Neuromuscular propagation after fatiguing contractions of the paralyzed soleus muscle in humans

We analyzed the M wave and torque after repetitive activation and recovery of the human soleus muscle in individuals with spinal cord injury. Fifteen individuals with complete paralysis had the tibial nerve activated for 330 ms every second with a 20-Hz train. The M wave and torque were analyzed before fatigue, immediately after fatigue, and during recovery. The torque and three M-wave measurements (amplitude, duration, median frequency) changed significantly after fatigue in the chronic group, but the M-wave area was not changed. The M wave was completely recovered after 5 min of rest, even though the torque remained depressed during recovery. The M-wave changes appeared to contribute minimally to the reduced torque in individuals with chronic paralysis. The disassociation in the M-wave-torque relationship during fatigue and recovery suggests, that electrical stimulation under electromyography control is not an ideal method to optimize torque in paralyzed muscle.     

A musculotendon model of the fatigue profiles of paralyzed quadriceps muscle under FES

In a previous work, we studied the mechanical and the metabolic profiles of fatigue of paralyzed quadriceps muscle under activation by FES. The metabolic state of the muscle during stimulation of paraplegic patients was monitored, simultaneously with the decaying force, by using 31P nuclear magnetic resonance spectroscopy. In the present work, a musculotendon model was developed to enable prediction of the force output during continuous electrical stimulation. The model consisted of five elements, including the tendon, the parallel elastic, contractile and damper muscle elements, as well as the muscle mass. The mechanism of the contractile element was based upon the length-tension and the velocity-tension curves, the activation trajectory, and the experimentally obtained relationship between force and intracellular pH. In the equations obtained, three sets of parameters were used: 1) general muscle parameters, associated with the length-tension curves of tendon, fascia, and muscle and the velocity-tension curve of the contractile element; 2) specific anthropometric parameters of the muscle; and 3) fatigue parameters which were obtained from our previously recorded experimental data. The model was formulated to allow prediction of the quadriceps muscle force under dynamic activation and at various levels of stimulation. The model solution was for isometric contraction in supermaximal stimulation, and it provided the force decaying profiles, which were compared to those obtained experimentally. The parameters yielding the best fit between the model and the experimental results were indicated. Particularly, two muscle nonspecific parameters, namely, the muscle stress parameter and the parameter representing the ratio between the muscle's slack length and its length in vivo at various knee angles, were determined using the model. The muscle stress parameter was found to be between 60 and 64 N/cm2, and the length ratio was 0.952, 0.935, 0.920, and 0.901 for the 0, 30, 60, and 90 degrees knee angle, respectively. Finally, a sensitivity analysis was conducted of the model to perturbations of these two estimated parameters, revealing that the model was sensitive to these parameters.     

Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans

BACKGROUND: During atrial fibrillation (AF), the atrium is activated by multiple wavelets that continuously change in size and direction. The aim of this study was to correlate the temporal variation in AF electrogram configuration with the varying spatial patterns of activation. METHODS AND RESULTS: In a group of 25 Wolff-Parkinson-White patients undergoing cardiac surgery, the free wall of the right atrium was mapped (244 points) during electrically induced AF. The unipolar electrograms recorded during 4 seconds of AF were classified into four categories: (1) single deflections, (2) short-double potentials, (3) long-double potentials, and (4) fragmented potentials. The proportion of these four types of electrograms during AF was as follows: singles, 77 +/- 12%; short-doubles, 7 +/- 3%; long-doubles, 10 +/- 7%; and fragmented, 6 +/- 4%. Electrogram morphology was an indicator for rapid uniform conduction (single potentials; positive predictive value [PPV] of 0.96), collision (short-double potentials; PPV of 0.33), conduction block (long-double potentials; PPV of 0.84), and pivoting points or slow conduction (fragmented potentials; PPV of 0.87). In type I, II, and III AF, the proportion of long-double potentials was 4 +/- 2%, 12 +/- 3%, and 18 +/- 7% (P < .05); the proportion of fragmented complexes was 2 +/- 2%, 6 +/- 3%, and 10 +/- 4% (P < .05), respectively. During electrically induced and self-terminating episodes of AF, no preferential anatomic sites for double or fragmented potentials were found in the right atrium. CONCLUSIONS: The morphology of single unipolar electrograms during AF reflects the occurrence of various specific patterns of conduction. This might be used to differentiate between different types of AF and to identify regions with structural conduction disturbances involved in perpetuation of chronic AF.     

Changes in stiffness induced by hindlimb suspension in rat soleus muscle

Soleus muscle atrophy was induced by hind-limb suspension of rats for 3 weeks with the intention of inducing a relative increase in the percentage of fast-twitch fibres and assessing modifications in muscle stiffness. A method of dual controlled releases was used to obtain tension/extension curves and force/velocity relationships characterizing the mechanical behaviour of the soleus. Fibre typing was achieved by myofibrillar adenosine 5'-triphosphatase staining. Results showed that hindlimb suspension decreased the percentage of slow-twitch fibres (-31%) to the profit of fast-twitch fibres (+370%) and intermediate fibres (+255%). This led to an increase in maximal shortening velocity. Tension/extension curves indicated a decrease in soleus stiffness after 3 weeks of unloading. Changes in elastic properties are interpreted in terms of modifications occurring in the active part and the passive part of the so-called series elastic component. These changes also suggest that the parameters derived from a twitch are inappropriate to account for modifications in speed-related properties of muscle.     

Regression-based indices of fatigue in paraplegics' electrically stimulated quadriceps

We studied muscle fatigue in 19 paraplegic patients during an isometric sustained contraction. Both quadriceps (n = 38) were maximally stimulated for 126 s. We defined a nonlinear equation with four coefficients to fit the data and extract fatigue indices carrying information on the amount (asymptotic values, torque coordinate at the inflection point, total decrement from initial value) and the rate of torque decrease (maximum slope, time constant, time coordinate at the inflection point, time at which the torque reached 50% of initial value). Most of the indices reported in the literature provide information limited to the amount of torque decrease. Three of the coefficients we defined could be graphically estimated. The goodness of fit was very high (r2 = 0.993 +/- 0.001) but none of the indices provided information on both the amount and the rate of decrease. Major differences were encountered among the patients. Therefore, some of the computed indices varied to a great extent. We studied the curves exhibiting the same fatigue indices and defined a simple general fatigue index able to distinguish from muscles having different resistance to fatigue (asymptotic value x the time constant). This index is carrying both types of information and is expressed in relative torque x second (range from 1.81 to 22.82).     

Effects of long-term phasic electrical stimulation on denervated soleus muscle: guinea-pig contrasted with rat

Guinea-pig soleus muscles were denervated and electrically stimulated for periods of 43 to 66 days. Stimuli were in 1 s bursts of 40 Hz pulses, repeated every 5 min. Other guinea-pigs were denervated for 82 days without stimulation and, in a third group, the soleus muscle was necrotized and allowed to regenerate without reinnervation for 13-15 days. Isometric and isotonic recordings were made in vivo. Denervated guinea-pig muscles were embedded in epoxy resin for light and electron microscopy. Chronic stimulation of denervated guinea-pig soleus had no effects on the prolonged twitch or on reduced maximal shortening velocity, maximal rate of rise of tension and tetanic force. This contrasts with the slow-to-fast conversion produced by denervation and denervation-stimulation of rat soleus. Loss of force was much greater in rat than guinea-pig after denervation, and chronic stimulation increased force in rat to the same level as in guinea-pig after denervation (with or without stimulation). Eighty-day denervated guinea-pig soleus did not reveal those morphological signs of fibre breakdown and regeneration which are prominent in denervated rat soleus muscles. Those changes in rat resembled aneurally regenerated muscles in several aspects, especially the increased incidence of fibres with internal myo-nuclei which did not appear in guinea-pig soleus after denervation. Aneurally regenerated guinea-pig soleus became fast like aneurally regenerated rat muscle. Our data are compatible with the hypothesis that slow-to-fast transformation of denervated rat soleus is not directly brought about by chronic stimulation but by de-novo formation of fast-contracting regenerated fibres. The persistence of fibrillation in guinea-pig but not rat after denervation may account for the species difference.     

Regional muscle flap-plasty and adjuvant measures for rehabilitation of the paralyzed face

BACKGROUND: The loss of facial nerve activity reduces the quality of life in regard to functional disturbances and to the appearance of the patient. As far as possible a reconstruction of the facial nerve should be advocated. Only this procedure allows the natural variety of differentiated facial expression. If reconstruction of the facial nerve is not indicated or turns out to be unsatisfactory, a dynamic muscle transposition should be considered. PATIENTS AND METHODS: The patient records of the ENT-Departments in Fulda for the period from 1988 to 1995 and in M?nchengladbach from 1993 to 1995 were reviewed to survey the experience of secondary plastic rehabilitation of the paralysed face. Our special interest focussed on the oral region with dynamic muscle transfer. The techniques leading to rehabilitation of the lid region were included in this study. RESULTS: Transfer of the temporalis muscle was performed 12 times and a masseter muscle flap 4 times to rehabilitate the oral region. Static rehabilitation (canthoplasty, tarsorrhaphy) of the lid was performed 8 times, implantation of a gold weight in the upper lid 5 times and dynamic rehabilitation of the lid region with a temporalis muscle transposition once. CONCLUSIONS: Rehabilitation of the oral region is best managed with a temporalis muscle flap because of its favourable vector of tension and its broad, flat form. Masseter muscle transposition is particularly indicated if a temporalis muscle transfer is not possible or if resection of the facial nerve because of malignancy of the parotid gland has to be performed and nerve reconstruction is not advisable.     

Effects of chronic low frequency stimulation on contractile and elastic properties of hindlimb suspended rat soleus muscle

Chronic low frequency stimulation (10 Hz, 8 h x day[-1]) was used in this study to prevent the changes in the contractile and elastic properties of rat soleus muscles induced by 3 weeks of hindlimb suspension (HS). Results showed that electrostimulation was able to counteract in part the decrease in soleus muscle mass and tension output induced by unweighting. On the other hand, the increases in maximal shortening velocity and twitch speed following HS were not prevented by stimulation. Unweighting was responsible for an increase in series elastic compliance of soleus muscle. Chronic stimulation successfully counteracted this increase in series compliance probably by changing the properties of the tendon. The partial recovery of muscle mass and tension output as a result of stimulation enhanced the role of contractile activity in preventing muscle atrophy. Moreover, the inefficiency of the tonic activity imposed by stimulation in preventing the increase in twitch speed of soleus muscle during HS demonstrated the primacy of neuronal activity. Discrepant results concerning changes in contraction kinetics deduced from the twitch could have been due to the fact that such myograms also depend on the series compliance.     

Threshold of the soleus muscle H-reflex is less sensitive to the change in excitability of the motoneuron pool during plantarflexion or dorsiflexion in humans

Pulmonary vasculitides require major therapeutic regimens which, though symptomatic, are often effective. Corticosteroids have greatly changed the prognosis of most of these vasculitides, particularly polyarteritis nodosa and the Churg and Strauss syndrome. Cyclophosphamide must be added for Wegener's granulomatosis although the route of administration is still under discussion. Plasma exchanges are rarely indicated. Other treatments for Wegener's granulomatosis including combined trimethoprim-sulfamethoxazole in limited forms and methotrexate in sub-acute systemic forms are currently under study. A better understanding of the underlying mechanisms, including the role of antineutrophil cytoplasmic antibodies, and especially the identification of the causative factors will lead to an aetiologic treatment still unknown today.     

Changes in transcriptional activity of chronically stimulated fast twitch muscle

mRNAs extracted from rabbit soleus, normal and 28-day, indirectly stimulated tibialis anterior muscles were translated in an in vitro system. Analysis for translation products by 2-dimensional electrophoresis showed fast myosin light chains in tibialis anterior, and slow myosin light chains in soleus muscle. The stoichiometry of the in vitro translated light chains varies from that seen in normal fast and slow twitch muscles. The stimulated muscle contained mRNA coding, both for fast and slow myosin light chains, although the pattern of slow myosin light chains appears not to be complete at this point of time of the transformation process.     

Calcium transients and the effect of a photolytically released calcium chelator during electrically induced contractions in rabbit rectococcygeus smooth muscle

Intracellular Ca2+ was determined with the fura-2 technique during electrically induced contractions in the rabbit rectococcygeus smooth muscle at 22 degreesC. The muscles were electrically activated to give short, reproducible contractions. Intracellular [Ca2+] increased during activation; the increase in [Ca2+] preceded force development by approximately 2 s. After cessation of stimulation Ca2+ fell, preceding the fall in force by approximately 4 s. The fluorescence properties of fura-2 were determined with time-resolved spectroscopy using synchrotron light at the MAX-storage ring, Lund, Sweden. The fluorescence decay of free fura-2 was best described by two exponential decays (time constants approximately 0.5 and 1.5 ns) at low Ca2+ (pCa 9). At high Ca2+ (pCa 4.5), fluorescence decay became slower and could be fitted by one exponential decay (1.9 ns). Time-resolved anisotropy of free fura-2 was characteristic of free rotational motion (correlation time 0.3 ns). Motion of fura-2 could be markedly inhibited by high concentrations of creatine kinase. Time-resolved spectroscopy measurements of muscle fibers loaded with fura-2 showed that the fluorescence lifetime of the probe was longer, suggesting an influence of the chemical environment. Anisotropy measurements revealed, however, that the probe was mobile in the cells. The Ca2+-dependence of contraction and relaxation was studied using a photolabile calcium chelator, diazo-2, which could be loaded into the muscle cells in a similar manner as fura-2. Photolysis of diazo-2 leads to an increase in its Ca2+-affinity and a fall in free Ca2+. When muscles that had been loaded with diazo-2 were illuminated with UV light flashes during the rising phase of contraction, the rate of contraction became slower, suggesting a close relation between intracellular Ca2+ and the cross-bridge interaction. In contrast, photolysis during relaxation did not influence the rate of force decay, suggesting that relaxation of these contractions is not determined by the rate of Ca2+ removal or due to an increased Ca2+ sensitivity, but instead is limited by other processes such as deactivation by dephosphorylation or detachment of tension-bearing cross-bridges, possibly regulated by thin filament systems.     

Isolated rupture of the soleus muscle: a case report

Injuries to the musculature of the posterior compartment of the calf are a frequent cause of pain, particularly among athletes. The majority of ruptures and strains in this area occur in the gastrocnemius muscle and, to a much lesser extent, in the plantaris muscle. We present a case of an unusual cause of calf pain--an isolated rupture of the soleus muscle--that developed in a 15-year-old girl after participation in a volleyball match. The injury was confirmed by T1- and T2-weighted magnetic resonance imaging. In this case, magnetic resonance imaging was helpful; however, the cost effectiveness of its use for this injury has yet to be proved.     

Investigation of the Hammerstein hypothesis in the modeling of electrically stimulated muscle

To restore functional use of paralyzed muscles by automatically controlled stimulation, an accurate quantitative model of the stimulated muscles is desirable. The most commonly used model for isometric muscle has had a Hammerstein structure, in which a linear dynamic block is preceded by a static nonlinear function. To investigate the accuracy of the Hammerstein model, the responses to a pseudo-random binary sequence (PRBS) excitation of normal human plantarflexors, stimulated with surface electrodes, were used to identify a Hammerstein model but also four local models which describe the responses to small signals at different mean levels of activation. Comparison of the local models with the linearized Hammerstein model showed that the Hammerstein model concealed a fivefold variation in the speed of response. Also, the small-signal gain of the Hammerstein model was in error by factors up to three. We conclude that, despite the past widespread use of the Hammerstein model, it is not an accurate representation of isometric muscle. On the other hand, local models, which are more accurate predictors, can be identified from the responses to short PRBS sequences. The utility of local models for controller design is discussed.     

Myosin and troponin changes in rat soleus muscle after hindlimb suspension

We examined the myosin heavy-chain (MHC), troponin T (TnT), and troponin I (TnI) isoform composition in the rat soleus muscle after 21 days of hindlimb suspension using electrophoretic and immunoblotting analysis with specific monoclonal antibodies. The suspended soleus showed a shift in the MHC isoform distribution with a marked increase (from 1.0 to 33%) in the relative amount of type IIa and IIx MHC and a corresponding decrease in type I MHC. However, type IIb MHC, which represents a major component in fast-twitch muscles, was not detected in suspended soleus muscles. TnT and TnI isoform composition was also changed with the appearance of fast-type TnI and TnT bands. However, a high-mobility TnT band, which represents a major component in fast-twitch muscles, was not expressed in suspended soleus. These isoform transitions may be related to the increased maximal velocity of shortening and higher calcium sensitivity previously reported in the rat soleus after hindlimb suspension.     

Lengthening contraction and interpretations of active state tension in the isometric twitch response of skeletal muscle

The plateau of tetanic tension in a lengthening contraction of muscle at any given length is always greater than that in an isometric contraction at the same given length. To account for this excess of tension, it is suggested that the contractile machinery is "locked" in a strained condition that might make the muscle capable of bearing a greater tension in a lengthening contraction than it can develop in an isometric contraction. It is proposed that this strained condition also occurs in a lengthening contraction of the twitch response. If this proposal is valid it seems certain that the plateu of tension in the lengthening contraction of the twitch response cannot be equated with the plateau of tension in the isometric contraction of tetanus. The design of the original concept, that the plateau of active state tension in the lengthening contraction of the twitch is equal to the plateau of tension (Po) in the isometric contraction of tetanus, is based upon the assumption that the contractile component is neither lengthening nor shortening during both of these plateaus. This assumption is made without considering the possibility that the plateau in the lengthening contraction might be due to concurrent lengthening of series elastic elements and shortening of the contractile component. To account for the plateau of tension observed after quick lengthening in the early phase of twitch contraction indirect evidence is presented favoring the view that the quick lengthening during stretch is followed by slow lengthening and stress relaxation (decrease of tension) in series elastic elements and simultaneous shortening and increase of tension in the contractile component. When the original concept of active state tension in the twitch response is interpreted in the light of lengthening contraction, it is concluded that the labeled or implied Po for the plateau of the active state tension is unwarranted and confusing. It seems that the primary source of confusion is the assumption that the tension a muscle is capable of bearing in a lengthening contraction is equatable with the tension it can develop in an isometric contraction.     

Capillaries with fenestrations around regenerating muscle fibers in the soleus muscle of the dystrophic (dy) mouse

A 65-year-old woman developed nephrotic syndrome 7 years after receiving a cadaveric renal allograft. Renal biopsy and clinical laboratory evaluation revealed the underlying disease process to be AL amyloidosis. To our knowledge, this is the first reported case of de novo AL amyloid occurring in a renal allograft.     

Influence of two weeks of non-weight bearing on rat soleus motoneurons and muscle fibers

OBJECTIVES: To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR). DESIGN: Questionnaire. SETTING: Nationwide, 6 months after the publication of guidelines on DNR in 1994. SUBJECTS: A 10% random sample of the members of the Swedish Cardiac Society. 104 physicians and 196 nurses. MAIN OUTCOME MEASURES: To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? RESULTS: Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient. but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. CONCLUSIONS: Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?     

Doublet potentiation during eccentric and concentric contractions of cat soleus muscle

The addition of an extra stimulus pulse, or doublet, at the beginning of a low-frequency train has been shown to substantially increase isometric force. This study examined the effects of muscle movement on this doublet potentiation. The soleus muscles of anesthetized cats were stimulated at 10 Hz for 1 s, with and without an added doublet (0.01-s interval). Isovelocity releases reduced but did not eliminate peak and early doublet potentiation (average 0.0-0.5 s after the doublet). Large releases, >0.4 s after the doublet, completely abolished sustained doublet potentiation (average 0.5-1.0 s after the doublet). In contrast, early isovelocity stretches boosted peak doublet potentiation. Yet, large stretches later in the stimulus almost completely eliminated sustained doublet potentiation. This suggests that a different mechanism is responsible for early and sustained doublet potentiations. Because peak and average initial doublet potentiation were not strongly affected by movement, doublets still offer a viable control strategy to increase force during movement while minimizing the number of stimulus pulses.