Muscular Changes Research Articles

Quadriceps Neuromuscular Impairments after Arthroscopic Knee Surgery: Comparison between Procedures.

Quadriceps neuromuscular function remains impaired in the short- and long-term following knee arthroscopy for meniscal surgery and/or anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare quadriceps neuromuscular impairments in patients following meniscal surgery with and without ACL reconstruction. Thirty patients were tested six months after meniscal surgery with (n = 15) and without (n = 15) ACL reconstruction. We bilaterally assessed knee extension maximal voluntary contraction (MVC) torque using dynamometry, vastus lateralis thickness using ultrasound, quadriceps voluntary activation and evoked knee extension torque with transcutaneous electrical stimulation. Patient-reported outcomes were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Compared with meniscus patients, ACL patients demonstrated larger asymmetries in MVC torque (15% vs. 5%, p = 0.049) and vastus lateralis thickness (6% vs. 0%, p = 0.021). In ACL patients, asymmetries in MVC torque correlated with asymmetries in evoked torque (r = 0.622, p = 0.013). In meniscus patients, asymmetries in muscle activation correlated with KOOS quality of life (r = 0.619, p = 0.018). Patients demonstrated persistent quadriceps muscle weakness six months after ACL reconstruction, but not after isolated meniscal surgery. Quantitative and/or qualitative muscular changes likely underlie quadriceps muscle weakness in ACL patients, whereas activation failure is associated with poor quality of life in some meniscus patients.

A novel segmentation framework dedicated to the follow-up of fat infiltration in individual muscles of patients with neuromuscular disorders.

To propose a novel segmentation framework that is dedicated to the follow-up of fat infiltration in individual muscles of patients with neuromuscular disorders. We designed a semi-automatic segmentation pipeline of individual leg muscles in MR images based on automatic propagation through nonlinear registrations of initial delineation in a minimal number of MR slices. This approach has been validated for the segmentation of individual muscles from MRI data sets, acquired over a 10-month period, from thighs and legs in 10 patients with muscular dystrophy. The robustness of the framework was evaluated using conventional metrics related to muscle volume and clinical metrics related to fat infiltration. High accuracy of the semi-automatic segmentation (mean Dice similarity coefficient higher than 0.89) was reported. The provided method has excellent reliability regarding the reproducibility of the fat fraction estimation, with an average intraclass correlation coefficient score of 0.99. Furthermore, the present segmentation framework was determined to be more reliable than the intra-expert performance, which had an average intraclass correlation coefficient of 0.93. The proposed framework of segmentation can successfully provide an effective and reliable tool for accurate follow-up of any MRI biomarkers in neuromuscular disorders. This method could assist the quantitative assessment of muscular changes occurring in such diseases.

Muscle Evaluation in Axial Spondyloarthritis-The Evidence for Sarcopenia.

Sarcopenia is a syndrome defined as a progressive and generalized skeletal muscle disorder associated with an increased likelihood of adverse outcomes such as falls, fractures, physical disability, and death. The actual definition of sarcopenia is based on a reduction in the values of three parameters: strength, muscle mass quantity or quality, and physical performance (the determinant of severity). Muscle wasting is a common feature in several chronic diseases, such as spondyloarthritis (SpA), and significantly increases patient morbidity and mortality. Although there has been huge progress in this field over recent years, the absence of a clear definition and clear diagnostic criteria of sarcopenia has resulted in inconsistent information regarding muscle-involvement in SpA. Thus, the aim of this review is to collect relevant evidence on muscular changes occurring during the disease process from the published literature, according to the recommended tools for sarcopenia evaluation proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). In addition, data from histological, electromyography, and biochemical muscle analyses of SpA patients are also reviewed. Overall, a reduction in muscle strength with a systemic decrease in lean mass seems to be associated with a gait speed compromise. This information is usually fragmented, with no studies considering the three parameters together. This paper represents a call-to-action for the design of new studies in the future.

Effectiveness of combining microcurrent with resistance training in trained males

IntroductionMicrocurrent has been used to promote tissue healing after injury or to hasten muscle remodeling post exercise post exercise.PurposeTo compare the effects of resistance training in combination with either, microcurrent or sham treatment, on-body composition and muscular architecture. Additionally, changes in performance and perceived delayed onset muscle soreness (DOMS) were determined.MethodsEighteen males (25.7 ± 7.6 years) completed an 8-week resistance training program involving 3 workouts per week (24 total sessions) wearing a microcurrent (MIC, n = 9) or a sham (SH, n = 9) device for 3-h post-workout or in the morning during non-training days. Measurements were conducted at pre and post intervention.ResultsCompared to baseline, both groups increased (p < 0.05) muscle thickness of the elbow flexors (MIC + 2.9 ± 1.4 mm; SH + 3.0 ± 2.4 mm), triceps brachialis (MIC + 4.3 ± 2.8 mm; SH + 2.7 ± 2.6 mm), vastus medialis (MIC + 1.5 ± 1.5 mm; SH + 0.9 ± 0.8 mm) and vastus lateralis (MIC + 6.8 ± 8.0 mm; SH + 3.2 ± 1.8 mm). Although both groups increased (p < 0.01) the pennation angle of vastus lateralis (MIC + 2.90° ± 0.95°; SH + 1.90° ± 1.35°, p < 0.01), the change measured in MIC was higher (p = 0.045) than that observed in SH. Furthermore, only MIC enlarged (p < 0.01) the pennation angle of brachialis (MIC + 1.93 ± 1.51). Both groups improved (p < 0.05) bench press strength and power but only MIC enhanced (p < 0.01) vertical jump height. At post intervention, only MIC decreased (p < 0.05) DOMS at 12-h, 24-h, and 48-h after performing an exercise-induced muscle soreness protocol.ConclusionA 3-h daily use of microcurrent maximized muscular architectural changes and attenuated DOMS with no added significant benefits on body composition and performance.

Impact of hippotherapy for balance improvement and flexibility in elderly people

IntroductionThe decrease in functional ability, strength, balance, flexibility, agility, and coordination owing to neurological and muscular changes is one of the characteristic features of the human aging process. Hippotherapy has been highlighted as a therapeutic approach with physical and psychological benefits for this section of the population. However, the effects of hippotherapy in elderly people need to be further studied by assessing their balance and flexibility. MethodsThirty elderly people were recruited and divided into two groups; 15 in the Hippotherapy Group (HG), and 15 in the control group (CG) (aged 66.07 ± 5.80 and 68.47 ± 5.85 years, respectively). The HG received ten 30-min sessions of hippotherapy once a week. Assessment included the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), the Functional Reach Test (FRT)and the Sit-and-Reach Test with the Well's box before the first and after the tenth session of hippotherapy; and the Sit-and-Reach Test before and after each session. ResultsThe HG demonstrated a significant difference in the TUG test execution time and the FRT scores before and after the hippotherapy sessions (p = 0.036, p = 0.030, respectively), indicating an improvement in functional range. The examination of flexibility with the Wells's box also revealed a significant difference in the rates (cm) before and after 10 sessions of the hippotherapy for the HG (p = 0.033). ConclusionsThe present findings showthat hippotherapy improved elderly people's functional mobility, dynamic balance, and flexibility. These results will guide professionals who treat this population.

P.33Quantified muscle testing: the right way to assess muscle strength impairments in DM1

Myotonic dystrophy type 1 (DM1) is a degenerative neuromuscular disease in which maximal muscle strength (MMS) loss is a strong indicator of physical limitations. As standardized protocols with high quality hand held dynamometers (HHD) are now available, it is possible to use precise, valid, reliable, and responsive MMS evaluation in DM1. In previous studies, we assessed, in various healthy populations, the intra and inter-rater reliability, standard error of measurement (SEM), minimal detectable change (MDC), and the concurrent validity (CVal) with the BIODEX as gold standard, of QMT using a HHD for 12 muscle groups of both lower (hip abductors, flexors and extensors; knee flexors and extensors (KE); ankle evertors, dorsiflexors and plantarflexors) and upper limbs (shoulder abductors and lateral rotators; elbow flexors and extensors). In healthy participants, using intraclass correlation coefficient (ICC), we have shown that the intra- and inter-rater reliability was varying from 0.84 to 0.98 and 0.75 to 0.97, respectively. The SEM was varying across muscle groups from 0.5 Nm (ankle dorsiflexors) to 6.1 Nm (hip flexors) while the MDC was also relatively low but only assessed for the ankle plantarflexors (12.7 Nm). In 19 men with the adult form of DM1 and specifically for the KE, the intra-rater reliability was excellent with an ICC of 0.98 (0.96-0.99: 95% confidence interval) while the SEM and MDC values were 1.05 Nm and 2.92 Nm, respectively. Concurrent validity of QMT of KE muscle group with the Biodex was also excellent with a Spearman's correlation of ρ = 0.98. The good to excellent metrological qualities of QMT using HHD protocols make of QMT a method of choice, in a clinical or research setting, to precisely evaluate muscle strength impairments in DM1. QMT should be considered the most appropriate method for monitoring muscular changes for such a slow progressive disease. So, let's talk about what is required for you to adopt such a protocol, and why not?

Upregulation of Systemic Inflammatory Pathways Following Anterior Cruciate Ligament Injury Relates to Both Cartilage and Muscular Changes: A Pilot Study.

In conjunction with cartilage breakdown, muscle maladaptation including atrophy and increased fibrosis have been observed in the quadriceps following anterior cruciate ligament (ACL) injury. Previously observed upregulated muscle-related proteins in the synovial fluid following ACL rupture allude to cellular communication between the joint and muscle. Therefore, the purpose of this study was to determine whether muscle-related analytes are differentially expressed in the serum. Sixteen patients with an acute ACL tear participated in this IRB-approved study. Serum was obtained at two different time points at a mean of 6 and 14 days post-injury, and serum was analyzed by a highly multiplexed assay of 1,300 proteins. Pathway analysis using DAVID was performed; genes included met three criteria: significant change between the two study time points using a paired t test, significant change between the two study time points using a Mann-Whitney non-parametric test, and significant Benjamini post hoc analysis. Twelve analytes significantly increased between time points. Proteins chitinase-3-like protein 1 (p = 0.01), insulin-like growth factor binding protein 1 (p = 0.01), insulin-like growth factor binding protein 5 (p = 0.02), renin (p = 0.004), and lymphotoxin alpha 1: beta 2 (p = 0.03) were significantly upregulated in serum following acute ACL injury. The current results confirm the inflammatory pattern previously seen in the synovial fluid thought to play a role in the progression of post-traumatic osteoarthritis after ACL injury, and this data also provides further insights into important communication between the joint and quadriceps group, whose function is important in long term health. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:387-392, 2020.

Differentially methylated gene patterns between age-matched sarcopenic and non-sarcopenic women.

BackgroundSarcopenia is characterized by progressive decreases in muscle mass, muscle strength, and muscle function with ageing. Although many studies have investigated the mechanisms of sarcopenia, its connection with epigenetic factors, such as DNA methylation, still remains poorly understood. The aim of this study was to explore sarcopenia‐related DNA methylation differences in blood samples between age‐matched sarcopenic and non‐sarcopenic older women.MethodsA sarcopenic group (n = 24) was identified and selected from a set of 247 older Caucasian women (aged 65–80 years) based on cut‐off points of skeletal muscle index at 6.75 kg/m2 and grip strength at 26 kg (the lower quintile of grip strength in the set). A non‐sarcopenic group (n = 24) was created with a similar age distribution as that of the sarcopenic group. DNA methylation patterns of whole blood samples from both groups were analysed using Infinium MethylationEPIC BeadChip arrays. Differentially methylated cytosin–phosphate–guanine sites (dmCpGs) were identified at a P value threshold of 0.01 by comparing methylation levels between the sarcopenic and non‐sarcopenic groups at each CpG site. dmCpG‐related genes were annotated based on Homo sapiens hg19 genome build. The functions of these genes were further examined by GO and KEGG pathway enrichment analysis.ResultsThe global methylation level of all analysed CpG sites (n = 788 074) showed no significant difference between the sarcopenic and non‐sarcopenic groups (0.812), while the average methylation level of dmCpGs (n = 6258) was significantly lower in the sarcopenic group (0.004). The sarcopenic group had significantly higher methylation levels in TSS200 (the region from transcription start site to 200 nucleotides upstream of the site) and lower methylation levels in gene body and 3'UTR regions. In respect of CpG regions, CpG islands in promoters and some intragenic regions showed greater levels of methylation in the sarcopenic group. dmCpG‐related KEGG pathways were mainly associated with muscle function, actin cytoskeleton regulation, and energy metabolism. Seven genes (HSPB1, PBX4, CNKSR3, ORMDL3, MIR10A, ZNF619, and CRADD) were found with the same methylation direction as previous studies of blood sample methylation during ageing. Fifty‐four genes were shared with previous studies of resistance training.ConclusionsOur results improve understanding of epigenetic mechanisms of sarcopenia by identifying sarcopenia‐related DNA methylation differences in blood samples of older women. These methylation differences suggest underlying alterations of gene expression and pathway function, which can partially explain sarcopenia‐related muscular changes.

A pilot study of the responsiveness of wireless motion analysis in facioscapulohumeral muscular dystrophy.

We determined whether instrumenting timed functional tasks with wireless inertial motion sensors were responsive to facioscapulohumeral muscular dystrophy (FSHD) progression and movement pattern changes. Ten individuals who were clinically affected with genetically confirmed FSHD, mean age 54 years (range 42-65), performed an instrumented timed up and go (iTUG) trial at each visit, wearing six wireless inertial sensors. We determined the estimated average monthly slope of progression and 12-month change for temporal and spatial motion variables using a linear mixed effects model. For an average of 20.6 months (range 6.1-34.5), the iTUG duration stayed constant, whereas stride length, stride velocity, and trunk sagittal range of motion changed, indicating poorer performance. Arm swing changed in a compensatory direction toward the normative mean. This study provides preliminary evidence that iTUG motion variables could be sensitive to progression in FSHD, but this requires validation in a larger study.

The Effect of Tongue–Jaw Coupling on Phonetic Distinctiveness of Vowels in Amyotrophic Lateral Sclerosis

Purpose The aim of this study was to determine the relation of tongue-jaw coupling to phonetic distinctiveness of vowels in persons at different stages (i.e., early, middle, late) of bulbar motor involvement in amyotrophic lateral sclerosis (ALS) and healthy controls. Method The pattern of spatial tongue-jaw coupling was derived from 11 individuals with ALS and 11 healthy controls using the parallel factor analysis. Two articulatory components, which correspond to tongue displacement independent of the jaw (iTongue) and jaw contribution to tongue displacement (cJaw), were extracted from the composite tongue-jaw displacement. These articulatory components were correlated with F1 (i.e., height) and F2-F1 (i.e., advancement) of 4 vowels (/i/, /u/, /æ/, and /ɔ/) across all participants in each group. In addition, a comprehensive index of functional tongue-jaw coupling was derived as the ratio of cJaw/(iTongue + cJaw), and an acoustic index of vowel distortion (VowelDis) was derived to quantify the overall disease-related changes in phonetic distinctiveness of vowels. Based on these indices, disease-related changes in tongue-jaw coupling and phonetic distinctiveness of vowels were examined in individuals at the early, middle, and late stages of the disease. Results For healthy controls, both iTongue and cJaw contributed to F2-F1, while only cJaw contributed to F1. For individuals with ALS, both iTongue and cJaw contributed to F1, whereas only cJaw contributed to F2-F1. Disease-related changes in tongue-jaw coupling included (a) an overall decrease of the percent contribution of the tongue to the composite tongue-jaw displacement accompanied by an increase of percent contribution of the jaw and (b) several changes in the direction of tongue and jaw displacements occurred at different stages of the disease. These disease-related changes in tongue-jaw coupling had various impacts on phonetic distinctiveness of vowels, resulting in (a) a backward shift of front vowels and reduced front-back vowel contrasts, which occurred early and throughout the disease stages; (b) raising of all vowels during the middle stage of the disease; and (c) reduced high-low vowel contrasts during the late stage of the disease. Overall, phonetic distinctiveness of vowels deteriorated progressively throughout the disease course. Conclusions Different from healthy controls who established optimal functional coupling between the tongue and the jaw during vowel productions, individuals at the early-to-middle stages of bulbar ALS showed various adaptive changes in tongue-jaw coupling in response to the disease-related biomechanical and muscular changes in the articulators (particularly in the tongue). These adaptive changes in tongue-jaw coupling were found to be partially effective in mitigating the negative effect of articulatory involvement on phonetic distinctiveness of vowels. As the disease progressed to the late stage, such adaptations appeared to be no longer evident, resulting in a substantial overall reduction of vowel contrasts.

THERAPEUTIC EFFICACY OF CHITOSAN NANOPARTICLES LOADED WITH ALBENDAZOLE ON PARENTERAL PHASE OF EXPERIMENTAL TRICHINELLOSIS

Most of the drugs used for trichinellosis treatment showed a limited bioavailability, a high degree of resistance and a weak activity against encapsulated larvae. Therefore, there is an urgent need to develop new agents to improve the bioavailability of these drugs. So, the aim of the present study was to assess the use of chitosan (CH) nanoparticles alone or loaded with full and half dose albendazole (ABZ) to increase albendazole dissolution rate, to enhance its antiparasitic activity during the muscular phases of T. spiralis infection. Fifty male albino mice were used. They were divided into six experimental groups. Two control groups each includes five mice and four infected treated groups each includes ten mice. Chitosan nanoparticles were used orally at a dose of 100mg/kg/day starting from the 31st -day post infection (dpi) for seven successive days either alone or loaded with full dose or half dose of ABZ. Results revealed a significant improvement in all treated groups with the highest reduction rate (97.3%) of muscle larval counts, improvement of muscular histopathological changes, and degeneration of encysted larvae with minimal pathologic changes of infected skeletal muscles. A significant decrease in inducible nitric oxide synthetize (iNOS) expression in muscle tissues was in mice treated by CH loaded with a full dose of ABZ compared to control group.

Early and long-term changes in the muscles of the mandible following orthognathic surgery.

The aim of the present study is to evaluate the early and long-term postoperative dimensional changes of the muscles of the mandible in patients with orthognathic surgery for class II and class III malocclusions by using ultrasonography (US). Twenty-six patients who underwent bimaxillary orthognathic surgery for class II or class III malocclusions (14 and 12 patients, respectively) were ultrasonographically examined. The length, width, and cross-sectional area of the masseter and suprahyoid muscles were measured at three different time points: T0 (preoperatively), T1 (early postoperatively at 1month after the surgery), and T2 (late postoperatively at 9months). A repeated measures ANOVA was used to calculate statistically significant dimensional changes of the mandibular muscles. Statistically significant dimensional changes were found postoperatively in class II malocclusion patients only. The digastric muscle showed higher values for the length and lower values for the width (p < .05) at T1. The geniohyoid muscles were higher in length at T1 and lower in cross-sectional area (CSA) (p < .05) at T2. A decreased measured length and an increased measured width were found in case of the mylohyoid muscle (p < .05) at T2. The early and long-term postoperative dimensional changes of the masseter muscle were not statistically significant. The mandibular muscles showed a variable adaptive response to the orthognathic surgery. US should be considered for the long-term follow-up of muscular dimensional changes in class II malocclusion patients. From a clinical perspective, US is a reliable, non-invasive, and widely available method, which allows monitoring the postoperative muscular changes occurring in class II malocclusion patients.

Ankrd2 in Mechanotransduction and Oxidative Stress Response in Skeletal Muscle: New Cues for the Pathogenesis of Muscular Laminopathies.

Ankrd2 (ankyrin repeats containing domain 2) or Arpp (ankyrin repeat, PEST sequence, and proline-rich region) is a member of the muscle ankyrin repeat protein family. Ankrd2 is mostly expressed in skeletal muscle, where it plays an intriguing role in the transcriptional response to stress induced by mechanical stimulation as well as by cellular reactive oxygen species. Our studies in myoblasts from Emery-Dreifuss muscular dystrophy 2, a LMNA-linked disease affecting skeletal and cardiac muscles, demonstrated that Ankrd2 is a lamin A-binding protein and that mutated lamins found in Emery-Dreifuss muscular dystrophy change the dynamics of Ankrd2 nuclear import, thus affecting oxidative stress response. In this review, besides describing the latest advances related to Ankrd2 studies, including novel discoveries on Ankrd2 isoform-specific functions, we report the main findings on the relationship of Ankrd2 with A-type lamins and discuss known and potential mechanisms involving defective Ankrd2-lamin A interplay in the pathogenesis of muscular laminopathies.

Evaluation of vastus lateralis architecture and strength of knee extensors in middle-aged and older individuals with knee osteoarthritis.

To investigate any differences in muscle architecture (fascicle angle, fascicle length, and muscle thickness) and muscle strength in people of different ages with and without knee osteoarthritis (OA). This is a cross-sectional study conducted with 40 individuals with and 40 without knee OA. Four groups were analyzed, middle-aged OA group (KL II/III) aged 40-50years (n = 20), middle-aged healthy (H) group aged 40-50years (n = 20), older OA group (KL II/III) aged 70years and over (n = 20), and older H group, aged 70years and over (n = 20). Outcomes analyzed were isometric and isokinetic peak torque of knee extensors, level of physical activity, self-reported pain level, and vastus lateralis fascicle length, fascicle angle, and muscle thickness assessed by ultrasound. One-way ANOVA was used to identify differences between groups, followed by the Tukey post hoc test. There were no differences between the middle-aged OA group and older H group for any variables. The older OA group presented the smallest muscle architecture parameters and worst isometric and concentric peak torques compared to the other three groups (p < 0.001). In contrast, the middle-aged H group presented the largest muscle architecture parameters and was the strongest group compared to the others (p < 0.001). The presence of knee OA is associated with early muscular changes and seems to intensify these thigh changes that are similar to the effects of the aging process.

Melanized focal changes in skeletal muscle in farmed Atlantic salmon after natural infection with Piscine orthoreovirus (PRV).

Melanized focal changes in skeletal muscle of farmed Atlantic salmon (Salmo salar) are a major quality problem. The aetiology is unknown, but infection with Piscine orthoreovirus (PRV) has been associated with the condition. Here, we addressed the pathogenesis of red and melanized focal changes and their association with PRV. First, a population of farmed fish (PRV‐negative prior to sea transfer) was sequentially investigated throughout the seawater period. The fish were autopsied and tested for PRV infection. Muscular changes were described by macroscopy and histology, and a classification system was established. Second, in an experimental infection trial, PRV was injected intramuscularly to induce changes. The farmed fish was gradually infected with PRV. Red focal changes occurred throughout the observation period with a low prevalence regardless of PRV status. Melanized changes were highly diverse and their prevalence increased during the trial. Changes of low macroscopic grade and histological category were more prevalent in PRV‐negative fish. Diffuse granulomatous melanized changes only occurred after PRV infection. No muscular changes were observed in the experimentally challenged fish. Our studies do not indicate that PRV infection causes red focal changes, but seems important in the development of granulomatous melanized changes.

Nerve sprouting and neurogenic inflammation characterize the neurogenic detrusor overactive bladder of patients no longer responsive to drug therapies.

Urothelium and Lamina Propria (LP) are considered an integrate sensory system which is able to control the detrusor activity. Complete supra‐sacral spinal cord lesions cause Neurogenic Detrusor Overactivity (NDO) whose main symptoms are urgency and incontinence. NDO therapy at first consists in anti‐muscarinic drugs; secondly, in intra‐vesical injection of botulinum toxin. However, with time, all the patients become insensitive to the drugs and decide for cystoplastic surgery. With the aim to get deeper in both NDO and drug's efficacy lack pathogenesis, we investigated the innervation, muscular and connective changes in NDO bladders after surgery by using morphological and quantitative methodologies. Bladder innervation showed a significant global loss associated with an increase in the nerve endings located in the upper LP where a neurogenic inflammation was also present. Smooth muscle cells (SMC) anomalies and fibrosis were found in the detrusor. The increased innervation in the ULP is suggestive for a sprouting and could condition NDO evolution and drug efficacy length. Denervation might cause the SMC anomalies responsible for the detrusor altered contractile activity and intra‐cellular traffic and favour the appearance of fibrosis. Inflammation might accelerate these damages. From the clinical point of view, an early anti‐inflammatory treatment could positively influence the disease fate.

Strength and muscle structure preserved during long-term therapy in a patient with hypokalemic periodic paralysis (Cav1.1-R1239G)

We report a young wheelchair-dependent patient with an unclear proximal myopathy and a heterozygous, de-novo Cav1.1-R1239G mutation suggesting hypokalemic periodic paralysis (HypoPP). Sonography showed a loss of the pennate pattern indicative of an edema, whereas fatty degeneration was excluded. Within 7days of therapy with spironolactone, potassium and physical therapy, muscle strength almost completely normalized, a normal pennate pattern appeared and the edema was markedly reduced. She learned to walk without aid and to do sports and has continued to do so for 11years until now. Over the years, we tested serum potassium values, muscle strength, muscle edema and muscular sodium content by 1.5 T, 3 T and 7 T 1H and 23Na magnetic resonance imaging. No fatty muscle degeneration developed. Muscular edema-like changes only occurred when she was pregnant and was set to reduced therapy. Because of the ability to do sports again, her mobility was further increased. Our observational study on this single patient may suggest that: (1) muscle imaging and molecular genetics are important diagnostic tools, (2) weakness in periodic paralysis may be reversible, and (3) continued adequate therapy may preserve muscle structure and strength on a longterm, whereas weakness due to fatty degeneration could be considered progressive and irreversible. Although HypoPP is a rare disease, it should be included in differential diagnosis not only if there is paroxysmal weakness, but also in cases of myopathy of unknown origin.

Intramuscular Pressure of Human Tibialis Anterior Muscle Reflects in vivo Muscular Activity.

Intramuscular pressure (IMP) is the fluid hydrostatic pressure generated within a muscle and reflects the mechanical forces produced by a muscle. By providing accurate quantification of interstitial fluid pressure, the measurement of IMP may be useful to detect changes in skeletal muscle function not identified with established techniques. However, the relationship between IMP and muscle activity has never been studied in vivo in healthy human muscles. To determine if IMP is able to evaluate electromechanical performance of muscles in vivo, we tested the following hypotheses on the human tibialis anterior (TA) muscle: (i) IMP increases in proportion to muscle activity as measured by electrical [Compound Muscle Action Potential (CMAP)] and mechanical (ankle torque) responses to activation by nerve stimulation and (ii) the onset delay of IMP (IMPD) is shorter than the ankle torque electromechanical delay (EMD). Twelve healthy adults [six females; mean (SD) = 28.1 (5.0) years old] were recruited. Ankle torque, TA IMP, and CMAP responses were collected during maximal stimulation of the fibular nerve at different intensity levels of electrical stimulation, and at different frequencies of supramaximal stimulation, i.e., at 2, 5, 10, and 20 Hz. The IMP response at different stimulation intensities was correlated with the CMAP amplitude (r2 = 0.94). The area of the IMP response at different stimulation intensities was also significantly correlated with the area of the CMAP (r2 = 0.93). Increasing stimulation intensity resulted in an increase of the IMP response (P < 0.001). Increasing stimulation frequency caused torque (P < 0.001) as well as the IMP (P < 0.001) to increase. The ankle torque EMD [median (interquartile range) = 41.8 (14.4) ms] was later than the IMPD [33.0 (23.6) ms]. These findings support the hypotheses and suggest that IMP captures active mechanical properties of muscle in vivo and can be used to detect muscular changes due to drugs, diseases, or aging.

Evaluation of Thiopentone Sodium, Propofol and Midazolam for Modified Electro Convulsive Therapy

Background: Modified Electroconvulsive therapy (MECT), is evidence based, safe and established treatment for varieties of psychiatric diseases that includes acute mania, major depressive disorder, schizophrenia, suicidal tendency and many more conditions. Government of India and world health organization has mandated use of sedative / anesthetic drug to make MECT acceptable method of treatment. MECT is administered under anesthesia to control acute cardiovascular, cerebrovascular and musculoskeletal changes occurring subsequent to delivery of electric current across the cerebral cortex. This also prevents respiratory and traumatic complications. Subjects and Methods: In the present clinical observational study we analyzed 113 MECT administrations for evaluating suitability of thiopentone sodium, propofol and midazolam with succinyl choline chloride; on 45 patients belonging to ASA grade II with no associated systemic diseases. Results: We observed the induction characteristics, induction and recovery time, associated changes in hemodynamic parameters during and after procedure, duration and energy required to induce muscular convulsions and changes in serum potassium level. Our observations indicates that induction was quicker with propofol than with thiopentone 43.67 ± 9.13v/s 61.31 ± 15.58 seconds and recovery time was also quicker with propofol than thiopentone 518.73 ± 69.67 v/s 595.25 ± 112.68 seconds . Only on one occasion in thiopentone group induction was turbulent. Acute but short lasting changes in heart rate, systolic, diastolic and mean arterial pressure was observed in both thiopentone and propofol groups. The energy requirement was less than 100 joules on 34 sittings in thiopentone group while in propofol group it was observed on 47 sittings. In thiopentone group on 17 occasion energy required were more than 100 joules and 5 sittings in propofol group. There was transient elevation of mean serum potassium of 0.55 mEq/lit after MECT in all patients. Midazolam did not produce satisfactory condition in dose of 5 mg and needed thiopentone supplement on 10 occasions. Conclusion: The findings allowed us to conclude that both thiopentone and propofol along with sub-paralytic dose of succinyl choline chloride produced satisfactory conditions for MECT sittings without complications. However propofol provided quick induction and recovery and lesser energy requirement.

Peripheral nerve transfers change target muscle structure and function

Selective nerve transfers surgically rewire motor neurons and are used in extremity reconstruction to restore muscle function or to facilitate intuitive prosthetic control. We investigated the neurophysiological effects of rewiring motor axons originating from spinal motor neuron pools into target muscles with lower innervation ratio in a rat model. Following reinnervation, the target muscle's force regenerated almost completely, with the motor unit population increasing to 116% in functional and 172% in histological assessments with subsequently smaller muscle units. Muscle fiber type populations transformed into the donor nerve's original muscles. We thus demonstrate that axons of alternative spinal origin can hyper-reinnervate target muscles without loss of muscle force regeneration, but with a donor-specific shift in muscle fiber type. These results explain the excellent clinical outcomes following nerve transfers in neuromuscular reconstruction. They indicate that reinnervated muscles can provide an accurate bioscreen to display neural information of lost body parts for high-fidelity prosthetic control.