Few sex-specific effects of fatigue on muscle synergies in a repetitive pointing task.

Previous studies have identified some sex differences in how individual muscles change their activation during repetitive multi-joint arm motion-induced fatigue. However, little is known about how indicators of multi-muscle coordination change with fatigue in males and females. Fifty-six (29 females) asymptomatic young adults performed a repetitive, forward-backward pointing task until scoring 8/10 on a Borg CR10 scale while surface electromyographic activity of upper trapezius, anterior deltoid, biceps brachii, and triceps brachii was recorded. Activation coefficient, synergy structure, and relative weight of each muscle within synergies were calculated using the non-negative matrix factorization method. Two muscle synergies were extracted from the fatiguing task. The synergy structures were mostly preserved after fatigue, while the activation coefficients were altered. A significant Sex × Fatigue interaction effect showed more use of the anterior deltoid in males especially before fatigue in synergy 1 during shoulder stabilization (p = 0.04). As for synergy 2, it was characterized by variations in the relative weight of biceps, which was higher by 16 % in females compared to males (p = 0.04), and increased with fatigue (p = 0.03) during the elbow flexion acceleration phase and the deceleration phase of the backward pointing movement. Findings suggest that both sexes adapted to fatigue similarly, using fixed synergy structures, with alterations in synergy activation patterns and relative weights of individual muscles. Results support previous findings of an important role for the biceps and anterior deltoid in explaining sex differences in patterns of repetitive motion-induced upper limb fatigue.

Females show less decline in contractile function than males after repeated all-out cycling.

Females demonstrate greater fatigue resistance during a range of exercise modalities; however, this may be confounded by the lower mechanical work completed. Accordingly, this study examined the sex-specific peripheral and central fatigue mechanisms during repeated all-out cycling and whether they are affected by total mechanical work performed. A total of 26 healthy young adults (12 females) performed 10 × 10 s all-out cycling interspersed by 30 s passive recovery. Metabolic responses, peripheral and central fatigue, were quantified via changes in pre- to post-exercise blood lactate, potentiated quadriceps twitch force (and contractile properties) evoked via supramaximal electrical stimulation of the femoral nerve, and voluntary activation of the knee extensors, respectively. During exercise, mechanical work, vastus lateralis muscle activation (via surface electromyography), and deoxygenation (via near-infrared spectroscopy) were recorded. Sex comparison analyses were performed before and after statistically controlling for total mechanical work (via ANCOVA). Mechanical work and muscle activation plateaued at similar sprint repetition (sprint 5) and voluntary activation change (pre vs. post) was similar between the sexes. Females, however, showed lower %work decrement (i.e., fatigability; P = 0.037) and peripheral responses as evident by lower reductions in quadriceps twitch force (P < 0.001) and muscle deoxygenation (P = 0.001). Adjusting for total mechanical work did not change these sex comparison results. We show that females' greater fatigue resistance during repeated all-out cycling may not be attributed to the greater total mechanical work performed but could be mediated by lower peripheral fatigue in the knee extensor muscles.

Males and females have similar neuromuscular coordination strategies of the quadriceps during fatiguing repeated all-out cycling.

Introduction: An imbalance of vastus medialis (VM) and vastus lateralis (VL) muscle activation and patterns of dyscoordination may contribute to the sex discrepancy in the incidence of patellofemoral pain syndrome (PFPS). While some studies have examined sex-specific VM/VL coordination strategies in some tasks, no previous studies have examined sex-specific VM/VL coordination strategies during repeated sprint exercise (RSE). Methods: In this study, asymptomatic young adults (N = 39, 19 females) completed a RSE protocol consisting of 10 × 10 s all-out cycling interspersed by 30 s of passive rest. Electromyographic (EMG) signals from the VM and VL muscles were recorded throughout exercise. Results: VM:VL ratio did not change with fatigue and was not different between the sexes. From sprint 1 to 10, VM-VL onset delay increased from 9.62 to 16.95 ms and from 19.28 to 45.09 ms in males and females, respectively (p < 0.001); however, no sex difference was found (p = 0.524). Muscle activation amplitude plateaued at different sprint repetitions in males and females while mechanical work plateaued at similar repetitions. Discussion: These findings suggest that sex differences in the incidence of PFPS may not be influenced by VM/VL muscle coordination as assessed by EMG.

Real-world results of autologous stem cell transplantation in newly diagnosed multiple myeloma: a report from the Canadian Myeloma Research Group database.

Autologous stem cell transplant (ASCT) remains an important option for eligible multiple myeloma (MM) patients as part of initial therapy. Using the Canadian Myeloma Research Group (CMRG) national database, we examined the details and outcomes of ASCT performed as first-line therapy in eligible Canadian MM patients between 2007 to 2021. We included 3821 patients with 72% receiving CyBorD induction and 2061 patients receiving maintenance, consisting of lenalidomide +/- steroids in 78.3%. The median PFS and OS for patients given a single ASCT were 35.4 and 126 months. Those receiving a second induction regimen had significantly inferior outcomes, although when maintenance was used, results were comparable regardless of the number of induction regimens administered (median PFS 55.3 vs 51.1 months [p = 0.11]; median OS 158.6 vs not yet reached [p = 0.13]). Consolidation patients had a longer median PFS (55.3 vs 34.4 months [p = 0.001]), but no significant gain in median OS (p = 0.065). Patients who received lenalidomide-based maintenance experienced a median PFS of 53.7 months and OS of 159 months. In the multivariable analysis, use of any type of maintenance therapy vs no maintenance was associated with a lower risk of progression (HR 0.52 (95% CI 0.47-0.57)) and death (HR 0.58 (95% CI 0.51-0.67)). This real-world study demonstrates that, overall, first-line treatment sequence in transplant-eligible patients produces a median OS of ≥10 years. It also highlights the contribution of post-ASCT maintenance, particularly lenalidomide given until progression.

The effects of hand dominance, fatigue, and sex on muscle activation during a repetitive overhead fatiguing task.

Previous studies have shown that the dominant arm is generally stronger and more resistant to fatigue. However, whether there are side differences in shoulder muscle activation during a fatiguing upper limb task, and whether this varies according to sex, is unknown. Thirty right-handed adults (15 females) were recruited to complete two sessions of an overhead repetitive fatiguing task (shoulder flexion between 90 and 135° at 1 Hz), performed in two separate sessions with their dominant arm (DA) and non-dominant arm (NDA) until exhaustion. Electromyographic (EMG) data was collected from 11 shoulder muscles of the moving arm, and their activation amplitude (RMS) and activation variability (SD) were assessed. Results show that time to exhaustion was not affected by arm or by sex. There were some main arm effects on EMG activity amplitude, with higher activity on the DA's pectoralis major (p < 0.001), and on the NDA's middle (p = 0.009) and posterior deltoid (p = 0.001) and infraspinatus (p < 0.001). The pectoralis major was affected by arm and fatigue mostly in males. Their DA's pectoralis major activity amplitude was higher, and the amplitude variability was lower, compared to the NDA, with both parameters showing fatigue-dependent decreases at the NDA only (arm x sex x fatigue: RMS: p = 0.007; SD: p = 0.001). As for females, the DA variability of their lower trapezius was smaller, and that of their subscapularis was higher, compared to the NDA (sex x arm, p = 0.028, p = 0.05). There was also more EMG variability on the supraspinatus' dominant side, and on the posterior deltoid and infraspinatus ND side. Results show an overhead shoulder flexion task dependency on pectoralis major control in males, and on lower trapezius and shoulder girdle stabilizers in females, which could be related to both sex- and gender-based factors. This knowledge can help identify side-specific injury risk factors due to overhead work in males and females, and help determine the appropriateness of implementing sex-specific workplace protocols, including alternating arms as fatigue compensatory and recovery strategies.

Should I Rest or Should I Go Now? A Randomized Cross-Over Trial Comparing Fixed and Self-Selected Rest Durations in High-Intensity Interval Training Cycling Sessions.

BACKGROUND: In high-intensity interval training (HIIT), the rest durations between intervals are commonly prescribed using a fixed approach (e.g., 30 s between intervals). An alternative is the self-selected (SS) approach, in which trainees select their resting durations. Studies comparing the two approaches report mixed results. However, in these studies, trainees in the SS condition rested for as little or as long as they wished, leading to dissimilar total rest durations between conditions. Here, for the first time, we compare the two approaches while controlling for total rest duration. METHODS: Twenty-four amateur adult male cyclists completed a familiarization session, followed by two counterbalanced cycling HIIT sessions. Each session was composed of nine, 30-s intervals, in which the goal was to accumulate as many watts as possible on an SRM ergometer. In the fixed condition, cyclists rested for 90 s between intervals. In the SS condition, cyclists had 720 s (i.e., 8 × 90 s) of rest to allocate in any way they wished. We measured and compared watts, heart rate, electromyography of the knee flexors and extensors, rating of perceived effort and fatigue, perception of autonomy and enjoyment. Additionally, a subsample of ten cyclists completed a retest of the SS condition. RESULTS: With the exception of perception of autonomy, which was higher in the SS condition, outcomes were highly similar in both conditions. For example, the average aggregated differences were: 0.57 (95% CI - 8.94, 10.09) for watts; - 0.85 (95% CI - 2.89, 1.18) for heart rate; and 0.01 (95% CI - 0.29, 0.30) for rating of perceived effort (on a 0-10 scale). Additionally, the retest of the SS condition resulted in a similar rest allocation pattern across the intervals and in similar outcomes. CONCLUSION: Given the similarities in performance, physiological and psychological outcomes between the fixed and SS conditions, both can be equally utilized based on coaches' and cyclists' preferences and training goals.

A Phase II, Open-Label Study of an Accelerated Infusion Rate of Daratumumab in Patients With Relapsed and Refractory Multiple Myeloma.

INTRODUCTION/BACKGROUND: Daratumumab is an anti-CD38 monoclonal antibody initially approved as a single agent for the treatment of relapsed and refractory multiple myeloma. The infusion-related reactions (IRRs) commonly seen with intravenous daratumumab have been managed by prolonging the first infusion, temporarily stopping/slowing the rate if reactions occur and using adequate pre- and post-infusion medications. Several retrospective studies have evaluated shorter infusions after ≥ 2 prior doses administered at the standard rates. Although the shorter infusions were well-tolerated, patients in these reports were given heterogeneous daratumumab regimens and had often already received multiple doses at the longer standard rates. PATIENTS AND METHODS: CMRG-009 is a prospective study designed to demonstrate the safety of accelerated daratumumab infusions commencing with the second dose. After an initial dose on Cycle 1 Day consisting of 8 mg/kg over 4 hours, all subsequent doses were given over 90 minutes. RESULTS: No grade 3 IRRs were observed with the 90-minutes infusions. Both the safety profile and anti-myeloma effects were otherwise similar to those observed with other single agent daratumumab studies using longer infusion times. CONCLUSION: This is the first formal prospective trial using infusion times shorter than the standard schedule directly after an initial 4-hours dose. This rapid infusion protocol has resulted in more efficient resource utilization and has become the standard protocol for the use in all intravenous daratumumab regimens in Canada. This approach has been particularly helpful in shortening chair time during the COVID-19 pandemic and providing a useful alternative in jurisdictions without access to subcutaneous daratumumab.

Sex differences in torque steadiness, accuracy and activation of the shoulder girdle muscles during isometric shoulder scaption.

Females present more neck/shoulder musculoskeletal disorders and have different activation strategies of the shoulder girdle muscles than males. However, the sensorimotor performance and potential sex differences are still largely unexplored. The aim of this study was to investigate sex differences in torque steadiness and accuracy during isometric shoulder scaption. We also examined the amplitude and variability of the activation of the trapezius, serratus anterior (SA), and anterior deltoid muscles during torque output evaluation. Thirty-four asymptomatic adults (17 females) participated. Torque steadiness and accuracy were evaluated during submaximal contractions at 20 % and 35 % of peak torque (PT). There was no sex difference in torque coefficient of variation, but females had significantly lower torque standard deviation (SD) values than males at the two intensities evaluated (p < 0.001) and lower torque median frequency values compared to males, regardless of intensity (p < 0.01). Females had significantly lower absolute error values than males for torque output at 35 %PT (p < 0.01) and lower constant error values compared to males, regardless of intensity (p = 0.01). Females had significantly higher muscle amplitude values than males, except for SA (p = 0.10) and in general, females showed higher muscle activation SD values compared to males (p < 0.05). Females may require more complex muscle activation patterns to achieve a more stable and accurate torque output. Therefore, these sex differences may reflect control mechanisms that may also be at play when explaining the greater risk of neck/shoulder musculoskeletal disorders in females than males.

Size and structure of motor variability in young and old adults performing a rhythmic, repetitive tapping task.

The size of motor variability increases with fatigue in repetitive upper limb tasks, and the structure of variability differs with old age. However, the combined influences of old age and fatigue on the size and structure of movement-to-movement variability are unclear. Eighteen young and sixteen old adults performed a fatiguing repetitive tapping task while seated using their dominant arm. Optoelectronic motion capture served to measure upper body angles via forward kinematics. Movement-to-movement variability was measured by the size at joints (standard deviation: SD) and by the structure of the uncontrolled manifold (variance: VUCM, VORT; synergy index: ΔVz) in the first and final minutes of the task for the early, middle, and late forward movement phases. Outcomes were analyzed by Age*Condition*Phase general estimating equations. Old adults had lower humerothoracic abduction/adduction and flexion/extension SD, wrist flexion/extension SD, VUCM, and VORT, mainly in the early movement phase (p < 0.014). With fatigue, humerothoracic flexion/extension SD increased in young adults only and humerothoracic abduction/adduction SD, wrist pronation/supination SD, wrist flexion/extension SD, and VUCM increased in both groups. ΔVz was positive and did not differ with age or fatigue (p > 0.014). Results indicate that fatigue adjustments were mainly in the frontal plane, old age did not affect the ratio of good vs. bad variability, and motor synergy was preserved during fatigue despite less motor flexibility in old age.

First Line Treatment of Newly Diagnosed Transplant Ineligible Multiple Myeloma: Recommendations from the Canadian Myeloma Research Group Consensus Guideline Consortium.

Although the availability of effective novel treatments has positively impacted the quality of life and survival of newly diagnosed multiple myeloma (MM) patients, benefits in the transplant ineligible MM population may be limited by functional/frailty status. The Canadian Myeloma Research Group Consensus Guideline Consortium proposes consensus recommendations for the first-line treatment of transplant ineligible MM. To address the needs of physicians and people diagnosed with MM, this document further focuses on eligibility for transplant, frailty assessment, management of adverse events, assessment of treatment response, and monitoring for disease relapse. The Canadian Myeloma Research Group Consensus Guideline Consortium will periodically review the recommendations herein and update as necessary.

Effects of anti-fatigue lenses on performance, muscle activity and subjective discomfort responses during a seated computer task.

Anti-fatigue lenses (AFL) intend to provide health benefits in association with computer work. Their effects on visual and muscle discomfort mechanisms and task performance remain unclear. Twenty-three computer users (n = 12 males) underwent two 90-min computer sessions with AFL or placebo lenses. Eye strain, body discomfort, typing performance, upper trapezius (UT) activation amplitude and variability, and neck posture were analyzed for time, condition, and sex effects. No significant effects of condition were observed on the dependent measures evaluated. Discomfort increased over time (neck/shoulder: p < .001), more so in females (eye strain: p < .001). Females' UT activation amplitude was negatively correlated to eye strain in the placebo condition (p = .05).

The Effect of Cycling While Typing on Patterns of Upper Body Muscle Activation.

OBJECTIVE: To investigate the effect of one's sex and pedaling intensity on upper body muscle activation patterns during typing while cycling. BACKGROUND: Females are at a higher risk for computer work-related musculoskeletal disorders, and mobile workstations have been suggested to induce healthier muscular patterns compared with sitting. However, the neuromuscular characteristics of performing computer work in a cycling workstation have not been investigated. METHOD: Twenty-two participants (10 females) completed a 60-min computer typing task while pedaling on a cycle ergometer at two different intensities (25%, 4% heart rate reserve). Surface electromyography (EMG) was recorded from seven muscles of the upper body. Effects of time, sex, and intensity were assessed for muscle activation (RMS), activation variability (CV), and normalized mutual information (NMI) via generalized estimating equations. RESULTS: With time, neck/shoulder CV increased in males during higher pedaling intensity, whereas in females it decreased during lower intensity. In females, RMS of neck/shoulder and NMI of neck/shoulder muscle pairs were lower, whereas forearm RMS was 34.2% higher with higher intensity cycling compared with lower intensity. Lower back RMS decreased 28.3% in the initial half of the task in females, but in males it increased 14.4% in the later half. CONCLUSION AND APPLICATION: Cycling workstation showed a sex- and intensity-specific EMG response. These differing responses should be considered when implementing the use of cycling workstation and may be important for preventing/managing sex-specific muscle fatigue and musculoskeletal disorders.

Validation of Automatically Quantified Swim Stroke Mechanics Using an Inertial Measurement Unit in Paralympic Athletes.

Biomechanics and training load monitoring are important for performance evaluation and injury prevention in elite swimming. Monitoring of performance and swim stroke parameters is possible with inertial measurement units (IMU) but has not been validated in para-swimmers. The purpose of this study was to validate a single IMU-based system to accurately estimate pool-swam lap time, stroke count (SC), stroke duration, instantaneous stroke rate (ISR), and distance per stroke (DPS). Eight Paralympic athletes completed 4 × 50 m swims with an IMU worn on the sacrum. Strokes cycles were identified using a zero-crossing algorithm on the medio-lateral (freestyle and backstroke) or forward-backward (butterfly and breaststroke) instantaneous velocity data. Video-derived metrics were estimated using Dartfish and Kinovea. Agreement analyses, including Bland-Altman and Intraclass Correlation Coefficient (ICC), were performed on all outcome variables. SC Bland-Altman bias was 0.13 strokes, and ICC was 0.97. ISR Bland-Altman biases were within 1.5 strokes/min, and ICCs ranged from 0.26 to 0.96. DPS Bland-Altman biases were within 0.20 m, and ICCs ranged from 0.39 to 0.93. A single-IMU system can provide highly valid performance and swim stroke monitoring data for elite para-swimmers for the majority of strokes, with the exception of backstroke. Future work should improve bilateral stroke detection algorithms in this population.

Sex-specific myoelectric manifestations of localized fatigue during a multi-joint repetitive task.

We have previously demonstrated that fatigue at different locations impacts joint angles, angular variability, and coordination variability differently. However, the neuromuscular control aspects underlying these kinematic changes have never been demonstrated. Seventeen young adults (8 males) were recruited. Electromyographic electrodes were placed on: upper trapezius, pectoralis major, anterior and middle deltoid, biceps and triceps brachii, and left and right erector spinae. Subjects performed the repetitive pointing task (RPT) at 1 Hz for 30 s before and after localized fatigue tasks, which consisted of one shoulder, one elbow and one lower back isometric fatiguing protocols until exhaustion in randomized order. Electromyographic amplitude (RMS), variability (SD) and mean power frequency (MnPF) were calculated for each of the pre-fatigue and post-fatigue RPT trials. There were sex × fatigue location interaction effects on upper trapezius RMS (p = 0.038) with males' values increasing the most after shoulder fatigue. Females' triceps brachii RMS was greater compared to males after shoulder, elbow, and trunk fatigue (p = 0.003, p = 0.001 and p = 0.007 respectively). There were sex × fatigue location effects on left erector spinae MnPF (p = 0.011) with males and females' values decreasing the most after trunk fatigue, but more so in males. Results demonstrate that males and females compensate differently during a repetitive pointing task when their elbows, shoulders and trunks are locally fatigued, which could have implications on sex-specific workplace injury risks. See Table 1 for acronyms.

Power Spectrum of Acceleration and Angular Velocity Signals as Indicators of Muscle Fatigue during Upper Limb Low-Load Repetitive Tasks.

Muscle fatigue is a risk factor for developing musculoskeletal disorders during low-load repetitive tasks. The objective of this study was to assess the effect of muscle fatigue on power spectrum changes of upper limb and trunk acceleration and angular velocity during a repetitive pointing task (RPT) and a work task. Twenty-four participants equipped with 11 inertial measurement units, that include acceleration and gyroscope sensors, performed a tea bag filling work task before and immediately after a fatiguing RPT. During the RPT, the power spectrum of acceleration and angular velocity increased in the movement and in 6-12 Hz frequency bands for sensors positioned on the head, sternum, and pelvis. Alternatively, for the sensor positioned on the hand, the power spectrum of acceleration and angular velocity decreased in the movement frequency band. During the work task, following the performance of the fatiguing RPT, the power spectrum of acceleration and angular velocity increased in the movement frequency band for sensors positioned on the head, sternum, pelvis, and arm. Interestingly, for both the RPT and work task, Cohens' d effect sizes were systematically larger for results extracted from angular velocity than acceleration. Although fatigue-related changes were task-specific between the RPT and the work task, fatigue systematically increased the power spectrum in the movement frequency band for the head, sternum, pelvis, which highlights the relevance of this indicator for assessing fatigue. Angular velocity may be more efficient to assess fatigue than acceleration. The use of low cost, wearable, and uncalibrated sensors, such as acceleration and gyroscope, in industrial settings is promising to assess muscle fatigue in workers assigned to upper limb repetitive tasks.

Uncontrolled Manifold Analysis of the Effects of Different Fatigue Locations on Kinematic Coordination During a Repetitive Upper-Limb Task.

Fatigue at individual joints is known to affect interjoint coordination during repetitive multijoint tasks. However, how these coordination adjustments affect overall task stability is unknown. Twelve participants completed a repetitive pointing task at rest and after fatigue of the shoulder, elbow, and trunk. Upper-limb and trunk kinematics were collected. Uncontrolled manifold framework was applied to a kinematic model to link elemental variables to endpoint fingertip position. Mixed and one-way analysis of variances determined effects (phase and fatigue location) on variance components and synergy index, respectively. The shoulder fatigue condition had the greatest impact in causing increases in variance components and a decreased synergy index in the late phase of movement, suggesting more destabilization of the interjoint task caused by shoulder fatigue.

Changes in Muscle Activation During and After a Shoulder-Fatiguing Task: A Comparison of Elite Female Swimmers and Water Polo Players.

This study compared female athletes with different aquatic sports expertise in their neuromuscular activation before, during, and after a shoulder internal rotation fatigue protocol. Eleven water polo players, 12 swimmers, and 14 controls completed concentric maximal voluntary external and internal shoulder rotations before and after a fatigue protocol consisting of concentric internal rotations at 50% of maximal voluntary contraction for at least 3 min or until reporting a rating of perceived effort RPE of 8/10 or higher. Muscle activation was measured for the maximal voluntary contractions, as well as for the first (T1), middle (T2), and third (T3) minute of the fatigue protocol using surface electromyography (EMG) on pectoralis major, anterior and posterior deltoid, upper and middle trapezius, and latissimus dorsi. Intramuscular EMG was used for supraspinatus, infraspinatus, and subscapularis. Pre-fatigue internal rotation torque was significantly correlated with shorter task duration (r = -0.39, p = 0.02), with water polo players producing significantly greater torque than controls but having significantly lower endurance. Swimmers demonstrated decreased latissimus dorsi activation at T3 compared to T2 (p = 0.020, g = 0.44) and T1 (p = 0.029, g = 0.74), differing from water polo players and controls who exhibited increased agonist activation and decreased activation of stabilizers. Comparing the pre-fatigue to the post-fatigue maximal shoulder rotations, water polo players had decreased activation in subscapularis (p = 0.018, g = 0.67); all groups had decreased activation in latissimus dorsi (p < 0.001), though swimmers demonstrated a large effect (g = 0.97); and controls had decreased activation in supraspinatus (p = 0.005, g = 0.71). Together, these results suggest that sports expertise may be associated with different muscle activation both while and after fatigue is induced. Further research should continue to explore sports-specific patterns of muscle recruitment and fatigue adaptations, as well as if certain strategies are adaptive or maladaptive. This may have important consequences for injury prevention among athletes who perform repetitive overhead movements in their sports and who are susceptible to overuse injuries.

Sex-specific effects of localized muscle fatigue on upper body kinematics during a repetitive pointing task.

BACKGROUND: Females are reported to have a higher risk of musculoskeletal disorders than males. Repetitive motions can lead to muscle fatigue, which may play a mediator role in the development of musculoskeletal disorders. However, sex differences in adaptations to localized fatigue at different joints are poorly understood. We examined the sex-specific effects of fatigue location on shoulder, elbow and spinal joint angles, and angular variabilities during a repetitive pointing task. METHODS: Seven males and ten females performed a 30-s standing repetitive pointing task with their right upper limb when they were non-fatigued (NF), elbow-fatigued (EF), shoulder-fatigued (SF) and trunk-fatigued (TF), while trunk and upper body tridimensional kinematic data was recorded. Joint angles and angular variabilities of shoulder, elbow, upper thoracic spine, lower thoracic spine, and lumbar spine were calculated. RESULTS: Results showed that shoulder angles changed the most after EF in males, but after SF in females. The similarities between sexes were that SF increased the variabilities at upper (lateral flexion: 0.15° greater than NF, rotation: 0.26° greater than all other conditions) and lower thoracic spine (lateral flexion: 0.13° greater than NF, rotation: averagely 0.1° greater than all other condition) in both sexes. TF altered upper thoracic spine variability (0.36° smaller than SF), lower thoracic spine angle (lateral flexion: 3.00° greater than NF, rotation: 1.68° greater than SF), and lumbar angle (averagely 1.8° smaller than all other conditions) in both sexes. However, females had greater lower thoracic spine angle (lateral flexion: 8.3° greater, p = 0.005) as well as greater upper (rotation: 0.53° greater, p = 0.006) and lower thoracic spine (rotation: 0.5° greater, p = 0.007; flexion: 0.6° greater, p = 0.014) angular variabilities than males. CONCLUSIONS: Results suggest that females' fatigue responses focused on the trunk and spine. Results highlight a few sex differences in adapting to localized muscle fatigue, which may help explain how sex differences in repetitive motion-related injuries differ between joints.

Sex-specific muscle activation and oxygenation kinetics during a repetitive forward pointing task.

We compared the minute-by-minute muscle activity and oxygenation responses to a repetitive arm motion-induced fatiguing task between the sexes in order to address the literature gap on these time-dependent fatigue responses. Twenty-six (13 females) healthy adults performed a repetitive pointing task (RPT) with the arm moving forward/backward at shoulder height until reaching 8/10 (Borg CR10) for neck/shoulder perceived exertion (RPE). Neck/shoulder RPE, oxygenation and electromyography were recorded every minute and compared between first and second half of the task and between the sexes. Greater changes in oxygen supply and activation amplitude occurred during the second half of the task. Despite similar time to fatigue-terminal (p > 0.05), females showed greater anterior deltoid activation amplitude at all time points than males, and only the males showed increases in anterior and posterior deltoid activation amplitudes. In females, middle (ρ = -0.34, p = 0.04) and posterior (ρ = -0.44, p = 0.01) deltoid amplitudes were negatively correlated with perceived exertion during the first half of the task. Results suggest that reduced modulation of anterior deltoid activation amplitude in females may reflect a sub-optimal fatigue-mitigation mechanism compared with males and may help explain their greater susceptibility to neck/shoulder musculoskeletal disorders. Novelty: Despite similar fatigability and trapezius oxygenation, females showed greater deltoid activation throughout the task. Deltoid activation increased in males but not in females. The results support the important role of the deltoid in sex-specific neck/shoulder injury mechanisms.

Management of Myeloma Manifestations and Complications: The Cornerstone of Supportive Care: Recommendation of the Canadian Myeloma Research Group (formerly Myeloma Canada Research Network) Consensus Guideline Consortium.

Multiple myeloma (MM) is a hematological cancer associated with significant symptomatic burden. Bone disease, renal insufficiency, cytopenias, infection, and peripheral neuropathy, among other disease manifestations and complications, impair patients' quality of life. The Canadian Myeloma Research Group Consensus Guideline Consortium, formerly Myeloma Canada Research Network Consensus Guideline Consortium, proposes national consensus recommendations for the management of MM-related manifestations and complications. To address the needs of Canadian physicians and people living with MM across the country, this document focuses on the improvement and maintenance of patient care by clarifying best-practice approaches for the prevention, detection and management of disease manifestations and complications. The Canadian Myeloma Research Group Consensus Guideline Consortium will periodically review the recommendations herein and update as necessary.