Procalcitonin, C-reactive protein, interleukin-6, and soluble intercellular adhesion molecule-1 as markers of postoperative orthopaedic joint prosthesis infections

There is a universally recognized need to identify new, reliable markers of inflammation that can aid in the rapid diagnosis of orthopaedic joint prosthesis infections (OJP-Is). Since prompt diagnosis is key to timely intervention in the course of infection, different molecules have been studied. In this study, we examined three groups of patients: those with prosthesis infection, those without infection, and a third group with previous infection in whom the infection had been cleared. Four presumed markers of infection were tested: procalcitonin (PCT); C-reactive protein (CRP); interleukin-6 (IL-6); and soluble intercellular adhesion molecule-1 (sICAM-1). The results showed that PCT cannot be considered as a good marker of periprosthetic infection as no statistically significant difference in serum PCT levels emerged between patients with infection and controls or patients without infection. In contrast, both sICAM-1 and CRP may be considered as good markers of infection, as measurement of their levels allowed us to distinguish between patients with and without infection, and between patients with infection and those with previous infection, since marker levels quickly returned to baseline values after clearance of the infection. IL-6 was found to be a good marker for inflammation, as it distinguished between patients with infection and the other groups. In the patients with previous infection, the IL-6 values remained high versus the controls but lower and with a statistically significant difference versus the patients with infection. Further studies are needed to determine the cut-off value of IL-6 between patients with infection and those with previous infection.

Convergence of Ia fibres from synergistic and antagonistic muscles onto interneurones inhibitory to soleus in humans

1. The possibility that Ia afferent fibres from the gastrocnemius medialis (GM) and from the tibialis anterior (TA) muscle could converge on to a single interneuronal pool inhibitory to the soleus motoneurones was investigated. 2. The soleus H reflex, evoked by tibial nerve stimulation in the popliteal fossa, was conditioned by separate or combined stimulation of the nerves to the GM or TA muscles. Stimulus intensity was below the motor threshold (MTh), and the conditioning-test intervals were such as to evoke short-latency inhibition of the soleus H reflex. Care was taken to avoid current spread and artifacts connected with the closeness in time and space of the conditioning and test stimuli. 3. Separate stimulation of both GM and TA nerves was able to induce significant inhibitory effects on the H reflex amplitude at stimulus strengths larger than 0.75 x MTh, on the average. Combined stimulation of the two nerves was able to reduce the H reflex at lower stimulus strengths, at which either nerve was ineffective alone. 4. Conditioning stimulus strengths close to the MTh reduced the H reflex to approximately 80% of the control value, both on single and combined stimulation, i.e. saturation of the inhibitory effect was found. 5. By extrapolating the regression line through the normalized data from all subjects, it was assumed that the smallest stimulus strength necessary to drive the inhibitory interneurones to threshold was, on the average, 0.5 and 0.6 x MTh, on combined and separate nerve stimulation, respectively. 6. Tonic voluntary activation of the soleus abolished the inhibitory effects of both separate and combined stimulations. This was tested on the H reflex, on the rectified and averaged EMG, and on the peristimulus histogram of single motor unit discharge. 7. The findings strongly suggest the existence of spatial summation of the effects from GM and TA muscle at the level of a single interneuronal pool. Most probably, the responsible afferent fibres are group I spindle afferents, and the interneurones those mediating the reciprocal inhibition. The data do not support the notion of parallel pathways, exclusive to each nerve.

Selective recruitment of high-threshold human motor units during voluntary isotonic lengthening of active muscles

1. We have investigated the possibility that voluntary muscle lengthening contractions can be performed by selective recruitment of fast-twitch motor units, accompanied by derecruitment of slow-twitch motor units. 2. The behaviour of motor units in soleus, gastrocnemius lateralis and gastrocnemius medialis muscles was studied during (a) controlled isotonic plantar flexion against a constant load (shortening contraction, S), maintained plantar flexion, or dorsal flexion resisting the load and gradually yielding to it (lengthening contraction, L), (b) isometric increasing or decreasing plantar torque accomplished by graded contraction or relaxation of the triceps surae muscles, (c) isometric or isotonic ballistic contractions, and (d) periodic, quasi-sinusoidal isotonic contractions at different velocities. The above tasks were performed under visual control of foot position, without activation of antagonist muscles. The motor units discharging during foot rotation were grouped on the basis of the phase(s) during which they were active as S, S + L and L. The units were also characterized according to both the level of isometric ramp plantar torque at which they were first recruited and the amplitude of their action potential. 3. S units were never active during dorsal flexion; some of them were active during the sustained contraction between plantar and dorsal flexion. Most S + L units were active also during the maintenance phase and were slowly derecruited during lengthening; their behaviour during foot rotations was similar to that during isometric contractions or relaxations. L units were never active during either plantar or maintained flexion, but discharged during lengthening contraction in a given range of rotation velocities; the velocity of lengthening consistently influenced the firing frequency of these units. Such dependence on velocity was not observed in S + L units. 4. A correlation was found between the amplitude of the action potential and the threshold torque of recruitment among all the units. In addition, the amplitudes of both the action potential and the threshold torque were higher in the case of L units than in the case of S and S + L units. Most L units could be voluntarily recruited only in the case of ballistic isometric or isotonic contraction. 5. Occasionally, L units were directly activated by electrical stimulation of motor fibres and their conduction velocity was in the higher range for alpha-axons. In contrast, nerve stimulation could induce a reflex activation of S and S + L units.(ABSTRACT TRUNCATED AT 400 WORDS)

Reflex excitability of human soleus motoneurones during voluntary shortening or lengthening contractions

1. We investigated the possibility that increase or decrease in the monosynaptic reflex excitability of the soleus muscle in man might play a role in matching the muscle mechanical output to the voluntary command aimed at performing isotonic contractions or relaxations, at various velocities. 2. Rectified and integrated electromyographic activity (e.m.g.) and the H reflex of soleus were measured during plantar flexions against a constant load (shortening contractions) or dorsal flexions resisting the load (lengthening contraction), performed without activation of pretibial muscles. 3. At the same ankle joint angle, integrated e.m.g. was larger during shortening contractions than during lengthening contractions. During shortening contractions, integrated e.m.g. increased as a function of the velocity of plantar flexion. During lengthening contractions, integrated e.m.g. decreased as a function of dorsal flexion and angular velocity and nearly disappeared in the last part of the most rapid lengthening contractions. 4. During shortening contractions, the H reflex increased beyond the extent expected for the level of e.m.g. activity; during lengthening contractions, reduction of the H reflex below control values at rest occurred in spite of background e.m.g. activity. 5. When the level of e.m.g. activity was kept constant, the above changes in H reflex were larger in both directions as a function of the velocity of the movement. 6. Passive rotation in the dorsal direction contributed to the inhibition observed during lengthening contractions. 7. It is suggested that these changes in the excitability of the H reflex, probably presynaptic in origin, serve the purpose of appropriately modulating the rate and extent of motoneurone recruitment during shortening and lengthening contractions. This allows the foot to follow a constant-velocity path in spite of the perturbing effects of the spindle afferent inputs and of the muscle characteristics described by the force--length and force--velocity diagrams.