The development of conduction block in single human axons following a focal nerve injury.

1. Using microneurography with a conventional monopolar electrode, the action potentials of ten myelinated axons in the peripheral nerves of human subjects were followed while they developed conduction block. 2. The action potentials had initially (n = 6) or developed (n = 4) a positive double-peaked morphology. The time interval between the two positive peaks represents the conduction time across the impaled internode. 3. When the interpeak interval was < 500 micros, conduction across the site of impalement was secure, even if the conduction time was markedly prolonged. When the interval was > 600 microseconds, intermittent conduction failure occurred. For all units the longest interpeak interval recorded just prior to complete conduction failure was, on average, 1.12 ms (range, 0.8-1.4 ms). 4. For five axons, there was evidence that natural activity triggered the conduction failure. 5. Impalement of the nerve fibre by the microelectrode impairs the ability of the axon to conduct impulses across the site of injury, but impulse transmission can be secure even when the conduction time across individual internodes is prolonged to 500 microseconds. These findings are therefore relevant to the conduction deficits that occur in focal injuries of human axons.

Voluntary activation of human elbow flexor muscles during maximal concentric contractions.

1. To measure voluntary activation of human elbow flexor muscles during maximal concentric contractions, the twitch interpolation method was modified to enable detection of torque increments evoked by single stimuli during contractions of up to 300 deg s-1. Subjects flexed the elbow to rotate a loaded beam 'as fast as possible' (load typically 23-58 N m) from 70 deg below to 70 deg above the horizontal. Electrical stimuli were delivered to biceps brachii when the beam passed through the horizontal. Voluntary activation was estimated from the amplitude of the interpolated twitch, which was expressed as a percentage of the twitch produced by relaxed muscles shortening at the same velocity. 2. In eleven subjects, the level of voluntary activation during repeated maximal concentric contractions (median 99.4%) did not differ significantly from that during maximal isometric contractions (98.0%). Voluntary activation during maximal contractions did not depend on shortening velocity and was the same when tested at two angles 30 deg apart. 3. To induce fatigue, five subjects repeatedly lifted and lowered a heavy load at about 30 deg s-1, and continued for ten to twelve contractions after they needed assistance to continue lifting. All maintained the capacity to attain maximal levels of activation. 4. It is concluded that voluntary drive to elbow flexor muscles during maximal concentric contractions is usually maximal or near-maximal, and that this level of drive can be maintained during development of peripheral fatigue.

Weak short-latency spinal projections to the long flexor of the human thumb.

The human thumb is controlled by a muscle, flexor pollicis longus (FPL), that is unique among mammals and contributes to manual dexterity. The present study sought to define whether the spinal reflex circuitry for this muscle differed from that for an adjacent muscle (flexor carpi radialis, FCR). In peri-stimulus time histograms, short-latency, largely monosynaptic excitation produced by median nerve stimulation was significantly less frequent and significantly smaller for FPL motor units than FCR motor units. Thus the motoneurone pools of adjacent muscles differ in their spinal reflex accessibility. The reflex control of FPL may thus be achieved by supraspinal pathways rather than the traditional monosynaptic arc.

Neural drive to the diaphragm in patients with severe COPD.

Patients with severe chronic obstructive pulmonary disease (COPD) have a greater neural drive to the parasternal intercostal and scalene muscles and greater inspiratory expansion of the rib cage than do healthy individuals. However, such patients also have a reduced outward displacement or a paradoxical inward displacement of the ventral abdominal wall during inspiration. This has led to the suggestion that they may have less use of the diaphragm, possibly secondary to chronic muscle fatigue. To assess the effect of COPD on the neural drive to the diaphragm, we inserted needle electrodes into the costal part of the right hemidiaphragm in eight patients with severe disease (mean [+/- SD] FEV1: 0.82 [+/- 0.27] L) and six control subjects of similar age, and measured the discharge frequencies of single motor units during resting breathing. A total of 115 diaphragmatic motor units were recorded in the control subjects and 122 in the patients. All motor units discharged rhythmically in phase with inspiration. However, whereas 95% of the units in the control subjects had a peak discharge frequency between 7 and 14 Hz, 79% of the units in the COPD patients had a peak discharge frequency greater than 15 Hz. As a result, the discharge frequency of all units averaged 10.5 [+/- 2.4] Hz in the control subjects, but 17.9 [+/- 4.3] Hz in the patients (p < 0.001). These observations indicate that patients with severe COPD have an increased neural drive not only to the rib cage inspiratory muscles, but also to the diaphragm. Consequently, the reduced inspiratory expansion of the abdomen in severe COPD results from mechanical factors alone.

Morphology of action potentials recorded from human nerves using microneurography.

This study investigated the morphology of action potentials and the frequency of occurrence of the various waveforms encountered when using microneurography to record single-unit muscle afferent activity in humans. With 75% of the afferents recorded in this study (55 of 73 afferents), action potentials had a double-peaked morphology. For action potentials with an initial, positive double-peaked morphology, the relevant afferent conducts impulses past the microelectrode, with the second peak representing current fluctuations at the node of Ranvier proximal to the electrode. Accordingly, in the majority of recordings, the afferent is capable of conducting impulses to the spinal cord. The mean interpeak interval for these double-peaked units was 168 microseconds (range 90-310 microseconds). This represents marked prolongation of conduction time across the impaled internode. When the interpeak interval was relatively short (90-120 microseconds), the double-peaked morphology could be recognized only if the low-pass filter was high (> or = 10 kHz). The probability of recording a double-peaked unit was the same whether the recording was acquired early or late in a 3-h experiment. Conduction block developed in 6 of 73 single units during the recordings. These findings indicate that the majority of isolated single afferents and, indeed, the majority of afferents within the relevant fascicle are capable of transmitting impulses across the recording site, even though conduction across the impaled internode is slow. Conduction block due to direct injury or pressure is relatively uncommon.

Discharge frequencies of parasternal intercostal and scalene motor units during breathing in normal and COPD subjects.

To determine whether patients with chronic obstructive pulmonary disease (COPD) contract the inspiratory muscles of the rib cage more strongly than do healthy subjects, we recorded the discharge frequencies of single motor units in the scalene and second parasternal intercostal muscles of seven patients with stable COPD (FEV1 = 33 +/- 13% predicted, mean +/- SD) and seven control subjects. Recordings were made with insulated monopolar electrodes during resting breathing, and single motor-unit discharges were identified with a customized method based on "template" matching. A total of 211 motor units were recorded in the control subjects and 260 in the patients. The inspiratory discharge frequencies were greater in the COPD patients than in the control subjects for both the parasternal (13.4 versus 10.1 Hz, p < 0.05) and scalene (11.4 versus 8.5 Hz, p < 0.02) muscles. Recording sites at which no motor units were recruited were more common in the control subjects than in the patients (p < 0.001). The sternomastoid muscle was silent in both subject groups. Therefore, effective central neural drive is increased to both the scalene and parasternal intercostal muscles but not to the sternomastoid muscle in patients with COPD.

Software compensation for lung volume in assessment of inspiratory muscle strength and endurance.

BACKGROUND: To increase the sensitivity of measurements of maximal inspiratory pressure (MIP) as a test of inspiratory muscle strength and endurance, software was developed to correct for variation in lung volume. METHODS: Using a body plethysmograph to determine absolute lung volume during each manoeuvre, values for MIP were expressed as a percentage of the pressure "expected" from the unfatigued MIP/lung volume relation in each subject. RESULTS: The method reduced the variance in peak and average pressure during a series of 18 MIP manoeuvres of 10 seconds duration separated by rest intervals of 10 seconds. CONCLUSIONS: The correlation between average pressure and contraction number was improved significantly by the MIP/lung volume correction. This simple correction has many applications in measurements of the MIP.

Temperature artifacts produced by thermocouples used in conjunction with 1 and 3 MHz ultrasound.

The relative temperature artifacts produced by a selection of commercially available thermocouples and catheters were evaluated in radiation bolus and beef phantoms heated by 1 and 3 MHz continuous ultrasound. The thermocouples included a 23 gauge needle microprobe inserted directly into the phantoms, polyurethane-sheathed, Teflon-sheathed, and exposed-tip thermocouples, each inserted into a 19 gauge polyurethane closed-end catheter, a multisensor Teflon-sheathed probe inserted into a 16 gauge polyurethane catheter and a Teflon-sheathed single-sensor probe without a catheter. The needle microprobe and the polyurethane-sheathed thermocouple produce equivalent artifacts. The artifacts produced by the Teflon and exposed-tip thermocouples are 1.4 +/- 0.3 times greater, that produced by the multisensor Teflon-sheathed probe is 2.1 +/- 0.3 times greater, and that produced by the Teflon-sheathed thermocouple without a catheter is 2.3 +/- 0.4 times greater. The results in the beef phantom indicate that the needle microprobe and polyurethane-sheathed thermocouple both produce artifacts of 0.7 +/- 0.1 degree in tissue at an SAR of 100 W/kg.

Catheter induced temperature artifacts in ultrasound hyperthermia.

Temperature artifacts were evaluated at 72 different sensor locations in 10 different tumour sites heated by use of planar ultrasound transducers operated at 1 and 3 MHz. Thermometry was carried out by single- and multisensor thermocouple probes inserted into 19- and 16-gauge polyurethane catheters, respectively. Nearly all catheters were oriented approximately perpendicular to the ultrasound beam. The artifacts were determined by backward extrapolation of the thermal decay 30-60s after the power was turned off. The effective blood flow and specific absorption rate (SAR) at the sensor locations were determined from the rate of decay and the steady-state temperature. The sample mean steady-state temperature, effective blood flow, and SAR were 41.4 degrees C, 17.5 ml/100 g/min, and 46.3 W/kg, respectively. The most frequent artifact was in the range 0-0.2 degrees C and the mean artifact was 0.6 degrees C. Less than 15% of the artifacts were above 1 degree C. The magnitude of the artifact correlates with the SAR of ultrasonic power, the effective blood flow rate, and the steady-state temperature. These results indicate that the artifact produced at 1 MHz by a multisensor, Teflon-sheathed thermocouple inserted into a 16-gauge polyurethane catheter is 1.7 +/- 0.4 degrees at an SAR of 100 W/kg.