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Fiber composition of the rat sciatic nerve.

The rat sciatic nerve originates from the spinal segments L4-L6. It is unifascicular at the trochanter; 5-7 mm distally, the nerve splits into two and then into four fascicles. The tibial portion gives rise to the tibial and the sural nerves, and the peroneal portion gives rise to the peroneal nerve and a cutaneous branch that perforates the lateral hamstring muscles to innervate the proximolateral face of the calf. The number and type of the axons in these branches were determined in light and electron micrographs of normal nerves, and after de-efferentation or sympathectomy. Deafferentation was technically not feasible because spinal ganglia and ventral roots were supplied by the same vascular plexus. The tibial nerve contained 1,000 motor and 3,500 myelinated afferent axons, 3,700 sympathetic axons, and 5,400 unmyelinated afferent axons. The peroneal nerve contained 600 motor and 1,300 myelinated afferent axons, 1,100 sympathetic axons and 3,000 unmyelinated afferent axons. The sural nerve contained 1,100 myelinated and 2,800 unmyelinated afferent axons; in addition, there were 1,500 unmyelinated sympathetic axons. The cutaneous branch consisted of 400 myelinated and 1,800 unmyelinated afferent axons. Thus, the entire sciatic nerve at midthigh is composed of about 27,000 axons; 6% are myelinated motor axons, 23% and 48% are myelinated and unmyelinated sensory axons, respectively, and 23% are unmyelinated sympathetic axons. The techniques used did not demonstrate sympathetic axons in the cutaneous branch and did not reveal the few motor axons contained in the sural nerve.

Adrenergic Fibers↗

The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients.

Patients with anterior cruciate ligament (ACL) injury experience atrophy and weakening of the extensor as well as the hamstrings muscles at the injured leg. Especially, the weakness of the quadriceps muscle has been ascribed to hamper daily physical tasks. The purpose of the present study was therefore to investigate if nutrient supplementation during 12 weeks of conservative rehabilitation strength training could enhance hypertrophy and strength of the quadriceps muscle in ACL-injured patients. Twenty-six ACL-injured men and women were included and randomly distributed into three supplementation groups: Protein+Carbohydrate (PC), Isocaloric-Carbohydrate (IC), or Placebo (PL), ingesting the supplementation immediately after each of 36 training sessions. Determined from images of thigh cross-sections (magnetic resonance imaging) the hypertrophy of the quadriceps muscle differed significantly between groups at the distal part, with the PC group demonstrating the largest hypertrophy. Peak torque of the quadriceps muscle at constant velocity 60 degrees.s-1 was significantly elevated in the PC group only, and the time to reach peak torque tended to decrease as well only in the PC group. The results from this study demonstrate that restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions. Thus, exercise-related protein supplementation may seem important for surgery-related rehabilitation of skeletal muscle.

Adolescent↗

Intrathecal galanin at low doses increases spinal reflex excitability in rats more to thermal than mechanical stimuli.

The neuropeptide galanin (GAL) was injected intrathecally (i.t.) in decerebrate, spinalized, unanesthetized rats and its effect on the nocifensive flexor reflex was examined. The reflex, which was evoked by intense mechanical or thermal stimulation of the foot, was recorded from the ipsilateral hamstring muscles. I.t. GAL increased reflex excitability significantly more to thermal than to mechanical stimuli. It is suggested that GAL, which is present in sensory fibers that innervate the skin, is released by the central terminals of cutaneous afferents that are much more sensitive to thermal than to mechanical stimuli.

Animals↗

The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation.

Endurance for dynamic exercise, cardiac output, blood pressure, heart rate, ventilation, and oxygen consumption was measured in eight individuals with paraplegia at the end of 4-min bouts of exercise on a friction braked cycle ergometer. Movement of the subjects' legs was induced by electrically stimulating the quadriceps, gluteus maximus and hamstring muscles with a computer-controlled biphasic square--wave current at a frequency of 30 Hz. The friction braked cycle ergometer was pedalled at work rates which varied between 0 and 40 W. Measurements were repeated after 3 and 6 months to assess the affect of training. After 3 months of training it was found that endurance increased from 8 min at a work rate of 0 W to 30 min at a work rate of 40 W. Compared to the cardiovascular responses in non-paralyzed subjects, computerized cycle ergometry was found to be associated with higher relative stresses for a given level of absolute work. Mean blood pressure, for example, increased by over 30% during maximal work in individuals with paralysis compared to the typical response obtained for able-bodied subjects. Analysis of the data showed that instead of the 20-30% metabolic efficiency commonly reported for cycle ergometry, the calculated metabolic efficiency during computer-controlled cycle ergometry was only 3.6%.

Adult↗

Body composition and its relation to bone mass and fractures in an urban and a rural population.

A higher incidence of fragility fractures in urban than in rural populations has been described. The present study included 954 randomly selected men and women between the ages of 40 to 80 years living in the cities of Malmö, an urban population, and Sjöbo, a typical agricultural community. Lean body mass (LBM) was estimated with a bioelectrical impedance method; bone mineral content (BMC) of the forearm was evaluated by single photon absorptiometry, and strength of the quadriceps, and hamstring muscles of the right knee, and hand grip were measured. The age-related difference in LBM between the ages of 50 to 80 were 7.8 kg in men and 2.9 kg in women. Urban men aged 60 and 70, and women aged 50 and 70 had a 1.8 to 3.7 kg lower LBM than rural subjects. One hundred women (17%) and 28 men (11%) had experienced fragility fractures. Women aged 70 with fragility fractures had 3.1 kg lower LBM than women without fractures, and the age-dependent difference in LBM was greater in the urban and rural women with fracture, than in women without fracture. LBM showed a higher correlation to BMC, in the range of 0.20-0.28, than the correlation between body weight and BMC. Quadriceps muscle strength was lower in the elderly age groups in both sexes, and a 40% decline was seen both in those from the highest and lowest quartiles of LBM. Use of LBM instead of body weight showed higher correlations to flexion strength of the knee and hand grip.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Knee-bending and -stretching-spastic in infant cerebral palsy. Surgery aimed at functional improvement and its results].

Any treatment of disorders of the knee in patients with cerebral palsy is a complex task in terms of indications and surgical technique. Surgical management has the potential to considerably improve function in walkers as well as tetraparetic patients. The close functional relationship between the knee joint and the adjacent hip and ankle joints requires an integrated view. An increased anterior pelvic tilt aggravates any shortening of the hamstring muscles. An equinus foot deformity increases knee extensor movement. When evaluating postoperative results, it is never sufficient to indicate the postoperative range of motion only. Instead, functional evaluation criteria complemented by instrumented gait analysis must be used to define the results more quickly and to uncover postoperative problems.

Cerebral Palsy↗

The amplitude modulation of the quadriceps H-reflex in relation to the knee joint action during walking.

Previously the modulation of the quadriceps H-reflex has only been investigated in the initial part of the gait cycle, and it was suggested that the quadriceps H-reflex modulates with relative high reflex gain at heel contact and decreases during the subsequent part of stance (Dietz et al. 1990b). The objectives of the present study was to elaborate on the previous results by increasing the measurement resolution around heel contact and include additional measures in order to relate the H-reflex modulation to the mechanical function of the knee extensors throughout the gait cycle. EMG profiles were measured in quadriceps and the antagonistic hamstring muscles simultaneously with the knee joint kinematics in ten subjects during treadmill walking at preferred speed. H-reflex excitability was measured in vastus lateralis (VL) and rectus femoris (RF) at 11 selected positions during the gait cycle. The resulting excitability curves showed a significant modulation of the quadriceps H-reflex during the gait cycle. The H-reflex amplitude increases shortly after heel contact and reflex inhibition is present in the remaining part of stance and most of the swing phase. The modulation of the quadriceps H-reflex during walking does not follow the classical pattern of reciprocal inhibition between antagonistic muscles. It is suggested that at least during the stance phase the modulation of the quadriceps H-reflex is controlled by presynaptic inhibition. The present results confirm the idea that the excitability of the quadriceps H-reflex is controlled to comply with the different mechanical demands on the muscle during the gait cycle in humans.

Adult↗

Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging.

We present multimodality imaging features of an ischial tuberosity apophysitis in a 13-year-old boy who was an active baseball pitcher. Roentgenography of the pelvis and computed tomography showed mild irregularity in the inferior margin of the left ischial tuberosity. T1-weighted MRI showed a wide area with low signal intensity in the left ischial body; T2-weighted fat-suppression images showed areas with markedly high signal intensity in the ischial apophysis and body and the surrounding periosteum; contrast-enhanced T1-weighted fat-suppression MRI showed that the ischial body, surrounding periosteum, and origin of the hamstring muscles strongly enhanced; technetium-99m scintigraphic scans showed increased isotope uptake in the entire ischial body. Histological specimens obtained from the bone showed increased osteoblastic activity, edema, and proliferation of benign spindle cells and small vessels in the bone marrow spaces. In the present case, because MR imaging demonstrated extensive signal abnormalities involving the apophysis, periosteum, and intramedullary portion of bone, a neoplasm could not be excluded, and a biopsy was undertaken.

Athletic Injuries↗

Effects of hydrogen peroxide cleaning procedures on bone graft osteoinductivity and mechanical properties.

Bone allografts are frequently used during orthopaedic trauma cases or other reconstructive procedures. Most allografts are processed and cleaned before use. Our goals were to determine if an improved cleaning procedure compromises the strength or osteoinductivity of a graft. We compared our improved cleaning procedure to our standard cleaning procedure on cortical bone allograft. The cleaning procedures are generally composed of a series of chemical steps with nonionic detergents, hydrogen peroxide, and alcohol under time and temperature control, subjected to ultrasonic agitation. We tested the compressive strength, impact strength, and shear strength following the standard and improved cleaning procedures. Osteoinductivity was tested in 4 groups, using the improved cleaning procedure with four different hydrogen peroxide cleaning times: 0, 1, 3, and 5 h. Osteoinductivity was evaluated in vivo, using a 28-day implant in the hamstring muscle of an athymic, nude mouse. Results demonstrated that osteoinductivity is maintained with cleaning in hydrogen peroxide for up to 1 h, and that compressive strength, impact strength, and shear strength were all unaffected by the improved cleaning procedure. The improved cleaning procedure therefore did not compromise the strength or osteoinductivity of cortical bone allografts in comparison to the standard procedure.

Adult↗

Sizes of soma and stem dendrites in intracellularly labelled alpha-motoneurones of the cat.

The morphology of identified hindlimb motoneurones was studied after intracellular labelling with Procion yellow (59 cells), Procion red (19 cells) or horseradish peroxidase (9 cells). With respect to the measurements performed, all three intracellular labels gave similar results. As judged by their axonal conduction velocity (62-117 m/sec) all included cells were alpha-motoneurones. The motoneuronal cell bodies had cross-sectional areas of 816-3732 sq. microns, corresponding to diameters of about 32-69 microns. On average each neurone had 12 (5-20) dendritic stems. For all cells together, the number of dendritic stems per neurone was not strongly correlated to soma diameter. In the whole material, the dendritic stem diameters varied between about 0.5 and 19 microns. Stem dendrites of 4-5 microns were common in all kinds of cells, whereas thicker dendritic stems were preferentially distributed to cells with larger somas. The maximum as well as the mean stem-dendrite diameter (d) per cell was clearly correlated to, and roughly proportional to, the diameter of the cell body. The sum of the cross-sectional areas of all the dendritic stems emanating from a cell ('sum of dendritic holes' = sigma pi d2/4) was roughly proportional to the volume of the soma. Quadriceps motoneurones had a markedly greater number of dendritic stems per cell (mean 16.9) than other kinds of hindlimb motoneurones studied (mean 11.5; includes motoneurones of the hamstring muscles, triceps surae and intrinsic foot muscles). The many quadruceps dendrites were, however, also relatively thin, and the average ratio between 'sum of dendritic holes' and soma volume was the same for quadriceps motoneurones as for the other cells.

Animals↗

Adapting human postural reflexes following localized cerebrovascular lesion: analysis of bilateral long latency responses.

The symmetry and adaptability of long latency stretch responses was studied in a group of 4 adult hemiplegics and 5 normals of similar age. Subjects stood on a moveable platform which directly rotated the ankles unexpectedly during a series of horizontal anterioposterior (AP) translations. When the platform was rotated toes-up, long latency discharge of gastrocnemius and hamstring muscles enhanced loss of balance by pulling the body backwards. Toes-down platform rotation elicited a reflex response from tibialis anterior and quadriceps which inappropriately pulled the body forward. Attenuation of these long latency responses was necessary to minimize functional destabilization. Normal and stroke subjects demonstrated appropriate suppression of long latency responses, but the magnitude of attenuation was not uniform in hemiplegics. Adaptation was decreased in the proximal synergists compared to normal. Latency of muscle activation in the paretic limb was prolonged, and a preference for initial non-paretic limb activation was evident. Both lower extremities in hemiplegics showed a disruption of timing between distal and proximal synergists. These results suggest that stroke victims retain or recover the ability to modulate stretch reflex activity for balance. Temporal and spatial response asymmetries surface as critical factors underlying disequilibrium associated with localized cerebrovascular lesion.

Adaptation, Physiological↗

Substance P N-terminus inhibits C-fiber-dependent facilitation of the rat flexor reflex.

Substance P injected intrathecally or a conditioning stimulus (1 Hz, 20 s) at C-fiber strength, which releases substance P from intraspinal primary afferent terminals, each enhance the hamstring muscle flexor reflex elicited by electrical stimulation of the sural nerve in decerebrate, spinalized rats. This suggests a role for substance P in pain transmission. Since substance P N-terminal metabolites are biologically active, we examined the effect of the metabolite substance P-(1-7) on the flexor reflex and the enhancement of the flexor reflex following a conditioning stimulus of the sural nerve. In contrast to the excitatory effect of substance P, intrathecal injection of substance P-(1-7) had no effect on the flexor reflex. However, 10 and 30 min after injection, 0.6 or 6 micrograms of substance P-(1-7) attenuated the facilitation of the flexor reflex by the conditioning stimulus. These data indicate that substance P-(1-7) may modulate the expression of nociception involving repetitive firing of C-fibers while having no significant effect on acute or phasic responses.

Animals↗

A noninvasive method for studying quantitatively heat-evoked nocifensive hindlimb withdrawal reflexes in lightly anesthetized rats.

We have developed a noninvasive method for studying quantitatively the magnitude of hindlimb withdrawal reflexes induced by noxious heat in lightly anesthetized rats. The amplitude, latency, and duration of the hindlimb withdrawal was determined by a very small piezoceramic device placed on the hamstring muscle while the glabrous skin of the hindpaw was stimulated using a feedback-controlled contact thermostimulator. An increase in the amplitude and duration of the withdrawal response, concomitant with a decrease in the response latency, was found with increasing stimulus temperature. The sensitivity of the method was verified using morphine, which produced a dose-related (3.5-7.0 mg/kg) attenuation of all these response components. The use of a piezoceramic device for measuring the withdrawal response provides a quantitative, noninvasive method for evaluating the magnitude of various components of the nocifensive withdrawal reflexes induced by noxious stimuli in lightly anesthetized rats.

Animals↗

Morphine-sensitive late components of the flexion reflex in the neonatal rat.

The 8-15-day-old rat spinal cord was isolated together with peripheral nerves innervating a hindlimb. Multiunit neural discharges in response to electrical stimulation of a cutaneous nerve (sural, plantar of superficial peroneal nerve) were recorded from a flexor nerve (deep peroneal nerve or nerve innervating the hamstring muscles). Attempts were made to find relations between the magnitude of the flexion reflex discharges and the sizes of the volleys in the myelinated or unmyelinated afferent fibers. The neonatal flexion reflex discharges due to myelinated fiber volleys were exaggerated when compared with those in the adult rats. Higher stimulus strengths recruited later components of the flexion reflex discharges. The observed increment of the flexion reflex discharges was precisely associated with the recruitment of unmyelinated afferent fibers in the nerve. These late flexion reflex discharges were shown to be depressed by the opiate analgesic morphine in a naloxone-reversible manner.

Animals↗

The effects of intrathecal morphine and clonidine on the prevention and reversal of spinal cord hyperexcitability following sciatic nerve section in the rat.

We have previously shown that intrathecal (i.t.) morphine, but not the alpha 2-adrenoreceptor agonist clonidine, administered prior to sciatic nerve section, reduced the level of autotomy in rats, which is a behavioural model of neuropathic pain. Neither drug was effective when administered 15 min after nerve section. We now examined the effects of i.t. morphine and clonidine on the development of flexor reflex hyperexcitability following sciatic nerve section in acute physiological experiments. The flexor reflex was recorded from the hamstring muscles in decerebrate, spinalized, unanesthetized rats. The effect of sciatic nerve section on the flexor reflex without drugs was compared with axotomy performed 60 min after i.t. injection of 3 micrograms or 30 micrograms morphine, as well as 50 micrograms clonidine. The effect of these drugs on reversing reflex hyperexcitability was also examined. Both doses of morphine administered prior to sciatic nerve section profoundly depressed the baseline reflex and the higher dose almost completely abolished reflex hyperexcitability following nerve section. In contrast, clonidine pre-administration was less effective in depressing the baseline reflex and blocked reflex hyperexcitability less than morphine. Both morphine and clonidine administered 15 min after nerve section reversed spinal hyperexcitability. Thus, the ability of morphine to prevent the occurrence of autotomy may be related to its effectiveness in blocking axotomy-induced hyperexcitability. These physiological data suggest that even a short period of spinal cord hyperexcitability following nerve injury may lead to the development of neuropathic pain.

Animals↗

Spinal substance P and N-methyl-D-aspartate receptors are coactivated in the induction of central sensitization of the nociceptive flexor reflex.

We have studied the effects and interactions of the neurokinin-1 receptor antagonist CP-96,345 and the N-methyl-D-aspartate receptor/channel blocker MK-801, both applied intravenously, on the flexor reflex and on the facilitation of the flexor reflex by conditioning stimulation of cutaneous C-afferents in decerebrate, spinalized, unanesthetized rats. The flexor reflex was evoked by subcutaneous electrical stimuli applied to the sural nerve innervation area 1/min at an intensity that activated C-fibers and was recorded as electromyogram from the ipsilateral hamstring muscles. The magnitude of the baseline flexor reflex was usually highly stable in the course of the experiments without experimental manipulations. The same stimulus was used as a conditioning train (0.9 Hz, 20 shocks) and caused a brief facilitation of the flexor reflex, which was maximal 0.5 and 1 min after stimulation (255.1 +/- 23.6% over baseline). During the course of the conditioning stimulus train, the reflex magnitude was gradually increased (wind-up). MK-801 (0.1 and 0.5 mg/kg) consistently depressed the polysynaptic flexor reflex. At a dose of 0.5 mg/kg, but not 0.1 mg/kg, MK-801 reduced the wind-up and blocked the facilitation of the flexor reflex induced by the conditioning stimulus by 90%. The facilitatory effect of 7 pmol intrathecal substance P was also partially reduced by MK-801. CP 96,345 (1 and 3 mg/kg) did not depress the flexor reflex, but dose-dependently antagonized reflex facilitation by the conditioning stimulus train, similarly to its antagonism of intrathecally applied 7 pmol substance P-induced facilitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Intrathecal pituitary adenylate cyclase activating polypeptide facilitates the spinal nociceptive flexor reflex in the rat.

We have examined the effects of intrathecal (i.t.) pituitary adenylate cyclase activating polypeptide on the spinal nociceptive flexor reflex in decerebrate, spinalized, unanaesthetized rats. The flexor reflex was elicited by electrical stimulation applied subcutaneously to the sural nerve innervation area and recorded as electromyogram activity from ipsilateral hamstring muscles. Pituitary adenylate cyclase activating polypeptide(l-27) was administered over a wide dose range (10 ng to 10 mu g) and elicited a dose-dependent facilitation of the flexor reflex and did not depress the reflex at any dose. Furthermore, pituitary adenylate cyclase activating polypeptide did not inhibit the facilitation of the flexor reflex induced by repetitive stimulation of C-fibres. It is concluded that pituitary adenylate cyclase activating polypeptide had an excitatory effect on spinal cord function which may indicate a role for this peptide in nociceptive transmission and modulation. Moreover, in contrast to previous studies, we found no evidence suggesting that pituitary adenylate cyclase activating polypeptide exerts antinociceptive action at spinal level.

Animals↗

Kinematic analysis of conventional and high-flexion cruciate-retaining total knee arthroplasties: an in vitro investigation.

This study examined the kinematics of a cruciate-retaining (CR) total knee arthroplasty (TKA) component that attempts to enhance knee flexion by improving posterior tibiofemoral articular contact at high-flexion angles. Using an in vitro robotic experimental setup, medial and lateral femoral translations of this CR design were compared with that of a conventional CR TKA design and intact knee under a combined quadriceps and hamstring muscle load. Both CR TKA designs showed similar kinematics throughout the range of flexion (0 degrees -150 degrees ). The TKAs restored nearly 80% of the posterior femoral translation of the intact knee at 150 degrees . The posterior cruciate ligament (PCL) forces measured for the high-flexion CR TKA component indicate that the PCL is important in the mid-flexion range but has little effect on knee kinematics at high flexion.

Aged↗