Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome.

PURPOSE: The role of frontal plane tibiofemoral alignment in subjects with patellofemoral pain syndrome (PFPS) is controversial and rarely discussed in the literature. As well, little research has been done on the effects of the hamstrings muscles on PFPS. The aim of the current study was to determine whether, in individuals with PFPS, frontal plane tibiofemoral alignment or muscular activity of the index knee's crossing muscles is altered during maximum eccentric leg press exercise. METHODS: This cross-sectional study involved 19 patients with PFPS and 19 control subjects who were matched according to gender, age, and physical activity. During eccentric leg press action, frontal plane tibiofemoral alignment was assessed with a motion analysis system based on skin markers. Simultaneously, surface-electromyography was used to assess the activity levels of the relevant knee crossing muscles. To assess the activity under functional conditions, a leg press with a footplate having variable stability was used for barefoot testing. RESULTS: The PFPS subjects did not have significantly different frontal plane leg alignment compared to controls. On electromyography (EMG), PFPS patients had significantly lower levels of hamstring activity during eccentric leg exercise. The differences between the two groups (%; absolute differences normalized EMG) ranged from 20% (semitendinosus; stable footplate; p=0.017) to 21% (biceps femoris; unstable footplate; p=0.019) and 32% (semitendinosus; unstable footplate; p=0.002). CONCLUSIONS: PFPS is not linked to altered frontal plane leg alignment during eccentric leg pressing. However, PFPS is associated with eccentric under-activation of the hamstrings, which may be a compensatory strategy that maintains patellofemoral joint pressure within bearable levels.

Effects of indomethacin on the L-selectin expression in humans.

Based on an in vitro study and an uncontrolled in vivo trial we examined the effects of indomethacin on the expression of L-selectin by leukocytes in healthy volunteers. Eight subjects received infusions of 0.7 mg/kg indomethacin and placebo t.i.d. (three times daily) in a randomized, controlled trial. Indomethacin decreased the mean fluorescence intensity of the L-selectin expression on isolated neutrophils incubated with toxic indomethacin concentrations. However, indomethacin did not lower the L-selectin expression in whole blood or in-vivo. Thus, therapeutic doses of the cyclo-oxygenase inhibitor indomethacin do not lower the L-selectin expression on leukocytes. Hence, the inhibition of cyclo-oxygenase cannot explain the previously observed dexamethasone-induced decrease in L-selectin.

Effects of histamine and nitric oxide synthase inhibition on plasma levels of von Willebrand factor antigen.

Endothelial cells release von Willebrand factor (vWf) either constitutively or by a regulated pathway. Based on various studies in vitro, we hypothesized that the stimulatory action of histamine on vWf release could also be induced in vivo and that it may be inhibited by endogenous production of nitric oxide (NO). Nine healthy subjects received placebo or one of two dosages of a primed constant infusion of the NO-synthase inhibitor N-monomethyl-L-arginine (L-NMMA) in a randomized, double-blind, three-way crossover trial. Histamine was coinfused for 15 minutes at 0.16 microg/kg/min after 30 minutes of pretreatment with either placebo or L-NMMA. Thirty minutes after either the low or the high L-NMMA dose was started, which caused, respectively, a 40% decrease and a 60% decrease in exhaled end expiratory NO level (p = 0.008), there was no increase in von Willebrand factor antigen (vWf-Ag) level (p > 0.05). Histamine caused an 11% (95% confidence interval (CI): 0.4% to 22%; p = 0.011) increase in vWf-Ag level at 125 minutes. After pretreatment with the low and the high L-NMMA doses, vWf-Ag level increased by 18% (Cl: 5% to 31%; p = 0.011) and by 29% (CI: 15% to 42%; p = 0.008), respectively. At 125 minutes, vWf-Ag level was significantly higher after either L-NMMA pretreatment when compared with the results after histamine alone (p < 0.05). In conclusion, the infusion of histamine increased vWf-Ag level, and the inhibition of NO-synthase enhanced this effect, whereas it did not by itself elevate vWf-Ag level. Thus endogenously produced NO may dampen the regulated pathway of vWf secretion; it will be interesting to investigate whether endogenous NO production also inhibits vWf release caused by other stimulators.

Effects of nitroglycerin and sodium nitroprusside on endexpiratory concentrations of nitric oxide in healthy humans.

The cellular origin of nitric oxide (NO) in exhaled air of healthy humans is unknown. It is currently not known, whether changes in NO concentrations that originate from pulmonary vessels, can be detected as changes in exhaled NO. Thus, we have studied the effects of increased intravascular NO generation on endexpiratory NO-levels. Twenty-four young healthy volunteers received nitroglycerin (GTN), sodium nitroprusside (SNP) or placebo i.v. in a randomized, double blind cross-over trial. Diastolic blood pressure decreased from 59 mmHg (95% confidence interval: 56-62) during placebo to 48 mmHg (CI: 45-51) and to 48 mmHg (CI: 45-50) after infusions of GTN and SNP, respectively. Heart rate increased from 69 (CI: 65-73) during placebo to 78 (CI: 72-84) and to 84 (CI: 77-92) after infusions of GTN and SNP, respectively (p<0.01 for all comparisons). However, no increase in exhaled NO was detected: endexpiratory NO-concentrations averaged 6.1 ppb (CI: 4.9-7.4), 5.7 ppb (CI: 4.4-7.0) and 6.4 ppb (CI: 5.3-7.6) under placebo, GTN and SNP infusions, respectively (Friedman ANOVA p=0.328). NO release from within the pulmonary vasculature does not significantly contribute to endexpiratory NO concentrations in non-intubated healthy humans suggesting that such NO measurements quantify NO production mainly from non-vascular pulmonary cells.

Effects of exercise on circulating vascular adhesion molecules in healthy men.

Based on previous studies showing an increase in circulating soluble intercellular adhesion molecule-1 (sICAM-1) after exercise, we hypothesized that exercise may also increase serum levels of the vascular cell adhesion molecule-1 (sVCAM-1) and sE-selection. In a prospective controlled clinical trial, serum levels of sE-selectin, sICAM-1 and sVAM-1 were measured before and after two different exercise protocols in healthy untrained men. Lactate levels increased up to 12.7 mmol/L (95% confidence interval: 10.1-15.9) and 3.6 mmol/L (CI: 2.4-4.7) after ergometry and after an one hour endurance exercise at 60% of the maximal work intensity, respectively (p = 0.028 vs baseline and controls). The maximal increase in lymphocyte counts of 106% (CI: 63-146), which was only of short duration, was higher immediately after ergometry as compared to that observed after endurance exercise (p = 0.028). However, the maximal increase in neutrophil counts of 178% (CI: 120-298) which was seen at 2 hours after endurance exercise was higher than that seen after ergometry (p = 0.028). In contrast, only small changes of circulating adhesion molecules were seen immediately after ergometry: sICAM-1 increased by 11% (CI: 4-25; p = 0.028), and similar tendencies were also observed for sVCAM-1 and sE-selectin. No other consistent and time-dependent changes of circulating adhesion molecules were observed and all differences and changes were < or = 11%. In sum our study provides evidence that recreational sporting activities in untrained healthy subjects at normal altitude have little influence on serum levels of the circulating vascular adhesion molecules sE-selectin, sVCAM-1 or sICAM-1.

Evidence against an effect of endothelin-1 on blood coagulation, fibrinolysis, and endothelial cell integrity in healthy men.

On the basis of an array of preclinical experimental results, it has been widely assumed that endothelin-1 (ET-1) may affect blood coagulation, fibrinolysis, and endothelial cell function, thereby playing a pathophysiological role in various cardiovascular diseases in humans. However, confirmation of this assumption is still lacking. ET-1 or placebo was administered intravenously to 12 healthy volunteers in a prospective, randomized, double-blind, crossover trial. Pathophysiologically relevant concentrations of ET-1 (an approximate threefold increase of normal blood levels) causing hemodynamic effects were reached by continuous intravenous infusion for 6 hours. Components of the coagulation (thrombin-antithrombin complexes, prothrombin fragment F1 + 2, activated factor VII, and factor VII antigen) and fibrinolytic (fibrin split product D-dimer, plasmin-plasmin inhibitor complex, tissue-type plasminogen activator, urokinase-type plasminogen activator, and plasminogen activator inhibitor-1) systems and markers of endothelial cell perturbation/dysfunction (von Willebrand factor and thrombomodulin) were measured before the start of infusion and after 2, 6, 12, and 24 hours. Comparing changes in the plasma concentrations of these parameters during and after infusion of ET-1 and placebo, we found no specific effects of ET-1. In contrast to previous reports from preclinical experiments, ET-1 does not appear to affect coagulation or fibrinolysis, nor does this peptide induce relevant endothelial cell perturbations in humans.

Effects of endothelin-1 on circulating adhesion molecules in man.

Several studies point to a role for endothelin-1 (ET-1) in enhancing adhesion molecule expression and leucocyte adhesion. We thus hypothesized that ET-1 would induce expression of adhesion molecules by endothelial cells and by leucocytes in humans, and hence compared with placebo the effect of a continuous 6-h ET-1 infusion on plasma levels of circulating (c)E-selectin, cP-selectin, intercellular and vascular cell adhesion molecule 1. In addition, we investigated the effects of ET-1 on expression of the leucocyte adhesion molecules CD11b/CD18 and L-selectin on monocytes and neutrophils. After an open pilot study to evaluate the safety of a 6-h ET-1 infusion of 0.4 pmol kg-1 min-1 (n = 4), the main study was conducted as a randomized, double-blind, two-way, cross-over trial in 12 additional young healthy male volunteers, who received the same treatment and were observed over a period of 24 h. ET-1 infusion decreased renal plasma flow by 43% (CI 35-51%; P < 0.001) and increased the filtration fraction by 80% (CI 20-110%; P < 0.001). Heart rate decreased by -10% (CI -4% to -15%) at 6 h under ET-1 infusion in the cross-over trial (P = 0.012 between periods). Although ET-1 infusions increased plasma levels of ET-1 by about 300%, ET-1 elicited no relevant changes in any circulating adhesion molecules or leucocyte adhesion molecules measured. In the placebo period small diurnal changes were observed for cP-selectin (-8%, CI -14 to -3%, P = 0.008) and cE-selectin (-6%, CI -10 to -3%, P = 0.003) at 12 h (20.45 h). In sum, ET-1 does not regulate circulating adhesion molecules in healthy men. Circadian variations may exist for plasma levels of cP-selectin and cE-selectin.

Partial blockade of nitric oxide synthase blunts the exercise-induced increase of von Willebrand factor antigen and of factor VIII in man.

BACKGROUND: Until now the effects of beta-adrenergic agonists have largely been ascribed to their ability to induce intracellular formation of cyclic adenosine monophosphate. Recently evidence has been accumulating that at least some beta1 and beta2-adrenoceptor effects may be mediated by nitric oxide (NO). Based on these studies, we hypothesized that the beta-adrenoceptor mediated increase of von Willebrand factor and factor VIII-activity (FVIII:C) in plasma during exercise, is caused by an NO-dependent mechanism. METHODS: Thirteen young healthy subjects finished an exhaustive bicycle exercise protocol while they were infused placebo or the NO-synthase inhibitor N-monomethyl-L-arginine (L-NMMA) on two separate days in a randomized, double blind cross-over design. FINDINGS: During exercise systemic haemodynamic changes were parallel in both treatment periods, but L-NMMA caused a partial inhibition of NO-synthase as evidenced by a 30% decrease in exhaled NO. The workload capacities were not different during L-NMMA or placebo infusion. However, under placebo treatment exercise increased vWF-Ag by a maximum of 61% (CI: 43-84; p = 0.002) and FVIII:C by 44% (CI: 31-59; p = 0.001), which was significantly attenuated when subjects were treated with L-NMMA (p <0.05): under L-NMMA treatment vWF-Ag increased by only 25% (CI: 5-51; p = 0.001) and FVIII:C by 12% (CI: 6-39; p = 0.001). INTERPRETATION: Partial blockade of NO-synthase with L-NMMA blunts the exercise-induced increase in vWF-Ag and FVIII:C. Our trial points to a role of endogenous NO-generation in the beta2-adrenergic increase in vWF/FVIII. Thus, we propose that physiologic processes which are induced by systemic beta2-adrenoceptor stimulation may at least partly be mediated by NO.

Menstrual cycle-associated changes in blood levels of interleukin-6, alpha1 acid glycoprotein, and C-reactive protein.

Based on previous studies we hypothesized that interleukin-6 (IL-6) plasma levels would increase during the menstrual cycle, in analogy to the increase in IL-1 levels seen during the luteal phase. Thus we have investigated menstrual cycle-associated changes in IL-6, alpha1 acid glycoprotein (AGP), and C-reactive protein (CRP). The study design was cross-sectional and was conducted in 18 healthy premenopausal women with regular menstrual cycles and in 15 age-matched men. The women had blood drawings in the follicular phase, at midcycle, and in the luteal phase of the menstrual cycle. A single blood sample was obtained from men to compare IL-6 levels between sexes. The median IL-6 level was 0.68 pg/ml (95% confidence interval (CI): 0.60 to 1.05) in the follicular phase and did not change significantly during the menstrual cycle. IL-6 levels did not differ between women and men (0.79 pg/ml; CI: 0.66 to 1.05; p > 0.05). Median AGP levels decreased by 6% (CI: -14% to 1%) during the luteal phase (p = 0.005), and a significant correlation between mean AGP and IL-6 levels was found (r = 0.60; p = 0.01). Median CRP levels increased by 44% (CI: 27% to 59%; p < 0.001) at midcycle and by 31% (CI: 17% to 68%; p = 0.002) in the luteal phase, and there was a significant correlation between the relative increase in CRP at midcycle and the relative increase in progesterone levels during midcycle (r = 0.60; p = 0.01) and the luteal phase (r = 0.71; p = 0.001). In conclusion, we found no sustained menstrual cycle-dependent changes in systemic IL-6 plasma levels. AGP and CRP levels may be differentially regulated during the menstrual cycle of healthy women: AGP levels correlated with IL-6 levels, and AGP levels decreased during the menstrual cycle, whereas CRP levels increased during the menstrual cycle and correlated with the increase in progesterone levels. The reason for the observed changes in CRP levels remains to be elucidated.

Effects of angiotensin-II infusion at pressor and subpressor doses on endothelin-1 plasma levels in healthy men.

Several lines of evidence suggest that effects of angiotensin-II (A-II) could be mediated in part by endothelin-1 (ET-1): A-II enhances production and secretion of ET-1 which in turn may contribute to the pressor effects and mitogenic actions of A-II. We have conducted a randomized controlled cross-over study to investigate whether A-II increases ET-1 plasma levels in humans at pressor doses. Each of the eight healthy male volunteers received a subpressor and pressor dose of A-II which were assessed by titration of the individual dose dependent blood pressure responses to A-II-infusion. The mean subpressor dose of A-II was 0.62 ng/kg/min. (range: 0.31-1.25); the mean pressor dose of A-II was 8.44 ng/kg/min. (range 2.5-20), yielding an average increase in mean arterial pressure by 35% (95% confidence interval [CI]: 24-45%). Plasma ET-1 concentrations increased significantly only in response to pressor doses of A-II (Friedman ANOVA p=0.022): ET-1 increased by 89 % (CI: 24-154%) over baseline (1.7 pmol/L; CI: 1.4-2.0) 60 min. after starting the pressor infusion of A-II and remained elevated throughout the 4-hours observation period. In conclusion, A-II at pressor doses but not at subpressor doses induced an increase in plasma levels of ET- 1 in healthy subjects. This finding may be of relevance for various diseases associated with increased production of A-II and could potentially have therapeutic implications.