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Biomedical subjects

C L Rice

Publications and source records attributed to C L Rice.

At least 19 recordsLinked to original sources
PubMed2004

The molecular epidemiology of Streptococcus pneumoniae with quinolone resistance mutations.

BACKGROUND: The purpose of this study was to determine the prevalence of fluoroquinolone resistance and quinolone resistance-determining region (QRDR) mutations among Streptococcus pneumoniae isolates in the United States during the period of 2001-2002. A second objective was to examine the genetic relatedness of pneumococcal isolates with parC and/or gyrA mutations during the period of 1994-2002. METHODS: Susceptibility testing was performed for 1902 S. pneumoniae isolates collected in the United States during the period of 2001-2002. On the basis of the minimum inhibitory concentration (MIC) of ciprofloxacin, 146 isolates were selected from the 2001-2002 study for QRDR analysis of parC, parE, gyrA, and gyrB genes. The genetic relatedness of isolates with parC and/or gyrA mutations from 2001-2002 (n=55) and from 3 US surveillance studies conducted during 1994-2000 (n=56) was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Between 1999-2000 and 2001-2002, there was a 2-fold increase in the rate of ciprofloxacin resistance (MIC, >or=4 micro g/mL), from 1.2% to 2.7%, and in the rate of levofloxacin nonsusceptibility (MIC, >or=4 micro g/mL), from 0.6% to 1.3%. The 111 isolates with parC and/or gyrA mutations were assigned to 48 different PFGE types. Forty-four isolates (40%) belonged to 8 PFGE types that were closely related to widespread clones. Fifteen of the 43 levofloxacin-nonsusceptible pneumococci (LNSP) belonged to 4 PFGE types that were closely related to major clones (Spain(23F)-1 [n=6]; Spain(6B)-2 [n=5], Taiwan(19F)-14 [n=2], and Tennessee(23F)-4 [n=2]). CONCLUSION: The population of fluoroquinolone-resistant S. pneumoniae in the United States has increased but remains genetically diverse. However, 35% of LNSP were related to widespread pneumococcal clones, increasing the potential for the rapid spread of quinolone resistance in this species.

Anti-Bacterial Agents↗
PubMed2002

Muscle size, strength, and bone geometry in the upper limbs of young and old men.

BACKGROUND: Bone loss in old men is associated with a decrease in muscle mass and strength. However, the influence of muscle size and strength on age-related changes in bone geometry has not been comprehensively described. Methods. Men in their third (group I, 23 +/- 3 y, n = 20), eighth (group II, 77 +/- 1 y, n = 10), and ninth (group III, 86 +/- 4 y, n = 13) decades of age were studied. The cross-sectional area (CSA) of the elbow flexors, elbow extensors, and forearm muscles, the total area (TA), cortical area (CA), and medullary area (MA) of the midhumerus, and distal third of the radius and ulna (n = 7 group II; n = 6 group III) were measured with magnetic resonance imaging. The maximal isometric strength (MVC) of the elbow flexors and elbow extensors was also determined. RESULTS: The CSA and MVC of the arm muscles (elbow flexors plus elbow extensors) were less in group II (-17% and -22%) and III (-32% and -39%), respectively, compared to group I. However, forearm CSA was less (-21%) in group III only. The TA and MA of all bones were greater in the older groups. The CA of the humerus (-14%) and ulna (-10%), but not the radius, was less in group III compared to group I, whereas CA was unchanged in group II. Stepwise multiple linear regression determined that arm muscle CSA (r = 0.52, p <.01) and forearm muscle CSA (r = 0.41, p <.05) provided the best prediction of CA in the humerus and forearm, respectively. CONCLUSIONS: Muscle size and strength are important determinants of CA in the humerus and forearm. The lower CA in the ninth decade may be explained, in part, by reduced bone strains due to a smaller muscle mass.

Adult↗
PubMed2002

Changes in motor unit discharge rate are not associated with the amount of twitch potentiation in old men.

This study examined, in nine old men (82 +/- 4 yr), whether there is an association between the magnitude of change in motor unit discharge rate and the amount of twitch potentiation after a conditioning contraction (CC). The evoked twitch force and motor unit discharge rate during isometric ramp-and-hold contractions (10-18 s) of the triceps brachii muscle at 10, 20, and 30% of the maximal voluntary contraction were determined before and 10 s, 2 min, 6 min, and 11 min after a 5-s CC at 75% maximal voluntary contraction. After the CC, there was a potentiation of twitch force (approximately twofold), and the discharge rate of the 47 sampled motor units declined (P < 0.05) an average of 1 Hz 10 s after the CC, compared with the control condition. The CC had no effect on the variability (coefficient of variation) of both force and discharge rate, as well as the electromyographic activity recorded over the triceps brachii and biceps brachii muscles. In contrast to our earlier study of young men (Klein CS, Ivanova TD, Rice CL, and Garland SJ, Neurosci Lett 316: 153-156, 2001), the magnitude of the reduction in discharge rate after the CC was not associated (r = 0.06) with the amount of twitch potentiation. These findings suggest an age-related alteration in the neural strategy for adjusting motor output to a muscle after a CC.

Aged↗
PubMed2001

Motor unit discharge rate following twitch potentiation in human triceps brachii muscle.

It has been proposed that during brief voluntary contractions, twitch potentiation may sustain force output despite a decline in motor unit discharge rate. This study examined the evoked twitch force and motor unit discharge rates during submaximal voluntary contractions of the triceps brachii muscle before and after a 5 s conditioning contraction (CC) at 75% of maximal voluntary force. After the CC, twitch force potentiated ( approximately 1.3-2-fold), and the discharge rate in 33 of 35 motor units declined significantly by 1-6 Hz. The increase in twitch force was significantly correlated with the decline in discharge rate (r=-0.74). These findings suggest that the extent of the decrease in motor unit discharge rate following a CC is associated with the magnitude of twitch potentiation.

Action Potentials↗
PubMed2001

Quadriceps muscle function and fatigue in women with Addison's disease.

In nine patients with Addison's disease (mean +/- SE: 51 +/- 2 years) receiving conventional steroid treatment, and nine age-matched healthy controls (56 +/- 2 years), we investigated maximum voluntary quadriceps force (MVC) and contractile properties evoked with stimulation and central activation both at rest and during a submaximal intermittent fatigue task. The MVC was similar (-3%), but twitch tension (-27%) and central activation were significantly less (-7%), and tetanic half-relaxation time was approximately 40% slower in the patients. Twitch amplitudes were potentiated by 6% in the patients, but unchanged in the control group. The patients self-terminated a submaximal intermittent fatigue protocol (0.6 duty cycle) at approximately 5 +/- 1 min, whereas the controls stopped when they lost 50% of MVC force ( approximately 10 +/- 1 min). Force loss was similar between groups over the first 5 min of the fatigue task. In the patient group, maximal and submaximal relative integrated electromyogram (IEMG) increased significantly in the first minute of fatigue and remained elevated, whereas the controls exhibited a gradual increase in submaximal IEMG with little change in maximal IEMG. These results indicate that conventionally treated Addison's patients have similar MVC strength, but altered contractile properties and decreased endurance compared with controls.

Addison Disease↗
PubMed2001

Incomplete recovery of voluntary isometric force after fatigue is not affected by old age.

The 60-min recovery profiles of voluntary and electrically stimulated force, contractile speed, surface electromyography, muscle activation via twitch interpolation, and muscle compound action potentials (M-waves) in the elbow flexors of seven young men (24 +/- 2 years) and seven men over 80 years of age (84 +/- 2 years) were compared following intermittent (3 s on, 2 s off) contractions at 60% of each subject's maximum voluntary contraction (MVC) force. There was no age-related difference between groups in the average time to fatigue or the rate of voluntary force loss; both groups lost 40% of their force within approximately 5 min. Despite a rapid increase to approximately 83% of the prefatigue MVC by the third minute of recovery for both groups, MVC force did not return to the prefatigue value within 60 min (94 +/- 4% young, 91 +/- 3% old). These results suggest that the incomplete recovery of voluntary force was likely due to a peripheral limitation in the muscle at the level of excitation--contraction coupling, and was not affected by age. Delayed recovery of voluntary force and a greater degree of low-frequency fatigue in the old men were not observed and there were no age-related impairments in any parameter normalized to the prefatigue value during fatigue or recovery. We suggest that the specific fatigue task may be more important to recovery than proposed alterations in the aged neuromuscular system when normalization and matching of the fatigue task criteria occurs.

Adult↗
PubMed2001

Neuromuscular properties and fatigue in older men following acute creatine supplementation.

The purpose of this study was to investigate the effects of creatine (Cr) supplementation in 12 older (65-82 years) men. The subjects were randomly assigned to a Cr or a placebo (P) group. Seven men were supplemented with 5 g of Cr and 5 g maltodextrin four times a day for 5 days (Cr), and 5 men consumed 5 g of maltodextrin four times a day for 5 days (P). Following this treatment body mass increased significantly in the Cr group (1 kg), but did not change in the P group, and measurements of arm anthropometry were not affected in either group. Prior to and following supplementation maximal isometric voluntary force (MVC), muscle activation, contractile properties and surface electromyography (EMG) were measured in the elbow flexor muscles at baseline, during a fatiguing task and over 10 min of recovery. The fatigue protocol involved both voluntary and contractile stimulated. Stimulated contractile properties, MVC, and muscle activation were not affected by Cr supplementation. Furthermore, there were no changes in time to fatigue, decline in MVC force, muscle activation, EMG or contractile properties during the fatigue protocol. The rates of recovery of voluntary force, and stimulated contractile force did not change following Cr supplementation. These results indicate that short-term Cr supplementation in older men does not influence isometric performance of the elbow flexor muscles.

Aged↗
PubMed2001

Normalized force, activation, and coactivation in the arm muscles of young and old men.

The purpose of this study was to determine whether the loss of muscle strength in the elderly could be explained entirely by a decline in the physiological cross-sectional area (PCSA) of muscle. Isometric force, muscle activation (twitch interpolation), and coactivation (surface electromyograph) were measured during maximal voluntary contractions (MVCs) of the elbow flexors (EFs) and extensors (EEs) in 20 young (23 +/- 3 yr) and 13 older (81 +/- 6 yr) healthy men. PCSA was determined using magnetic resonance imaging, and normalized force (NF) was calculated as the MVC/PCSA ratio. The PCSA was smaller in the old compared with the young men, more so in the EEs (28%) compared with the EFs (19%) (P < 0.001); however, the decline in MVC (approximately 30%) with age was similar in the two muscle groups. Muscle activation was not different between the groups, but coactivation was greater (5%) (P < 0.001) in the old men for both muscles. NF was less (11%) in the EFs (P < 0.01) and tended to be unchanged in the EEs of the old compared with young subjects. The relative maintenance of NF in the EEs compared with the EFs may be related to age-associated changes in the architecture of the triceps brachii muscle. In conclusion, although the decline in PCSA explained the majority of strength loss in the old men, additional factors such as greater coactivation or reduced specific tension also may have contributed to the age-related loss of isometric strength.

Adult↗
PubMed2001

Cutting healthcare costs without rationing at the bedside: preserving the doctor-patient fiduciary relationship.

In his essay on bedside rationing, Peter Ubel argues that in an era of rising healthcare costs, it is time to relax the patient-centered ethic of physicians as unconditional patient advocates so they can individualize rationing decisions. This paper raises several concerns with the arguments and the examples he provides to make his case. First, he overlooks cost-effectiveness when making medical spending decisions. Second, his examples of wasteful, unproven and potentially harmful interventions call for physician education, not rationing, as he suggests. Third, informed patients can play a role in lowering costs through shared decision making. Fourth, individualized rationing decisions will worsen already pervasive disparities in medical care. The paper envisions the ideal cost-conscious physician as one who is knowledgeable about cost-effective practices, avoids unproven interventions whenever possible, and facilitates shared decision making through patient education. Such an individual would not, however, withhold interventions of proven benefit except when accommodating a patient's preferences for a particular therapy. The doctor and patient can only work together within the constraints of system-wide rationing if the fiduciary relationship is never violated.

Cost Savings↗
PubMed2000

Contractile properties, fatigue and recovery are not influenced by short-term creatine supplementation in human muscle.

There have been several studies on the effect of short-term creatine (Cr) supplementation on exercise performance, but none have investigated both voluntary and stimulated muscle contractions in the same experiment. Fourteen moderately active young men (19-28 years) were randomly assigned, in a double blind manner, to either a creatine (Cr) or placebo (P) group. The subjects supplemented their regular diet 4 times a day for 5 days with either 5 g Cr + 5 g maltodextrin (Cr group), or 5 g maltodextrin (P group). Isometric maximal voluntary contraction (MVC), muscle activation, as assessed using the modified twitch interpolation technique, electrically stimulated contractile properties, electromyography (EMG), endurance time and recovery from fatigue were measured in the elbow flexors. The fatigue protocol involved both voluntary and stimulated contractions. Following supplementation there was a significant weight gain in the Cr group (1.0 kg), whereas the P group did not change. For each group, pre-supplementation measures were not significantly different from post-supplementation for MVC, twitch and tetanic tensions at rest, time to peak tension, half-relaxation time and contraction duration. Prior to Cr supplementation time to fatigue was 10 +/- 4 min (mean +/- S.E.M.) for both groups, and following supplementation there was a non-significant increase of 1 min in each group. MVC force, muscle activation, EMG, stimulated tensions and durations were similar for the Cr and P groups over the course of the fatigue protocol and did not change after supplementation. Furthermore, recovery of MVC, stimulated tensions and contractile speeds did not differ as a result of Cr supplementation. These results indicate that short-term Cr supplementation does not influence isometric elbow flexion force, muscle activation, stimulated contractile properties, or delay time to fatigue or improve recovery.

Adult↗
PubMed1999

Quadriceps muscle strength, contractile properties, and motor unit firing rates in young and old men.

Changes with age in the voluntary static and dynamic strength of the quadriceps muscle group have been well characterized, and the importance of the muscle group for locomotion and independent living have been highlighted in both normal human aging and in clinical studies. Surprisingly few studies of this muscle group have described age-related changes in voluntary activation ability using twitch interpolation and changes in stimulated contractile properties, and none have assessed the influence of old age on motor unit firing rates. We compared in 13 young (mean age 26 years) and 12 old (mean age 80 years) men the voluntary isometric strength, stimulated contractile properties, and average steady state motor unit firing rates in the quadriceps muscle. Maximum voluntary contraction (MVC) force and twitch tension were approximately 50% lower in the old men, but contractile speed was only approximately 10% slower than in the young men. There was no difference in the ability of either group to activate the quadriceps to a high degree (94-96%). At all isometric force levels tested (10%, 25%, 50%, 75%, and 100% MVC), there were no differences in mean motor unit firing rates. In both groups, the range of firing rates was similar and not large ( approximately 8 Hz at 10% MVC and 26 Hz at MVC). Thus, the substantial age-related weakness in this muscle does not seem to be related to changes in neural drive.

Adult↗
PubMed1999

Motor unit firing rates and contractile properties in tibialis anterior of young and old men.

The effects of aging on motoneuron firing rates and muscle contractile properties were studied in tibialis anterior muscle by comparing results from six young (20.8 +/- 0.8 yr) and six old men (82.0 +/- 1.7 yr). For each subject, data were collected from repeated tests over a 2-wk period. Contractile tests included maximal voluntary contraction (MVC) with twitch interpolation and stimulated twitch contractions. The old men had 26% lower MVC torque (P < 0.01) than did the young men, but percent activation was not different (99.1 and 99.3%, respectively). Twitch contraction durations were 23% longer (P < 0.01) in the old compared with the young men. During a series of repeated brief steady-state contractions at 10, 25, 50, 75, and 100% MVC, motor unit firing rates were recorded. Results from approximately 950 motor unit trains in each subject group indicated that at all relative torque levels mean firing rates were 30-35% lower (P < 0.01) in the old subjects. Comparisons between young and old subjects' mean firing rates at each of 10%, 50%, and MVC torques and their corresponding mean twitch contraction duration yielded a range of moderate-to-high correlations (r = -0.67 to -0.84). That lower firing rates were matched to longer twitch contraction durations in the muscle of old men, and relatively higher firing rates were matched with shorter contraction times from the young men, indirectly supports the neuromuscular age-related remodeling principle.

Action Potentials↗
PubMed1998

Outcome after hemorrhagic shock in trauma patients.

BACKGROUND: It is essential to identify patients at high risk of death and complications for future studies of interventions to decrease reperfusion injury. METHODS: We conducted an inception cohort study at a Level I trauma center to determine the rates and predictors of death, organ failure, and infection in trauma patients with systolic blood pressure < or = 90 mm Hg in the field or in the emergency department. RESULTS: Among the 208 patients with hemorrhagic shock (blood pressure < or = 90 mm Hg), 31% died within 2 hours of emergency department arrival, 12% died between 2 and 24 hours, 11% died after 24 hours, and 46% survived. Among those who survived > or = 24 hours, 39% developed infection and 24% developed organ failure. Increasing volume of crystalloid in the first 24 hours was strongly associated with increased mortality (p = 0.00001). CONCLUSION: Hemorrhage-induced hypotension in trauma patients is predictive of high mortality (54%) and morbidity. The requirement for large volumes of crystalloid was associated with increased mortality.

Adolescent↗
PubMed1997

Age-related changes in motor unit function.

This review focuses on the functional relationship between age-related morphological and physiological changes at the level of the motor unit (MU). It is well established that older humans are weaker than younger people, exhibit reduced force control, and have slower neuromuscular contractile properties. Older people may also exhibit a decrease in MU discharge rate, and an increase in variability of MU discharge at high force levels. The matching of MU discharge and contractile properties may be an age-related neurophysiological strategy adopted to optimize motor control, similar to that observed in acute conditions such as fatigue. Because muscle force output is modulated partially by MU discharge behavior, the study of these properties may offer insights into the physiology of muscular weakness and motor function in older people. In turn, this will allow the implementation of optimal exercise and rehabilitation programs to reduce the degree of dependence associated with aging.

Aging↗
PubMed1995

Task-dependent factors in fatigue of human voluntary contractions.

This chapter explores the hypothesis that fatigue is not caused uniquely by any common set of factors, but rather that the amount of stress placed on each site depends on the type of exercise from which fatigue develops. Evidence supporting this idea is presented by comparing results from various studies in which fatigue was caused by different exercise protocols. However, the way in which human endurance capacity changes with the type or intensity of the task performed suggest a unitary process. Thus, perhaps the neuromuscular system as a whole is so well adjusted that any task-related additional impairment at one site is compensated by corresponding functional improvements at others. We suggest that nature has had a long time in which to "get it right".

Exercise↗