises that were carried out on lower extremity on kicking speed and range of motion (ROM) performance in young soccer players. Twenty-four soccer players (15.6 ± 0.4 years) were selected from nonprofessional young soccer team. All players' height, weight, ROM (ankle plantar and dorsal flexions, hip flexions and extensions), and kicking speed tests were evaluated before and after 8 weeks. The participants were divided into PNF (n = 11) and control (n = 11) groups. Both groups continued technical and tactical soccer training together 3 days (120 min·d) a week. The PNF group attended additionally unassisted PNF-contract-relax (CR) stretching through 8 weeks, 2 days per week, 20 minutes' session duration. The control group did not participate in any additional PNF stretching sessions. There were significant differences in kicking speed, right ankle active dorsal flexion, and hip active flexion (right and left) (p ≤ 0.05) of the PNF group, whereas there were no significant differences between groups in left ankle active dorsal flexion, hip active extension (right and left), and ankle active plantar flexion (right and left) (p > 0.05). We conclude that an 8-week unassisted PNF-CR improved on the ROM of particular lower extremity joints and the kicking speed in the young male soccer players. These results provide strength and conditioning coaches with a practical way to use unassisted PNF-CR in warm-up for positive improvements in the ROM of the hip and ankle and the applications of the kicking speed.
Lilian Chrystiane Giannasi
Full Text Available Cerebral palsy (CP is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea. Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG and polysomnography (PSG, respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE. EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05; mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03. A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05; total sleep time improved from 185 min to 250 min (p = 0.04 and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04. NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP. Trial registration: ReBEC RBR994XFS http://www.ensaiosclinicos.gov.br.
Magnussen, Robert A.; Pottkotter, Kristy; DiStasi, Stephanie; PATERNO, MARK V.; Wordeman, Samuel Clayton; Schmitt, Laura; Flanigan, David C.; Kaeding, Christopher C.; Hewett, Timothy E.
Objectives: Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous high level studies have assessed the efficacy of FNB?s, there has been little to no research into the effect of such blocks on post-operative strength and patient-reported outcomes. Exacerbation of post-operative quadriceps weakness by a FNB could negatively impact recovery, particularly in the early post-operative period. We hypothesized that p...
Petersen, Pernille Lykke; Stjernholm, Pia; Kristiansen, Viggo B
Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesi...... hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery....
Haapala, Eero A; Väistö, Juuso; Lintu, Niina; Tompuri, Tuomo; Brage, Soren; Westgate, Kate; Ekelund, Ulf; Lampinen, Eeva-Kaarina; Sääkslahti, Arja; Lindi, Virpi; Lakka, Timo A
We investigated the associations of body fat percentage (BF%), objectively assessed moderate-to-vigorous physical activity (MVPA) and different types of physical activity assessed by a questionnaire with neuromuscular performance. The participants were 404 children aged 6-8 years. BF% was assessed using dual-energy x-ray absorptiometry and physical activity by combined heart rate and movement sensing and a questionnaire. The results of 50-m shuttle run, 15-m sprint run, hand grip strength, standing long jump, sit-up, modified flamingo balance, box-and-block and sit-and-reach tests were used as measures of neuromuscular performance. Children who had a combination of higher BF% and lower levels of physical activity had the poorest performance in 50-m shuttle run, 15-m sprint run and standing long jump tests. Higher BF% was associated with slower 50-m shuttle run and 15-m sprint times, shorter distance jumped in standing long jump test, fewer sit-ups, more errors in balance test and less cubes moved in box-and-block test. Higher levels of physical activity and particularly MVPA assessed objectively by combined accelerometer and heart rate monitor were related to shorter 50-m shuttle run and 15-m sprint times. In conclusion, higher BF% and lower levels of physical activity and particularly the combination of these two factors were associated with worse neuromuscular performance.
Kopman, A F; Lien, C A; Naguib, M
Investigators planning dose-response studies of neuromuscular blockers have rarely used a priori power analysis to determine the minimal sample size their protocols require. Institutional Review Boards and peer-reviewed journals now generally ask for this information. This study outlines a proposed method for meeting these requirements. The slopes of the dose-response relationships of eight neuromuscular blocking agents were determined using regression analysis. These values were substituted for γ in the Hill equation. When this is done, the coefficient of variation (COV) around the mean value of the ED₅₀ for each drug is easily calculated. Using these values, we performed an a priori one-sample two-tailed t-test of the means to determine the required sample size when the allowable error in the ED₅₀ was varied from ±10-20%. The COV averaged 22% (range 15-27%). We used a COV value of 25% in determining the sample size. If the allowable error in finding the mean ED₅₀ is ±15%, a sample size of 24 is needed to achieve a power of 80%. Increasing 'accuracy' beyond this point requires increasing greater sample sizes (e.g. an 'n' of 37 for a ±12% error). On the basis of the results of this retrospective analysis, a total sample size of not less than 24 subjects should be adequate for determining a neuromuscular blocking drug's clinical potency with a reasonable degree of assurance.
Pillen, S.; Arts, I.M.P.; Zwarts, M.J.
Muscle ultrasound is a useful tool in the diagnosis of neuromuscular disorders, as these disorders result in muscle atrophy and intramuscular fibrosis and fatty infiltration, which can be visualized with ultrasound. Several prospective studies have reported high sensitivities and specificities in
de Visser, Marianne; Oliver, David J.
Purpose of review Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness. Neuromuscular disorders (NMDs) are characterized by progressive muscle weakness, leading to pronounced and incapacitating
Andries, F.; Wevers, C. W.; Wintzen, A. R.; Busch, H. F.; Höweler, C. J.; de Jager, A. E.; Padberg, G. W.; de Visser, M.; Wokke, J. H.
The present study analyses the actual occupational situation, vocational handicaps and past labour career of a group of about 1000 Dutch patients suffering from a neuromuscular disorder (NMD). On the basis of the likelihood of a substantial employment history and sufficient numbers of patients, four
Chen, Yong-quan; Hu, Guang-xiang; Fu, Qun; Jin, Xiao-ju
To investigate the effects of stellate ganglion block (SGB) on blood pressure in spontaneously hypertensive rats(SHRs). Thirty-two 10-week-old male spontaneously hypertensive rats(SHRs) were assigned randomly into four groups: left stellate ganglion block group(Group LS), right stellate ganglion block group(Group RS), captopril group(Group D) and control group(Group C). Arterial systolic blood pressure(SBP) was measured, and endothelin (ET-1) and endothelial nitric oxide synthase(eNOS) in blood vessels were detected by radioimmunoassay. Compared with baseline value, the blood pressure of Group LS gradually increased significantly (P0.05) and increased only at week 2(P block can significantly lower blood pressure, down-regulate ET-1 and up-regulate eNOS protein expression.
Mølgaard, Carsten; Kersting, Uwe G.
design/type on the effectiveness of lateral wedging has not been investigated so far. The Purpose of the present study was to explore alterations in knee loading due to lateral foot wedges in three different shoes. Methods: Thirteen healthy participants with no history of knee pain were tested using...... wedging is effective regardless of shoe design. Differences between the three neutral walking conditions underline the importance of footwear choice in individuals. It is safe to apply lateral wedges without jeopardising muscular control during walking regardless of shoe type. Possible effects of altering...... three-dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analysed. The shoes were tested both with and without a 10-degree full-length laterally wedged insole. Results: There were significant shoe wedge interactions on the first...
Full Text Available Background: Diabetic Mellitus is a group of metabolic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Distal Sensorimotor Polyneuropathy is the most common complication of diabetes which mainly affects the lower limbs. Most of the studies aimed at individually increasing muscle strength or sensation but not on overall performance enhancements of the diabetic lower limbs. The evidence supporting the effectiveness of PNF in diabetic neuropathic patients is scarce. Methods: 30 patients, with age between 50 to 70 years, diagnosed with Diabetic Sensorimotor Polyneuropathy (DSP were selected from the department of Medicine and department of Neurosurgery Guru Gobind Singh Medical College and Hospital. Patients were evaluated at the beginning and at the end of the intervention using Diabetic Neuropathy Examination scores. Patients received 3 sets of exercises one hour/day with 3 days/week for 3 months. Each set of exercises consists of 5 repetitions of PNF patterns (alternate day and techniques. Results: D1 & D2 patterns of PNF are effective in improving both motor and sensory functions of diabetic patients with neuropathic symptoms. Improvement in muscle strength, reflex and sensations occurred to a greater extent after the treatment of three months in these subjects. This study shows that PNF patterns were effective at enhancing sensorimotor problems of lower limbs. Conclusion: This study concluded that PNF is found to be effective in improving sensorimotor functions of diabetic neuropathic patients affecting lower limbs.
IJmker, T.; Lamoth, C. J.; Houdijk, H.; Tolsma, M.; van der Woude, L. H. V.; Daffertshofer, A.; Beek, P. J.
Background: Holding a handrail or using a cane may decrease the energy cost of walking in stroke survivors. However, the factors underlying this decrease have not yet been previously identified. The purpose of the current study was to fill this void by investigating the effect of physical support
IJmker, T.; Lamoth, C.J.C.; Houdijk, J.H.P.; Tolsma, M.; der Woude, van L.H.V.; Daffertshofer, A.; Beek, P.J.
BACKGROUND: Holding a handrail or using a cane may decrease the energy cost of walking in stroke survivors. However, the factors underlying this decrease have not yet been previously identified. The purpose of the current study was to fill this void by investigating the effect of physical support
Sugimoto, Dai; Myer, Gregory D.; Barber Foss, Kim D.; Hewett, Timothy E.
Background Although a series of meta-analysis demonstrated neuromuscular training (NMT) is an effective intervention to reduce anterior cruciate ligament (ACL) injury in female athletes, the potential existence of a dosage effect remains unknown. Objective To systematically review previously published clinical trials and evaluate potential dosage effects of NMT for ACL injury reduction in female athletes. Design Meta- and Sub-group analyses Setting The key words “knee”, “anterior cruciate ligament”, “ACL”, “prospective”, “neuromuscular”, “training”, “female”, and “prevention” were utilized in PubMed and EBSCO host for studies published between 1995 and May 2012. Participants Inclusion criteria set for studies in the current analysis were: 1) recruited female athletes as subjects, 2) documented the number of ACL injuries, 3) employed a NMT intervention aimed to reduce ACL injuries, 4) had a control group, 5) used a prospective control trial design and 6) provided NMT session duration and frequency information. Main outcome measures The number of ACL injuries and female athletes in each group (control and intervention) were compared based on duration, frequency, and volume of NMT through odds ratio (OR). Results A total of 14 studies were reviewed. Analyses that compared the number of ACL injuries with short versus long NMT duration showed greater ACL injury reduction in female athletes who were in the long NMT duration (OR:0.35, 95%CI: 0.23, 0.53, p=0.001) than the short NMT duration (OR: 0.61, 95%CI: 0.41, 0.90, p=0.013) group. Analysis that compared single versus multi NMT frequency indicated greater ACL injury reduction in multi NMT frequency (OR: 0.35, 95%CI: 0.23, 0.53, p=0.001) compared to single NMT frequency (OR: 0.62, 95%CI:0.41, 0.94, p=0.024). Combining the duration and frequency of NMT programs, an inverse dose-response association emerged among low (OR: 0.66, 95%CI: 0.43, 0.99, p=0.045), moderate (OR: 0.46, 95%CI: 0.21, 1
Full Text Available BackgroundImpaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG-driven neuromuscular electrical stimulation (NMES robotic hand was designed previously, whereas its rehabilitation effects were not investigated.ObjectivesThis study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke.MethodA clinical trial with single-group design was conducted on chronic stroke participants (n = 15 who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA, the Action Research Arm Test (ARAT, the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS. Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs of the target muscles in the upper limb.ResultsSignificant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05, the ARAT (P < 0.05, and in the MAS (P < 0.05 were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD and biceps brachii (P < 0.05, as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05.ConclusionThe upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later.Trial registration
Ayala, Francisco; Calderón-López, Ana; Delgado-Gosálbez, Juan Carlos; Parra-Sánchez, Sergio; Pomares-Noguera, Carlos; Hernández-Sánchez, Sergio; López-Valenciano, Alejandro; De Ste Croix, Mark
No studies have analysed the acute effects of the FIFA 11+ and Harmoknee warm-up programmes on major physical performance measures. The aim of this study was to analyse the acute (post-exercise) effects of the FIFA 11+, Harmoknee and dynamic warm-up routines on several physical performance measures in amateur football players. A randomized, crossover and counterbalanced study design was used to address the purpose of this study. A total of sixteen amateur football players completed the following protocols in a randomized order on separate days: a) FIFA 11+; b) Harmoknee; and c) dynamic warm-up (DWU). In each experimental session, 19 physical performance measures (joint range of motion, hamstring to quadriceps [H/Q] strength ratios, dynamic postural control, 10 and 20 m sprint times, jump height and reactive strength index) were assessed. Measures were compared via a magnitude-based inference analysis. The results of this study showed no main effects between paired comparisons (FIFA 11+ vs. DWU, Harmoknee vs. DWU and Harmoknee vs. FIFA 11+) for joint range of motions, dynamic postural control, H/Q ratios, jumping height and reactive strength index measures. However, significant main effects (likely effects with a probability of >75–99%) were found for 10 (1.7%) and 20 (2.4%) m sprint times, demonstrating that both the FIFA 11+ and Harmoknee resulted in slower sprint times in comparison with the DWU. Therefore, neither the FIFA 11+ nor the Harmoknee routines appear to be preferable to dynamic warm-up routines currently performed by most football players prior to training sessions and matches. PMID:28060927
Full Text Available No studies have analysed the acute effects of the FIFA 11+ and Harmoknee warm-up programmes on major physical performance measures. The aim of this study was to analyse the acute (post-exercise effects of the FIFA 11+, Harmoknee and dynamic warm-up routines on several physical performance measures in amateur football players. A randomized, crossover and counterbalanced study design was used to address the purpose of this study. A total of sixteen amateur football players completed the following protocols in a randomized order on separate days: a FIFA 11+; b Harmoknee; and c dynamic warm-up (DWU. In each experimental session, 19 physical performance measures (joint range of motion, hamstring to quadriceps [H/Q] strength ratios, dynamic postural control, 10 and 20 m sprint times, jump height and reactive strength index were assessed. Measures were compared via a magnitude-based inference analysis. The results of this study showed no main effects between paired comparisons (FIFA 11+ vs. DWU, Harmoknee vs. DWU and Harmoknee vs. FIFA 11+ for joint range of motions, dynamic postural control, H/Q ratios, jumping height and reactive strength index measures. However, significant main effects (likely effects with a probability of >75-99% were found for 10 (1.7% and 20 (2.4% m sprint times, demonstrating that both the FIFA 11+ and Harmoknee resulted in slower sprint times in comparison with the DWU. Therefore, neither the FIFA 11+ nor the Harmoknee routines appear to be preferable to dynamic warm-up routines currently performed by most football players prior to training sessions and matches.
Efeitos da facilitação neuromuscular proprioceptiva na estabilidade postural e risco de quedas em pacientes com sequela de acidente vascular encefálico: estudo piloto Efectos de la facilitación neuromuscular propioceptiva en la estabilidad postural y riesgo de caídas en pacientes con secuela de accidente vascular encefálico: estudio piloto Effects of proprioceptive neuromuscular facilitation in postural stability and risk of falls in patients with sequelae of stroke: pilot study
Natália Noman de Lacerda
a basic motor skill necessary to perform many functional tasks and is deficient in patients suffering from cerebrovascular accident (CVA. Objective: To evaluate the effect of proprioceptive neuromuscular facilitation (PNF on trunk balance and risk of falls in patients with sequelae of stroke. Methodology: An intervention study was conducted consisting of trunk stability training through a fixed protocol of five exercises using the PNF method. 10 sessions were conducted, with a frequency of 3 times per week and average length of 45 minutes. To evaluate the results, we used the Berg balance scale (BBS. Results: Twelve men with left hemiparesis and at least six months of evolution were attended; there was a highly significant difference between pre and posttest values by means of BBS (p<0.01. Conclusion: PNF had beneficial effects in stabilizing the trunk and impact on risk of falls in subjects with left hemiparesis.
Long, Chengzu; Amoasii, Leonela; Bassel-Duby, Rhonda; Olson, Eric N
Muscle weakness, the most common symptom of neuromuscular disease, may result from muscle dysfunction or may be caused indirectly by neuronal and neuromuscular junction abnormalities. To date, more than 780 monogenic neuromuscular diseases, linked to 417 different genes, have been identified in humans. Genome-editing methods, especially the CRISPR (clustered regularly interspaced short palindromic repeats)-Cas9 (CRISPR-associated protein 9) system, hold clinical potential for curing many monogenic disorders, including neuromuscular diseases such as Duchenne muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, and myotonic dystrophy type 1. To provide an overview of genome-editing approaches; to summarize published reports on the feasibility, efficacy, and safety of current genome-editing methods as they relate to the potential correction of monogenic neuromuscular diseases; and to highlight scientific and clinical opportunities and obstacles toward permanent correction of disease-causing mutations responsible for monogenic neuromuscular diseases by genome editing. PubMed and Google Scholar were searched for articles published from June 30, 1989, through June 9, 2016, using the following keywords: genome editing, CRISPR-Cas9, neuromuscular disease, Duchenne muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, and myotonic dystrophy type 1. The following sources were reviewed: 341 articles describing different approaches to edit mammalian genomes; 330 articles describing CRISPR-Cas9-mediated genome editing in cell culture lines (in vitro) and animal models (in vivo); 16 websites used to generate single-guide RNA; 4 websites for off-target effects; and 382 articles describing viral and nonviral delivery systems. Articles describing neuromuscular diseases, including Duchenne muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, and myotonic dystrophy type 1, were also reviewed. Multiple proof
Paul, Jing Z.; Grüter, Theres
This study investigated order-of-learning effects on the acquisition of classifier-noun associations in Chinese in two experiments modeled after Arnon and Ramscar's (2012) study of artificial language learning. In Experiment 1, learners with no prior exposure to Chinese showed better learning of classifier-noun associations when exposed to larger…
Full Text Available Background: N-acetylcysteine (NAC has been indicated against experimental seizures, but with relatively inconclusive results. This study was undertaken to evaluate whether NAC exerts a dose-dependent anticonvulsant effect and to determine NAC safe therapeutic dose range and its muscle-relaxant activity in both acute and chronic uses. Methods: Following intraperitoneal (i.p. administration of N-acetylcysteine acutely (50-300 mg/kg or chronically for 8 days (25-300 mg/kg, mice were injected with PTZ (90 mg/kg, i.p. and latency times to the onset of myoclonic and clonic seizures and protection against death were recorded. Changes in body weight and mortality rate were considered as parameters for drug safety. The muscle-relaxant activity of NAC was assessed by rotarod test. Results: Acute and chronic treatment with NAC delayed latency times to myoclonic and clonic seizures in a dose-dependent manner, but with no significant prevention against PTZ-induced death. Chronic administration of 300 mg/kg NAC was fully lethal while lower doses (100 and 150 mg/kg resulted in a significant weight loss and decreased stay time on rotarod. Acute treatment with NAC had no significant effect on stay time on rotarod at all studied doses. Conclusion: NAC exerts a dose-dependent anticonvulsant effect in acute and chronic uses, with no muscle relaxant activity. NAC has higher efficacy in preventing seizure in chronic than acute treatment, but its chronic use at higher doses of 75 mg/kg may be associated with side effects and/or toxicity. These findings suggest that low doses of NAC may have a potential use as a prophylactic treatment for absence seizure in human.
Read, Paul J; Oliver, Jon L; Myer, Gregory D; De Ste Croix, Mark B A; Lloyd, Rhodri S
Asymmetry is a risk factor for male youth soccer players. There is a paucity of data confirming the presence of asymmetry using practically viable screening tasks in players at different stages of maturation. A cross sectional sample (N = 347) of elite male youth soccer players who were either (pre-, circa- or post-peak height velocity (PHV)) completed the following single leg assessments: Y-Balance anterior reach (Y-Bal); hop for distance (SLHD); 75% hop and stick (75%Hop) and countermovement jumps (SLCMJ). SLCMJ landing force asymmetry was higher in both circa and post-PHV groups, (p < 0.001; d = 0.41 - 0.43). 75%Hop landing force asymmetries were also highest in circa PHV players but between group comparisons were not statistically significant and effect sizes were small. SLHD and Y-Bal asymmetries reduced with maturation; however, no group differences were significant, with small to trivial effect sizes (d = ≤ 0.25). Stage of maturation did not have a profound effect on asymmetry. Between-limb differences in functional performance seem to be established in early childhood; thus, targeted interventions to reduce this injury risk factor should commence in pre-PHV athletes and be maintained throughout childhood and adolescence to ensure asymmetry does not increase.
Chuang, Li-Ling; Chen, You-Lin; Chen, Chih-Chung; Li, Yen-Chen; Wong, Alice May-Kuen; Hsu, An-Lun; Chang, Ya-Ju
Hemiplegic shoulder pain is a frequent complication after stroke, leading to limited use of the affected arm. Neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) are two widely used interventions to reduce pain, but the comparative efficacy of these two modalities remains uncertain. The purpose of this research was to compare the immediate and retained effects of EMG-triggered NMES and TENS, both in combination with bilateral arm training, on hemiplegic shoulder pain and arm function of stroke patients. A single-blind, randomized controlled trial was conducted at two medical centers. Thirty-eight patients (25 males and 13 females, 60.75 ± 10.84 years old, post stroke duration 32.68 ± 53.07 months) who had experienced a stroke more than 3 months ago at the time of recruitment and hemiplegic shoulder pain were randomized to EMG-triggered NMES or TENS. Both groups received electrical stimulation followed by bilateral arm training 3 times a week for 4 weeks. The primary outcome measures included a vertical Numerical Rating Scale supplemented with a Faces Rating Scale, and the short form of the Brief Pain Inventory. The secondary outcome measures were the upper-limb subscale of the Fugl-Meyer Assessment, and pain-free passive shoulder range of motion. All outcomes were measured pretreatment, post-treatment, and at 1-month after post-treatment. Two-way mixed repeated measures ANOVAs were used to examine treatment effects. Compared to TENS with bilateral arm training, the EMG-triggered NMES with bilateral arm training was associated with lower pain intensity during active and passive shoulder movement (P =0.007, P =0.008), lower worst pain intensity (P = 0.003), and greater pain-free passive shoulder abduction (P =0.001) and internal rotation (P =0.004) at follow-up. Both groups improved in pain at rest (P =0.02), pain interference with daily activities, the Fugl-Meyer Assessment, and pain-free passive
Clausen, Brian; Holsgaard-Larsen, Anders; Søndergaard, Jens
performance measures, in addition to changes in self-reported pain, function, health status, and quality of life. DISCUSSION: These findings will help determine whether 8 weeks of neuromuscular exercise is superior to optimized use of analgesics and antiinflammatory drugs regarding knee-joint load, pain......BACKGROUND: Knee osteoarthritis (OA) is a mechanically driven disease, and it is suggested that medial tibiofemoral knee-joint load increases with pharmacologic pain relief, indicating that pharmacologic pain relief may be positively associated with disease progression. Treatment modalities...... that can both relieve pain and reduce knee-joint load would be preferable. The knee-joint load is influenced by functional alignment of the trunk, pelvis, and lower-limb segments with respect to the knee, as well as the ground-reaction force generated during movement. Neuromuscular exercise can influence...
Liu, Yujiang; Yue, Yuan; Yu, Yuguo; Liu, Liwei; Yu, Lianchun
Action potentials are the information carriers of neural systems. The generation of action potentials involves the cooperative opening and closing of sodium and potassium channels. This process is metabolically expensive because the ions flowing through open channels need to be restored to maintain concentration gradients of these ions. Toxins like tetraethylammonium can block working ion channels, thus affecting the function and energy cost of neurons. In this paper, by computer simulation of the Hodgkin-Huxley neuron model, we studied the effects of channel blocking with toxins on the information transmission and energy efficiency in squid giant axons. We found that gradually blocking sodium channels will sequentially maximize the information transmission and energy efficiency of the axons, whereas moderate blocking of potassium channels will have little impact on the information transmission and will decrease the energy efficiency. Heavy blocking of potassium channels will cause self-sustained oscillation of membrane potentials. Simultaneously blocking sodium and potassium channels with the same ratio increases both information transmission and energy efficiency. Our results are in line with previous studies suggesting that information processing capacity and energy efficiency can be maximized by regulating the number of active ion channels, and this indicates a viable avenue for future experimentation.
Sun Ah Kim
Full Text Available Many researchers have found that one of the most important characteristics of the structure of linkage disequilibrium is that the human genome can be divided into non-overlapping block partitions in which only a small number of haplotypes are observed. The location and distribution of haplotype blocks can be seen as a population property influenced by population genetic events such as selection, mutation, recombination and population structure. In this study, we investigate the effects of the density of markers relative to the full set of all polymorphisms in the region on the results of haplotype partitioning for five popular haplotype block partition methods: three methods in Haploview (confidence interval, four gamete test, and solid spine, MIG++ implemented in PLINK 1.9 and S-MIG++. We used several experimental datasets obtained by sampling subsets of single nucleotide polymorphism (SNP markers of chromosome 22 region in the 1000 Genomes Project data and also the HapMap phase 3 data to compare the results of haplotype block partitions by five methods. With decreasing sampling ratio down to 20% of the original SNP markers, the total number of haplotype blocks decreases and the length of haplotype blocks increases for all algorithms. When we examined the marker-independence of the haplotype block locations constructed from the datasets of different density, the results using below 50% of the entire SNP markers were very different from the results using the entire SNP markers. We conclude that the haplotype block construction results should be used and interpreted carefully depending on the selection of markers and the purpose of the study.
Zhang, Qin; Xue, Minghua; Li, Zhan; Wang, Haiyan; Zhu, Lei; Liu, Xinling; Meng, Haiyan; Hou, Yinglong
The purpose of this study was to investigate the effects of an isolated complete right bundle branch block on mechanical ventricular function. Two groups of participants were enrolled in this study: a block group, consisting of 98 patients with isolated complete right bundle branch blocks without structural heart disease, and a control group, consisting of 92 healthy adults. The diameter, end-diastolic area, end-systolic area, and right ventricular (RV) fractional area change were obtained to evaluate morphologic and systolic function by 2-dimensional sonographic technology. Systolic and diastolic velocities and time interval parameters were measured to assess mechanical ventricular performance using pulsed wave tissue Doppler imaging. Although there was no significant difference in the RV fractional area change between the patients with blocks and controls, the diameter, end-diastolic area, and end-systolic area of the RV were significantly larger in the patients with blocks (P blocks, the peak velocities during systole and early diastole and the ratio of the peak velocities during early and late diastole decreased. The block group had a prolonged pre-ejection period, electromechanical delay time, and isovolumic relaxation time, a decreased ejection time, and an increased pre-ejection period/ejection time ratio, and the myocardial performance index (Tei index) at the basal RV lateral wall was significantly increased. There were no significant differences in any echocardiographic parameters at different sites of the left ventricle. In patients with isolated complete right bundle branch blocks, systolic and diastolic functions are impaired in the RV, and follow-up is needed. © 2015 by the American Institute of Ultrasound in Medicine.
Full Text Available Unexpected sudden perturbations challenge postural equilibrium and require reactive compensation. This study aimed to assess interaction effects of the direction, displacement and velocity of perturbations on electromyographic (EMG activity, centre of pressure (COP displacement and joint kinematics to detect neuromuscular characteristics (phasic and segmental and kinematic strategies of compensatory reactions in an unilateral balance paradigm. In 20 subjects, COP displacement and velocity, ankle, knee and hip joint excursions and EMG during short (SLR, medium (MLR and long latency response (LLR of four shank and five thigh muscles were analysed during random surface translations varying in direction (anterior-posterior (sagittal plane, medial-lateral (frontal plane, displacement (2 vs. 3 cm and velocity (0.11 vs. 0.18 m/s of perturbation when balancing on one leg on a movable platform. Phases: SLR and MLR were scaled to increased velocity (P<0.05; LLR was scaled to increased displacement (P<0.05. Segments: phasic interrelationships were accompanied by segmental distinctions: distal muscles were used for fast compensation in SLR (P<0.05 and proximal muscles to stabilise in LLR (P<0.05. Kinematics: ankle joints compensated for both increasing displacement and velocity in all directions (P<0.05, whereas knee joint deflections were particularly sensitive to increasing displacement in the sagittal (P<0.05 and hip joint deflections to increasing velocity in the frontal plane (P<0.05. COP measures increased with increasing perturbation velocity and displacement (P<0.05. Interaction effects indicate that compensatory responses are based on complex processes, including different postural strategies characterised by phasic and segmental specifications, precisely adjusted to the type of balance disturbance. To regain balance after surface translation, muscles of the distal segment govern the quick regain of equilibrium; the muscles of the proximal limb
Nieuwveld, D; Mojica, V; Herrera, A E; Pomés, J; Prats, A; Sala-Blanch, X
clinical effectiveness using 20ml of 1.5% mepivacaine. The sympathetic block can be evaluated with all three parameters studied. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
Luis Andrés Fajardo Arturo
Full Text Available In Colombia, the articles 93, 94 and 214 of the Constitutional Charter create a bridge of implementation through the International Law of Human Rights and International Humanitarian Law are integrated into the Colombian law under the figure of the Constitutional Bloc . The main effect of this is to adapt the internal law to the international obligations of the State, and consequently, the evolution in the protection and guarantee of human rights domestically.However, the implementation process can generate complex problems that arise, for example, the contradictions between the rules of law which are based on legal principles rooted in the country and the bloc of of constitutionality’s rules. The case of prescription of prosecution in Colombia is a complex case, but international norms is evident in the existence of a rule on the applicability of prosecution of war crimes and crimes against humanity. This article is the conclusion of a balance of the principles found there.
Fuhrer, W; Ostermayer, F; Zimmermann, M; Meier, M; Müller, H
The synthesis of a group of potential beta-blockers bearing a new 5-ethoxysalicylamide substituent on nitrogen is described. These compounds were tested for beta-adrenergic blocking potency in vitro and compared with analogous compounds bearing a tert-butyl group on nitrogen. The new N-substituent increased the beta-blocking potency substantially. In a series of five homologous compounds of the type Ar(CH2)nCHOHCH2NHR (R = 5-ethoxysalicylamide; n = 0-4), two maxima of beta-blocking potency were found for n = 0 and 2. Moreover, the carbon isostere of the corresponding (aryloxy)propanolamine still proved to be a very potent beta-blocker. The ether oxygen in the side chain is therefore not an absolute requirement for activity. Structure-activity relationships are discussed.
Grevstad, Jens Ulrik; Mathiesen, Ole; Valentiner, Laura Risted Staun
BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the adductor canal block (ACB) could increase functional muscle...... strength. METHODS: We included 50 TKA patients with severe movement-related pain; defined as having visual analog scale pain score of greater than 60 mm during active flexion of the knee. The ACB group received an ACB with ropivacaine 0.2% 30 mL and a femoral nerve block (FNB) with 30 mL saline. The FNB...... to ambulate and changes in pain scores (Clinicaltrials.gov identifier NCT01922596). RESULTS: After block, the quadriceps maximum voluntary isometric contraction increased to 193% (95% confidence interval [CI], 143-288) of the baseline value in the ACB group and decreased to 16% (95% CI, 3-33) in the FNB group...
Chen, Hsiu-Pin; Shen, Shih-Jyun; Tsai, Hsin-I; Kao, Sheng-Chin; Yu, Huang-Ping
Shoulder surgery can produce severe postoperative pain and movement limitations. Evidence has shown that regional nerve block is an effective management for postoperative shoulder pain. The purpose of this study was to investigate the postoperative analgesic effect of intravenous patient-controlled analgesia (PCA) combined with interscalene nerve block in comparison to PCA alone after shoulder surgery. In this study, 103 patients receiving PCA combined with interscalene nerve block (PCAIB) and 48 patients receiving PCA alone after shoulder surgery were included. Patients' characteristics, preoperative shoulder score and range of motion, surgical and anesthetic condition in addition to visual analog scale (VAS) pain score, postoperative PCA consumption, and adverse outcomes were evaluated. The results showed that PCA combined with interscalene nerve block (PCAIB) group required less volume of analgesics than PCA alone group in 24 hours (57.76 ± 23.29 mL versus 87.29 ± 33.73 mL, p block is effective postoperatively in reducing the demand for PCA analgesics and decreasing opioids-induced adverse events following shoulder surgery.
Full Text Available To deal with multi-source, complex and massive data in photogrammetry, and solve the high memory requirement and low computation efficiency of irregular normal equation caused by the randomly aligned and large scale datasets, we introduce the preconditioned conjugate gradient combined with inexact Newton method to solve the normal equation which do not have strip characteristics due to the randomly aligned images. We also use an effective sparse matrix compression format to compress the big normal matrix, a brand new workflow of bundle adjustment is developed. Our method can avoid the direct inversion of the big normal matrix, the memory requirement of the normal matrix is also decreased by the proposed sparse matrix compression format. Combining all these techniques, the proposed method can not only decrease the memory requirement of normal matrix, but also largely improve the efficiency of bundle adjustment while maintaining the same accuracy as the conventional method. Preliminary experiment results show that the bundle adjustment of a dataset with about 4500 images and 9 million image points can be done in only 15 minutes while achieving sub-pixel accuracy.
Hellsten, Ylva; Krustrup, Peter; Iaia, F Marcello
This study examined the role of acetylcholine for skeletal muscle blood flow during exercise by use of the competitive neuromuscular blocking agent cisatracurium in combination with the acetylcholine receptor blocker glycopyrrone. Nine healthy male subjects performed a 10-min bout of one-legged k......This study examined the role of acetylcholine for skeletal muscle blood flow during exercise by use of the competitive neuromuscular blocking agent cisatracurium in combination with the acetylcholine receptor blocker glycopyrrone. Nine healthy male subjects performed a 10-min bout of one....... The enhanced exercise hyperemia during partial neuromuscular blockade may be related to a greater recruitment of fast-twitch muscle fibres. Key words: blood flow, neuromuscular blockade, exercise, skeletal muscle....
Peltier Sébastien L
Full Text Available Abstract Background Carbohydrates (CHOs, branched-chain amino acids (BCAAs and caffeine are known to improve running performance. However, no information is available on the effects of a combination of these ingredients on performance and neuromuscular function during running. Methods The present study was designed as a randomized double-blind cross-over placebo-controlled trial. Thirteen trained adult males completed two protocols, each including two conditions: placebo (PLA and Sports Drink (SPD: CHOs 68.6 g.L-1, BCAAs 4 g.L-1, caffeine 75 mg.L-1. Protocol 1 consisted of an all-out 2 h treadmill run. Total distance run and glycemia were measured. In protocol 2, subjects exercised for 2 h at 95% of their lowest average speeds recorded during protocol 1 (whatever the condition. Glycemia, blood lactate concentration and neuromuscular function were determined immediately before and after exercise. Oxygen consumption (V˙O2, heart rate (HR and rate of perceived exertion (RPE were recorded during the exercise. Total fluids ingested were 2 L whatever the protocols and conditions. Results Compared to PLA, ingestion of SPD increased running performance (p = 0.01, maintained glycemia and attenuated central fatigue (p = 0.04, an index of peripheral fatigue (p = 0.04 and RPE (p = 0.006. Maximal voluntary contraction, V˙O2, and HR did not differ between the two conditions. Conclusions This study showed that ingestion of a combination of CHOs, BCAAs and caffeine increased performance by about 2% during a 2-h treadmill run. The results of neuromuscular function were contrasted: no clear cut effects of SPD were observed. Trial registration ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT00799630
Sano, Masami; Shan, Feng; Hara, Mitsuo; Nagano, Shusaku; Shinohara, Yuya; Amemiya, Yoshiyuki; Seki, Takahiro
A series of block copolymers composed of an amorphous poly(butyl methacrylate) (PBMA) block connected with an azobenzene (Az)-containing liquid crystalline (PAz) block were synthesized by changing the chain length and polymer architecture. With these block copolymer films, the dynamic realignment process of microphase separated (MPS) cylinder arrays of PBMA in the PAz matrix induced by irradiation with linearly polarized light was studied by UV-visible absorption spectroscopy, and time-resolved grazing incidence small angle X-ray scattering (GI-SAXS) measurements using a synchrotron beam. Unexpectedly, the change in the chain length hardly affected the realignment rate. In contrast, the architecture of the AB-type diblock or the ABA-type triblock essentially altered the realignment feature. The strongly cooperative motion with an induction period before realignment was characteristic only for the diblock copolymer series, and the LPL-induced alignment change immediately started for triblock copolymers and the PAz homopolymer. Additionally, a marked acceleration in the photoinduced dynamic motions was unveiled in comparison with a thermal randomization process.
Imai, S; Nakahara, H; Nakazawa, M; Takeda, K
The acute antihypertensive effects and possible underlying mechanisms of 3 beta-adrenergic-blocking drugs with alpha-blocking activity, i.e. labetalol, drugs with alpha-blocking activity, i.e. labetalol, nipradilol and arotinolol, were studied in conscious spontaneously hypertensive rats (SHR) and compared with the effects of prazosin, propranolol and hydralazine. Prazosin produced a dose-dependent antihypertensive effect which paralleled inhibition of the pressor response to phenylephrine. Labetalol (30 mg/kg), nipradilol (30 and 100 mg/kg) and arotinolol (30 and 100 mg/kg) also produced a fall in blood pressure. However, inhibition of the pressor response to phenylephrine was not seen in association with the antihypertensive effect after the lower dose of nipradilol and arotinolol. Propranolol (100 mg/kg) did not lower blood pressure. These results suggest that a mechanism(s) other than an alpha-adrenergic-blocking effect plays a role in the acute antihypertensive effects produced by the lower dose of nipradilol and arotinolol.
Martínez Carrasco, C; Cols Roig, M; Salcedo Posadas, A; Sardon Prado, O; Asensio de la Cruz, O; Torrent Vernetta, A
In a previous article, a review was presented of the respiratory pathophysiology of the patient with neuromuscular disease, as well as their clinical evaluation and the major complications causing pulmonary deterioration. This article presents the respiratory treatments required to preserve lung function in neuromuscular disease as long as possible, as well as in special situations (respiratory infections, spinal curvature surgery, etc.). Special emphasis is made on the use of non-invasive ventilation, which is changing the natural history of many of these diseases. The increase in survival and life expectancy of these children means that they can continue their clinical care in adult units. The transition from pediatric care must be an active, timely and progressive process. It may be slightly stressful for the patient before the adaptation to this new environment, with multidisciplinary care always being maintained. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
Girard, Olivier; Millet, Grégoire P
This article describes the physiologic and neural mechanisms that cause neuromuscular fatigue in racquet sports: table tennis, tennis, squash, and badminton. In these intermittent and dual activities, performance may be limited as a match progresses because of a reduced central activation, linked to changes in neurotransmitter concentration or in response to afferent sensory feedback. Alternatively, modulation of spinal loop properties may occur because of changes in metabolic or mechanical properties within the muscle. Finally, increased fatigue manifested by mistimed strokes, lower speed, and altered on-court movements may be caused by ionic disturbances and impairments in excitation-contraction coupling properties. These alterations in neuromuscular function contribute to decrease in racquet sports performance observed under fatigue.
The effects of a strength and neuromuscular exercise programme for the lower extremity on knee load, pain and function in obese children and adolescents: study protocol for a randomised controlled trial.
Horsak, Brian; Artner, David; Baca, Arnold; Pobatschnig, Barbara; Greber-Platzer, Susanne; Nehrer, Stefan; Wondrasch, Barbara
Childhood obesity is one of the most critical and accelerating health challenges throughout the world. It is a major risk factor for developing varus/valgus misalignments of the knee joint. The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage. A training programme, which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading during locomotion. Despite the large number of guidelines for muscle strength training and neuromuscular exercises that exist, most are not specifically designed to target the obese children and adolescent demographic. Therefore, the aim of this study is to evaluate a training programme which combines strength and neuromuscular exercises specifically designed to the needs and limitations of obese children and adolescents and analyse the effects of the training programme from a biomechanical and clinical point of view. A single assessor-blinded, pre-test and post-test randomised controlled trial, with one control and one intervention group will be conducted with 48 boys and girls aged between 10 and 18 years. Intervention group participants will receive a 12-week neuromuscular and quadriceps/hip strength training programme. Three-dimensional (3D) gait analyses during level walking and stair climbing will be performed at baseline and follow-up sessions. The primary outcome parameters for this study will be the overall peak external frontal knee moment and impulse during walking. Secondary outcomes include the subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS), frontal and sagittal kinematics and kinetics for the lower extremities during walking and stair climbing, ratings of change in knee-related well-being, pain and function and adherence to the training programme. In addition, the training programme will be evaulated from a clinical and health status perspective by
Routray, Sidharth Sraban; Mishra, Debasis; Routray, Daityari; Nanda, Kasturi
Many adjuvants have been used with local anesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with levobupivacaine. This study aims to study the effects of verapamil as adjuvant to levobupivacaine in supraclavicular block for upper extremity surgery. In this double-blinded clinical trial, 60 American Society of Anesthesiologist Class I and II patients posted to undergo upper extremity surgery were divided into 2 different groups randomly. In Group A, the patients received 30 ml levobupivacaine 0.5% plus 2 ml normal saline and Group B patients received 30 ml levobupivacaine 0.5% plus 5 mg verapamil diluted to 2 ml normal saline for supraclavicular block. Time of request for rescue analgesia, onset and duration of sensory motor blocks and changes in hemodynamic parameters were studied and analyzed. P < 0.001 was considered statistically significant. Time for a request for rescue analgesia was 425.80 ± 90.46 min in Group B and 366.13 ± 70.42 min in Group A which was clinically significant. The mean of sensory and motor block onset time in Group B was less than in Group A, the difference between the two groups being statistically significant (P < 0.001). In Group A, mean duration of sensory block was 316.13 ± 91.08 min and in Group B was 375.83 ± 114.48 min, which was statistically significant (P < 0.001). The addition of verapamil as an adjuvant to levobupivacaine in brachial plexus blockade delayed the requirement of rescue analgesia with decreased onset time and prolonged duration of sensory and motor block characteristics.
Staehr-Rye, Anne K; Rasmussen, Lars S; Rosenberg, Jacob
Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mm......Hg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions....
Staehr-Rye, Anne K; Rasmussen, Lars S; Rosenberg, Jacob
Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (surgical conditions may not be optimal. The present study aimed at comparing surgical space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mm......Hg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions....
Fink, H.; Hollmann, M. W.
Pharmacologic reversal of neuromuscular blockade is a topic nor very well acknowledged and controversially discussed. Reasons for this are numerous and include missing perception of the potential complications of residual neuromuscular paralysis including an increased morbidity and mortality, as
Computational models of lexical selection in spoken word production have been applied to semantic interference effects in picture naming response times obtained with continuous naming, blocked-cyclic naming, and picture-word interference paradigms. However, a unified computational account of the effects in the three paradigms is lacking. Here, I show that the inclusion of conceptual bias in the WEAVER++model (Levelt, Roelofs, & Meyer, 1999) explains cumulative semantic and semantic blocking effects while preserving the model's account of semantic distractor effects. The key assumptions of the account are (1) lexical selection by competition, and (2) a conceptual origin and lexical locus of the semantic effects. I provide a proof of concept of the account by reporting computer simulation results, addressing behavioral and neuroimaging evidence. The assumptions are sufficient for a unified account of semantic effects in the three paradigms, contrary to pessimistic views of this area. Copyright © 2017 Elsevier B.V. All rights reserved.
Hofmann-Kiefer, K; Herbrich, C; Seebauer, A; Schwender, D; Peter, K
We investigated ropivacaine 75 mg/ml in comparison with bupivacaine 5 mg/ml in patients receiving interscalene brachial plexus block (ISB) and general anaesthesia. In this randomized, double-blind, prospective clinical trial, each patient received an ISB block according to the technique originally described by Winnie and a catheter technique as per Meier. The rapidity of onset and the quality of sensory and motor block were determined. After general anaesthesia had been induced further parameters evaluated were consumption of local anaesthetic, opioid and neuromuscular blocking drug. After arrival in the recovery room, the patients were assessed for intensity of pain using a visual analog scale (VAS). One hundred and twenty patients were included in the study. The onset and development of sensory block was similar in both groups. Development and quality of motor block was also nearly identical for both local anaesthetics. Consumption of neuromuscular blocking drug and opioid did not differ between ropivacaine and bupivacaine. In the recovery room the mean pain score was less than 25 in both groups. There were no significant differences in terms of onset and quality of sensory or motor block during the intraoperative and early postoperative period. In addition we did not identify any side-effects related to the administration of the local anaesthetics. Ropivacaine 7.5 mg/ml and bupivacaine 5mg/ml proved to be nearly indistinguishable when administered for interscalene brachial plexus block.
Full Text Available INTRODUCTION: The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90 of bupivacaine for axillary brachial plexus block. METHODS: Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous. The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability or the same concentration (0.9 probability. Surgical anesthesia was defined as driving force ≤2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4 h after the blockade. RESULTS: MEC90 was 0.241% [R 2: 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4 h. CONCLUSION: This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.
Wenger, Andrea; Rothenberger, Jens; Hakim-Meibodi, Lara-Elena; Notheisen, Thomas; Schaller, Hans-Eberhard
Axillary plexus block is a common method for regional anesthesia, especially in hand and wrist surgery. Local anesthetics (e.g., mepivacaine) are injected around the peripheral nerves in the axilla. A vasodilatory effect due to sympathicolysis has been described, but not quantified. In a prospective controlled study between October 2012 and July 2013, we analyzed 20 patients with saddle joint arthritis undergoing trapeziectomy under axillary plexus block. Patients received a mixture of mepivacaine 1% and ropivacaine 0.75% in a 3:1 ratio. The measurements were carried out on the plexus side and the contralateral hand, which acted as the control. Laser-Doppler spectrophotometry (oxygen to see [O2C] device) was used to measure various perfusion factors before and after the plexus block, after surgery and in 2-h intervals until 6 h postoperatively. Compared with the contralateral side, the plexus block produced an enhancement of tissue oxygen saturation of 117.35 ± 34.99% (cf. control SO2: 92.92 ± 22.30%, P plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremity over the first 4 h after the inception of anesthesia. Copyright © 2017 Elsevier Inc. All rights reserved.
Poort, J.; Leenheer, J.; van der Ham, J.; Dumitru, C.
In the fight against unauthorised sharing of copyright protected material, Dutch Internet Service Providers have been summoned by courts to block their subscribers' access to The Pirate Bay and related sites. This paper studies the effectiveness of this approach towards online copyright enforcement,
Formsma, S. A.; van der Sluis, C. K.; Dijkstra, P. U.
The purpose was to evaluate the effect of a metacarpal phalangeal joint blocking splint combined with exercises, aimed at regaining strength, manipulative skills, and a normal pattern of movement of the hands in patients with rheumatoid arthritis (RA). All patients were measured three times: before
The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.
Brouwer, A.M.; Wouwe, N.C. van; Mühl, C.; Erp, J.B.F. van; Toet, A.
Most studies on physiological effects of emotion-inducing images and sounds examine stimulus locked variables reflecting a state of at most a few seconds. We here aimed to induce longer lasting emotional states using blocks of repetitive visual, auditory, and bimodal stimuli corresponding to
Full Text Available This review is on ultrastructure and subcellular physiology at normal and abnormal neuromuscular junctions. The clinical and electrophysiological findings in myasthenia gravis, Lambert-Eaton myasthenic syndrome (LEMS, congenital myasthenic syndromes, and botulinum intoxication are discussed. Single fiber electromyography (SFEMG helps to explain the basis of testing neuromuscular junction function by repetitive nerve stimulation (RNS. SFEMG requires skill and patience and its availability is limited to a few centers. For RNS supramaximal stimulation is essential and so is display of the whole waveform of each muscle response at maximum amplitude. The amplitudes of the negative phase of the first and fourth responses are measured from baseline to negative peak, and the percent change of the fourth response compared with the first represents the decrement or increment. A decrement greater than 10% is accepted as abnormal and smooth progression of response amplitude train and reproducibility form the crux. In suspected LEMS the effect of fast rates of stimulation should be determined after RNS response to slow rates of stimulation. Caution is required to avoid misinterpretation of potentiation and pseudofacilitation.
Chen, Yongquan; Hu, Guangxiang; Fu, Qun; Jin, Xiaoju
To determine the effect of stellate ganglion block on reconstruction of the left ventricle in spontaneously hypertensive rats (SHRs). Thirty-two 10-week-old male SHRs were randomly assigned into 4 groups: a left stellate ganglion block group (group LS), a right stellate ganglion block group (group RS), a captopril group (group D) and a control group (group C). The arterial systolic blood pressure (SBP) was measured by ALC-NIBP measuring system. After 10 weeks, we observed the left ventricular mass index (LVMI), myocardial pathologic changes, and detected the endothelin (ET-1) and endothelial nitric oxide synthase (eNOS) level in the left ventricle by radioimmunoassay and the collagen protein level in the left ventricle by immunohistochemical method. Compared with group LS and group C, the LVMI in group RS was lowered most notably (Pblock can not only decrease the arterial pressure but also reverse the reconstruction of the left ventricle.
Ma, Jie; Guo, Huaming; Lei, Mei; Wan, Xiaoming; Zhang, Hanzhi; Feng, Xiaojuan; Wei, Rongfei; Tian, Liyan; Han, Xiaokun
Transport of environmental pollutants through porous media is influenced by colloids. Co-transport of As(V) and soil colloids at different pH were systematically investigated by monitoring breakthrough curves (BTCs) in saturated sand columns. A solute transport model was applied to characterize transport and retention sites of As(V) in saturated sand in the presence of soil colloids. A colloid transport model and the DLVO theory were used to reveal the mechanism and hypothesis of soil colloid-promoted As(V) transport in the columns. Results showed that rapid transport of soil colloids, regulated by pH and ionic strength, promoted As(V) transport by blocking As(V) adsorption onto sand, although soil colloids had low adsorption for As(V). The promoted transport was more significant at higher concentrations of soil colloids (between 25 mg L(-1) and 150 mg L(-1)) due to greater blocking effect on As(V) adsorption onto the sand surfaces. The blocking effect of colloids was explained by the decreases in both instantaneous (equilibrium) As adsorption and first-order kinetic As adsorption on the sand surface sites. The discovery of this blocking effect improves our understanding of colloid-promoted As transport in saturated porous media, which provides new insights into role of colloids, especially colloids with low As adsorption capacity, in As transport and mobilization in soil-groundwater systems. Copyright © 2016 Elsevier Ltd. All rights reserved.
O'Donnell, Brian D
Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block.
Lin, Tzu-Pin; Chang, Alice B; Luo, Shao-Xiong; Chen, Hsiang-Yun; Lee, Byeongdu; Grubbs, Robert H
Grafting density is an important structural parameter that exerts significant influences over the physical properties of architecturally complex polymers. In this report, the physical consequences of varying the grafting density (z) were studied in the context of block polymer self-assembly. Well-defined block polymers spanning the linear, comb, and bottlebrush regimes (0 ≤ z ≤ 1) were prepared via grafting-through ring-opening-metathesis polymerization. ω-Norbornenyl poly(d,l-lactide) and polystyrene macromonomers were copolymerized with discrete comonomers in different feed ratios, enabling precise control over both the grafting density and molecular weight. Small-angle X-ray scattering experiments demonstrate that these graft block polymers self-assemble into long-range-ordered lamellar structures. For 17 series of block polymers with variable z, the scaling of the lamellar period with the total backbone degree of polymerization (d* ∼ Nbbα) was studied. The scaling exponent α monotonically decreases with decreasing z and exhibits an apparent transition at z ≈ 0.2, suggesting significant changes in the chain conformations. Comparison of two block polymer systems, one that is strongly segregated for all z (System I) and one that experiences weak segregation at low z (System II), indicates that the observed trends are primarily caused by the polymer architectures, not segregation effects. A model is proposed in which the characteristic ratio (C∞), a proxy for the backbone stiffness, scales with Nbb as a function of the grafting density: C∞ ∼ Nbbf(z). The scaling behavior disclosed herein provides valuable insights into conformational changes with grafting density, thus introducing opportunities for block polymer and material design.
Landers, John A; Tamblyn, David; Perriam, Don
To evaluate whether implantation of a blue-light-blocking intraocular lens (IOL) affects sleep quality. Repatriation General Hospital, Adelaide, Australia. This study comprised patients who had bilateral cataract surgery during the preceding 12 months with implantation of a conventional SI40NB IOL or an AcrySof Natural SN60WF blue-light-blocking IOL. Patients were contacted by telephone at least 6 months after second-eye surgery, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered. Results were compared between groups. Of the 49 patients, 31 received conventional IOLs and 18, blue-light-blocking IOLs. The mean age of the patients was 80 years +/- 8.1 (SD). The median PSQI score was 6 (interquartile range 3 to 8). There were no statistically significant differences in PSQI scores between the 2 IOL groups (P = .65). This remained true after adjustment for sex, age, medication, and time since surgery. The blue-light-blocking IOL had no effect on the sleep quality of patients, indicating that these IOLs might serve as an alternative to conventional IOLs without a detrimental effect on circadian rhythm.
Taradaj, J; Halski, T; Kucharzewski, M; Walewicz, K; Smykla, A; Ozon, M; Slupska, L; Dymarek, R; Ptaszkowski, K; Rajfur, J; Pasternok, M
The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.
Full Text Available The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction on the quadriceps muscle. The 80 participants (NMES = 40, control = 40 received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz three times daily (3 hours of break between treatments, 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months were applied. The results of this study show that NMES (in presented parameters in experiment is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.
Chittrakarn, Somsmorn; Keawpradub, Niwat; Sawangjaroen, Kitja; Kansenalak, Supaporn; Janchawee, Benjamas
The effects of pure alkaloid, mitragynine and a methanolic extract of kratom leaves were investigated on neuromuscular junction and compound nerve action potential. Wistar rats were killed by cervical dislocation and decapitated. The phrenic nerve-hemidiaphragms, hemidiaphragms and sciatic nerve were isolated. Kratom methanolic extract present at 0.1-1 mg/mL and mitragynine (0.0156 mg/mL) decreased the muscle twitch on the isolated phrenic nerve-hemidiaphragm and hemidiaphragm preparation. Muscle relaxation caused by kratom extract (1 mg/mL) was greater than the effect of mitragynine. Pancuronium and succinylcholine potentiated the effect of kratom extract. It also had a direct relaxation effect on the hemidiaphragm muscle. The muscle relaxation caused by kratom extract was not antagonized by neostigmine, tetraethylammonium and calcium chloride. High concentrations of kratom extract (10-40 mg/mL) and mitragynine (2 mg/mL) blocked the nerve conduction, amplitude and duration of compound nerve action potential. The mechanism of action of kratom extract might not act as a competitive antagonist of acetylcholine yet its dominant effect was at the neuromuscular junction and not at the skeletal muscle or somatic nerve. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
Kellis, Eleftherios; Mademli, Lida; Patikas, Dimitrios; Kofotolis, Nikolaos
Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly...
Witt, Jessica K; Tenhundfeld, Nathan L; Bielak, Allison A M
The action-specific approach to perception claims that a person's ability to act directly influences perceptual processes related to spatial vision. For example, a person's ability to block a moving ball impacts perceptual judgments of the ball's speed. However, an alternative explanation is that action rather than perception influences judgments. Here, we explore this distinction directly. Our method produces two distinct effects, one that is clearly a judgment-based effect and is based on the outcome of the trial (trial-outcome effect) and one that is under debate as to whether or not it is perceptual and is based on the ease with which the ball can be blocked (paddle-size effect). We explored whether these two effects would produce convergence or dissociations across various populations and manipulations. A dissociation is evidence for two separate underlying processes, whereas if the two effects did not dissociate, this would be consistent with claims that both effects were judgment-based. In Experiment 1, we examined whether older and younger adults would show a dissociation between the two effects given some precedent for older adults to show greater susceptibility to nonperceptual factors in their judgments. In Experiment 2, we used a cover story to excuse poor performance and examined its effects on both types of effects. Both experiments revealed dissociations, suggesting that while one effect is judgment-based, the other effect is not. Coupled with prior research, we conclude that the action-specific effect of ease to block a ball on estimated ball speed is perceptual.
Stubblefield, Michael D
Radiation-induced toxicity is a major cause of long-term disability after cancer treatment. Radiation fibrosis describes the insidious pathologic fibrotic tissue sclerosis that can occur in response to radiation exposure. Radiation fibrosis syndrome describes the myriad clinical manifestations of progressive fibrotic tissue sclerosis resulting from radiation treatment. Radiation-induced damage can include "myelo-radiculo-plexo-neuro-myopathy," causing muscle weakness and dysfunction and contributing to neuromuscular injury. Similarly, radiation damage to neuromuscular structures contributes to radiation-induced trismus and cervical dystonia in head and neck cancer survivors. This narrative review discusses the pathophysiology, anatomy, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders that can result as late effects of radiation treatment. Rehabilitation medicine physicians with extensive training in neuromuscular and musculoskeletal medicine as well as in the principles of functional restoration are uniquely positioned to help lead efforts to improve the quality of life for cancer survivors with radiation fibrosis syndrome. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Hara, Y; Nakahara, H; Miyagishi, A; Nakatani, H
Effects of a new adrenergic beta-blocking agent, arotinolol (S-596), on the blood pressure and heart rate were assessed in comparison with those of other beta-blocking agents in deoxycorticosterone acetate (DOCA)-saline induced and spontaneously hypertensive rats (SHR). The relationship between the antihypertensive effect and the beta- or alpha-adrenoceptor blocking action of S-596 was also investigated in normotensive conscious rats. In the rat, a cannula was implanted chronically in a femoral artery, from which blood pressure was recorded. The test drugs were administered orally once a day for 14 days at several dose levels. The development of hypertension in DOCA-saline treated rats was clearly retarded with the consecutive oral administration of propranolol (100 mg/kg/day) and hydrochlorothiazide (10 mg/kg/day), but not with S-596 (20, 50 and 100 mg/kg/day) or pindolol (10 mg/kg/day). On the other hand, in SHR, S-596 (more than 10 mg/kg/day) propranolol (50 mg/kg/day), pindolol (10 mg/kg/day), labetalol (100 mg/kg/day) and hydrochlorothiazide (10 mg/kg/day) produced definite antihypertensive effects after the chronic administration. In normotensive conscious rats, the vasodepressor responses induced by isoproterenol were reduced by the beta-blocking agents at lower dose levels than those required for development of antihypertensive effects. The acute effects on blood pressure were determined in hypertensive rats during the chronic treatment with the test drugs. In either type of hypertension, S-596, (10-50 mg/kg/day) showed a depressor effect at 4 and/or 8 hr after administration. In normotensive conscious rats, S-596 antagonized the pressor responses to phenylephrine at doses more than 30 mg/kg. It is therefore suggested that an adrenergic alpha-blocking property is at least partly involved in the hypotensive effect of S-596 as labetalol. In the experiment of acute effect in SHR, pindolol and labetalol showed prominent hypotensive effect after the 1st
Efeitos do treinamento neuromuscular na aptidão cardiorrespiratória e composição corporal de atletas de voleibol do sexo feminino Effects of the neuromuscular training in the cardiorespiratory fitness and body composition of female volleyball athletes
Ricardo Adamoli Simões
Full Text Available As respostas do organismo humano submetido a estímulos diversos, mensuradas através de parâmetros de performance, têm sido objeto de estudo a fim de aprimorar os métodos de treinamento. O objetivo deste estudo foi investigar os efeitos do treinamento neuromuscular na capacidade cardiorrespiratória e composição corporal de atletas de voleibol. Foram avaliadas 11 mulheres, antes e após 12 semanas de treinamento, referente à fase preparatória do ciclo anual de treinamento. O protocolo experimental constou de avaliação da composição corporal (percentual de gordura, massa magra e a gordura corporal e da aptidão cardiorrespiratória por meio de ergoespirometria em esteira rolante com protocolo contínuo e carga crescente, na qual se determinaram o consumo máximo de oxigênio, a frequência cardíaca máxima, o limiar anaeróbio, a frequência cardíaca do limiar anaeróbio e a velocidade do limiar anaeróbio. O treinamento teve frequência de cinco dias por semana dividido em duas sessões: uma de treinamento de força e outra de treinamento técnico e tático. Após o período estudado ocorreram aumentos (p The responses of the human body submitted to several stimuli measured by performance parameters have been object of studies in order to improve training methods. The aim of this study was to investigate the effects of the neuromuscular training in the cardiorespiratory fitness and body composition of volleyball athletes. Eleven women were assessed before and after 12 weeks of training, concerning the preparatory phase of the annual training cycle. The experimental protocol consisted of assessment of the body composition (fat percentage, lean mass and body fat and of the cardiorespiratory fitness through ergospirometry on treadmill with continuous protocol and increasing load, in which the oxygen maximal uptake, maximum heart rate, anaerobic threshold, heart rate threshold and anaerobic threshold velocity were determined. The
The background of this thesis is presented in the introductory chapters and stafts with a brief history of neuromuscular relaxants. It is followed by a short description of the neuromuscular physiology and pharmacology in chapters 2 and 3, respectively. In chapter 4 the aim of the thesis is
Brown, Rosalind; Dissanayake, Kosala N; Skehel, Paul A; Ribchester, Richard R
Objective Electromyography (EMG) is used routinely to diagnose neuromuscular dysfunction in a wide range of peripheral neuropathies, myopathies, and neuromuscular degenerative diseases including motor neuron diseases such as amyotrophic lateral sclerosis (ALS). Definitive neurological diagnosis may also be indicated by the analysis of pathological neuromuscular innervation in motor-point biopsies. Our objective in this study was to preempt motor-point biopsy by combining live imaging with electrophysiological analysis of slow degeneration of neuromuscular junctions (NMJs) in vivo. Methods We combined conventional needle electromyography with fiber-optic confocal endomicroscopy (CEM), using an integrated hand-held, 1.5-mm-diameter probe. We utilized as a test bed, various axotomized muscles in the hind limbs of anaesthetized, double-homozygous thy1.2YFP16: WldS mice, which coexpress the Wallerian-degeneration Slow (WldS) protein and yellow fluorescent protein (YFP) in motor neurons. We also tested exogenous vital stains, including Alexa488-α-bungarotoxin; the styryl pyridinium dye 4-Di-2-Asp; and a GFP conjugate of botulinum toxin Type A heavy chain (GFP-HcBoNT/A). Results We show that an integrated EMG/CEM probe is effective in longitudinal evaluation of functional and morphological changes that take place over a 7-day period during axotomy-induced, slow neuromuscular synaptic degeneration. EMG amplitude declined in parallel with overt degeneration of motor nerve terminals. EMG/CEM was safe and effective when nerve terminals and motor endplates were selectively stained with vital dyes. Interpretation Our findings constitute proof-of-concept, based on live imaging in an animal model, that combining EMG/CEM may be useful as a minimally invasive precursor or alternative to motor-point biopsy in neurological diagnosis and for monitoring local administration of potential therapeutics. PMID:25540801
Maffiuletti, Nicola A.; Roig, Marc; Karatzanos, Eleftherios
Background: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically...
The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial.
Mailuhu, Adinda K E; Verhagen, Evert A L M; van Ochten, John M; Bindels, Patrick J E; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke
Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in The Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice, however promising results were achieved in a preventive trial among athletes. Therefore, the objective is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice. This study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement. For general practitioners the treatment of acute ankle sprains is a challenge. A neuromuscular training program that has proven to be effective for athletes might be a direct treatment tool for acute ankle sprains in general practice. Positive results of this randomized controlled trial can lead to changes in
Niculae, G.; Lacatusu, I.; Badea, N.; Meghea, A.
The aim of the present study was to obtain efficient lipid nanoparticles loaded with butyl-methoxydibenzoylmethane (BMDBM) in order to develop cosmetic formulations with enhanced UVA blocking effect. For this purpose, two adequate liquid lipids (medium chain triglycerides and squalene) have been used in combination with two solid lipids (cetyl palmitate and glyceryl stearate) in order to create appropriate nanostructured carriers with a disordered lipid network able to accommodate up to 1.5% BMDBM. The lipid nanoparticles (LNs) were characterized in terms of particle size, zeta potential, entrapment efficiency, loading capacity and in vitro UVA blocking effect. The efficiency of lipid nanoparticles in developing some cosmetic formulations has been evaluated by determining the in vitro erythemal UVA protection factor. In order to quantify the photoprotective effect, some selected cream formulations based on BMDBM-LNs and a conventional emulsion were exposed to photochemical UV irradiation at a low energy to simulate the solar energy during the midday. The results obtained demonstrated the high ability of cream formulations based on BMDBM-LNs to absorb more than 96% of UVA radiation. Moreover, the developed cosmetic formulations manifest an enhanced UVA blocking effect, the erythemal UVA protection factor being four times higher than those specific to conventional emulsions.
Full Text Available Most studies on physiological effects of emotion inducing images and sounds examine stimulus locked variables reflecting a state of at most a few seconds. We here aimed to induce longer lasting emotional states using blocks of repetitive visual, auditory and bimodal stimuli corresponding to specific valence and arousal levels. The duration of these blocks enabled us to reliably measure heart rate variability as a possible indicator of arousal. In addition, heart rate and skin conductance were determined without taking stimulus timing into account. Heart rate was higher for pleasant and low arousal stimuli compared to unpleasant and high arousal stimuli. Heart rate variability and skin conductance increased with arousal. Effects of valence and arousal on cardiovascular measures habituated or remained the same over 2-minute intervals whereas the arousal effect on skin conductance increased. We did not find any effect of stimulus modality. Our results indicate that blocks of images and sounds of specific valence and arousal levels consistently influence different physiological parameters. These parameters need not be stimulus locked. We found no evidence for differences in emotion induction between visual and auditory stimuli, nor did we find bimodal stimuli to be more potent than unimodal stimuli. The latter could be (partly due to the fact that our bimodal stimuli were not optimally congruent.
Efeitos da estimulação elétrica neuromuscular durante a imobilização nas propriedades mecânicas do músculo esquelético Efectos de la estimulación eléctrica neuromuscular durante la inmovilización en las propiedades mecánicas del músculo esquelético Effects of neuromuscular electric stimulation during immobilization in the mechanical properties of the skeletal muscle
João Paulo Chieregato Matheus
inmovilizadas en alongamiento y electro estimuladas (ILP + EE. Para la inmovilización, el miembro posterior derecho fue envuelto por una malla tubular y vendas de algodón en conjunto con vendas de escayola. La EENM fue utilizada con una frecuencia de 50 Hz, 10 minutos por día, totalizando 20 contracciones en cada sesión. Después de 7 días los animales fueron sometidos a eutanasia y los músculos gastrocnemios fueron retirados para la realización del ensayo mecánico de tracción en una máquina universal de ensayos (EMIC®. A partir de los gráficos carga versus alongamiento se calculó las siguientes propiedades mecánicas: alongamiento en el límite de proporcionalidad (ALP, carga en el límite de proporcionalidad (CLP y rigidez. Las inmovilizaciones SP y LP dieron reducciones significativas (p The neuromuscular electric stimulation (NMES is an important tool used in sports medicine to accelerate the recovery process. The objective of this study was to analyze the effects of NMES during immobilization of the gastrocnemius muscle, in lengthened (LP and shortened positions (SP. Sixty young female Wistar rats were distributed into six groups and followed for 7 days: control (C; electric stimulation (ES; immobilized in shortening (ISP; immobilized in lengthening (ILP; immobilized in shortening and electric stimulation (ISP + ES and immobilized in lengthening and electric stimulation (ILP + ES. For the immobilization, a tubular mesh and cotton rolls together with the plaster were wrapped around the rat's right posterior paw. NMES in a frequency of 50 Hz was used 10 minutes a day, totaling 20 contractions in each session. After 7 days the animals were sacrificed and their gastrocnemius muscles of the right paw were submitted to a mechanical test of traction in a universal test machine (EMIC®. From the load versus elongation curves the following mechanical properties were obtained: elongation in the yield limit (EPL, load in the yield limit (LPL and stiffness. The SP and LP
Klemin, A.I.; Samoylov, O.B.; Frolov, E.V.
The effect on reliability of the use of sectional steam generators is examined, and a mathematical model is developed. The advantage of sectionalizing is to increase the reliability and safety of nuclear reactors by localization of possible accidents caused by leakage of the heat exchange piping within a steam generating section. This sectioning requires that such factors as the repair strategy of the steam generator, the number of steam-generating sections in a single cooling loop and the operating restrictions of the available power of the power block be taken into account in the mathematical model of the reliability of the AES block. A mathematical model which can be used to investigate the effect of the enumerated factors on the reliability indicators of a plant with fast reactor is given.
John B. Harris
Full Text Available Neuro- and myotoxicological signs and symptoms are significant clinical features of envenoming snakebites in many parts of the world. The toxins primarily responsible for the neuro and myotoxicity fall into one of two categories—those that bind to and block the post-synaptic acetylcholine receptors (AChR at the neuromuscular junction and neurotoxic phospholipases A2 (PLAs that bind to and hydrolyse membrane phospholipids of the motor nerve terminal (and, in most cases, the plasma membrane of skeletal muscle to cause degeneration of the nerve terminal and skeletal muscle. This review provides an introduction to the biochemical properties of secreted sPLA2s in the venoms of many dangerous snakes and a detailed discussion of their role in the initiation of the neurologically important consequences of snakebite. The rationale behind the experimental studies on the pharmacology and toxicology of the venoms and isolated PLAs in the venoms is discussed, with particular reference to the way these studies allow one to understand the biological basis of the clinical syndrome. The review also introduces the involvement of PLAs in inflammatory and degenerative disorders of the central nervous system (CNS and their commercial use in the food industry. It concludes with an introduction to the problems associated with the use of antivenoms in the treatment of neuro-myotoxic snakebite and the search for alternative treatments.
Harris, John B; Scott-Davey, Tracey
Neuro- and myotoxicological signs and symptoms are significant clinical features of envenoming snakebites in many parts of the world. The toxins primarily responsible for the neuro and myotoxicity fall into one of two categories--those that bind to and block the post-synaptic acetylcholine receptors (AChR) at the neuromuscular junction and neurotoxic phospholipases A2 (PLAs) that bind to and hydrolyse membrane phospholipids of the motor nerve terminal (and, in most cases, the plasma membrane of skeletal muscle) to cause degeneration of the nerve terminal and skeletal muscle. This review provides an introduction to the biochemical properties of secreted sPLA2s in the venoms of many dangerous snakes and a detailed discussion of their role in the initiation of the neurologically important consequences of snakebite. The rationale behind the experimental studies on the pharmacology and toxicology of the venoms and isolated PLAs in the venoms is discussed, with particular reference to the way these studies allow one to understand the biological basis of the clinical syndrome. The review also introduces the involvement of PLAs in inflammatory and degenerative disorders of the central nervous system (CNS) and their commercial use in the food industry. It concludes with an introduction to the problems associated with the use of antivenoms in the treatment of neuro-myotoxic snakebite and the search for alternative treatments.
Cristiane dos Santos Honsho
Full Text Available The objective of this study was to evaluate the ocular effects, the feasibility and the quality of retrobulbar block using the inferior temporal technique with different local anesthetics applied with the Tuohy epidural needle in dogs. Eight dogs were included in the experiment and each one was studied four times, with interval of 15 days between the treatments: Lido - 2% lidocaine, Ropi - 0.75% ropivacaine, Bupi - 0.5% racemic bupivacaine and Levo - 0.75% levobupivacaine. Except for the ropivacaine, all of the local anesthetics contained epinephrine at 1:200.000. The blocks were performed in the right eyes immediately after anesthetic induction, and the left eyes were not blocked and were used as controls. The intraocular pressure, tear production and corneal sensitivity were evaluated before any procedure (T0, 30 min after premedication (TMPA, 30 min after anesthetic induction (T30, after recovery from anesthesia (TREC, every 60 min up to 360 min and 12 and 24 h after the block. The pupil diameter was evaluated at the same time points, excepted at T0. The maximum pupillary dilatation was observed in Lido group at T120 followed by Ropi at TREC, and Bupi and Levo at T30. All of the anesthetics maintained eye pressure within acceptable levels for normal dogs and significantly reduced tear production. Tear production returned earliest in group Lido, followed by Bupi, Ropi and Levo. The corneal sensitivity returned earliest in group Lido, followed by Ropi, Bupi and Levo. The retrobulbar block using the temporal inferior technique proved to be feasible and safe, although lubrication of the ocular surface is suggested.
Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando dos Reis; Tardelli, Maria Angela
The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block. Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4h after the blockade. MEC90 was 0.241% [R(2): 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4h. This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Effect of three different types of high school class schedules (traditional, rotating block, and accelerated block) on high school biology achievement and on differences in science learning environments
Keller, Brenda Jo
This study analyzes the effect of three different high school scheduling options on the delivery of biology instruction, on student achievement, and on student perceptions of their instructional activities. Participants were biology students and teachers from twelve high schools in a north Texas urban school district of 76,000. Block classes had 11 to 18 percent less instructional time than traditional classes. Texas Biology I End-of-Course Examination achievement results for 3,195 students along with student and teacher surveys provided information on instructional activities, attitudes, and individualization. Using an analysis of variance at a pscheduled comparisons groups, test score means were not statistically significant between the scheduled comparison groups for different ethnic groups, economically disadvantaged students, and magnet students. No significant differences were found between the science learning activity index for each of the scheduled groups. Student response data when disaggregrated and reaggregrated into program groups found a statistically significant higher index of science activity at a pclasses were found to hold a significantly more positive attitude about their science learning conditions than did the traditional students. These data suggest that during the first two years of block scheduling, the initial impact of block scheduling, where total time for science is reduced, results in lower student achievement scores when compared to traditionally scheduled classes. Yet, block scheduled student attitudes and perceptions about science learning are significantly more positive than the traditionally scheduled students.
Full Text Available Cholangiocarcinomas (CCs are malignant tumors that originate from epithelial cells lining the biliary tree and gallbladder. Ras correlative C3 creotoxin substrate 1 (Rac1, a small guanosine triphosphatase, is a critical mediator of various aspects of endothelial cell functions. The objective of the present investigation was to study the effect of blocking Rac1 expression in CCs. Seventy-four extrahepatic CC (ECC specimens and matched adjacent normal mucosa were obtained from the Department of Pathology, Inner Mongolia Medicine Hospital, between 2007 and 2009. Our results showed that the expression of Rac1 was significantly higher (53.12% in tumor tissues than in normal tissues. Western blotting data indicated a significant reduction in Rac1-miRNA cell protein levels. Rac1-miRNA cell growth rate was significantly different at 24, 48, and 72 h after transfection. Flow cytometry analysis showed that Rac1-miRNA cells undergo apoptosis more effectively than control QBC939 cells. Blocking Rac1 expression by RNAi effectively inhibits the growth of CCs. miRNA silencing of the Rac1 gene suppresses proliferation and induces apoptosis of QBC939 cells. These results suggest that Rac1 may be a new gene therapy target for CC. Blocking Rac1 expression in CC cells induces apoptosis of these tumor cells and may thus represent a new therapeutic approach.
Full Text Available BACKGROUND AND OBJECTIVES: Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia.CASE REPORT: We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level.CONCLUSIONS: Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.
fectos en el rendimiento físico a corto plazo de dos programas de entrenamiento neuromuscular con diferente orientación aplicados en jugadores de fútbol de élite U-17. [Short-term physical performance effects of two different neuromuscular oriented training programs on U-17 elite soccer players].
Full Text Available El objetivo de este trabajo fue comparar el efecto de dos programas de entrenamiento neuromuscular (orientación vertical vs horizontal, realizados durante 6 semanas, sobre el rendimiento físico en jugadores de fútbol. Dieciséis futbolistas de 16,6 ± 0,3 años fueron asignados de manera aleatoria en dos grupos experimentales que complementaron su entrenamiento habitual de fútbol con un programa de entrenamiento neuromuscular dos días a la semana. El entrenamiento del grupo vertical (n=8, GV consistió en los ejercicios ½ sentadilla y squat lateral realizados en un dispositivo inercial, y salto vertical al cajón, y el entrenamiento del grupo horizontal (n=8, GH estuvo basado en ejercicios resistidos de sprint lineal y con cambio de dirección (COD. Antes y después del periodo de intervención se midió la altura de salto vertical, el tiempo de sprint lineal y COD y la potencia del tren inferior. Se obtuvieron mejoras sustanciales (probables a muy probables en GV en salto con contramovimiento (CMJ [TE: 0,49, VC: Probable (93/7/0%], test de Abalakov (ABK [TE: 0,38, VC: Probable (83/16/1%] y velocidad media propulsiva (VMP en todas las cargas utilizadas, además de empeorar el tiempo de sprint lineal y COD hacia la izquierda (COD-I. El GH mejoró sustancialmente el tiempo de sprint 10m [TE = 0,63, VC: Muy Probable (98/2/0%], COD hacia la derecha (COD-D [TE = 0,36, VC: Probable (76/23/1%], COD-I [TE = 0,34, VC: Probable (80/19/1%], y VMP con 15-30-50kg, además de una posible mejora en el tiempo de sprint en 20 y 30m. El análisis inter-grupos mostró mejoras sustanciales mayores en GV en CMJ [TE = 0,39, VC: Muy Probable (76/22/0%], y en GH en tiempo de sprint en 10-20-30m y COD hacia la derecha (COD-D. Los resultados obtenidos sugieren que el entrenamiento del GH es más efectivo en la optimización de la condición física específica del futbolista. Abstract The aim of this research was to compare the effects of two different
Namazu, Takahiro; Ito, Shun; Kanetsuki, Shunsuke; Miyake, Shugo
In this paper, the threshold size of sputtered Al/Ni multilayer blocks required for inducing a self-propagating exothermic reaction on a Si wafer is described. An Al/Ni multilayer film with a bilayer thickness of 100 nm is deposited on a Si wafer, and then micronsized Al/Ni multilayer blocks from the film are fabricated using a focused ion beam. By inducing small sparks in the vicinity of the blocks, we investigate reactivity. From scanning electron microscopy observations, we confirm that Al/Ni multilayer blocks with high aspect ratios and small widths can react easily. The effect of Al/Ni multilayer block size on reactivity is discussed from the viewpoint of heat conduction from the block to a Si wafer during an exothermic reaction.
Pablo César Rodríguez Gómez
Full Text Available Context: Because feedback systems are very common and widely used, studies of the structural characteristics under which chaotic behavior is generated have been developed. These can be separated into a nonlinear system and a linear system at least of the third order. Methods such as the descriptive function have been used for analysis. Method: A feedback system is proposed comprising a linear system, a nonlinear system and a delay block, in order to assess his behavior using Lyapunov exponents. It is evaluated with three different linear systems, different delay values and different values for parameters of nonlinear characteristic, aiming to reach chaotic behavior. Results: One hundred experiments were carried out for each of the three linear systems, by changing the value of some parameters, assessing their influence on the dynamics of the system. Contour plots that relate these parameters to the Largest Lyapunov exponent were obtained and analyzed. Conclusions: In spite non-linearity is a condition for the existence of chaos, this does not imply that any nonlinear characteristic generates a chaotic system, it is reflected by the contour plots showing the transitions between chaotic and no chaotic behavior of the feedback system. Language: English
Moon, Sung-Jun; Kim, Yong-Wook
[Purpose] The purpose of this study was to compare the effect of treadmill training with the eyes closed and eyes open on the joint position sense of chronic stroke patients. [Subjects and Methods] Thirty patients with chronic stroke participated in this study. Patients performed the timed up and go test and were assigned to one of two treadmill training groups with and without visual deprivation. The treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a week for 4 weeks. The knee joint proprioception was measured using the Biodex System Pro 3 before and after the intervention. [Results] The knee joint proprioception of the treadmill training with blocked vision group showed more significant improvement after the treadmill training sessions than that of the eyes open group. [Conclusion] This study demonstrated that treadmill training with blocked vision may be useful for the proprioceptive sensory rehabilitation of patients with chronic stroke.
Hye Won Shin
Full Text Available Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB. This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery.We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software.We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004, motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003, and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001 compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001 and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010. In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05 but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies.In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and
Hughes, Gerwyn; Watkins, James; Owen, Nick
The aim of this study was to examine the effect of opposition and gender on knee kinematics and ground reaction force during landing from a volleyball block jump. Six female and six male university volleyball players performed two landing tasks: (a) an unopposed and (b) an opposed volleyball block jump and landing. A 12-camera motion analysis…
Crumb, W J
The prevalence of concurrent use of two or more drugs that block human ether-a-go-go-related gene product (hERG) K(+) channels is not uncommon, but is not well characterized. This study defined the effects of concurrent exposure of two hERG-blocking drugs on hERG current amplitude. Experiments were conducted to determine if concomitant exposure to two potent pore hERG blockers, thioridazine and terfenadine and a weak hERG blocker, erythromycin, would result in an additive, synergistic or inhibitory effect. hERG currents from stably transfected HEK cells were measured using the whole-cell variant of the patch-clamp method at physiological temperatures. Concentration-response relationships for thioridazine or terfenadine were obtained with cells pre-exposed to erythromycin. Pre-exposure of cells to erythromycin resulted in an approximately 14-22-fold rightward shift in the hERG concentration-response curve for thioridazine and terfenadine respectively. This reduction in affinity was not the result of a change in the voltage-dependent characteristics of the channel. Results suggest an external binding site for erythromycin. Pretreatment with erythromycin induced an approximately 14-22-fold reduction in hERG affinity for pore-binding drugs at concentrations of erythromycin, which by themselves only block hERG by 10% or less. These results suggest distinct, allosterically linked binding sites on opposite sides of the hERG channel. Occupancy of the external site by erythromycin reduces the affinity of the pore binding site. Furthermore, these results suggest that co-administration of erythromycin may provide some reduction in cardiac liability of potent hERG-blocking drugs. © 2014 The British Pharmacological Society.
Bosco, C; Colli, R; Bonomi, R; von Duvillard, S P; Viru, A
This study investigated changes induced by a single heavy resistance training session on neuromuscular and endocrine systems in trained athletes, using the same exercises for training and testing. Five different groups volunteered: track and field male sprinters (MS, N = 6), track and field female sprinters (FS, N = 6), body builders (BB, N = 6), and weight lifters performing low-repetition exercise (WLL, N = 4) and high-repetition exercise (WLH, N = 4). In training, the work performed during half and full squat exercise was monitored for mechanical power output as well as EMG analysis on leg extensor muscles of the subjects belonging to the MS, FS, and BB groups. Just before and immediately after the training session, venous blood samples were obtained for RIA determination of testosterone (T), cortisol (C), lutropin (LH), human prolactin (PRL), and follitropin (FSH) in FS and MS. In the other three groups (BB, WLH, and WLL), the hormonal profile was limited to T and human growth hormone (hGH) only. After training the power developed in full squat demonstrated a statistically significant decrease (P training session. Consequently, the EMG/Power ratio increased in both MS and FS, although only in MS a statistical significance was noted (P < 0.05). In MS immediately after the session the levels of C, T, and LH were significantly lower (P < 0.05). No changes were found in FS. In both groups and in BB significant negative correlation was found between changes in T level and EMG/Power ratio in half squat performance. It is likely that adequate T level may compensate the effect of fatigue in FT fibers by ensuring a better neuromuscular efficiency.
Sinha, R; Sharma, A; Ray, B R; Chandiran, R; Chandralekha, C; Sinha, R
Magnesium sulphate has been used along with local anesthetics in different regional blocks and found to be effective in decreasing the time of onset of the block and increasing the duration of the block. To evaluate the effect of addition of magnesium sulfate to standard local anesthetics mixture on the time for onset of the globe and lid akinesia for peribulbar block in ophthalmic surgeries. Sixty patients with American Society of Anesthesiologists status I to III undergoing ophthalmic surgery under peribulbar block were included in this study. Patients were randomized into two groups. Both the groups received 4.5 ml of 2% lidocaine, 4.5 ml of 0.5% bupivacaine with150 IU hyaluronidase. Group NS received normal saline 1 ml in the peribulbar block and Group MS, magnesium sulfate 50 mg in 1 ml normal saline. The onset of akinesia, satisfactory block and complications were observed by an independent observer. Demographic data was statistically similar. In the Group NS at 3, 5, 10 and 15 min after the block, complete akinesia was seen in 0, 2, 11 and 28 patients respectively. In the Group MS, at 3, 5, 10 and 15 min after the block, complete akinesia was seen in 13, 23, 27 and 28 patients respectively. Patients received magnesium sulfate showed the statistically significant rapid onset of lid and globe akinesia than the control group till 10 min (P block and had complications during the surgery. Addition of 50 mg of magnesium sulfate to the lidocaine-bupivacaine mixture for peribulbar block decreases the onset of akinesia without any obvious side effect.
Full Text Available It is a great pleasure to be asked to honour the memory of Dr. Baldev Singh by reviewing the field of autoantibodies in myasthenia gravis and other neurotransmission disorders. The neuromuscular junction (NMJ is the site of a number of different autoimmune and genetic disorders, and it is also the target of many neurotoxins from venomous snakes, spiders, scorpions and other species. The molecular organization of the NMJ is graphically represented in [Figure 1A], where different ion channels, receptors and other proteins are shown. Four of the ion channels or receptors are directly involved in autoimmune diseases. This brief review will not only concentrate on these conditions but also illustrate how their study is helping us to understand the etiology of rare but treatable neurological syndromes of the central nervous system.
Full Text Available Sustainable development of the built environment in developing countries is a major challenge in the 21st century. The use of local materials in construction of buildings is one of the potential ways to support sustainable development in both urban and rural areas. Building with Compressed Earthen Blocks (CEBs is becoming more popular due to their low cost and relative abundance of materials. The proposed Green-Compressed Earth Block (GCEB consists of ordinary CEB ingredients plus Banana fibers, which will be the focus of this study. Banana fibers are widely available worldwide as agricultural waste from Banana cultivation. Banana fibers are environmentally friendly and present important attributes, such as low density, light weight, low cost, high tensile strength, as well as being water and fire resistant. This kind of waste has a greater chance of being utilized for different application in construction and building materials. This focused on the use of banana fiber and its effect on the compressive and flexural strength in CEB. The deflection at the mid-span of the blocks studied was calculated using the Linear Variable Differential Transformer (LVDT. The results of this study will highlight general trends in the strength properties of different soil mixes for CEBs. These efforts are necessary to ensure that GCEB technology becomes more widely accepted in the world of building materials and is considered a reliable option for providing low-cost housing.
Hanamatsu, Naotoshi; Yamashiro, Mikiko; Sumitomo, Masahito; Furuya, Hideki
Stellate ganglion block (SGB) is one treatment option for human trigeminal nerve injury. The aim of this study was to evaluate the effectiveness of cervical sympathetic ganglia blocks (SB) by comparing the recovery of severed nerves in 2 rat models, treated or not treated by SB. The infraorbital nerves (ION) were cut in 108 rats. Fifty-four of them were treated daily by SB for 30 days (SB group). The remainder were left untreated (Control group). The stages of recovery were evaluated neurophysiologically by measuring somatosensory evoked potentials (SEPs) and were histologically analyzed via microscopic observation. The neurophysiologic evaluation showed that SEP amplitude was detected 1 month after cutting the ION in the SB group, but not in the Control group. The average recovery after 8 months was almost 100% in the SB group and about 70% in the Control group. The histologic evaluation showed no significant difference in the number of myelinated nerve fibers per unit area between the 2 groups. However, in the SB group, the mean diameter and distribution of diameters of the myelinated fibers were greater, and myelinated fibers of large diameter were observed at an early stage. The findings suggest that cervical sympathetic nerve block may accelerate the recovery and regeneration of severed ION. The clinical correlation in patients with peripheral trigeminal paralysis remains to be established.
Full Text Available Main functions of a neuromuscular (NM centre are making diagnosis, treatment and counselling. Some other functions, e. g. forming a register and epidemiological endeavours, could be added. All these activities are expected to be achieved by multidisciplinary approach with the idea that members use the same guidelines and share the same knowledge.NM diseases affect lower levels of the nervous system that is motor units (motor cells in the brainstem and spinal cord, nerve roots, cranial and peripheral nerves, neuromuscular junction, and muscles. There are many such diseases; a few are more common others are rare.Rational approach in making a diagnosis can be divided into several steps. The process begins with a person with clinical symptoms and signs which raise the suspicion of NM disease. The first step is the description of the predominant pattern of muscular wasting and weakness (e. g. limb-girdle, distal, ocular, facio-scapulo-humeral. Each of these syndromes require a differential diagnosis within the motor unit territory what is achieved by means of EMG and muscle biopsy. The latter is even more important to define the nature of the abnormality. Disease nature can also be determined biochemically and, as NM disorders are commonly genetically determined, at the molecular genetic level. Treatment modalities include drugs (causative and symptomatic and other measures such as promoting and maintaining good general health, preventing skeletal deformities, physiotherapy, orthoses, surgery, and prevention of respiratory and cardiac functions. Counselling is mainly by social workers that focus on the practical aspects of coping with illness and disability and by genetic counsellors who gave advise on family planning.
Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando Dos Reis; Tardelli, Maria Angela
The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block (ABPB). Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block: a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4hours after the blockade. MEC90 was 0.241% [R2: 0.978, confidence interval: 0.20%-0.34%]. No successful block patient reported pain after 4hours. This study demonstrated that ultrasound guided ABPB can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Chen, Ming-quan; Xia, Zhong-yuan
The aim of the study was to determine the median effective dose (ED50) for motor block of various concentrations of intrathecally administered plain bupivacaine. Between 2011 and 2013, 64 patients aged ≥70 years, undergoing transurethral, or lower limb surgery with combined spinal and epidural anesthesia in a single hospital were enrolled. The patients were randomized into 3 groups to receive intrathecal 0.75% bupivacaine (Group 1), 0.375% bupivacaine (Group 2) or 0.25% bupivacaine (Group 3). Spinal anesthesia was achieved using injections of up-and-down doses of 0.75%, 0.375%, or 0.25% plain bupivacaine. The first patient in each group received 7.5 mg bupivacaine, and the testing interval was set at 0.75 mg. The efficacy of motor block in both legs was determined using a modified Bromage and a hip motor function scale. The ED50 for motor block was estimated according to the Dixon's up-and-down method. The ED50 for motor block of bupivacaine was 6.10 (95% CI 5.58-6.66) mg in Group 1, 6.04 (95% CI 5.82-6.28) mg in Group 2, and 5.43 (95% CI 5.19-5.67) mg in Group 3. There were significant differences in the ED50 for motor block among the groups (P=0.008). The ED50 doses for motor block with 3 bupivacaine concentrations were significantly different in elderly patients; the ED50 dose of 0.75% bupivacaine being significantly higher than that of 0.25% bupivacaine.
Kim, Byoung Jae [School of Mechanical Engineering, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134 (Korea, Republic of); Kim, Jongrok; Kim, Kihwan; Bae, Sung Won [Thermal-Hydraulic Safety Research Division, Korea Atomic Energy Research Division, 111 Daedeok-daero, Yuseong-gu, Daejeon 34057 (Korea, Republic of); Moon, Sang-Ki, E-mail: email@example.com [Thermal-Hydraulic Safety Research Division, Korea Atomic Energy Research Division, 111 Daedeok-daero, Yuseong-gu, Daejeon 34057 (Korea, Republic of)
Ballooning of the fuel rods has been an important issue, since it can influence the coolability of the rod bundle in a large-break loss-of-coolant accident (LBLOCA). Numerous past studies have investigated the effect of blockage geometry on the heat transfer in a partially blocked rod bundle. However, they did not consider the occurrence of fuel relocation and the corresponding effect on two-phase heat transfer. Some fragmented fuel particles located above the ballooned region may drop into the enlarged volume of the balloon. Accordingly, the fuel relocation brings in a local power increase in the ballooned region. The present study’s objective is to investigate the effect of the fuel relocation on the reflood under a LBLOCA condition. Toward this end, experiments were performed in a 5 × 5 partially-blocked rod bundle. Two power profiles were tested: one is a typical cosine shape and the other is the modified shape considering the effect of the fuel relocation. For a typical power shape, the peak temperature in the ballooned rods was lower than that in the intact rods. On the other hand, for the modified power shape, the peak temperature in the ballooned rods was higher than that in the intact rods. Numerical simulations were also performed using the MARS code. The tendencies of the peak clad temperatures were well predicted.
Sugimoto, Dai; Myer, Gregory D; Barber Foss, Kim D; Pepin, Michael J; Micheli, Lyle J; Hewett, Timothy E
Objective The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. Design Systematic review and meta-regression. Data sources The literature search was performed in PubMed and EBSCO. Eligibility criteria Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. Results The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2–17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). Conclusions Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes. PMID:27251898
Sugimoto, Dai; Myer, Gregory D; Barber Foss, Kim D; Pepin, Michael J; Micheli, Lyle J; Hewett, Timothy E
The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses. Systematic review and meta-regression. The literature search was performed in PubMed and EBSCO. Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted. The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2-17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence). Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
Lateral ankle sprain is a common orthopedic injury with a very high recurrence rate in athletes. After decades of research, it is still unclear what contributes to the high recurrence rate of ankle sprain, and what is the most effective intervention to reduce the incident of initial and recurrent injuries. In addition, clinicians often implement balance training as part of the rehabilitation protocol in hopes of enhancing the neuromuscular control and proprioception of the ankle joint. Howeve...
Rodiek, S.O.; Kuether, G.
CT-documentation of skeletal muscular lesions caused by neuromuscular diseases implies an essential contribution to conventional techniques in the macroscopic field. Size, distribution and degree of lesions as well as compensatory mechanisms are proved thereby. We report about the different effects on muscle appearance referring to 106 patients of our own experience in amyotrophic lateral sclerosis, spinal muscular atrophy, poliomyelitis, polyradiculitis, polyneuropathy as well as peripheral traumatic nerve lesions.
Full Text Available Background: Neuromuscular electric stimulation (NMES induces repeated muscular contraction, possibly promoting the perfusion/oxygenation of the regional tissues. It remains unclear how NMES influences vascular hemodynamic property and segmental fluid distribution/composition in paretic extremities of hemiplegic patients. Methods: Eleven hemiplegic patients aged 62.6 ± 12.5 years in the subacute stage of stroke received NMES for paretic wrist extensor and flexor muscles 30 min daily, 5 days per week for 4 weeks. The non-paretic upper extremities (NPUE that did not receive NMES served as control. Distribution of fluid to intra/extracellular milieu and arterial hemodynamic properties were determined by using the multi-frequency bioelectrical impedance and pulse wave analysis, respectively. Results: Compared with NPUE without NMES, paretic upper extremity (PUE with NMES revealed a significantly less decrease in arterial blood flow, impedance quotient, slope quotient, and less increase in crest width and crest time of arterial pulse wave. NMES for 4 weeks increased body cell mass in PUE. Furthermore, NPUE without NMES reduced intracellular water, whereas PUE with NMES retarded loss of intracellular water after stroke. Conclusion: NMES therapy increases body cell mass, attenuates reduction of intracellular water, and alleviates arterial hemodynamic disturbance in PUE in subacute stroke. However, stroke-related physical deconditioning may negatively regulate body composition and impair hemodynamic function in NPUE.
Full Text Available Neuromuscular diseases are inherited, chronic, degenerative and progressive. The main characteristics of neuromuscular diseases are: muscular weakness, contractures, scoliosis, respiratory insufficiency, cardiac affection, nutrition disturbances, dependence on the help of others, possible social isolation and physiological problems. Appropriate rehabilitation programs should influence all mentioned characteristics. A special unit for rehabilitation of patients with neuromuscular diseases within the Institute for rehabilitation of the Republic of Slovenia was established in 1993 at the initiative of the Muscular Dystrophy Association of Slovenia. The main aim of this establishment was to try to guide the patient and his family through the course of the disease. The article describes the work of the mentioned unit. Different clinical rehabilitation programs for people with neuromuscular diseases are presented and some research results of the unit are mentioned.
Priyanto, Basuki Endah; Sørensen, Troels Bundgaard; Jensen, Ole Kiel
In this paper we investigate the impact of in-band interference on the uplink multiple access of UMTS Terrestrial Radio Access, long term evolution (UTRA LTE). In- band and out-of-band interference arise as a result of transmitter imperfections. Out-of- band, or adjacent channel, interference can......, and when the interfering signal is received at higher power spectral density (PSD). The effect of frequency offset and different PSD level from the UE interferers to a victim UE is studied. The impact on different UE resource block size allocation is also investigated. The results are obtained from an LTE...
Full Text Available Manufacturing complexity increases as a result of product configuration, and even though different manufacturing complexity measures have been developed, none of them seem to put attention to the blocking effect a product’s bill-of-material imposes to the process flow. The following paper extends the research presented by the authors in a previous paper, where a set of entropic formulations were developed to act as an increase/decrease indicator of a manufacturing system’s performance parameters. Our findings show that the improvements to the entropic formulations provide results that are closer to the system’s performance parameters final values.
Efeitos da crioterapia e facilitação neuromuscular proprioceptiva sobre a força muscular nas musculaturas flexora e extensora de joelho Effects of cryotherapy and proprioceptive neuromuscular facilitation on muscle strength at the flexor and extensor muscles of the knee
Daiana Moreira Mortari
Full Text Available As musculaturas flexora e extensora do joelho são freqüentemente lesionadas devido a um desequilíbrio entre esses grupos. Recursos térmicos, como a crioterapia, e técnicas de alongamento, como a técnica mantém-relaxa da facilitação neuromuscular proprioceptiva (FNP, influenciam a flexibilidade e força muscular, proporcionando maior homogeneidade entre essas musculaturas e diminuindo a incidência de lesões. Este estudo objetivou verificar os efeitos da crioterapia e da FNP sobre a força das musculaturas flexora e extensora de joelho. A amostra foi composta por 18 mulheres com idade entre 18 e 24 anos, não-praticantes de atividade física regular, divididas em dois grupos: um submetido a crioterapia e o outro à técnica mantém-relaxa da FNP. Antes e após uma sessão de aplicação das técnicas foi feita avaliação isocinética. A aplicação da técnica mantém-relaxa provocou aumento da força em ambas as musculaturas em ambos os membros, atingindo nível de significância nos flexores do membro inferior direito (p=0,04. A crioterapia diminuiu a força dos extensores e exerceu efeito contrário sobre os flexores, tendo gerado aumento significativo nos flexores do membro inferior direito (p=0,035. Quando comparadas as técnicas, a técnica mantém-relaxa gerou maiores valores de pico de torque, principalmente nos extensores do membro inferior esquerdo (p=0,042. Conclui-se que a técnica mantém-relaxa da FNP gerou maiores valores no pico de torque em relação à crioterapia.Knee extensor and flexor muscles are often injured due to an imbalance between these groups, which may lead to a deficit in muscle performance. Thermal resources, such as cryotherapy, and stretching techniques, such as the "hold-relax" of proprioceptive neuromuscular facilitation (PNF, influence flexibility and muscle strength and may reduce the chances of muscle tendon injuries. The aim of the study was to verify the effects of cryotherapy and of the PNF
Effects of neuromuscular electrical stimulation on tibialis anterior muscle of spastic hemiparetic children Efeitos de estimulação elétrica neuromuscular no músculo tibial anterior em crianças hemiparéticas espásticas
Full Text Available OBJECTIVE: This study evaluated the effects of neuromuscular electrical stimulation (NMES on muscle strength, range of motion (ROM and gross motor function, among spastic hemiparetic children while standing, walking, running and jumping. METHODS: Ten children were divided into two groups of five. The children who were normally receiving physical therapy sessions twice a week had two 30-minute NMES sessions per week (group 1, while those who were having one physical therapy session per week had one 30-minute NMES session per week (group 2, for seven weeks in both groups. The children were evaluated three times: before beginning the NMES protocol (initial, right after the end of the protocol (final and eight weeks after the final evaluation (follow-up. The evaluations included manual goniometry on ankle dorsiflexion, manual muscle strength of the tibialis anterior and gross motor function (measurements while standing, walking, running and jumping. The statistical analysis was performed using the Wilcoxon and Mann-Whitney tests, considering a p level of 0.05. RESULTS: There were significant increases in muscle strength, gross motor function and passive ROM of ankle dorsiflexion, in both groups, and in active dorsiflexion in the first group. No significant differences were found between the groups. CONCLUSIONS: The improvements in ROM, muscle strength and gross motor function demonstrated that the use of NMES was effective in both groups, since no significant differences were found between the groups. This study suggests that NMES may be a useful therapeutic tool, even when applied once a week. Further studies are needed to confirm these findings.OBJETIVO: Este estudo avaliou os efeitos da estimulação elétrica neuromuscular (EENM na força, amplitude de movimento (ADM e função motora grossa (FMG em pé, andando, correndo e pulando de crianças hemiparéticas espásticas. MÉTODOS: Dez crianças foram divididas em dois grupos de cinco. As que
Wied, D. de
The effect of autonomic blocking agents and structurally related substances was studied in rats in which thirst was produced by the administration of a hypertonic sodium chloride solution. Scopolamine, methamphetamine, amphetamine, chlorpromazine, atropine, mecamylamine, hexamethonium, nethalide,
Full Text Available Abstract We report on the use of the self-organization process of sputtered gold nanoparticles on a self-assembled block copolymer film deposited by horizontal precipitation Langmuir-Blodgett (HP-LB method. The morphology and the phase-separation of a film of poly-n-butylacrylate-block-polyacrylic acid (PnBuA-b-PAA were studied at the nanometric scale by using atomic force microscopy (AFM and Time of Flight Secondary Ion Mass Spectrometry (TOF-SIMS. The templating capability of the PnBuA-b-PAA phase-separated film was studied by sputtering gold nanoparticles (NPs, forming a film of nanometric thickness. The effect of the polymer chain mobility onto the organization of gold nanoparticle layer was assessed by heating the obtained hybrid PnBuA-b-PAA/Au NPs bilayer at T >Tg. The nanoparticles' distribution onto the different copolymer domains was found strongly affected by the annealing treatment, showing a peculiar memory effect, which modifies the AFM phase response of the Au NPs layer onto the polar domains, without affecting their surfacial composition. The effect is discussed in terms of the peculiar morphological features induced by enhanced mobility of polymer chains on the Au NPs layer.
Efeitos da facilitação neuromuscular proprioceptiva na estabilidade postural e risco de quedas em pacientes com sequela de acidente vascular encefálico: estudo piloto Efectos de la facilitación neuromuscular propioceptiva en la estabilidad postural y riesgo de caídas en pacientes con secuela de accidente vascular encefálico: estudio piloto Effects of proprioceptive neuromuscular facilitation in postural stability and risk of falls in patients with sequelae of stroke: pilot study
Natália Noman de Lacerda; Érika Baptista Gomes; Hudson Azevedo Pinheiro
O controle do tronco é uma habilidade motora básica necessária para executar diversas tarefas funcionais, e é deficiente em pacientes que sofreram acidente vascular encefálico (AVE). Objetivo: Avaliar o efeito do método facilitação neuromuscular proprioceptiva (PNF) na estabilidade postural e risco de quedas em pacientes com sequela de AVE. Metodologia: Foi realizado estudo de intervenção que consistiu em treinamento da estabilidade postural por meio de um protocolo fixo constituído por 5 exe...
Ramsay, D A; Drachman, D B; Pestronk, A
The rate of acetylcholine receptor (AChR) degradation in mature, innervated mammalian neuromuscular junctions has recently been shown to be biphasic; up to 20% are rapidly turned over (RTOs; half life less than 1 day) whereas the remainder are lost more slowly ('stable' AChRs; half life 10-12 days). In order to maintain normal junctional receptor density, synthesis and insertion of AChRs should presumably be sufficiently rapid to replace both the RTOs and the stable receptors. We have tested this prediction by blocking pre-existing AChRs in the mouse sternomastoid muscle with alpha-bungarotoxin (alpha-BuTx), and monitoring the subsequent appearance of 'new' junctional AChRs at intervals of 3 h to 20 days by labeling them with 125I-alpha-BuTx. The results show that new receptors were initially inserted rapidly (16% at 24 h and 28% at 48 h). The rate of increase of 'new' 125I-alpha-BuTx binding sites gradually slowed down during the remainder of the time period studied. Control observations excluded possible artifacts of the experimental procedure including incomplete blockade of AChRs, dissociation of toxin-receptor complexes, or experimentally induced alteration of receptor synthesis. The present demonstration of rapid synthesis and incorporation of AChRs at innervated neuromuscular junctions provides support for the concept of a subpopulation of rapidly turned over AChRs. The RTOs may serve as precursors for the larger population of stable receptors and have an important role in the metabolism of the neuromuscular synapse.
Full Text Available Local anesthesia is important to do prior to tooth extraction procedure to control the patient's pain. Local anesthetic technique in dentistry consists of topical, infiltration, and anesthetic blocks. For molar tooth extraction, mandibular block technique is used either direct or indirect. This study aimed to see if there are differences in effectiveness of inferior alveolar nerve block anesthesia techniques between direct and indirect. This clinical experimental design study used 20 patients as samples during February-April. 10 patients were taken as a group that carried out direct technique while 10 others group conducted indirect techniques. The sample selection using purposive sampling method. Pain level were measured using objective assessments (pain experienced by the patient after a given stimulus and subjective evaluation (thick taste perceived by the patient. The average time of onset in direct and indirect techniques in each sample was 16.88 ± 5.30 and 102.00 ± 19.56 seconds (subjectively and 22.50 ± 8.02 and 159.00 ± 25.10 (objectively. These results indicated direct techniques onset faster than indirect techniques. The average duration of direct and indirect techniques respectively was 121.63 ± 8.80 and 87.80 ± 9.96 minutes (subjectively and 91.88 ± 8.37 and 60.20 ± 10.40 minutes (objectively. These results indicated the duration of direct technique is longer than indirect technique. There was no significant difference when viewed from anesthesia depth and aspiration level. This study indicated that direct technique had better effect than indirect technique in terms of onset and duration, while in terms of anesthesia depth and aspiration level was relatively equal. Insignificant differences were obtained when assessing anesthetic technique successful rate based on gender, age and extracted tooth.
I. S. Rubina
Full Text Available The paper deals with image interpolation methods and their applicability to eliminate some of the artifacts related to both the dynamic properties of objects in video sequences and algorithms used in the order of encoding steps. The main drawback of existing methods is the high computational complexity, unacceptable in video processing. Interpolation of signal samples for blocking - effect elimination at the output of the convertion encoding is proposed as a part of the study. It was necessary to develop methods for improvement of compression ratio and quality of the reconstructed video data by blocking effect elimination on the borders of the segments by intraframe interpolating of video sequence segments. The main point of developed methods is an adaptive recursive algorithm application with adaptive-sized interpolation kernel both with and without the brightness gradient consideration at the boundaries of objects and video sequence blocks. Within theoretical part of the research, methods of information theory (RD-theory and data redundancy elimination, methods of pattern recognition and digital signal processing, as well as methods of probability theory are used. Within experimental part of the research, software implementation of compression algorithms with subsequent comparison of the implemented algorithms with the existing ones was carried out. Proposed methods were compared with the simple averaging algorithm and the adaptive algorithm of central counting interpolation. The advantage of the algorithm based on the adaptive kernel size selection interpolation is in compression ratio increasing by 30%, and the advantage of the modified algorithm based on the adaptive interpolation kernel size selection is in the compression ratio increasing by 35% in comparison with existing algorithms, interpolation and quality of the reconstructed video sequence improving by 3% compared to the one compressed without interpolation. The findings will be
Full Text Available The biological function of the cholinesterase (ChE enzymes is well known and has been studied since the beginning of the XXth century; in particular, acetylcholinesterase (AChE, E.C. 220.127.116.11 is an enzyme playing a key role in the modulation of neuromuscular impulse transmission. However, in the past decades, there has been increasing interest concerning its role in regulating non-neuromuscular cell-to-cell interactions mediated by intracellular ion concentration changes, like the ones occurring during gamete interaction and embryonic development. An understanding of the mechanisms of the cholinergic regulation of these events can help us foresee the possible impact on environmental and human health, including gamete efficiency and possible teratogenic effects on different models, and help elucidate the extent to which exposure to ChE inhibitors may affect human health.
Maity, Sudhangshu; Jana, Tushar
A series of meta-polybenzimidazole-block-para-polybenzimidazole (m-PBI-b-p-PBI), segmented block copolymers of PBI, were synthesized with various structural motifs and block lengths by condensing the diamine terminated meta-PBI (m-PBI-Am) and acid terminated para-PBI (p-PBI-Ac) oligomers. NMR studies and existence of two distinct glass transition temperatures (Tg), obtained from dynamical mechanical analysis (DMA) results, unequivocally confirmed the formation of block copolymer structure through the current polymerization methodology. Appropriate and careful selection of oligomers chain length enabled us to tailor the block length of block copolymers and also to make varieties of structural motifs. Increasingly distinct Tg peaks with higher block length of segmented block structure attributed the decrease in phase mixing between the meta-PBI and para-PBI blocks, which in turn resulted into nanophase segregated domains. The proton conductivities of proton exchange membrane (PEM) developed from phosphoric acid (PA) doped block copolymer membranes were found to be increasing substantially with increasing block length of copolymers even though PA loading of these membranes did not alter appreciably with varying block length. For example when molecular weight (Mn) of blocks were increased from 1000 to 5500 then the proton conductivities at 160 °C of resulting copolymers increased from 0.05 to 0.11 S/cm. Higher block length induced nanophase separation between the blocks by creating less morphological barrier within the block which facilitated the movement of the proton in the block and hence resulting higher proton conductivity of the PEM. The structural varieties also influenced the phase separation and proton conductivity. In comparison to meta-para random copolymers reported earlier, the current meta-para segmented block copolymers were found to be more suitable for PBI-based PEM.
Full Text Available Progesterone-induced blocking factor (PIBF is a progesterone (P4 regulated protein expressed in different types of high proliferative cells including astrocytomas, the most frequent and aggressive brain tumors. It has been shown that PIBF increases the number of human astrocytoma cells. In this work, we evaluated PIBF regulation by P4 and the effects of PIBF on proliferation, migration, and invasion of U87 and U251 cells, both derived from human glioblastomas. PIBF mRNA expression was upregulated by P4 (10 nM from 12 to 24 h. Glioblastoma cells expressed two PIBF isoforms, 90 and 57 kDa. The content of the shorter isoform was increased by P4 at 24 h, while progesterone receptor antagonist RU486 (10 μM blocked this effect. PIBF (100 ng/mL increased the number of U87 cells on days 4 and 5 of treatment and induced cell proliferation on day 4. Wound-healing assays showed that PIBF increased the migration of U87 (12–48 h and U251 (24 and 48 h cells. Transwell invasion assays showed that PIBF augmented the number of invasive cells in both cell lines at 24 h. These data suggest that PIBF promotes proliferation, migration, and invasion of human glioblastoma cells.
Full Text Available CD47 is a glycoprotein of the immunoglobulin superfamily that is often overexpressed in different types of hematological and solid cancer tumors and plays important role in blocking phagocytosis, increased tumor survival, metastasis and angiogenesis. In the present report, we designed CAR (chimeric antigen receptor-T cells that bind CD47 antigen. We used ScFv (single chain variable fragment from mouse CD47 antibody to generate CD47-CAR-T cells for targeting different cancer cell lines. CD47-CAR-T cells effectively killed ovarian, pancreatic and other cancer cells and produced high level of cytokines that correlated with expression of CD47 antigen. In addition, CD47-CAR-T cells significantly blocked BxPC3 pancreatic xenograft tumor growth after intratumoral injection into NSG mice. Moreover, we humanized mouse CD47 ScFv and showed that it effectively bound CD47 antigen. The humanized CD47-CAR-T cells also specifically killed ovarian, pancreatic, and cervical cancer cell lines and produced IL-2 that correlated with expression of CD47. Thus, CD47-CAR-T cells can be used as a novel cellular therapeutic agent for treating different types of cancer.
Golubovskaya, Vita; Berahovich, Robert; Zhou, Hua; Xu, Shirley; Harto, Hizkia; Li, Le; Chao, Cheng-Chi; Mao, Mike Ming; Wu, Lijun
CD47 is a glycoprotein of the immunoglobulin superfamily that is often overexpressed in different types of hematological and solid cancer tumors and plays important role in blocking phagocytosis, increased tumor survival, metastasis and angiogenesis. In the present report, we designed CAR (chimeric antigen receptor)-T cells that bind CD47 antigen. We used ScFv (single chain variable fragment) from mouse CD47 antibody to generate CD47-CAR-T cells for targeting different cancer cell lines. CD47-CAR-T cells effectively killed ovarian, pancreatic and other cancer cells and produced high level of cytokines that correlated with expression of CD47 antigen. In addition, CD47-CAR-T cells significantly blocked BxPC3 pancreatic xenograft tumor growth after intratumoral injection into NSG mice. Moreover, we humanized mouse CD47 ScFv and showed that it effectively bound CD47 antigen. The humanized CD47-CAR-T cells also specifically killed ovarian, pancreatic, and cervical cancer cell lines and produced IL-2 that correlated with expression of CD47. Thus, CD47-CAR-T cells can be used as a novel cellular therapeutic agent for treating different types of cancer.
Lombardi, A.; Ravindran, C.; MacKay, R.
The use of Al engine blocks has increased significantly to improve vehicle fuel efficiency. However, the gray cast iron cylinder liners cause the development of large tensile residual stress along the cylinder bores which necessitates the optimization of mechanical properties in this region to prevent premature engine failure. This study compared the microstructure of T4-treated Al billet castings of varying cooling rate to that of the cylinder region of T4-treated (current production schedule) Al engine blocks. The aim of this study was to develop a cost-effective small scale heat treatment optimization method for engine block production. Comparisons in microstructure between the engine block and the billet castings were carried out using optical and scanning electron microscopy. The results suggest that the microstructure and hardness at the top, middle, and bottom of the cylinder were similar to those of each representative billet casting, indicating that heat treatment resulted in successful replication of the engine block locations. In addition, tensile testing revealed that the YS and UTS increased slightly following T4 treatment for all billet castings, which was also observed at the middle of the engine block cylinder bridge. As such, this method can be an effective forerunner for future heat treatment optimization in Al engine block production.
Garguilo, Marine; Leroux, Karl; Lejaille, Michèle; Pascal, Sophie; Orlikowski, David; Lofaso, Frédéric; Prigent, Hélène
Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort. Optimal PEEP level (PEEPeff), defined as the PEEP level that allows complete expiration through the upper airways, was determined for 12 patients with neuromuscular disease who are supported by mechanical ventilation. Speech and respiratory parameters were studied without PEEP, with PEEPeff, and for an intermediate PEEP level. Flow and airway pressure were measured. Microphone speech recordings were subjected to both quantitative and qualitative assessments of speech, including an intelligibility score, a perceptual score, and an evaluation of prosody determined by two speech therapists blinded to PEEP condition. Text reading time, phonation flow, use of the respiratory cycle for phonation, and speech comfort significantly improved with increasing PEEP, whereas qualitative parameters remained unchanged. This resulted mostly from the increase of the expiratory volume through the upper airways available for speech for all patients combined, with a rise in respiratory rate for nine patients. Respiratory comfort remained stable despite high levels of PEEPeff (median, 10.0 cm H2O; interquartile range, 9.5-12.0 cm H₂O). Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients). The device studied could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy. ClinicalTrials.gov; No.: NCT01479959; URL: clinicaltrials.gov.
Cristian F. Pasluosta
Full Text Available Patients suffering from Parkinson’s disease (PD present motor impairments reflected in the dynamics of the center of pressure (CoP adjustments during quiet standing. One method to study the dynamics of CoP adjustments is the entropic half-life (EnHL, which measures the short-term correlations of a time series at different time scales. Changes in the EnHL of CoP time series suggest neuromuscular adaptations in the control of posture. In this study, we sought to investigate the immediate changes in the EnHL of CoP adjustments of patients with PD during one session of perturbed (experimental group and unperturbed treadmill walking (control group. A total of 39 patients with PD participated in this study. The experimental group (n = 19 walked on a treadmill providing small tilting of the treadmill platform. The control group (n = 20 walked without perturbations. Each participant performed 5-min practice followed by three 5-min training blocks of walking with or without perturbation (with 3-min resting in between. Quiet standing CoP data was collected for 30 s at pre-training, after each training block, immediately post-training, and after 10 min retention. The EnHL was computed on the original and surrogates (phase-randomized CoP signals in the medio-lateral (ML and anterior–posterior (AP directions. Data was analyzed using four-way mixed ANOVA. Increased EnHL values were observed for both groups (Time effect, p < 0.001 as the intervention progressed, suggesting neuromuscular adaptations in the control of posture. The EnHL of surrogate signals were significantly lower than for original signals (p < 0.001, confirming that these adaptations come from non-random control processes. There was no Group effect (p = 0.622, however by analyzing the significant Group by Direction by Time interaction (p < 0.05, a more pronounced effect in the ML direction of the perturbed group was observed. Altogether, our findings show that treadmill walking decreases
Li, Baochang; Guo, Lirong; Li, Yubao; Zhang, Tiantian; Tan, Yufei
As a self-insulating building material which can meet the 65 percent energy-efficiency requirements in cold region of China, aerated concrete blocks often go moldy, frost heaving, or cause plaster layer hollowing at thermal bridge parts in the extremely cold regions due to the restrictions of environmental climate and construction technique. L-shaped part and T-shaped part of aerated concrete walls are the most easily influenced parts by thermal bridge effect. In this paper, a field test is performed to investigate the scope of the thermal bridge effect. Moreover, a heat transfer calculation model for L-shaped wall and T-shaped wall is developed. According to the simulation results, the temperature fields of the thermal bridge affected regions are simulated and analyzed. The research outputs can provide theoretical basis for the application of aerated concrete wall in extremely cold regions.
Lee, Jae Jun; Hwang, Jung-Taek; Kim, Do-Young; Lee, Sang-Soo; Hwang, Sung Mi; Lee, Na Rea; Kwak, Byung-Chan
The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p 4.0, p = 0.001). Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.
Wu, Jinping; Soucek, Mark D.
The effect of multifunctional monomers or oligomers (MFM/O) additives on electron beam (E-beam) radiation induced crosslinking of poly (styrene-block-isoprene/butadiene-block-styrene) (SIBS) was studied. Ten types of MFM/O were investigated, including trimethylolpropane trimethacrylate (TMPTMA), trimethylolpropane triacrylate (TMPTA), triallyl cyanurate (TAC), polybutadiene diacrylate (PB-diacrylate), ethylene glycol dimethylacrylate (EGDMA), butylene glycol dimethacrylate (BGDMA), 1,2-polybutadiene. The effects of MFM/O concentration and E-beam radiation dose on properties of SIBS were studied including tensile strength, elongation-at-break, modulus, gel content, equilibrium swelling and crosslink density. TMPTA significantly improved the tensile modulus and crosslink density of SIBS. SIBS with TMPTMA and TMTPMA with inhibitor showed a 50% increase in tensile strength. The solubility of MFM/O in SIBS was also investigated by a selective swelling method. The MFM/O were found to be soluble in both phases of SIBS. The viscosity of SIBS with methacrylate type MFM/O was stable at 200 °C.
Jones, Kelly; Croot, Karen
There are few investigations comparing practice schedules in speech motor learning, despite certain schedules being recommended for the clinical treatment of speech motor disorders. This study compared effects of random, blocked and mixed practice on tongue twister accuracy in unimpaired speakers. We hypothesized that blocked practice would benefit acquisition of learning, but that random practice and mixed blocked-then-random practice would yield superior retention of learning. We found that the random and blocked-random practice schedules yielded superior accuracy at the end of the acquisition phase of learning and at a 1-week retention test. Exploratory post hoc analyses raised the possibility that the retention effects were most evident when tongue twisters were elicited in a random schedule. Theoretical accounts of these results are discussed.
Kellis, Eleftherios; Mademli, Lida; Patikas, Dimitrios; Kofotolis, Nikolaos
Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly. The purpose of this study is to review recent evidence on age differences in neural activation and muscle balances around the knee when performing single joint movements. Particularly, current evidence indicates that there are some interesting similarities in the neuromuscular mechanisms by which children or the elderly differ compared with adults. Both children and elderly display a lower absolute muscle strength capacity than adults which cannot fully be explained by differences in muscle mass. Quadriceps activation failure is a common symptom of all knee injuries, irrespective of age but it is likely that its effect is more evident in children or adults. While one might expect that antagonist co-activation would differ between age categories, it appears that this is not the case. Although hamstring: quadriceps ratio levels are altered after knee injury, it is not clear whether this is an age specific response. Finally, evidence suggests that both children and the elderly display less stiffness of the quadriceps muscle-tendon unit than adults which affects their knee joint function.
Rønnestad, B R; Hansen, J; Ellefsen, S
The purpose of this study was to compare the effect of two different methods of organizing endurance training in trained cyclists. One group of cyclists performed block periodization, wherein the first week constituted five sessions of high-intensity aerobic training (HIT), followed by 3 weeks of one weekly HIT session and focus on low-intensity training (LIT) (BP; n = 10, VO2max = 62 ± 2 mL/kg/min). Another group of cyclists performed a more traditional organization, with 4 weeks of two weekly HIT sessions interspersed with LIT (TRAD; n = 9, VO2max = 63 ± 2 mL/kg/min). Similar volumes of both HIT and LIT was performed in the two groups. While BP increased VO2max , peak power output (Wmax) and power output at 2 mmol/L [la(-)] by 4.6 ± 3.7%, 2.1 ± 2.8%, and 10 ± 12%, respectively (P training compared with TRAD training (ES = 1.34, ES = 0.85, and ES = 0.71, respectively). The present study suggests that block periodization of training provides superior adaptations to traditional organization during a 4-week endurance training period, despite similar training volume and intensity. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Chen, Mingquan; Chen, Chun; Ke, Qibin
In this study, we sought to determine the median effective dose (ED50) for motor block of intrathecally administered plain bupivacaine in adults (20-80 years) and to assess the effect of age on ED50 required for motor block. This study was performed in 129 adult patients undergoing transurethral, urological, or lower limb surgery under combined spinal and epidural anesthesia. Patients were stratified according to age as follows: 20 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and 71 to 80 years. The spinal component of the anesthetic was established by bolus administration of up-and-down doses of 0.75% plain bupivacaine, determined by Dixon's method. The degree of motor block after in