Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia

BACKGROUND

We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC).

METHODS

Two groups of PAD-IC patients: unilateral (Unilat-IC; n = 15), bilateral (Bilat-IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain-free, onset of pain and maximum pain in PAD-IC patients.

FINDINGS

Single leg stance in the asymptomatic leg of Unilat-IC increases and becomes higher than the symptomatic leg and the Bilat-IC legs at maximum pain. Step time is higher and cadence is lower in PAC-IC than in controls. Tibialis anterior activation peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat-IC during maximum pain. Tibialis anterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemius medialis activation peak in Bilat-IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat-IC presents a significant decrease between pain-free and maximum pain phases.

INTERPRETATION

Ischemia impacts gait in PAD-IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat-IC induces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a 'double' Unilat-IC when evaluating gait.

Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study

Certain secondary effects derived from medical treatment in breast cancer can favor the development of alterations in shoulder biomechanics. To the best of our knowledge, persistent peripheral pain as a key factor for the development of neuromuscular activity impairments has not been analyzed. A cross-sectional descriptive study was carried out. A total of 90 women were included and allocated to three groups: (i) 30 women with persistent peripheral pain after breast cancer treatment, (ii) 30 women without pain after breast cancer treatment, and (iii) 30 healthy women. Surface electromyography was employed to measure the onset and amplitude of the muscle activity of three shoulder movements. Statistically significant differences were found in the neuromuscular activity for all the muscles and shoulder movements among women with persistent pain versus healthy women (i.e., amplitude muscle activity variable p < 0.001). Statistically significant differences were also observed in the neuromuscular activity for certain muscles in shoulder movements among women with persistent pain versus women without pain, as well as between women without pain versus healthy women. Therefore, following breast cancer treatment, women showed alterations in their shoulder neuromuscular activity, which were more significant if persistent pain existed. These findings may contribute to developing a selective therapeutic exercise program that optimizes the shoulder neuromuscular activity in women after breast cancer treatment.

Thirty years of translational research in Mobility Medicine: Collection of abstracts of the 2020 Padua Muscle Days

More than half a century of skeletal muscle research is continuing at Padua University (Italy) under the auspices of the Interdepartmental Research Centre of Myology (CIR-Myo), the European Journal of Translational Myology (EJTM) and recently also with the support of the A&CM-C Foundation for Translational Myology, Padova, Italy. The Volume 30(1), 2020 of the EJTM opens with the collection of abstracts for the conference "2020 Padua Muscle Days: Mobility Medicine 30 years of Translational Research". This is an international conference that will be held between March 18-21, 2020 in Euganei Hills and Padova in Italy. The abstracts are excellent examples of translational research and of the multidimensional approaches that are needed to classify and manage (in both the acute and chronic phases) diseases of Mobility that span from neurologic, metabolic and traumatic syndromes to the biological process of aging. One of the typical aim of Physical Medicine and Rehabilitation is indeed to reduce pain and increase mobility enough to enable impaired persons to walk freely, garden, and drive again. The excellent contents of this Collection of Abstracts reflect the high scientific caliber of researchers and clinicians who are eager to present their results at the PaduaMuscleDays. A series of EJTM Communications will also add to this preliminary evidence.

Metabolic Reprogramming Promotes Myogenesis During Aging

Sarcopenia is the age-related progressive loss of skeletal muscle mass and strength finally leading to poor physical performance. Impaired myogenesis contributes to the pathogenesis of sarcopenia, while mitochondrial dysfunctions are thought to play a primary role in skeletal muscle loss during aging. Here we studied the link between myogenesis and metabolism. In particular, we analyzed the effect of the metabolic modulator trimetazidine (TMZ) on myogenesis in aging. We show that reprogramming the metabolism by TMZ treatment for 12 consecutive days stimulates myogenic gene expression in skeletal muscle of 22-month-old mice. Our data also reveal that TMZ increases the levels of mitochondrial proteins and stimulates the oxidative metabolism in aged muscles, this finding being in line with our previous observations in cachectic mice. Moreover, we show that, besides TMZ also other types of metabolic modulators (i.e., 5-Aminoimidazole-4-Carboxamide Ribofuranoside-AICAR) can stimulate differentiation of skeletal muscle progenitors in vitro. Overall, our results reveal that reprogramming the metabolism stimulates myogenesis while triggering mitochondrial proteins synthesis in vivo during aging. Together with the previously reported ability of TMZ to increase muscle strength in aged mice, these new data suggest an interesting non-invasive therapeutic strategy which could contribute to improving muscle quality and neuromuscular communication in the elderly, and counteracting sarcopenia.

Silencing of Hypoglossal Motoneurons Leads to Sleep Disordered Breathing in Lean Mice

Obstructive Sleep Apnea (OSA) is a prevalent condition and a major cause of morbidity and mortality in Western Society. The loss of motor input to the tongue and specifically to the genioglossus muscle during sleep is associated with pharyngeal collapsibility and the development of OSA. We applied a novel chemogenetic method to develop a mouse model of sleep disordered breathing Our goal was to reversibly silence neuromotor input to the genioglossal muscle using an adeno-associated viral vector carrying inhibitory designer receptors exclusively activated by designer drugs AAV5-hM4Di-mCherry (DREADD), which was delivered bilaterally to the hypoglossal nucleus in fifteen C57BL/6J mice. In the in vivo experiment, 4 weeks after the viral administration mice were injected with a DREADD ligand clozapine-N-oxide (CNO, i.p., 1mg/kg) or saline followed by a sleep study; a week later treatments were alternated and a second sleep study was performed. Inspiratory flow limitation was recognized by the presence of a plateau in mid-respiratory flow; oxyhemoglobin desaturations were defined as desaturations >4% from baseline. In the in vitro electrophysiology experiment, four males and three females of 5 days of age were used. Sixteen-nineteen days after DREADD injection brain slices of medulla were prepared and individual hypoglossal motoneurons were recorded before and after CNO application. Positive mCherry staining was detected in the hypoglossal nucleus in all mice confirming successful targeting. In sleep studies, CNO markedly increased the frequency of flow limitation n NREM sleep (from 1.9 ± 1.3% after vehicle injection to 14.2 ± 3.4% after CNO, p < 0.05) and REM sleep (from 22.3% ± 4.1% to 30.9 ± 4.6%, respectively, p < 0.05) compared to saline treatment, but there was no significant oxyhemoglobin desaturation or sleep fragmentation. Electrophysiology recording in brain slices showed that CNO inhibited firing frequency of DREADD-containing hypoglossal motoneurons. We conclude that chemogenetic approach allows to silence hypoglossal motoneurons in mice, which leads to sleep disordered breathing manifested by inspiratory flow limitation during NREM and REM sleep without oxyhemoglobin desaturation or sleep fragmentation. Other co-morbid factors, such as compromised upper airway anatomy, may be needed to achieve recurrent pharyngeal obstruction observed in OSA.

Continuous Knee Cooling Affects Functional Hop Performance - A Randomized Controlled Trial

Cryotherapy is widely used in sports and rehabilitation to aid recovery and injury management. The purpose was to examine if a low temperature computer controlled continuous knee cooling protocol (10°C) for one hour and a moderate continuous knee cooling protocol (18°C) for one hour affected neuromuscular activity and functional performance tests. We used a randomized controlled study design. Twenty healthy male subjects (age = 24 ± 3 years) were included and randomized into 2 groups (10°C and 18°C). On day one, participants performed a maximal voluntary contraction of the quadriceps (MVC), single leg hop for distance (SLHD), and crossover hop for time (COHT) with both legs before and after cooling of their right leg. At day two, the same tests were performed with both legs before and after cooling of the left leg. Participants exposed to the 10°C-protocol showed a significant decrease in SLHD and COHT performance. For the 18°C-group, no significant changes in SLHD and COHT outcomes were noted. In both groups, EMG frequency during MVC decreased, but no significant increases were found in EMG amplitude. Continuous knee cooling at 18°C for one hour does not affect functional hop performance, though adaptations at the muscle level (EMG frequency decrease) can be observed. Applying a similar cooling protocol with 10°C results in a significant decrease in functional hop performance and EMG frequency. EMG amplitude remained unaffected. This infers that changes at muscle level due to local temperature manipulations may not always be detrimental to functional performance.

MAXIMAL HIP AND KNEE MUSCLE STRENGTH ARE NOT RELATED TO NEUROMUSCULAR PRE-ACTIVITY DURING SIDECUTTING MANEUVER: A CROSS-SECTIONAL STUDY

BACKGROUND

Reduced lower extremity muscle strength as well as reduced lower extremity muscle pre-activity (defined as muscular activity just prior to initial ground contact) during high-risk movements are factors related to increased risk of non-contact ACL injury in adolescent female athletes. A strong relationship exists between muscle strength and muscle activity obtained during an isometric contraction, however, whether these two measures are related when muscle activity is obtained during a movement associated with a high risk of non-contact ACL injury is not known. Absence or presence of such a relationship may have implications for which training modalities to choose in the prevention of ACL injuries.

PURPOSE

The purpose of this study was to examine the relationship between maximal muscle strength of the hip extensors, hip abductors and knee flexors and the pre-activity of these muscle groups recorded during a sidecutting maneuver (high-risk movement) in adolescent female soccer and handball athletes.

STUDY DESIGN

Cross-sectional study.

METHODS

Eighty-five adolescent (age 16.9 ± 1.2 years) female elite handball and soccer athletes were assessed for maximal hip extensor, hip abductor and knee flexor muscle strength; and muscle pre-activity (electromyography recordings over a 10 ms time interval prior to foot ground contact) of the gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF) and semitendinosus (ST) during a standardized sidecutting maneuver.

RESULTS

The results of the correlation analyses demonstrated poor and statistically non-significant correlations. Maximal hip extensor force (N/kg bw) and Gmax pre-activity [rs = 0.012 (95% CI -0.202 - 0.224), p = 0.91], maximal hip abductor force (N/kg bw) and Gmed pre-activity [rs = 0.171 (95% CI -0.044 - 0.371), p = 0.11], maximal knee flexor force (N/kg bw) and BF pre-activity [rs = 0.049 (95% CI -0.166 - 0.259), p = 0.65], and maximal knee flexor force and ST pre-activity [rs = 0.085 (95% CI -0.131 - 0.293), p = 0.44].

CONCLUSION

In the present exploratory study, the results imply that no relationship exists between maximal lower extremity isometric muscle strength and lower extremity muscle pre-activity during sidecutting. This means that athletes with low muscle strength may not necessarily demonstrate high (or low) muscle pre-activity during sidecutting - a well-known risk movement for sustaining non-contact ACL injury.

LEVELS OF EVIDENCE

Level 3.

Neurotoxic phospholipase A2 toxicity model: An insight from mammalian cells

The molecular mechanism of action of presynaptically neurotoxic secreted phospholipases A₂ (sPLA₂s) has not been fully elucidated. We have recently proposed a model to explain one of the hallmarks of their action – the reduction in endocytosis leading to synaptic vesicle depletion in nerve terminals. Our results speak strongly in favor of a mechanism in which both specific protein-protein interactions and enzymatic activity of the neurotoxic sPLA₂ ammodytoxin A (AtxA) are necessary for impairment of clathrin-dependent endocytosis in yeast cells. The reduction of endocytosis was strictly dependent on the enzymatic activity of sPLA₂s expressed ectopically in our yeast model cells and was not observed with the catalytically inactive, non-neurotoxic AtxA-homolog, ammodytin L (AtnL). Here we confirm the validity of the model in mammalian cells also, by demonstrating that the enzymatically active mutant of AtnL, shown to inhibit endocytosis in yeast, acts as a presynaptically neurotoxic sPLA₂ at the mammalian neuromuscular junction.

Quadriceps inhibition after repetitive lumbar extension exercise in persons with a history of low back pain

CONTEXT

A neuromuscular relationship exists between the lumbar extensor and quadriceps muscles during fatiguing exercise. However, this relationship may be different for persons with low back pain (LBP).

OBJECTIVE

To compare quadriceps inhibition after isometric, fatiguing lumbar extension exercise between persons with a history of LBP and control subjects.

DESIGN

A 2 x 3 factorial, repeated-measures, time-series design with independent variables of group (persons with a history of LBP, controls) and time (baseline, postexercise set 1, postexercise set 2).

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five subjects with a history of LBP were matched by sex, height, and mass to 25 healthy control subjects.

INTERVENTION(S)

Electromyography median frequency indexed lumbar paraspinal muscular fatigue while subjects performed 2 sets of isometric lumbar extension exercise. Subjects exercised until a 15% downward shift in median frequency for the first set and a 25% shift for the second set were demonstrated.

MAIN OUTCOME MEASURE(S)

Knee extension force was measured while subjects performed an isometric maximal quadriceps contraction. During this maximal effort, a percutaneous electric stimulus was applied to the quadriceps, causing a transient, supramaximal increase in force output. We used the ratio between the 2 forces to estimate quadriceps inhibition. Quadriceps electromyographic activity was recorded during the maximal contractions to compare median frequencies over time.

RESULTS

Both groups exhibited significantly increased quadriceps inhibition after the first (12.6% +/- 10.0%, P < .001) and second (15.2% +/- 9.7%, P < .001) exercise sets compared with baseline (9.6% +/- 9.3%). However, quadriceps inhibition was not different between groups.

CONCLUSIONS

Persons with a history of LBP do not appear to be any more or less vulnerable to quadriceps inhibition after fatiguing lumbar extension exercise.

Increased neuromuscular activity reduces sprouting in partially denervated muscles

The effects of increasing neural activity on sprouting remain unclear and controversial. In a rat model of partial denervation of skeletal muscles, we investigated the effect of neuromuscular activity on sprouting. Rat hindlimb muscles were partially denervated by avulsion of either L4 or L5 spinal root. Immediately after partial denervation, the rats were divided into three groups: (1) normal caged activity, (2) running exercise on wheels, 8 hr daily, and (3) functional electrical stimulation (FES) of sciatic nerves, 20 Hz for 8 hr daily. At 1 month, muscle unit (MU) enlargement was quantitated electrophysiologically and histochemically. MU twitch force was increased by four- to fivefold by partial denervation in extensively denervated tibialis anterior (TA) and medial gastrocnemius (MG) and by approximately twofold in moderately denervated plantaris (PL) and soleus (SOL). For the extensively denervated TA and MG muscles, MU enlargement, measured electrophysiologically, declined significantly after an average of 1757 +/- 310 m/d running exercise and daily FES for 1 month. The detrimental effects on MU enlargement were much less but significant in the moderately denervated PL and did not reach statistical significance in the moderately denervated SOL muscle. Histochemical evaluation of sprouting showed a reduction in the number of sprouts in the extensively denervated TA muscle, but not the moderately denervated PL and SOL muscles, by increased neuromuscular activity. Thus, increased neuromuscular activity is detrimental primarily in muscles that are extensively denervated, and the MUs are smaller than under conditions in which the muscles experience normal physiological levels of activation.