Specificity of early motor unit adaptations with resistive exercise training

After exposure of the human body to resistive exercise, the force-generation capacity of the trained muscles increases significantly. Despite decades of research, the neural and muscular stimuli that initiate these changes in muscle force are not yet fully understood. The study of these adaptations is further complicated by the fact that the changes may be partly specific to the training task. For example, short-term strength training does not always influence the neural drive to muscles during the early phase (<100 ms) of force development in rapid isometric contractions. Here we discuss some of the studies that have investigated neuromuscular adaptations underlying changes in maximal force and rate of force development produced by different strength training interventions, with a focus on changes observed at the level of spinal motor neurons. We discuss the different motor unit adjustments needed to increase force or speed, and the specificity of some of the adaptations elicited by differences in the training tasks.

Antagonism of 5-HT2 receptors attenuates self-sustained firing of human motor units

5-HT2 receptors on motoneurones play a critical role in facilitating persistent inward currents (PICs). Although facilitation of PICs can enhance self-sustained firing after periods of excitation, the relationship between 5-HT2 receptor activity and self-sustained firing in human motor units (MUs) has not been resolved. MU activity was assessed from the tibialis anterior of 10 healthy adults (24.9 ± 2.8 years) during two contraction protocols. Both protocols featured steady-state isometric contractions with constant descending drive to the motoneurone pool. However, one protocol also included an additional phase of superimposed descending drive. Adding and then removing descending drive in the middle of steady-state contractions altered MU firing behaviour across the motor pool, where newly recruited units in the superimposed phase were unable to switch off (P = 0.0002), and units recruited prior to additional descending drive reduced their discharge rates (P < 0.0001, difference in estimated marginal means (∆) = 2.24 pulses/s). The 5-HT2 receptor antagonist, cyproheptadine, was then administered to determine whether changes in MU firing were mediated by serotonergic mechanisms. 5-HT2 receptor antagonism caused reductions in MU discharge rate (P < 0.001, ∆ = 1.65 pulses/s), recruitment threshold (P = 0.00112, ∆ = 1.09% maximal voluntary contraction) and self-sustained firing duration (P < 0.0001, ∆ = 1.77s) after the additional descending drive was removed in the middle of the steady-state contraction. These findings indicate that serotonergic neuromodulation plays a key role in facilitating discharge and self-sustained firing of human motoneurones, where adaptive changes in MU recruitment must occur to meet the demands of the contraction. KEY POINTS: Animal and cellular preparations indicate that somato-dendritic 5-HT2 receptors regulate the intrinsic excitability of motoneurones. 5-HT2 receptor antagonism reduces estimates of persistent inward currents in motoneurones, which contribute to self-sustained firing when synaptic inputs are reduced or removed. This human study employed a contraction task that slowly increased (and then removed) the additional descending drive in the middle of a steady-state contraction where marked self-sustained firing occurred when the descending drive was removed. 5-HT2 receptor antagonism caused widespread reductions in motor unit (MU) discharge rates during contractions, which was accompanied by reduced recruitment threshold and attenuation of self-sustained firing duration after the removal of the additional descending drive to motoneurones. These findings support the role that serotonergic neuromodulation is a key facilitator of MU discharge and self-sustained firing of human motoneurones, where adaptative changes in MU recruitment must occur to meet the demands of the contraction.

Motor unit modes in the calf muscles during a submaximal isometric contraction are changed by brief stretches

The purpose of our study was to investigate the influence of a stretch intervention on the common modulation of discharge rate among motor units in the calf muscles during a submaximal isometric contraction. The current report comprises a computational analysis of a motor unit dataset that we published previously (Mazzo et al., 2021). Motor unit activity was recorded from the three main plantar flexor muscles while participants performed an isometric contraction at 10% of the maximal voluntary contraction force before and after each of two interventions. The interventions were a control task (standing balance) and static stretching of the plantar flexor muscles. A factorization analysis on the smoothed discharge rates of the motor units from all three muscles yielded three modes that were independent of the individual muscles. The composition of the modes was not changed by the standing-balance task, whereas the stretching exercise reduced the average correlation in the second mode and increased it in the third mode. A centroid analysis on the correlation values showed that most motor units were associated with two or three modes, which were presumed to indicate shared synaptic inputs. The percentage of motor units adjacent to the seven centroids changed after both interventions: Control intervention, mode 1 decreased and the shared mode 1 + 2 increased; stretch intervention, shared modes either decreased (1 + 2) or increased (1 + 3). These findings indicate that the neuromuscular adjustments during both interventions were sufficient to change the motor unit modes when the same task was performed after each intervention. KEY POINTS: Based on covariation of the discharge rates of motor units in the calf muscles during a submaximal isometric contraction, factor analysis was used to assign the correlated discharge trains to three motor unit modes. The motor unit modes were determined from the combined set of all identified motor units across the three muscles before and after each participant performed a control and a stretch intervention. The composition of the motor unit modes changed after the stretching exercise, but not after the control task (standing balance). A centroid analysis on the distribution of correlation values found that most motor units were associated with a shared centroid and this distribution, presumably reflecting shared synaptic input, changed after both interventions. Our results demonstrate how the distribution of multiple common synaptic inputs to the motor neurons innervating the plantar flexor muscles changes after a brief series of stretches.

Investigation of motor unit behavior in exercise and sports physiology: challenges and perspectives

Several methods are in use to record and analyze neuronal activation, each with specific advantages and challenges. New developments like the decomposition of high-density surface electromyography (HDsEMG) have enabled novel insights into discharge characteristics noninvasively in laboratory settings but face certain challenges to be applied in sports physiology in a broader scope. Several challenges can be accounted for by methodological considerations, others require further technological developments to allow this technology to be used in more applied settings. This paper aims to describe the developments of surface electromyography and identify the challenges and perspectives of HDsEMG in the context of an application in sports physiology. We further discuss methodological possibilities to overcome some of the challenges to investigate specific research questions and identify areas that require further advancements.

Influence of spatio-temporal filtering on hand kinematics estimation from high-density EMG signals. J Neural Eng 2024;21:026014. [PMID: 38525843 DOI: 10.1088/1741-2552/ad3498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective.Surface electromyography (sEMG) is a non-invasive technique that records the electrical signals generated by muscles through electrodes placed on the skin. sEMG is the state-of-the-art method used to control active upper limb prostheses because of the association between its amplitude and the neural drive sent from the spinal cord to muscles. However, accurately estimating the kinematics of a freely moving human hand using sEMG from extrinsic hand muscles remains a challenge. Deep learning has been recently successfully applied to this problem by mapping raw sEMG signals into kinematics. Nonetheless, the optimal number of EMG signals and the type of pre-processing that would maximize performance have not been investigated yet.Approach.Here, we analyze the impact of these factors on the accuracy in kinematics estimates. For this purpose, we processed monopolar sEMG signals that were originally recorded from 320 electrodes over the forearm muscles of 13 subjects. We used a previously published deep learning method that can map the kinematics of the human hand with real-time resolution.Main results.While myocontrol algorithms essentially use the temporal envelope of the EMG signal as the only EMG feature, we show that our approach requires the full bandwidth of the signal in the temporal domain for accurate estimates. Spatial filtering however, had a smaller impact and low-order spatial filters may be suitable. Moreover, reducing the number of channels by ablation resulted in large performance losses. The highest accuracy was reached with the highest number of available sensors (n = 320). Importantly and unexpected, our results suggest that increasing the number of channels above those used in this study may further enhance the accuracy in predicting the kinematics of the human hand.Significance.We conclude that full bandwidth high-density EMG systems of hundreds of electrodes are needed for accurate kinematic estimates of the human hand.

A direct spinal cord-computer interface enables the control of the paralysed hand in spinal cord injury

The paralysis of the muscles controlling the hand dramatically limits the quality of life of individuals living with spinal cord injury (SCI). Here, with a non-invasive neural interface, we demonstrate that eight motor complete SCI individuals (C5-C6) are still able to task-modulate in real-time the activity of populations of spinal motor neurons with residual neural pathways. In all SCI participants tested, we identified groups of motor units under voluntary control that encoded various hand movements. The motor unit discharges were mapped into more than 10 degrees of freedom, ranging from grasping to individual hand-digit flexion and extension. We then mapped the neural dynamics into a real-time controlled virtual hand. The SCI participants were able to match the cue hand posture by proportionally controlling four degrees of freedom (opening and closing the hand and index flexion/extension). These results demonstrate that wearable muscle sensors provide access to spared motor neurons that are fully under voluntary control in complete cervical SCI individuals. This non-invasive neural interface allows the investigation of motor neuron changes after the injury and has the potential to promote movement restoration when integrated with assistive devices.

Lower limb suspension induces threshold-specific alterations of motor units properties that are reversed by active recovery

PURPOSE

This study aimed to non-invasively test the hypothesis that (a) short-term lower limb unloading would induce changes in the neural control of force production (based on motor units (MUs) properties) in the vastus lateralis muscle and (b) possible changes are reversed by active recovery (AR).

METHODS

Ten young males underwent 10 days of unilateral lower limb suspension (ULLS) followed by 21 days of AR. During ULLS, participants walked exclusively on crutches with the dominant leg suspended in a slightly flexed position (15°-20°) and with the contralateral foot raised by an elevated shoe. The AR was based on resistance exercise (leg press and leg extension) and executed at 70% of each participant's 1 repetition maximum, 3 times/week. Maximal voluntary isometric contraction (MVC) of knee extensors and MUs properties of the vastus lateralis muscle were measured at baseline, after ULLS, and after AR. MUs were identified using high-density electromyography during trapezoidal isometric contractions at 10%, 25%, and 50% of the current MVC, and individual MUs were tracked across the 3 data collection points.

RESULTS

We identified 1428 unique MUs, and 270 of them (18.9%) were accurately tracked. After ULLS, MVC decreased by 29.77%, MUs absolute recruitment/derecruitment thresholds were reduced at all contraction intensities (with changes between the 2 variables strongly correlated), while discharge rate was reduced at 10% and 25% but not at 50% MVC. Impaired MVC and MUs properties fully recovered to baseline levels after AR. Similar changes were observed in the pool of total as well as tracked MUs.

CONCLUSION

Our novel results demonstrate, non-invasively, that 10 days of ULLS affected neural control predominantly by altering the discharge rate of lower-threshold but not of higher-threshold MUs, suggesting a preferential impact of disuse on motoneurons with a lower depolarization threshold. However, after 21 days of AR, the impaired MUs properties were fully restored to baseline levels, highlighting the plasticity of the components involved in neural control.

Is Smaller Better? Cu2+/Cu+ Coordination Chemistry and Copper-64 Radiochemical Investigation of a 1,4,7-Triazacyclononane-Based Sulfur-Rich Chelator

The biologically triggered reduction of Cu2+ to Cu+ has been postulated as a possible in vivo decomplexation pathway in 64/67Cu-based radiopharmaceuticals. In an attempt to hinder this phenomenon, we have previously developed a family of S-containing polyazamacrocycles based on 12-, 13-, or 14-membered tetraaza rings able to stabilize both oxidation states. However, despite the high thermodynamic stability of the resulting Cu2+/+ complexes, a marked [64Cu]Cu2+ release was detected in human serum, likely as a result of the partially saturated coordination sphere around the copper center. In the present work, a new hexadentate macrocyclic ligand, 1,4,7-tris[2-(methylsulfanyl)ethyl)]-1,4,7-triazacyclononane (NO3S), was synthesized by hypothesizing that a smaller macrocyclic backbone could thwart the observed demetalation by fully encapsulating the copper ion. To unveil the role of the S donors in the metal binding, the corresponding alkyl analogue 1,4,7-tris-n-butyl-1,4,7-triazacyclononane (TACN-n-Bu) was considered as comparison. The acid-base properties of the free ligands and the kinetic, thermodynamic, and structural properties of their Cu2+ and Cu+ complexes were investigated in solution and solid (crystal) states through a combination of spectroscopic and electrochemical techniques. The formation of two stable mononuclear species was detected in aqueous solution for both ligands. The pCu2+ value for NO3S at physiological pH was 6 orders of magnitude higher than that computed for TACN-n-Bu, pointing out the significant stabilizing contribution arising from the Cu2+-S interactions. In both the solid state and solution, Cu2+ was fully embedded in the ligand cleft in a hexacoordinated N3S3 environment. Furthermore, NO3S exhibited a remarkable ability to form a stable complex with Cu+ through the involvement of all of the donors in the coordination sphere. Radiolabeling studies evidenced an excellent affinity of NO3S toward [64Cu]Cu2+, as quantitative incorporation was achieved at high apparent molar activity (∼10 MBq/nmol) and under mild conditions (ambient temperature, neutral pH, 10 min reaction time). Human serum stability assays revealed an increased stability of [64Cu][Cu(NO3S)]2+ when compared to the corresponding complexes formed by 12-, 13-, or 14-membered tetraaza rings.

The Impact of Burst Motor Cortex Stimulation on Cardiovascular Autonomic Modulation in Chronic Pain: A Feasibility Study for a New Approach to Objectively Monitor Therapeutic Effects

INTRODUCTION

Chronic refractory pain of various origin occurs in 30-45% of pain patients, and a considerable proportion remains resistant to pharmacological and behavioral therapies, requiring adjunctive neurostimulation therapies. Chronic pain is known to stimulate sympathetic outflow, yet the impact of burst motor cortex stimulation (burstMCS) on objectifiable autonomic cardiovascular parameters in chronic pain remains largely unknown.

METHODS

In three patients with chronic pain (2 facial pain/1 post-stroke pain), we compared pain intensity using a visual analog scale (VAS 1-10) and parameters of autonomic cardiovascular modulation at supine rest, during parasympathetic challenge with six cycles per minute of metronomic deep breathing, and during sympathetic challenge (active standing) at baseline and after 4 months of burstMCS compared to age-/gender-matched healthy controls.

RESULTS

While two out of three patients were responsive after 4 months of adjunctive burstMCS (defined as pain reduction of > 30%), no differences were found in any of the three patients regarding the R-R intervals of adjacent QRS complexes (RRI, 642 vs. 676 ms) and blood pressure (BP, 139/88 vs. 141/90 mmHg). Under resting conditions, parameters of parasympathetic tone [normalized units of high-frequency oscillations of RRI (RRI-HFnu power) 0.24 vs. 0.38, root-mean-square differences of successive RRI (RRI-RMSSD) 7.7 vs. 14.7 ms], total autonomic cardiac modulation [RRI total power 129.3 vs. 406.2 ms2, standard deviation of RRI (RRI-SD) 11.6 vs. 18.5 ms, coefficient of variation of RRI (RRI-CV) 1.9 vs. 3.7%], and baroreceptor reflex sensitivity (BRS, 1.9 vs. 2.3 ms/mmHg) increased, and parameters of sympathetic tone [normalized units of low-frequency oscillations of RRI (RRI-LFnu power) 0.76 vs. 0.62] and sympatho-vagal balance [ratio of RR-LF to RRI-HF power (RRI-LF/HF ratio) 3.4 vs. 1.9] decreased after 4 months of burstMCS. Low-frequency oscillations of systolic blood pressure (SBP-LF power), a parameter of sympathetic cardiovascular modulation, increased slightly (17.6 vs. 20.4 mmHg2). During parasympathetic stimulation, the expiratory-inspiratory ratio (E/I ratio) increased slightly, while upon sympathetic stimulation, the ratio between the shortest RRI around the 15th heartbeat and the longest RRI around the 30th heartbeat after standing up (RRI 30/15 ratio) remained unchanged.

CONCLUSION

Four months of adjunctive burstMCS was associated with an increase in parameters reflecting both total and parasympathetic autonomic modulation and baroreceptor reflex sensitivity. In contrast, sympathetic tone declined in our three patients, suggesting stimulation-associated improvement not only in subjectively perceived VAS pain scores, but also in objectifiable parameters of autonomic cardiovascular modulation.

Mental fatigue impairs physical performance but not the neural drive to the muscle: a preliminary analysis

Mental fatigue (MF) does not only affect cognitive but also physical performance. This study aimed to explore the effects of MF on muscle endurance, rate of perceived exertion (RPE), and motor units' activity. Ten healthy males participated in a randomised crossover study. The subjects attended two identical experimental sessions separated by 3 days with the only difference of a cognitive task (incongruent Stroop task [ST]) and a control condition (watching a documentary). Perceived MF and motivation were measured for each session at baseline and after each cognitive task. Four contractions at 20% of maximal voluntary contraction (MVIC) were performed at baseline, after each cognitive and after muscle endurance task while measuring motor units by high-density surface electromyography. Muscle endurance until failure at 50% of MVIC was measured after each cognitive task and the RPE was measured right after failure. ST significantly increased MF (p = 0.001) reduced the motivation (p = 0.008) for the subsequent physical task and also impaired physical performance (p = 0.044). However, estimates of common synaptic inputs and motor unit discharge rates as well as RPE were not affected by MF (p > 0.11). In conclusion, MF impairs muscle endurance and motivation for the physical task but not the neural drive to the muscle at any frequency bands. Although it is physiologically possible for mentally fatigued subjects to generate an optimal neuromuscular function, the altered motivation seems to limit physical performance. Preliminarily, our results suggest that the corticospinal pathways are not affected by MF.

Standard intensities of transcranial alternating current stimulation over the motor cortex do not entrain corticospinal inputs to motor neurons

Transcranial alternating current stimulation (TACS) is commonly used to synchronize a cortical area and its outputs to the stimulus waveform, but gathering evidence for this based on brain recordings in humans is challenging. The corticospinal tract transmits beta oscillations (∼21 Hz) from the motor cortex to tonically contracted limb muscles linearly. Therefore, muscle activity may be used to measure the level of beta entrainment in the corticospinal tract due to TACS over the motor cortex. Here, we assessed whether TACS is able to modulate the neural inputs to muscles, which would provide indirect evidence for TACS-driven neural entrainment. In the first part of the study, we ran simulations of motor neuron (MN) pools receiving inputs from corticospinal neurons with different levels of beta entrainment. Results suggest that MNs are highly sensitive to changes in corticospinal beta activity. Then, we ran experiments on healthy human subjects (N = 10) in which TACS (at 1 mA) was delivered over the motor cortex at 21 Hz (beta stimulation), or at 7 Hz or 40 Hz (control conditions) while the abductor digiti minimi or the tibialis anterior muscle were tonically contracted. Muscle activity was measured using high-density electromyography, which allowed us to decompose the activity of pools of motor units innervating the muscles. By analysing motor unit pool activity, we observed that none of the TACS conditions could consistently alter the spectral contents of the common neural inputs received by the muscles. These results suggest that 1 mA TACS over the motor cortex given at beta frequencies does not entrain corticospinal activity. KEY POINTS: Transcranial alternating current stimulation (TACS) is commonly used to entrain the communication between brain regions. It is challenging to find direct evidence supporting TACS-driven neural entrainment due to the technical difficulties in recording brain activity during stimulation. Computational simulations of motor neuron pools receiving common inputs in the beta (∼21 Hz) band indicate that motor neurons are highly sensitive to corticospinal beta entrainment. Motor unit activity from human muscles does not support TACS-driven corticospinal entrainment.

Correlation networks of spinal motor neurons that innervate lower limb muscles during a multi-joint isometric task

Movements are reportedly controlled through the combination of synergies that generate specific motor outputs by imposing an activation pattern on a group of muscles. To date, the smallest unit of analysis of these synergies has been the muscle through the measurement of its activation. However, the muscle is not the lowest neural level of movement control. In this human study (n = 10), we used a purely data-driven method grounded on graph theory to extract networks of motor neurons based on their correlated activity during an isometric multi-joint task. Specifically, high-density surface electromyography recordings from six lower limb muscles were decomposed into motor neurons spiking activity. We analysed these activities by identifying their common low-frequency components, from which networks of correlated activity to the motor neurons were derived and interpreted as networks of common synaptic inputs. The vast majority of the identified motor neurons shared common inputs with other motor neuron(s). In addition, groups of motor neurons were partly decoupled from their innervated muscle, such that motor neurons innervating the same muscle did not necessarily receive common inputs. Conversely, some motor neurons from different muscles-including distant muscles-received common inputs. The study supports the theory that movements are produced through the control of small numbers of groups of motor neurons via common inputs and that there is a partial mismatch between these groups of motor neurons and muscle anatomy. We provide a new neural framework for a deeper understanding of the structure of common inputs to motor neurons. KEY POINTS: A central and unresolved question is how spinal motor neurons are controlled to generate movement. We decoded the spiking activities of dozens of spinal motor neurons innervating six muscles during a multi-joint task, and we used a purely data-driven method grounded on graph theory to extract networks of motor neurons based on their correlated activity (considered as common input). The vast majority of the identified motor neurons shared common inputs with other motor neuron(s). Groups of motor neurons were partly decoupled from their innervated muscle, such that motor neurons innervating the same muscle did not necessarily receive common inputs. Conversely, some motor neurons from different muscles, including distant muscles, received common inputs. The study supports the theory that movement is produced through the control of groups of motor neurons via common inputs and that there is a partial mismatch between these groups of motor neurons and muscle anatomy.

Proportional and Simultaneous Real-Time Control of the Full Human Hand From High-Density Electromyography

Surface electromyography (sEMG) is a non-invasive technique that measures the electrical activity generated by the muscles using sensors placed on the skin. It has been widely used in the field of prosthetics and other assistive systems because of the physiological connection between muscle electrical activity and movement dynamics. However, most existing sEMG-based decoding algorithms show a limited number of detectable degrees of freedom that can be proportionally and simultaneously controlled in real-time, which limits the use of EMG in a wide range of applications, including prosthetics and other consumer-level applications (e.g., human/machine interfacing). In this work, we propose a new deep learning method that can decode and map the electrophysiological activity of the forearm muscles into proportional and simultaneous control of > 20 degrees of freedom of the human hand with real-time resolution and with latency within the neuromuscular delays (< 50 ms). We recorded the kinematics of the human hand during grasping, pinching, individual digit movements and three gestures at slow (0.5 Hz) and fast (0.75 Hz) movement speeds in healthy participants. We demonstrate that our neural network can predict the kinematics of the hand in real-time at a constant 32 predictions per second. To achieve this, we employed transfer learning and created a prediction smoothing algorithm for the output of the neural network that reconstructed the full geometry of the hand in three-dimensional Cartesian space in real-time. Our results demonstrate that high-density EMG signals from the forearm muscles contain almost all the information that is needed to predict the kinematics of the human hand. The proposed method has the capability of predicting the full kinematics of the human hand with real-time resolution with immediate translational impact in subjects with motor impairments.

Motor unit tracking using blind source separation filters and waveform cross-correlations: reliability under physiological and pharmacological conditions

Recent advancements in the analysis of high-density surface electromyography (HDsEMG) have enabled the identification, and tracking, of motor units (MUs) to study muscle activation. This study aimed to evaluate the reliability of MU tracking using two common methods: blind source separation filters and two-dimensional waveform cross-correlation. An experiment design was developed to assess physiological reliability, and reliability for a drug intervention known to reduce the firing rate of motoneurones (cyproheptadine). HDsEMG signals were recorded from tibialis anterior during isometric dorsiflexions to 10%, 30%, 50% and 70% of maximal voluntary contraction. MUs were matched within session (2 hr) using the filter method, and between sessions (7 days) via the waveform method. Both tracking methods demonstrated similar reliability during physiological conditions (e.g., MU discharge: filter ICC 10% of MVC = 0.76, to 70% of MVC = 0.86; waveform ICC: 10% of MVC = 0.78, to 70% of MVC = 0.91). Although reliability slightly reduced after the pharmacological intervention, there were no discernible differences in tracking performance (e.g., MU disc filter ICC: 10% of MVC = 0.73, to 70% of MVC = 0.75; DR waveform ICC: 10% of MVC = 0.84, to 70% of MVC = 0.85). The poorest reliability typically occurred at higher contraction intensities, which aligned with the greatest variability in MU characteristics. This study confirms that tracking method may not impact the interpretation of MU data, provided that an appropriate experiment design is employed. However, caution should be used when tracking MUs during higher intensity isometric contractions.

SEM Evaluation of Thermal Effects Produced by a 445 nm Laser on Implant Surfaces

The aim of this in vitro study was to evaluate thermal effects on implant surfaces using a 445 nm diode laser (Eltech K-Laser Srl, Treviso, Italy) with different power settings and irradiation modalities. Fifteen new implants (Straumann, Basel, Switzerland) were irradiated to evaluate surface alteration. Each implant was divided into two zones: the anterior and posterior areas. The anterior coronal areas were irradiated with a distance of 1 mm between the optical fiber and the implant; the anterior apical ones were irradiated with the fiber in contact with the implant. Instead, the posterior surfaces of all of the implants were not irradiated and used as control surfaces. The protocol comprised two cycles of laser irradiation, lasting 30 s each, with a one-minute pause between them. Different power settings were tested: a 0.5 W pulsed beam (T-on 25 ms; T-off 25 ms), a 2 W continuous beam and a 3 W continuous beam. Lastly, through a scanning electron microscopy (SEM) analysis, dental implants' surfaces were evaluated to investigate surface alterations. No surface alterations were detected using a 0.5 W laser beam with a pulsed mode at a distance of 1 mm. Using powers of irradiation of 2 W and 3 W with a continuous mode at 1 mm from the implant caused damage on the titanium surfaces. After the irradiation protocol was changed to using the fiber in contact with the implant, the surface alterations increased highly compared to the non-contact irradiation modality. The SEM results suggest that a power of irradiation of 0.5 W with a pulsed laser light emission mode, using an inactivated optical fiber placed 1 mm away from the implant, could be used in the treatment of peri-implantitis, since no implant surface alterations were detected.

Adjustments in the motor unit discharge behavior following neuromuscular electrical stimulation compared to voluntary contractions

Introduction: The application of neuromuscular electrical stimulation superimposed on voluntary muscle contractions (NMES+) has demonstrated a considerable potential to enhance or restore muscle function in both healthy and individuals with neurological or orthopedic disorders. Improvements in muscle strength and power have been commonly associated with specific neural adaptations. In this study, we investigated changes in the discharge characteristics of the tibialis anterior motor units, following three acute exercises consisting of NMES+, passive NMES and voluntary isometric contractions alone. Methods: Seventeen young participants participated in the study. High-density surface electromyography was used to record myoelectric activity in the tibialis anterior muscle during trapezoidal force trajectories involving isometric contractions of ankle dorsi flexors with target forces set at 35, 50% and 70% of maximal voluntary isometric contraction (MVIC). From decomposition of the electromyographic signal, motor unit discharge rate, recruitment and derecruitment thresholds were extracted and the input-output gain of the motoneuron pool was estimated. Results: Global discharge rate increased following the isometric condition compared to baseline at 35% MVIC while it increased after all experimental conditions at 50% MVIC target force. Interestingly, at 70% MVIC target force, only NMES + led to greater discharge rate compared to baseline. Recruitment threshold decreased after the isometric condition, although only at 50% MVIC. Input-output gain of the motoneurons of the tibialis anterior muscle was unaltered after the experimental conditions. Discussion: These results indicated that acute exercise involving NMES + induces an increase in motor unit discharge rate, particularly when higher forces are required. This reflects an enhanced neural drive to the muscle and might be strongly related to the distinctive motor fiber recruitment characterizing NMES+.

Non-invasive estimation of muscle fibre size from high-density electromyography

Because of the biophysical relation between muscle fibre diameter and the propagation velocity of action potentials along the muscle fibres, motor unit conduction velocity could be a non-invasive index of muscle fibre size in humans. However, the relation between motor unit conduction velocity and fibre size has been only assessed indirectly in animal models and in human patients with invasive intramuscular EMG recordings, or it has been mathematically derived from computer simulations. By combining advanced non-invasive techniques to record motor unit activity in vivo, i.e. high-density surface EMG, with the gold standard technique for muscle tissue sampling, i.e. muscle biopsy, here we investigated the relation between the conduction velocity of populations of motor units identified from the biceps brachii muscle, and muscle fibre diameter. We demonstrate the possibility of predicting muscle fibre diameter (R2  = 0.66) and cross-sectional area (R2  = 0.65) from conduction velocity estimates with low systematic bias (∼2% and ∼4% respectively) and a relatively low margin of individual error (∼8% and ∼16%, respectively). The proposed neuromuscular interface opens new perspectives in the use of high-density EMG as a non-invasive tool to estimate muscle fibre size without the need of surgical biopsy sampling. The non-invasive nature of high-density surface EMG for the assessment of muscle fibre size may be useful in studies monitoring child development, ageing, space and exercise physiology, although the applicability and validity of the proposed methodology need to be more directly assessed in these specific populations by future studies. KEY POINTS: Because of the biophysical relation between muscle fibre size and the propagation velocity of action potentials along the sarcolemma, motor unit conduction velocity could represent a potential non-invasive candidate for estimating muscle fibre size in vivo. This relation has been previously assessed in animal models and humans with invasive techniques, or it has been mathematically derived from simulations. By combining high-density surface EMG with muscle biopsy, here we explored the relation between the conduction velocity of populations of motor units and muscle fibre size in healthy individuals. Our results confirmed that motor unit conduction velocity can be considered as a novel biomarker of fibre size, which can be adopted to predict muscle fibre diameter and cross-sectional area with low systematic bias and margin of individual error. The proposed neuromuscular interface opens new perspectives in the use of high-density EMG as a non-invasive tool to estimate muscle fibre size without the need of surgical biopsy sampling.

Motor Unit Discharge Characteristics and Conduction Velocity of the Vastii Muscles in Long-Term Resistance-Trained Men

PURPOSE

Adjustments in motor unit (MU) discharge properties have been shown after short-term resistance training; however, MU adaptations in long-term resistance-trained (RT) individuals are less clear. Here, we concurrently assessed MU discharge characteristics and MU conduction velocity in long-term RT and untrained (UT) men.

METHODS

Motor unit discharge characteristics (discharge rate, recruitment, and derecruitment threshold) and MU conduction velocity were assessed after the decomposition of high-density electromyograms recorded from vastus lateralis (VL) and vastus medialis (VM) of RT (>3 yr; n = 14) and UT ( n = 13) during submaximal and maximal isometric knee extension.

RESULTS

Resistance-trained men were on average 42% stronger (maximal voluntary force [MVF], 976.7 ± 85.4 N vs 685.5 ± 123.1 N; P < 0.0001), but exhibited similar relative MU recruitment (VL, 21.3% ± 4.3% vs 21.0% ± 2.3% MVF; VM, 24.5% ± 4.2% vs 22.7% ± 5.3% MVF) and derecruitment thresholds (VL, 20.3% ± 4.3% vs 19.8% ± 2.9% MVF; VM, 24.2% ± 4.8% vs 22.9% ± 3.7% MVF; P ≥ 0.4543). There were also no differences between groups in MU discharge rate at recruitment and derecruitment or at the plateau phase of submaximal contractions (VL, 10.6 ± 1.2 pps vs 10.3 ± 1.5 pps; VM, 10.7 ± 1.6 pps vs 10.8 ± 1.7 pps; P ≥ 0.3028). During maximal contractions of a subsample population (10 RT, 9 UT), MU discharge rate was also similar in RT compared with UT (VL, 21.1 ± 4.1 pps vs 14.0 ± 4.5 pps; VM, 19.5 ± 5.0 pps vs 17.0 ± 6.3 pps; P = 0.7173). Motor unit conduction velocity was greater in RT compared with UT individuals in both VL (4.9 ± 0.5 m·s -1 vs 4.5 ± 0.3 m·s -1 ; P < 0.0013) and VM (4.8 ± 0.5 m·s -1 vs 4.4 ± 0.3 m·s -1 ; P < 0.0073).

CONCLUSIONS

Resistance-trained and UT men display similar MU discharge characteristics in the knee extensor muscles during maximal and submaximal contractions. The between-group strength difference is likely explained by superior muscle morphology of RT as suggested by greater MU conduction velocity.

The Forces Generated by Agonist Muscles during Isometric Contractions Arise from Motor Unit Synergies

The purpose of our study was to identify the low-dimensional latent components, defined hereafter as motor unit modes, underlying the discharge rates of the motor units in two knee extensors (vastus medialis and lateralis, eight men) and two hand muscles (first dorsal interossei and thenars, seven men and one woman) during submaximal isometric contractions. Factor analysis identified two independent motor unit modes that captured most of the covariance of the motor unit discharge rates. We found divergent distributions of the motor unit modes for the hand and vastii muscles. On average, 75% of the motor units for the thenar muscles and first dorsal interosseus were strongly correlated with the module for the muscle in which they resided. In contrast, we found a continuous distribution of motor unit modes spanning the two vastii muscle modules. The proportion of the muscle-specific motor unit modes was 60% for vastus medialis and 45% for vastus lateralis. The other motor units were either correlated with both muscle modules (shared inputs) or belonged to the module for the other muscle (15% for vastus lateralis). Moreover, coherence of the discharge rates between motor unit pools was explained by the presence of shared synaptic inputs. In simulations with 480 integrate-and-fire neurons, we demonstrate that factor analysis identifies the motor unit modes with high levels of accuracy. Our results indicate that correlated discharge rates of motor units that comprise motor unit modes arise from at least two independent sources of common input among the motor neurons innervating synergistic muscles.SIGNIFICANCE STATEMENT It has been suggested that the nervous system controls synergistic muscles by projecting common synaptic inputs to the engaged motor neurons. In our study, we reduced the dimensionality of the output produced by pools of synergistic motor neurons innervating the hand and thigh muscles during isometric contractions. We found two neural modules, each representing a different common input, that were each specific for one of the muscles. In the vastii muscles, we found a continuous distribution of motor unit modes spanning the two synergistic muscles. Some of the motor units from the homonymous vastii muscle were controlled by the dominant neural module of the other synergistic muscle. In contrast, we found two distinct neural modules for the hand muscles.

Neural dysregulation in post-COVID fatigue

Following infection with SARS-CoV-2, a substantial minority of people develop lingering after-effects known as 'long COVID'. Fatigue is a common complaint with a substantial impact on daily life, but the neural mechanisms behind post-COVID fatigue remain unclear. We recruited 37 volunteers with self-reported fatigue after a mild COVID infection and carried out a battery of behavioural and neurophysiological tests assessing the central, peripheral and autonomic nervous systems. In comparison with age- and sex-matched volunteers without fatigue (n = 52), we show underactivity in specific cortical circuits, dysregulation of autonomic function and myopathic change in skeletal muscle. Cluster analysis revealed no subgroupings, suggesting post-COVID fatigue is a single entity with individual variation, rather than a small number of distinct syndromes. Based on our analysis, we were also able to exclude dysregulation in sensory feedback circuits and descending neuromodulatory control. These abnormalities on objective tests may aid in the development of novel approaches for disease monitoring.

Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis

Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be considered as a potential effective treatment option. We performed an individual participant data (IPD) meta-analysis including searches on PubMed, Embase, and the Cochrane Library (2000–2022). The primary endpoint was the change in pain intensity (visual analogue scale; VAS) at a defined time-point of ≤3 months post-DBS. In addition, correlation and regression analyses were performed to identify predictive markers (age, duration of pain, frequency, amplitude, intensity, contact configuration, and the DBS target). A total of seven trials consisting of 54 screened patients met the inclusion criteria. DBS significantly reduced the pain levels after 3 months without being related to a specific DBS target, age, contact configuration, stimulation intensity, frequency, amplitude, or chronic pain duration. Adverse events were an infection or lead fracture (19%), stimulation-induced side effects (7%), and three deaths (unrelated to DBS—from cancer progression or a second stroke). Although comparable long-term data are lacking, the current published data indicate that DBS (thalamic and PVG/PAG) effectively suppresses facial pain in the short-term. However, the low-quality evidence, reporting bias, and placebo effects must be considered in future randomized-controlled DBS trials for facial pain.

Blockade of 5-HT2 receptors suppresses motor unit firing and estimates of persistent inward currents during voluntary muscle contraction in humans

Serotonergic neuromodulation contributes to enhanced voluntary muscle activation. However, it is not known how the likely motoneurone receptor candidate (5-HT₂ ) influences the firing rate and activation threshold of motor units (MUs) in humans. The purpose of this study was to determine whether 5-HT₂ receptor activity contributes to human MU behaviour during voluntary ramped contractions of differing intensity. High-density surface EMG (HDsEMG) of the tibialis anterior was assessed during ramped isometric dorsiflexions at 10, 30, 50 and 70% of maximal voluntary contraction (MVC). MU characteristics were successfully extracted from HDsEMG of 11 young adults (four female) pre- and post-ingestion of 8 mg cyproheptadine or a placebo. Antagonism of 5-HT₂ receptors caused a reduction in MU discharge rate during steady-state muscle activation that was independent of the level of contraction intensity [P < 0.001; estimated mean difference (∆) = 1.06 pulses/s], in addition to an increase in MU derecruitment threshold (P < 0.013, ∆ = 1.23% MVC), without a change in force during MVC (P = 0.652). A reduction in estimates of persistent inward current amplitude was observed at 10% MVC (P < 0.001, ∆ = 0.99 Hz) and 30% MVC (P = 0.003, ∆ = 0.75 Hz) that aligned with 5-HT changes in MU firing behaviour attributable to 5-HT₂ antagonism. Overall, these findings indicate that 5-HT₂ receptor activity has a role in regulating the discharge rate in populations of spinal motoneurones when performing voluntary contractions. This study provides evidence of a direct link between MU discharge properties, persistent inward current activity and 5-HT₂ receptor activity in humans. KEY POINTS: Activation of 5-HT receptors on the soma and dendrites of motoneurones regulates their excitability. Previous work using chlorpromazine and cyproheptadine has demonstrated that the 5-HT₂ receptor regulates motoneurone activity in humans with chronic spinal cord injury and non-injured control subjects. It is not known how the 5-HT₂ receptor directly influences motor unit (MU) discharge and MU recruitment in larger populations of human motoneurones during voluntary contractions of differing intensity. Despite the absence of change in force during maximal voluntary dorsiflexions, 5-HT₂ receptor antagonism caused a reduction in MU discharge rate during submaximal steady-state muscle contraction, in addition to an increase in MU derecruitment threshold, irrespective of the submaximal contraction intensity. Reductions in estimates of persistent inward currents after 5-HT₂ receptor antagonism support the viewpoint that the 5-HT₂ receptor plays a crucial role in regulating motor activity, whereby a persistent inward current-based mechanism is involved in regulating the excitability of human motoneurones.

Neuromechanics of the Rate of Force Development

The rate at which an individual can develop force during rapid voluntary contractions can be influenced by both the neural drive to a muscle and its intrinsic musculotendinous properties. We hypothesize that the maximal rate of force development across human individuals is mainly attributable to the rate of motor unit recruitment.

Adaptations in motor unit properties underlying changes in recruitment, rate coding, and maximum force

Changes in the discharge characteristics of motor units as well as in the maximum force-producing capacity of the muscle are observed following training, aging, and fatiguability. The ability to measure the adaptations in the neuromuscular properties underlying these changes experimentally, however, is limited. In this study we used a computational model to systematically investigate the effects of various neural and muscular adaptations on motor unit recruitment thresholds, average motor unit discharge rates in submaximal contractions, and maximum force. The primary focus was to identify candidate adaptations that can explain experimentally observed changes in motor unit discharge characteristics after 4 wk of strength training (Del Vecchio A, Casolo A, Negro F, Scorcelletti M, Bazzucchi I, Enoka R, Felici F, Farina D. J Physiol 597: 1873-1887, 2019). The simulation results indicated that multiple combinations of adaptations, likely involving an increase in maximum discharge rate across motor units, may occur after such training. On a more general level, we found that the magnitude of the adaptations scales linearly with the change in recruitment thresholds, discharge rates, and maximum force. In addition, the combination of multiple adaptations can be predicted as the linear sum of their individual effects. Together, this implies that the outcomes of the simulations can be generalized to predict the effect of any combination of neural and muscular adaptations. In this way, the study provides a tool for estimating potential underlying adaptations in neural and muscular properties to explain any change in commonly used measures of rate coding, recruitment, and maximum force.NEW & NOTEWORTHY Our ability to measure adaptations in neuromuscular properties in vivo is limited. Using a computational model, we quantify the effect of multiple neuromuscular adaptations on common measures of motor unit recruitment, rate coding, and force-producing capacity. Scaling and combining adaptations had a near-linear effect on these measures, indicating that the results can explain and predict neuromuscular adaptations in a wide range of conditions, including, but not limited to, strength training.

Liquid biopsy in the assessment of microRNAs in oral squamous cell carcinoma: A systematic review

Background

The identification of non-invasive biomarkers from biological fluids collected by liquid biopsy provides new horizons for individualized therapeutic strategies and improves clinical decision-making in OSCC patients. Circulating microRNAs have emerged as biomarkers that may reflect not only the existence of cancer, but also the dynamic, malignant potential, and drug resistance of tumors. The aim of the systematic review is to evaluate and summarize the results of the published studies regarding the use of microRNAs as biomarkers for OSCC.

Material and Methods

A literature search was conducted on PubMed, Scopus, Web of Science, and Cochrane databases till November 2020. A total of 34 studies met the inclusion criteria and were therefore subjected to quality assessment. Each study was subjected to data extraction including; patient characteristics, type of fluid sample (whole blood, plasma, serum, or saliva), molecular analysis method, specific dysregulated microRNA, and microRNA expression pattern.

Results

The analysis showed that 57 microRNAs of liquid biopsy samples of four different fluids (whole blood, serum, plasma, and saliva) were analyzed. The prognostic and therapeutic significance of these microRNAs were suggested by several studies; where 41 microRNAs were upregulated while 16 were downregulated.

Conclusions

Scientific evidence supports the interest in the use of microRNAs in the diagnosis and prognosis in OSCC patients; however, further studies in a larger cohort of patients are mandatory to introduce liquid biopsy in the routine clinical practice for the OSCC management. Key words:Biomarkers, liquid biopsy, microRNA, oral squamous cell carcinoma, systematic review.

Interfacing Motor Units in Nonhuman Primates Identifies a Principal Neural Component for Force Control Constrained by the Size Principle

Motor units convert the last neural code of movement into muscle forces. The classic view of motor unit control is that the CNS sends common synaptic inputs to motoneuron pools and that motoneurons respond in an orderly fashion dictated by the size principle. This view, however, is in contrast with the large number of dimensions observed in motor cortex, which may allow individual and flexible control of motor units. Evidence for flexible control of motor units may be obtained by tracking motor units longitudinally during tasks with some level of behavioral variability. Here we identified and tracked populations of motor units in the brachioradialis muscle of two macaque monkeys during 10 sessions spanning >1 month with a broad range of rate of force development (1.8-38.6 N · m · s-1). We found a very stable recruitment order and discharge characteristics of the motor units over sessions and contraction trials. The small deviations from orderly recruitment were fully predicted by the motor unit recruitment intervals, so that small shifts in recruitment thresholds happened only during contractions at a high rate of force development. Moreover, we also found that one component explained more than ∼50% of the motor unit discharge rate variance, and that the remaining components represented a time-shifted version of the first. In conclusion, our results show that the recruitment of motoneurons is determined by the interplay of the size principle and common input and that this recruitment scheme is not violated over time or by the speed of the contractions.SIGNIFICANCE STATEMENT With a new noninvasive high-density electromyographic framework, we show the activity of motor unit ensembles in macaques during voluntary contractions. The discharge characteristics of brachioradialis motor units revealed a relatively fixed recruitment order and discharge characteristics across days and rate of force developments. These results were further confirmed through invasive axonal stimulation and recordings of intramuscular electromyographic activity from 16 arm muscles. The study shows for the first time the feasibility of longitudinal noninvasive motor unit interfacing and tracking of the same motor units in nonhuman primates.

Neural decoding from surface high-density EMG signals: influence of anatomy and synchronization on the number of identified motor units

OBJECTIVE

High-density surface electromyography (HD-sEMG) allows the reliable identification of individual motor unit (MU) action potentials. Despite the accuracy in decomposition, there is a large variability in the number of identified MUs across individuals and exerted forces. Here we present a systematic investigation of the anatomical and neural factors that determine this variability.

APPROACH

We investigated factors of influence on HD-sEMG decomposition, such as synchronization of MU discharges, distribution of MU territories, muscle-electrode distance (MED - subcutaneous adipose tissue thickness), maximum anatomical cross-sectional area (ACSA_max), and fiber CSA. For this purpose, we recorded HD-sEMG signals, ultrasound and, magnetic resonance images, and took a muscle biopsy from the biceps brachii muscle from 30 male participants drawn from two groups to ensure variability within the factors - untrained-controls (UT=14) and strength-trained individuals (ST=16). Participants performed isometric ramp contractions with elbow flexors (at 15, 35, 50 and 70% maximum voluntary torque - MVT). We assessed the correlation between the number of accurately detected MUs by HD-sEMG decomposition and each measured parameter, for each target force level. Multiple regression analysis was then applied.

MAIN RESULTS

ST subjects showed lower MED (UT=5.1±1.4 mm; ST=3.8±0.8 mm) and a greater number of identified motor units (UT:21.3±10.2 vs ST:29.2±11.8 MUs/subject across all force levels). The entire cohort showed a negative correlation between MED and the number of identified MUs at low forces (r= -0.6, p=0.002 at 15%MVT). Moreover, the number of identified MUs was positively correlated to the distribution of MU territories (r=0.56, p=0.01) and ACSA_max(r=0.48, p=0.03) at 15%MVT. By accounting for all anatomical parameters, we were able to partly predict the number of decomposed MUs at low but not at high forces.

SIGNIFICANCE

Our results confirmed the influence of subcutaneous tissue on the quality of HD-sEMG signals and demonstrated that MU spatial distribution and ACSA_maxare also relevant parameters of influence for current decomposition algorithms.

Startling stimuli increase maximal motor unit discharge rate and rate of force development in humans

Maximal rate of force development in adult humans is determined by the maximal motor unit discharge rate, however the origin of the underlying synaptic inputs remains unclear. Here, we tested a hypothesis that the maximal motor unit discharge rate will increase in response to a startling cue, a stimulus that purportedly activates the pontomedullary reticular formation neurons that make mono- and disynaptic connections to motoneurons via fast-conducting axons. Twenty-two men were required to produce isometric knee extensor forces "as fast and as hard" as possible from rest to 75% of maximal voluntary force, in response to visual (VC), visual-auditory (VAC; 80 dB), or visual-startling cue (VSC; 110 dB). Motoneuron activity was estimated via decomposition of high-density surface electromyogram recordings over the vastus lateralis and medialis muscles. Reaction time was significantly shorter in response to VSC compared to VAC and VC. The VSC further elicited faster neuromechanical responses including a greater number of discharges per motor unit per second and greater maximal rate of force development, with no differences between VAC and VC. We provide evidence, for the first time, that the synaptic input to motoneurons increases in response to a startling cue, suggesting a contribution of subcortical pathways to maximal motoneuron output in humans.

A Generalized Framework for the Study of Spinal Motor Neurons Controlling the Human Hand During Dynamic Movements

The human hand possesses a large number of degrees of freedom. Hand dexterity is encoded by the discharge times of spinal motor units (MUs). Most of our knowledge on the neural control of movement is based on the discharge times of MUs during isometric contractions. Here we designed a noninvasive framework to study spinal motor neurons during dynamic hand movements with the aim to understand the neural control of MUs during sinusoidal hand digit flexion and extension at different rates of force development. The framework included 320 high-density surface EMG electrodes placed on the forearm muscles, with markerless 3D hand kinematics extracted with deep learning, and a realistic virtual hand that displayed the motor tasks. The movements included flexion and extension of individual hand digits at two different speeds (0.5 Hz and 1.5 Hz) for 40 seconds. We found on average 4.7±1.7 MUs across participants and tasks. Most MUs showed a biphasic pattern closely mirroring the flexion and extension kinematics. Indeed, a factor analysis method (non-negative matrix factorization) was able to learn the two components (flexion/extension) with high accuracy at the individual MU level ( R=0.87±0.12). Although most MUs were highly correlated with either flexion or extension movements, there was a smaller proportion of MUs that was not task-modulated and controlled by a different neural module (7.1% of all MUs with ). This work shows a noninvasive visually guided framework to study motor neurons controlling the movement of the hand in human participants during dynamic hand digit movements.

Accurate Continuous Prediction of 14 Degrees of Freedom of the Hand from Myoelectrical Signals through Convolutive Deep Learning

Natural control of assistive devices requires continuous positional encoding and decoding of the user's volition. Human movement is encoded by recruitment and rate coding of spinal motor units. Surface electromyography provides some information on the neural code of movement and is usually decoded into finger joint angles. However, the current approaches to mapping the electrical signal into joint angles are unsatisfactory. There are no methods that allow precise estimation of joint angles during natural hand movements within the large numbers of degrees of freedom of the hand. We propose a framework to train a neural network from digital cameras and high-density surface electromyography from the extrinsic (forearm and wrist) hand muscles. Furthermore, we show that our 3D convolutional neural network optimally predicted 14 functional flexion/extension joints of the hand. We found in our experiments (4 subjects; mean age of 26±2.12 years) that our model can predict individual sinusoidal finger movement at different speeds (0.5 and 1.5 Hz), as well as two and three finger pinching, and hand opening and closing, covering 14 degrees of freedom of the hand. Our deep learning method shows a mean absolute error of 2.78±0.28 degrees with a mean correlation coefficient between predicted and expected joint angles of 0.94, 95% confidence interval (CI) [0.81, 0.98] with simulated real-time inference times lower than 30 milliseconds. These results demonstrate that our approach is capable of predicting the user's volition similar to digital cameras through a non-invasive wearable neural interface. Clinical relevance- This method establishes a viable interface that can be used for both immersive virtual reality medical simulations environments and assistive devices such as exoskeleton and prosthetics.

Deep brain stimulation and stereotactic-assisted brain graft injection targeting fronto-striatal circuits for Huntington's disease: an update

INTRODUCTION

Huntington's Disease as progressive neurological disorders associated with motor, behavioral, and cognitive impairment poses a therapeutic challenge in case of limited responsiveness to established therapeutics. Pallidal deep brain stimulation and neurorestorative strategies (brain grafts) scoping to modulate fronto-striatal circuits have gained increased recognition for the treatment of refractory Huntington's disease (HD).

AREAS COVERED

A review (2000-2022) was performed in PubMed, Embase, and Cochrane Library covering clinical trials conceptualized to determine the efficacy and safety of invasive, stereotactic-guided deep-brain stimulation and intracranial brain-graft injection targeting the globus pallidus and adjunct structures (striatum).

EXPERT OPINION

Stereotactic brain-grafting strategies were performed in few HD patients with inconsistent findings and mild-to-moderate clinical responsiveness with a recently published large, randomized-controlled trial (NCT00190450) yielding negative results. We identified 19 in-human DBS trials (uncontrolled) targeting the globus pallidus internus/externus along with randomized-controlled trial pending report (NCT02535884). We did not detect any significant changes in the UHDRS total score after restorative injections, while in contrast, the use of deep-brain stimulation resulted in a significant reduction of chorea. GPi-DBS should be considered in cases where selective chorea is present. However, both invasive therapies remain experimental and are not ready for the implementation in clinical use.

Reading and Modulating Cortical β Bursts from Motor Unit Spiking Activity

β Oscillations (13-30 Hz) are ubiquitous in the human motor nervous system. Yet, their origins and roles are unknown. Traditionally, β activity has been treated as a stationary signal. However, recent studies observed that cortical β occurs in "bursting events," which are transmitted to muscles. This short-lived nature of β events makes it possible to study the main mechanism of β activity found in the muscles in relation to cortical β. Here, we assessed whether muscle β activity mainly results from cortical projections. We ran two experiments in healthy humans of both sexes (N = 15 and N = 13, respectively) to characterize β activity at the cortical and motor unit (MU) levels during isometric contractions of the tibialis anterior muscle. We found that β rhythms observed at the cortical and MU levels are indeed in bursts. These bursts appeared to be time-locked and had comparable average durations (40-80 ms) and rates (approximately three to four bursts per second). To further confirm that cortical and MU β have the same source, we used a novel operant conditioning framework to allow subjects to volitionally modulate MU β. We showed that volitional modulation of β activity at the MU level was possible with minimal subject learning and was paralleled by similar changes in cortical β activity. These results support the hypothesis that MU β mainly results from cortical projections. Moreover, they demonstrate the possibility to decode cortical β activity from MU recordings, with a potential translation to future neural interfaces that use peripheral information to identify and modulate activity in the central nervous system.SIGNIFICANCE STATEMENT We show for the first time that β activity in motor unit (MU) populations occurs in bursting events. These bursts observed in the output of the spinal cord appear to be time-locked and share similar characteristics of β activity at the cortical level, such as the duration and rate at which they occur. Moreover, when subjects were exposed to a novel operant conditioning paradigm and modulated MU β activity, cortical β activity changed in a similar way as peripheral β. These results provide evidence for a strong correspondence between cortical and peripheral β activity, demonstrating the cortical origin of peripheral β and opening the pathway for a new generation of neural interfaces.

The role of the neural stimulus in regulating skeletal muscle hypertrophy

Resistance training is frequently performed with the goal of stimulating muscle hypertrophy. Due to the key roles motor unit recruitment and mechanical tension play to induce muscle growth, when programming, the manipulation of the training variables is oriented to provoke the correct stimulus. Although it is known that the nervous system is responsible for the control of motor units and active muscle force, muscle hypertrophy researchers and trainers tend to only focus on the adaptations of the musculotendinous unit and not in the nervous system behaviour. To better guide resistance exercise prescription for muscle hypertrophy and aiming to delve into the mechanisms that maximize this goal, this review provides evidence-based considerations for possible effects of neural behaviour on muscle growth when programming resistance training, and future neurophysiological measurement that should be tested when training to increase muscle mass. Combined information from the neural and muscular structures will allow to understand the exact adaptations of the muscle in response to a given input (neural drive to the muscle). Changes at different levels of the nervous system will affect the control of motor units and mechanical forces during resistance training, thus impacting the potential hypertrophic adaptations. Additionally, this article addresses how neural adaptations and fatigue accumulation that occur when resistance training may influence the hypertrophic response and propose neurophysiological assessments that may improve our understanding of resistance training variables that impact on muscular adaptations.

Lack of increased rate of force development after strength training is explained by specific neural, not muscular, motor unit adaptations

While maximal force increases following short-term isometric strength training, the rate of force development (RFD) may remain relatively unaffected. The underlying neural and muscular mechanisms during rapid contractions after strength training are largely unknown. Since strength training increases the neural drive to muscles, it may be hypothesized that there are distinct neural or muscular adaptations determining the change in RFD independently of an increase in maximal force. Therefore, we examined motor unit population data acquired from surface electromyography during the rapid generation of force before and after four weeks of strength training. We observed that strength training did not change the RFD because it did not influence the number of motor units recruited per second or their initial discharge rate during rapid contractions. While strength training did not change motoneuron behaviour in the force increase phase of rapid contractions, it increased the discharge rate of motoneurons (by ~4 spikes/s) when reaching the plateau phase (~150 ms) of the rapid contractions, determining an increase in maximal force production. Computer simulations with a motor unit model that included neural and muscular properties, closely matched the experimental observations and demonstrated that the lack of change in RFD following training is primarily mediated by an unchanged maximal recruitment speed of motoneurons. These results demonstrate that maximal force and contraction speed are determined by different adaptations in motoneuron behaviour following strength training and indicate that increases in the recruitment speed of motoneurons are required to evoke training-induced increases in RFD.

Sensing and decoding the neural drive to paralyzed muscles during attempted movements of a person with tetraplegia using a sleeve array

Motor neurons convey information about motor intent that can be extracted and interpreted to control assistive devices. However, most methods for measuring the firing activity of single neurons rely on implanted microelectrodes. Although intracortical brain-computer interfaces (BCIs) have been shown to be safe and effective, the requirement for surgery poses a barrier to widespread use that can be mitigated by instead using noninvasive interfaces. The objective of this study was to evaluate the feasibility of deriving motor control signals from a wearable sensor that can detect residual motor unit activity in paralyzed muscles after chronic cervical spinal cord injury (SCI). Despite generating no observable hand movement, volitional recruitment of motor units below the level of injury was observed across attempted movements of individual fingers and overt wrist and elbow movements. Subgroups of motor units were coactive during flexion or extension phases of the task. Single digit movement intentions were classified offline from the EMG power (RMS) or motor unit firing rates with median classification accuracies >75% in both cases. Simulated online control of a virtual hand was performed with a binary classifier to test feasibility of real-time extraction and decoding of motor units. The online decomposition algorithm extracted motor units in 1.2 ms, and the firing rates predicted the correct digit motion 88 ± 24% of the time. This study provides the first demonstration of a wearable interface for recording and decoding firing rates of motor units below the level of injury in a person with motor complete SCI.

Football beats hypertension: results of the 3F (Fit&Fun with Football) study

OBJECTIVES

Football as the most popular sport could improve insufficient physical activity in patients with cardiovascular risk factors. A modified 'healthy' football training format could motivate hypertensive patients to return to sport and improve risk factors.

METHODS

The 3F study: 'Fit and Fun with Football' a prospective interventional study with 1 year follow-up. Football group: n = 103, structured 'health'-football training (1×/week, 90 min) led by Deutscher Fußball Bund-licensed football coaches. Hypertensive patients at least 45 years who have not exercised for several years were compared with a control group (n = 105).

PRIMARY STUDY OBJECTIVE

Reduction of office (OBP) and/or 24-h ambulatory blood pressure (BP) monitoring (ABPM) and/or reduction of number or dosage of antihypertensive medication.

MAIN RESULTS

OBP values decreased significantly in the football group from 142.6/87.9 to 130.8/81.8 mmHg (P < 0.001), in the control group the values increased slightly (NS). ABPM values decreased significantly in the football group, while a slight increase was found in the control group. At the end of the study, the mean values in the football group of both OPB (P < 0.001) and ABPM (systolic P < 0.001, diastolic P = 0.017) were significantly lower than in the control group. Significantly more people in the football group were able to reduce antihypertensive patients than in the control group (football group:16, control group:6), while more participants in the control group intensified antihypertensive therapy (football group:3, control group:14) (P < 0.001). Among the secondary endpoints, there was a weight loss of 3 kg in the football group and an increase of 1.7 kg in the control group (P < 0.001).

CONCLUSION

Offering modified 'healthy' football-training to middle-aged hypertensive patients can lead to better BP control and a reduction of antihypertensive medication. Therefore, the offer of 'health football' should be established and supported by clubs, insurances and authorities.

Behavior of motor units during submaximal isometric contractions in chronically strength-trained individuals

Neural and morphological adaptations combine to underpin the enhanced muscle strength following prolonged exposure to strength training, although their relative importance remains unclear. We investigated the contribution of motor unit (MU) behavior and muscle size to submaximal force production in chronically strength-trained athletes (ST) versus untrained controls (UT). Sixteen ST (age: 22.9 ± 3.5 yr; training experience: 5.9 ± 3.5 yr) and 14 UT (age: 20.4 ± 2.3 yr) performed maximal voluntary isometric force (MViF) and ramp contractions (at 15%, 35%, 50%, and 70% MViF) with elbow flexors, whilst high-density surface electromyography (HDsEMG) was recorded from the biceps brachii (BB). Recruitment thresholds (RTs) and discharge rates (DRs) of MUs identified from the submaximal contractions were assessed. The neural drive-to-muscle gain was estimated from the relation between changes in force (ΔFORCE, i.e. muscle output) relative to changes in MU DR (ΔDR, i.e. neural input). BB maximum anatomical cross-sectional area (ACSA_MAX) was also assessed by MRI. MViF (+64.8% vs. UT, P < 0.001) and BB ACSA_MAX (+71.9%, P < 0.001) were higher in ST. Absolute MU RT was higher in ST (+62.6%, P < 0.001), but occurred at similar normalized forces. MU DR did not differ between groups at the same normalized forces. The absolute slope of the ΔFORCE - ΔDR relationship was higher in ST (+66.9%, P = 0.002), whereas it did not differ for normalized values. We observed similar MU behavior between ST athletes and UT controls. The greater absolute force-generating capacity of ST for the same neural input demonstrates that morphological, rather than neural, factors are the predominant mechanism for their enhanced force generation during submaximal efforts.NEW & NOTEWORTHY In this study, we observed that recruitment strategies and discharge characteristics of large populations of motor units identified from biceps brachii of strength-trained athletes were similar to those observed in untrained individuals during submaximal force tasks. We also found that for the same neural input, strength-trained athletes are able to produce greater absolute muscle forces (i.e., neural drive-to-muscle gain). This demonstrates that morphological factors are the predominant mechanism for the enhanced force generation during submaximal efforts.

Deficit in knee extension strength following anterior cruciate ligament reconstruction is explained by a reduced neural drive to the vasti muscles

The persistence of quadriceps weakness represents a major concern following anterior cruciate ligament reconstruction (ACLR). The underlying adaptations occurring in the activity of spinal motoneurons are still unexplored. This study examined the discharge patterns of large populations of motor units (MUs) in the vastus lateralis (VL) and vastus medialis muscles following ACLR. Nine ACLR individuals and 10 controls performed unilateral trapezoidal contractions of the knee extensor muscles at 35%, 50% and 70% of the maximal voluntary isometric force (MVIF). High-density surface electromyography (HDsEMG) was used to record the myoelectrical activity of the vasti muscles in both limbs. HDsEMG signals were decomposed with a convolutive blind source separation method and MU properties were extracted and compared between sides and groups. The ACLR group showed a lower MVIF on the reconstructed side compared to the contralateral side (28.1%; P < 0.001). This force deficit was accompanied by reduced MU discharge rates (∼21%; P < 0.05), lower absolute MU recruitment and derecruitment thresholds (∼22% and ∼22.5%, respectively; P < 0.05) and lower input-output gain of motoneurons (27.3%; P = 0.009). Deficits in MU discharge rates of the VL and in absolute recruitment and derecruitment thresholds of both vasti MUs were associated with deficits in MVIF (P < 0.05). A strong between-side correlation was found for MU discharge rates of the VL of ACLR individuals (P < 0.01). There were no significant between-group differences (P > 0.05). These results indicate that mid- to long-term strength deficits following ACLR may be attributable to a reduced neural drive to vasti muscles, with potential changes in excitatory and inhibitory synaptic inputs. KEY POINTS: Impaired expression and control of knee extension forces is common after anterior cruciate ligament reconstruction and is related to high risk of a second injury. To provide novel insights into the neural basis of this impairment, the discharge patterns of motor units in the vastus lateralis and vastus medialis were investigated during voluntary force contractions. There was lower knee extensor strength on the reconstructed side with respect to the contralateral side, which was explained by deficits in motor unit discharge rate and an altered motoneuronal input-output gain. Insufficient excitatory inputs to motoneurons and increased inhibitory afferent signals potentially contributed to these alterations. These results further our understanding of the neural underpinnings of quadriceps weakness following anterior cruciate ligament reconstruction and can help to develop effective rehabilitation protocols to regain muscle strength and reduce the risk of a second injury.

Surface EMG cross talk quantified at the motor unit population level for muscles of the hand, thigh, and calf

Cross talk is an important source of error in interpreting surface electromyography (EMG) signals. Here, we aimed at characterizing cross talk for three groups of synergistic muscles by the identification of individual motor unit action potentials. Moreover, we explored whether spatial filtering (single and double differential) of the EMG signals influences the level of cross talk. Three experiments were conducted. Participants (total 25) performed isometric contractions at 10% of the maximal voluntary contraction (MVC) with digit muscles and knee extensors and at 30% MVC with plantar flexors. High-density surface EMG signals were recorded and decomposed into motor unit spike trains. For each muscle, we quantified the cross talk induced to neighboring muscles and the level of contamination by the nearby muscle activity. We also estimated the influence of cross talk on the EMG power spectrum and intermuscular correlation. Most motor units (80%) generated significant cross-talk signals to neighboring muscle EMG in monopolar recording mode, but this proportion decreased with spatial filtering (50% and 42% for single and double differential, respectively). Cross talk induced overestimations of intermuscular correlation and has a small effect on the EMG power spectrum, which indicates that cross talk is not reduced with high-pass temporal filtering. Conversely, spatial filtering reduced the cross-talk magnitude and the overestimations of intermuscular correlation, confirming to be an effective and simple technique to reduce cross talk. This paper presents a new method for the identification and quantification of cross talk at the motor unit level and clarifies the influence of cross talk on EMG interpretation for muscles with different anatomy.NEW & NOTEWORTHY We proposed a new method for the identification and quantification of cross talk at the motor unit level. We show that surface EMG cross talk can lead to physiological misinterpretations of EMG signals such as overestimations in the muscle activity and intermuscular correlation. Cross talk had little influence on the EMG power spectrum, which indicates that conventional temporal filtering cannot minimize cross talk. Spatial filter (single and double differential) effectively reduces but not abolish cross talk.

Histological Ex Vivo Evaluation of the Suitability of a 976 nm Diode Laser in Oral Soft Tissue Biopsies

INTRODUCTION

Laser-induced thermal effects can preclude a safe histological evaluation of biopsy resection margins. The aim of this study was to evaluate the suitability of a 976 nm diode laser in oral soft tissue biopsies in an ex vivo study.

MATERIALS AND METHODS

A 976 nm diode laser (Solase®, Lazon Medical Laser, China) has been used in the contact mode, using a 400 μm fiber tip, at different parameters from 4 to 6 W in the continuous wave (CW), with a fluence between 3184 and 4777 J/cm2, and pulsed wave (PW) mode, with a fluence between 318,4 and 477,7 J/cm2, to obtain 30 samples from fresh pig cadaver tongues. All specimens were subdivided into 6 groups (from A to F), and each group consisted of 5 samples. Two sections were obtained from each sample. A histological analysis was performed using an optical microscope at magnifications of 5x and 10x. Statistical analysis was carried out using Kruskal-Wallis and Dunn's tests.

RESULTS

The results showed that histological readability was optimal in all the samples. The thermal damage was negligible in all groups. The average thermal damage was 208.40 ± 133.81 μm in the epithelial tissue and 330.14 ± 147.45 μm in the connective tissue. The statistical analysis showed no differences between the groups (p > 0.05).

CONCLUSION

A 976 nm diode laser demonstrated good surgical effectiveness that provoked little peripheral damage in the cut edges and allowed a safe histological diagnosis. Clinical Relevance. In oral pathology, many times, there is fear in using the laser to remove some lesions due to its thermal effect on the tissues close to the lesion. This effect is always present in the use of the laser, but the intent is to minimize this effect to have as little alteration as possible on the surrounding tissues.

Analysis of motor unit spike trains estimated from high-density surface electromyography is highly reliable across operators

There is a growing interest in decomposing high-density surface electromyography (HDsEMG) into motor unit spike trains to improve knowledge on the neural control of muscle contraction. However, the reliability of decomposition approaches is sometimes questioned, especially because they require manual editing of the outputs. We aimed to assess the inter-operator reliability of the identification of motor unit spike trains. Eight operators with varying experience in HDsEMG decomposition were provided with the same data extracted using the convolutive kernel compensation method. They were asked to manually edit them following established procedures. Data included signals from three lower leg muscles and different submaximal intensities. After manual analysis, 126 ± 5 motor units were retained (range across operators: 119-134). A total of 3380 rate of agreement values were calculated (28 pairwise comparisons × 11 contractions/muscles × 4-28 motor units). The median rate of agreement value was 99.6%. Inter-operator reliability was excellent for both mean discharge rate and time at recruitment (intraclass correlation coefficient > 0.99). These results show that when provided with the same decomposed data and the same basic instructions, operators converge toward almost identical results. Our data have been made available so that they can be used for training new operators.

Muscles from the same muscle group do not necessarily share common drive: evidence from the human triceps surae

In this study, we demonstrated that the three muscles composing the human triceps surae share minimal common drive during isometric contractions. Our results suggest that reducing the number of effectively controlled degrees of freedom may not always be the strategy used by the central nervous system to control movements. Independent control of some, but not all, synergist muscles may allow for more flexible control to comply with secondary goals (e.g., joint stabilization).

Laser dentistry in daily practice during the COVID-19 pandemic: Benefits, risks and recommendations for safe treatments

The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue–matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.