Spine to pelvis "T-Construct" using magnetic controlled growing rods in non-walkers neuromuscular early-onset scoliosis: a preliminary study.

BACKGROUNDS: Magnetic controlled growing rods (MCGRs) have been proven to be effective in controlling early onset neuromuscular scoliosis but no study has evaluated the combination with a sacro-bi-iliac construct. The aim of our study is to report surgical management of early onset non-walkers neuromuscular scoliosis correction using MCGRs associated with a sacro-bi-iliac "T-construct" and its mid-term outcomes. Our hypothesis was that this set-up provided well correction of the pelvic obliquity and that this correction was maintained over time. METHODS: A retrospective single-center study was conducted including all consecutive neuromuscular early onset scoliosis who underwent spinopelvic fixation using "T-construct" with two MCGRS. Four millimeters lengthening was performed every 4 months during outpatient clinics sessions. All children had a low-dose biplanar stereoradiography in EOS-Chair at pre/postoperative phase, each outpatient clinic appointment and last follow-up. RESULTS: Eighteen patients were included and 17 analyzed at the last follow-up. The mean age at surgery was 9.5 (range from 5 to 12 years), the mean follow-up was 4,7 years (range from 2.5 to 6.6 years) and 8 patients had a Risser stage above four. The global complication rate was 35% (N = 6/17 patients) including three medical and three mechanical complications related to "T-construct", while the reoperation rate was 18% (N = 2 patients for wound debridement and one for iterative pelvic fixation). Cobb angle and pelvic obliquity were significantly improved by surgery (mean correction was 33.2 ° (55%) and 11 ° (77%) respectively; p < 0.001). At the last follow-up, we noted a loss of frontal Cobb angle correction (p < 0.01) whereas we did not observe any significant loss of pelvic obliquity (p > 0.9). CONCLUSIONS: Although the global complication rate was 35% (half of which are mechanical complications), the treatment combining pelvic T-construct and MCGRs provides satisfactory correction of pelvic obliquity correction, good maintenance in the medium term and may be a procedure to consider for the surgical treatment of early onset neuromuscular scoliosis. LEVEL OF EVIDENCE: IV; Retrospective cohort prognostic study.

Quantitative Monitoring Maximizes Cost-Saving Strategies When Antagonizing Neuromuscular Block With Sugammadex.

Introduction Weight-based dosing combined with variable patient weights in pediatric anesthesia can lead to significant medication excess and waste from single-use medication vials packaged for dosing in adults. Medication aliquots have been proposed as a strategy to decrease waste and therefore expense when using high-cost medications such as sugammadex. Appropriate dosing of sugammadex to antagonize neuromuscular block is based on the results of quantitative monitoring, though the use of these monitors is not routine. In this quality improvement project, we demonstrate cost savings from aliquoting sugammadex from large, single-use vials and using quantitative monitoring to guide accurate and appropriate dosing.  Methods After institutional review and approval, patients receiving rocuronium neuromuscular block during their anesthetic care between October 10 and December 9, 2022, were included for analysis. Sugammadex aliquots were prepared under sterile conditions in the operating room pharmacy according to current compounding guidelines. Quantitative neuromuscular monitoring with electromyography-based monitors was used to guide accurate sugammadex dosing. Cost analysis included the actual savings achieved when aliquots were used instead of single-use vials, the potential savings if aliquots had been used as opposed to single-use vials, and the actual savings achieved when quantitative monitoring indicated that adequate spontaneous recovery was reached and sugammadex administration was not needed. Results A total of 200 patients were included in the analysis. In 73 patients, a 200 mg/2 ml vial of sugammadex was utilized, while 86 patients received sugammadex from pre-filled aliquot syringes of 50 mg/0.5 ml. Forty-one patients did not require sugammadex antagonism as they achieved spontaneous recovery to a train-of-four ratio ≥90%. Conclusion Administration of sugammadex from aliquots rather than manufacturer-packaged single-use vials, with dosing guided by quantitative neuromuscular monitoring, produced a net cost savings of approximately $46 per case and projected net annual cost savings of nearly $370,000 in our institution. Forty percent of the net cost savings came from confirmation by quantitative monitoring of adequate spontaneous recovery to a train-of-four ratio ≥90%.

Neural and Muscular Determinants of Performance Fatigability Are Independent of Work and Recovery Durations During High-Intensity Interval Exercise in Males.

The present study aimed to investigate the effect of two protocols of high-intensity interval exercise (HIIE) on performance fatigability and its neural and muscular determinants. On different days, 14 healthy males performed two HIIE protocols with different work and recovery durations (matched for total duration, work and recovery intensities, and density): 1) 4 × 4 min at 90% HRpeak,180-s recovery at 70% HRpeak; and 2) 16 × 1 min at 90% HRpeak, 45-s recovery at 70% HRpeak. Pre- to post-HIIE reduction in maximal voluntary isometric contraction (MVIC) was used as marker of performance fatigability, while voluntary activation (VA) and potentiated quadriceps twitch force (Qtw) as markers of the neural (i.e. central fatigue) and muscular (i.e. peripheral fatigue) determinants, respectively. In addition, pre- to post-HIIE reduction in twitch force stimulated at 100 Hz (Qtw100) and 10:100 Hz ratio (Qtw10:Qtw100) were used as markers of high- and low-frequency performance fatigability, respectively. The MVIC, VA, Tw, Qtw100, and Qtw10:Qtw100 ratio decreased similarly from pre- to post-HIIE in both HIIE protocols (p < .05). The rating of perceived effort, blood pH, and plasma lactate responses were similar between HIIE protocols (p > .05), but the heart rate was higher in the longer HIIE protocol (p < .05). In conclusion, performance fatigability and its neural and muscular determinants seemed to be independent of the work and recovery durations of the HIIE, at least when HIIE protocols were matched for total work duration, work and recovery intensities, and density. Further, HIIE with long work and recovery might be preferable when the intention is to stress the chronotropic response.

Sensorimotor control of functional joint stability: Scientific concepts, clinical considerations, and the articuloneuromuscular cascade paradigm in peripheral joint injury.

Human movement depends on sensorimotor control. Sensorimotor control refers to central nervous system (CNS) control of joint stability, posture, and movement, all of which are effected via the sensorimotor system. Given the nervous, muscular, and skeletal systems function as an integrated "neuromusculoskeletal system" for the purpose of executing movement, musculoskeletal conditions can result in a cascade of impairments that affect negatively all three systems. The purpose of this article is to revisit concepts in joint stability, sensorimotor control of functional joint stability (FJS), joint instability, and sensorimotor impairments contributing to functional joint instability. This article differs from historical work because it updates previous models of joint injury and joint instability by incorporating more recent research on CNS factors, skeletal muscle factors, and tendon factors. The new 'articuloneuromuscular cascade paradigm' presented here offers a framework for facilitating further investigation into physiological and biomechanical consequences of joint injury and, in turn, how these follow on to affect physical activity (functional) capability. Here, the term 'injury' represents traumatic joint injury with a focus is on peripheral joint injury. Understanding the configuration of the sensorimotor system and the cascade of post-injury sensorimotor impairments is particularly important for clinicians reasoning rational interventions for patients with mechanical instability and functional instability. Concurrently, neurocognitive processing and neurocognitive performance are also addressed relative to feedforward neuromuscular control of FJS. This article offers itself as an educational resource and scientific asset to contribute to the ongoing research and applied practice journey for developing optimal peripheral joint injury rehabilitation strategies.

Muscle-fiber specific genetic manipulation of Drosophila sallimus severely impacts neuromuscular development, morphology, and physiology.

The ability of skeletal muscles to contract is derived from the unique genes and proteins expressed within muscles, most notably myofilaments and elastic proteins. Here we investigated the role of the sallimus (sls) gene, which encodes a structural homologue of titin, in regulating development, structure, and function of Drosophila melanogaster. Knockdown of sls using RNA interference (RNAi) in all body-wall muscle fibers resulted in embryonic lethality. A screen for muscle-specific drivers revealed a Gal4 line that expresses in a single larval body wall muscle in each abdominal hemisegment. Disrupting sls expression in single muscle fibers did not impact egg or larval viability nor gross larval morphology but did significantly alter the morphology of individual muscle fibers. Ultrastructural analysis of individual muscles revealed significant changes in organization. Surprisingly, muscle-cell specific disruption of sls also severely impacted neuromuscular junction (NMJ) formation. The extent of motor-neuron (MN) innervation along disrupted muscles was significantly reduced along with the number of glutamatergic boutons, in MN-Is and MN-Ib. Electrophysiological recordings revealed a 40% reduction in excitatory junctional potentials correlating with the extent of motor neuron loss. Analysis of active zone (AZ) composition revealed changes in presynaptic scaffolding protein (brp) abundance, but no changes in postsynaptic glutamate receptors. Ultrastructural changes in muscle and NMJ development at these single muscle fibers were sufficient to lead to observable changes in neuromuscular transduction and ultimately, locomotory behavior. Collectively, the data demonstrate that sls mediates critical aspects of muscle and NMJ development and function, illuminating greater roles for sls/titin.

Countermovement Jump and Isometric Strength Test-Retest Reliability in English Premier League Academy Football Players.

PURPOSE: To examine the test-retest reliability of countermovement jump (CMJ) and isometric strength testing measures in elite-level under-18 and under-23 academy football players. METHODS: A total of 36 players performed 3 maximal CMJs and isometric abductor (IABS), adductor (IADS), and posterior chain (IPCS) strength tests on 2 separate test days using dual force plates (CMJ and IPCS) and a portable strength testing device (IABS and IADS). Relative (intraclass correlation coefficient) and absolute (coefficient of variation, standard error of the measurement, and minimal detectable change [MDC%]) reliabilities for 34 CMJ, 10 IABS, 10 IADS, and 11 IPCS measures were analyzed using between-sessions best, mean, and within-session methods. RESULTS: For all methods, relative reliability was good to excellent for all CMJ and all IADS measures and poor to good for all IABS and IPCS measures. Absolute reliability was good (ie, coefficient of variation < 10%) for 27 (best) and 28 (mean) CMJ variables and for 6 (IABS and IADS) and 2 (IPCS) isometric measures. Commonly used CMJ measures (jump height, eccentric duration, and flight-time:contraction-time ratio) had good to excellent relative reliability and an MDC% range of 14.6% to 23.7%. Likewise, commonly used isometric peak force measures for IABS, IADS, and IPCS had good to excellent relative reliability and an MDC% range of 22.2% to 26.4%. CONCLUSIONS: Commonly used CMJ and isometric strength measures had good test-retest reliability but might be limited by their MDC%. Rate-of-force-development measures (for all isometric tests) and impulse measures (IPCS) are limited by poor relative and absolute reliability and high MDC%. MDC% statistics should be considered in the context of typical responsiveness.

Longitudinal management in Duchenne muscular dystrophy with exon 63 duplication.

A boy with nonambulatory Duchenne muscular dystrophy (DMD) tested positive for exon 63 duplication and exhibited intellectual disability, overweight and dyslipidaemia. The patient underwent a comprehensive multidisciplinary approach involving pharmacological and non-pharmacological interventions. Despite challenges, such as socioeconomic constraints and limited access to advanced therapies, the patient received tailored care. The management included prednisone medication, dietary modifications and psychological support. The patient's journey highlighted the complex interplay of medical and psychosocial factors affecting DMD patients in resource-limited settings. Regular monitoring and the involvement of the patient's family in a peer group were arranged to improve overall quality of life. The case underscores the need for accessible and holistic care for DMD patients, addressing both medical and psychosocial challenges.

Effects of simultaneous neuromuscular electrical stimulation and static stretching on flexibility and strength: a randomized controlled trial.

[Purpose] This study aimed to determine the effects of simultaneous neuromuscular electrical stimulation (NMES) and static stretching on flexibility and muscle strength. [Participants and Methods] A randomized controlled trial was conducted with 96 healthy university students equally assigned to either a simultaneous NMES and static stretching group (Group S) or an NMES-only group (Group C). The gastrocnemius muscle was the target of both NMES and static stretching. Ankle dorsiflexion angle (DFA), forward flexion distance (FFD), and ankle plantar flexor strength (PFS) were measured before and directly following intervention. Outcomes in the two groups were evaluated using two-way analysis of variance. [Results] A significant time effect was observed for both DFA and FFD, whereas a significant interaction effect was observed for FFD only. Improvements in DFA were similar between the groups; however, improvements in FFD were significantly greater in Group S. PFS showed no significant interaction between the group and the time factor. [Conclusion] Our findings suggest that simultaneous intervention enhances flexibility. Despite targeting the gastrocnemius muscle, the observed improvement in hamstring flexibility may have been because of fascial connections. These findings support the efficacy and safety of NMES combined with static stretching for increasing flexibility.

The effects of soft vs. rigid back-support exoskeletons on trunk dynamic stability and trunk-pelvis coordination in young and old adults during repetitive lifting.

While back-support exoskeletons are increasing in popularity as an ergonomic intervention for manual material handling, they may cause alterations to neuromuscular control required for maintaining spinal stability. This study evaluated the effects of soft and rigid passive exoskeletons on trunk local dynamic stability and trunk-pelvis coordination. Thiry-two young (18-30 years) and old (45-60 years) men and women completed repetitive lifting and lowering tasks using two different exoskeletons and in a control condition. Both exoskeletons significantly reduced the short-term maximum Lyapunov exponent (LyE) of the trunk (p < 0.01), suggesting improved local dynamic stability. There was also a significant main effect of age (p = 0.05): older adults exhibited lower short-term LyE that young adults. Use of the soft exoskeleton significantly increased, while the rigid exoskeleton significantly decreased, long-term LyE, and these changes were more pronounced in the young group compared to the old group. Additionally, exoskeleton use resulted in significant increase (p < 0.001) of mean absolute relative phase (MARP) and deviation phase (DP) by ∼30-60 %, with greater increases due to the rigid than the soft device. Thus, trunk-pelvic coordination and coordination variability were negatively impacted by exoskeleton use. Potential reasons for these findings may include exoskeleton-induced changes in lifting strategy, reduced peak trunk flexion velocity, and cycle-to-cycle variability of trunk velocity. Furthermore, although the soft and rigid devices caused comparable changes in trunk-extensor muscle activity, they exhibited differential effects on long-term maximum Lyapunov exponents as well as trunk-pelvic coordination, indicating that exoskeleton design features can have complex effects on trunk neuromuscular control.

The GENESIS database and tools: A decade of discovery in Mendelian genomics.

In the past decade, human genetics research saw an acceleration of disease gene discovery and further dissection of the genetic architectures of many disorders. Much of this progress was enabled via data aggregation projects, collaborative data sharing among researchers, and the adoption of sophisticated and standardized bioinformatics analyses pipelines. In 2012, we launched the GENESIS platform, formerly known as GEM.app, with the aims to 1) empower clinical and basic researchers without bioinformatics expertise to analyze and explore genome level data and 2) facilitate the detection of novel pathogenic variation and novel disease genes by leveraging data aggregation and genetic matchmaking. The GENESIS database has grown to over 20,000 datasets from rare disease patients, which were provided by multiple academic research consortia and many individual investigators. Some of the largest global collections of genome-level data are available for Charcot-Marie-Tooth disease, hereditary spastic paraplegia, and cerebellar ataxia. A number of rare disease consortia and networks are archiving their data in this database. Over the past decade, more than 1500 scientists have registered and used this resource and published over 200 papers on gene and variant identifications, which garnered >6000 citations. GENESIS has supported >100 gene discoveries and contributed to approximately half of all gene identifications in the fields of inherited peripheral neuropathies and spastic paraplegia in this time frame. Many diagnostic odysseys of rare disease patients have been resolved. The concept of genomes-to-therapy has borne out for a number of such discoveries that let to rapid clinical trials and expedited natural history studies. This marks GENESIS as one of the most impactful data aggregation initiatives in rare monogenic diseases.

Novel therapies in CIDP.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a heterogeneous but clinically well-described disease within circumscribed parameters. It is immunologically mediated through several poorly understood mechanisms. First-line therapies with steroids, intravenous immunoglobulin (IVIG) or plasma exchange are each effective in about two-thirds of patients. These treatments are seldom associated with complete resolution or cure, and often pose considerable practical, financial and medical implications.Our understanding of many of the key pathological processes in autoimmune diseases is expanding, and novel targeted therapeutics are being developed with promise in several autoimmune neurological disorders.This narrative review looks first at detailing key pathogenic mechanisms of disease in CIDP, followed by an in-depth description of potential novel therapies and the current evidence of their application in clinical practice.

Longitudinal monitoring of hypertonia through a multimodal sensing glove.

As clinical evaluations of neuromuscular disorders such as hypertonia mostly rely on perception-based scales, the imprecise subjective ratings make it difficult to accurately monitor treatment progress. To promote objective evaluation, this work used a multi-modal sensing glove in a double-blind study to enable sensitive monitoring of medication effects across 19 participants. The biomechanical measurements from the sensing glove effectively distinguished patient cohorts receiving a baclofen treatment or a placebo with 95% confidence. Consistent monitoring over a two-month period was demonstrated, closely tracking variations in individual responses to treatment. The biomechanical changes were correlated to neural activities as recorded by electromyography, verifying the medication effects. The sensing glove is shown to be a reliable tool for point-of-care settings to facilitate precise evaluation of hypertonia, essential for tailoring individual treatment choices and timely management of chronic symptoms.

Neuromuscular impairments of cerebral palsy: contributions to gait abnormalities and implications for treatment.

Identification of neuromuscular impairments in cerebral palsy (CP) is essential to providing effective treatment. However, clinical recognition of neuromuscular impairments in CP and their contribution to gait abnormalities is limited, resulting in suboptimal treatment outcomes. While CP is the most common childhood movement disorder, clinical evaluations often do not accurately identify and delineate the primary neuromuscular and secondary musculoskeletal impairments or their specific impact on mobility. Here we discuss the primary neuromuscular impairments of CP that arise from early brain injury and the progressive secondary musculoskeletal impairments, with a focus on spastic CP, the most common form of CP. Spastic CP is characterized by four primary interrelated neuromuscular impairments: 1. muscle weakness, 2. short muscle-tendon units due to slow muscle growth relative to skeletal growth, 3. muscle spasticity characterized by increased sensitivity to stretch, and 4. impaired selective motor control including flexor and extensor muscle synergies. Specific gait events are affected by the four primary neuromuscular impairments of spastic CP and their delineation can improve evaluation to guide targeted treatment, prevent deformities and improve mobility. Emerging information on neural correlates of neuromuscular impairments in CP provides the clinician with a more complete context with which to evaluate and develop effective treatment plans. Specifically, addressing the primary neuromuscular impairments and reducing secondary musculoskeletal impairments are important treatment goals. This perspective on neuromuscular mechanisms underlying gait abnormalities in spastic CP aims to inform clinical evaluation of CP, focus treatment more strategically, and guide research priorities to provide targeted treatments for CP.

Electrical stimulation: a potential alternative to positively impact cerebral health?

An increasing body of evidence confirms the effectiveness of physical exercise (PE) in promoting brain health by preventing age-related cognitive decline and reducing the risk of neurodegenerative diseases. The benefits of PE are attributed to neuroplasticity processes which have been reported to enhance cerebral health. However, moderate to high-intensity PE is necessary to induce these responses and these intensities cannot always be achieved especially by people with physical limitations. As a countermeasure, electrical stimulation (ES) offers several benefits, particularly for improving physical functions, for various neurological diseases. This review aims to provide an overview of key mechanisms that could contribute to the enhancement in brain health in response to ES-induced exercise, including increases in cerebral blood flow, neuronal activity, and humoral pathways. This narrative review also focuses on the effects of ES protocols, applied to both humans and animals, on cognition. Despite a certain paucity of research when compared to the more classical aerobic exercise, it seems that ES could be of interest for improving cerebral health, particularly in people who have difficulty engaging in voluntary exercise.

Adherence to the Mediterranean Diet: A Tool to the Therapeutic Approaches for Patients With Temporomandibular Joint Disorders.

BACKGROUND AND AIM: Temporomandibular joint disorder (TMD) is characterized by symptoms such as clenching, clicking, and locking of the jaw, often due to improper positioning affecting occlusion. Nearly half of TMD patients rarely require treatment, as symptoms typically diminish on their own within a year. Nevertheless, a significant majority of persons who are diagnosed with TMD do necessitate therapy, and it may take up to three years for complete remission to occur. This study aims to determine the extent to which a healthy nutritional model, specifically the Mediterranean diet, can enhance the effectiveness of existing therapeutic treatments, like physiotherapy with warm pads. METHODS: An interventional study design was implemented. Baseline scores were obtained pre- and post-intervention, while Mediterranean diet adherence was evaluated once at the beginning. A dependent samples t-test and a one-way multivariate analysis of covariance (MANCOVA) were used to test the experimental hypotheses. RESULTS: There is a statistically significant difference (p=0.04) between the three groups associated with Mediterranean diet adherence, as indicated by the mean differences on the Jaw Functional Limitation Scale (JFLS-20) questionnaire. Participants following a medium or high level of Mediterranean diet (≥18) reported fewer problems with jaw functionality both before and after the intervention compared to those with low (<18) adherence to the diet. CONCLUSION: Adherence to the Mediterranean diet appears to have a therapeutic effect on patients with TMD, offering a new dimension to their treatment. The primary benefit is the low cost of treatment, as the diet is easily accessible. This dietary approach could significantly enhance the management of TMD symptoms.

Predictive Value of Diaphragm Muscle Ultrasound for Ventilator Weaning Outcomes After Cervical Spinal Cord Injury: A Retrospective Case Series.

OBJECTIVES: Neuromuscular respiratory failure after cervical spinal cord injury (cSCI) can lead to dependence on an invasive mechanical ventilator. Ventilator-free breathing after cSCI is associated with improved morbidity, mortality, and quality of life. We investigated the use of diaphragm muscle ultrasound to predict ventilator weaning outcomes after cSCI. METHODS: This is a retrospective case series conducted at a university-affiliated freestanding inpatient rehabilitation facility. We identified patients with cSCI who had a tracheostomy and were dependent on an invasive mechanical ventilator at the time of admission to inpatient rehabilitation. A diaphragm muscle ultrasound was performed, which included measurements of the thickness of the diaphragm and a calculation of the thickening ratio (TR), which reflects diaphragm muscle contraction. The primary outcome measure was the need for mechanical ventilation at time of discharge from the inpatient rehabilitation facility. Successful ventilator weaning was defined as either daytime or full 24-hour ventilator-free breathing. RESULTS: Of the 21 patients enrolled, 11 (52%) were able to wean successfully (partially or fully) from the ventilator. Of the ultrasound measurements that were taken, the TR was the optimal predictor for ventilator weaning outcomes. A threshold of TR ≥ 1.2 as the maximum hemidiaphragm measurement had a sensitivity of 1.0 and specificity of 0.90 for predicting ventilator weaning. CONCLUSION: Normal diaphragm contractility (TR ≥ 1.2) as determined by diaphragm muscle ultrasound is a strong positive predictor for successful ventilator weaning in patients with cSCI. Utilizing diaphragm ultrasound, rehabilitation physicians can set precision rehabilitation goals regarding ventilator weaning for inpatients with respiratory failure after cSCI, potentially improving both outcomes and quality of life.

An Experimental Study to Optimize Neuromuscular Blockade Protocols in Cynomolgus Macaques: Monitoring, Doses, and Antagonism.

BACKGROUND: Neuromuscular blocking agents (NMBAs) are a crucial component of anesthesia and intensive care through the relaxation of skeletal muscles. They can lead to adverse reactions such as postoperative residual neuromuscular block. Only one agent is capable of an instant block reversal in deep block situations, but is restricted to aminosteroid agents. Among animal models, non-human primates are an essential model for a great diversity of human disease models. The main objective of this study was to establish a model for NMBA monitoring with current available drugs before testing new reversal agents. METHODS: Seven healthy male cynomolgus macaques were randomly assigned to this study. Experiments using macaques were approved by the local ethical committee (CEtEA #44). All animals were anesthetized according to institutional guidelines, with ketamine and medetomidine, allowing IV line placement and tracheal intubation. Anesthesia was maintained with isoflurane. Either rocuronium bromine (with or without sugammadex reversal) or atracurium besylate was evaluated. Monitoring was performed with two devices, TOF-Watch and ToFscan, measuring the T4/T1 and the T4/Tref ratios, respectively. Nonparametric Mann-Whitney statistical analyses were done when indicated. RESULTS: NMBA monitoring required adaptation compared to humans, such as stimulus intensity and electrode placement, to be efficient and valid in cynomolgus macaques. When administered, both NMBAs induced deep and persistent neuro-muscular block at equivalent doses to clinical doses in humans. The rocuronium-induced profound neuromuscular block could be reversed using the cyclodextrin sugammadex as a reversal agent. We report no adverse effects in these models by clinical observation, blood chemistry, or complete blood count. CONCLUSION: These results support the use of non-human primate models for neuromuscular block monitoring. This represented the first step before the forthcoming testing of new NMBA-reversal agents.

Fluoxetine antagonizes the acute response of LPS: Blocks K2P channels.

The channels responsible for maintaining resting membrane potential are known as K2P (two-P-domain K+ subunit) channels, a subset of which are known to be blocked by Fluoxetine. In this experiment, the compound's effects on the membrane potential were examined on muscles in larval Drosophila overexpressing a subtype of K2P channel (known in Drosophila as dORKA1 or ORKA1) and compared to larvae without overexpression. The compound was also observed in sequence and/or combination with a form of lipopolysaccharide (LPS) that transiently activates K2P channels. Different concentrations of Fluoxetine were tested, and it was also examined in cocktail with the LPS. At 25 µM Fluoxetine exposure, muscle in control larvae underwent depolarization, while muscles overexpressing K2P channels hyperpolarized; at 50 µM, however, much more variable responses were observed. The LPS caused hyperpolarization in both larval strains, but the effect was more transient in the Canton-S line than in the K2P overexpressors. Finally, LPS continued to cause hyperpolarization even in the presence of Fluoxetine, while Fluoxetine quickly depolarized the muscle during exposure to LPS. The cocktail showed a smaller effect on muscles overexpressing ORKA1 as compared to the controls, indicating that Fluoxetine does not block the ORKA1 subtype. This study is significant because it demonstrates how overexpression of K2P channels alters membrane response to LPS and Fluoxetine exposure.

Investigation of Neuromuscular Activation in Older Female Adults during a Dynamic and Challenging Virtual Reality Activity: A Cross-Sectional Study.

The use of virtual reality (VR) in older adults promotes improvements in mobility, strength, and balance. Changes in neuromuscular activation have been found to be associated with these improvements; however, during VR activities, this aspect has not been thoroughly investigated. The aim of this study was to investigate neuromuscular activation among older female adults during VR activities. Sixteen older female adults, with the use of VR, performed dynamic punching movements involving elbow flexion/extension for one minute, and the muscle activation of the bicep brachii was recorded with electromyography (EMG) and normalized to the maximal voluntary isometric contraction of elbow flexion. The one-minute activity was divided into three time phases: 0-10 s, 25-35 s, and 50-60 s. The five highest EMG amplitude values (%) in each phase were selected and averaged. Differences between phases were analyzed using repeated ANOVA (αadj = 0.017). The EMG amplitude for the first phase was 39.1 ± 2.6%, that for the second phase was 44.8 ± 3.0%, and that for the third phase was 49.6 ± 3.1%. Statistically significant differences were found in all phases, with the first phase demonstrating a lower EMG amplitude (%) compared to the second (p = 0.002) and third phases (p = 0.000). The third phase demonstrated a higher EMG amplitude (%) compared to the second phase (p = 0.025). Engagement in VR activities can have significant effects on neuromuscular activation in older female adults, with our findings revealing a significant increase in the EMG amplitude within one minute of commencing a dynamic and challenging activity such as virtual boxing.

Perceived Factors That Contributed to Task Termination during Fatiguing Tasks Anchored to Perceptual Intensities.

This study examined the effects of sustained, isometric forearm flexion tasks anchored to ratings of perceived exertion of 2 (RPE2FT) and 8 (RPE8FT) on the patterns of fatigue-induced changes in torque and neuromuscular responses, time to task failure (TTF), performance fatigability (% decline in maximal voluntary isometric contraction [MVIC]), and perceived factors that contributed to task termination. Twelve men (mean ± SD: age = 20.9 ± 2.2 yrs) performed MVICs before and after the tasks and completed post-test questionnaires (PTQ). Data were analyzed using polynomial regression analyses, dependent t-tests, Spearman's rank order correlations, and Wilcoxon signed rank tests. The RPE8FT had greater (p < 0.001) performance fatigability than the RPE2FT, despite no difference (p > 0.05) in TTF. During both tasks, there were significant (p ≤ 0.05) composite linear decreases for torque, electromyographic amplitude, and neuromuscular efficiency, and substantial individual variability in the neuromuscular responses. There were no significant (p > 0.05) associations among the perceived factors and TTF or performance fatigability. Thus, there were RPE-specific differences in performance fatigability, but not TTF or the composite patterns of changes in torque and neuromuscular responses. In addition, in most cases, the individual neuromuscular, but not torque, patterns of responses were RPE-specific. Furthermore, the perceived factors assessed by the PTQ were not related to TTF or performance fatigability.