Oxygen cost of resistive-loaded breathing in quadriplegia.

We hypothesized that, in quadriplegia, chest wall distortion would increase the energy cost of ventilation. To assess this, we measured the oxygen cost of breathing (VO2 resp) and changes in chest wall configuration during inspiratory resistive-loaded breathing tasks in five quadriplegic and five normal subjects. Each subject performed three breathing tasks that spanned a range of work rates (Wtot). Configurational changes of the abdomen and upper, lower, and transverse rib cage were assessed with magnetometers. We found that 1) in both groups, VO2resp increased linearly with Wtot over the range of tasks performed, 2) the mean slope of the regression line of VO2resp vs. Wtot was greater for quadriplegic than for normal subjects (3.7 +/- 0.8 vs. 2.0 +/- 0.7 ml O2/J, P less than 0.01), 3) efficiency of breathing (Wtot/VO2resp) was less for quadriplegic than for normal subjects (1.9 +/- 0.6 vs. 3.5 +/- 1.4%, P less than 0.001), 4) during inhalation, upper and lower rib cages behaved similarly in the two groups, but the quadriplegic subjects had a decrease in transverse rib cage and a much greater increase in abdomen than normal subjects, and 5) functional residual capacity decreased in normal but not in quadriplegic subjects during the breathing tasks. We conclude that the lesser efficiency of breathing in quadriplegia may be related to the elastic work of chest wall distortion, shorter mean operational diaphragm length, and possibly differences between normal and quadriplegic subjects in mechanical advantage of available inspiratory muscles.     

Anisotropy of energy losses in high-current Z-pinches produced by the implosion of cylindrical tungsten wire arrays

Results are presented from measurements of the anisotropy of energy losses in high-current Z-pinches produced by the implosion of wire arrays at the ANGARA-5-1 facility at load currents of up to 4MA. The energy losses were measured in the radial direction and along the pinch axis from the anode side. The main diagnostics were time-integrated thermocouple calorimeters, nanosecond X-ray diodes (XRDs) with different filters, and a foil radiation calorimeter with a time resolution of 2 μs. The azimuthal anisotropy of energy losses was measured for different wire array configurations and different shapes of the high-voltage electrode. The presence of strong initial azimuthal inhomogeneity of the wire mass distribution (sectioned arrays), as well as the use of conical electrodes instead of plane ones, does not increase the azimuthal inhomogeneity of the total energy losses. For cylindrical wire arrays, energy losses in the radial direction are compared with those along the pinch axis. According to XRD and calorimetric measurements, the radiation yield per unit solid angle along the pinch axis is two to three times lower than that in the radial direction. In the axial direction, the energy flux density of the expanding plasma is two to three times lower than the radiation intensity. The measured radiation yield across the pinch is 2.5–5 kJ/sr, while that along the pinch axis is 1–2 kJ/sr. The results obtained by means of XRDs agree to within measurement errors with those obtained using the radiation calorimeter. It is found that the energy per unit solid angle carried by the expanding plasma in the radial direction does not exceed 10% of the soft X-ray yield. Analysis of the structure of time-integrated pinhole images and signals from the radial and axial XRDs shows that radiation emitted in the radial direction from the hot central region of the pinch is partially screened by the less dense surrounding plasma halo, whereas radiation emitted in the axial direction is a superposition of the emissions from the hot dense central region of the pinch and the colder less dense peripheral plasma.     

Quantitative pinch stimulator for exploring evoked nociceptive responses: A pilot study

Background  

A mechanical noxious stimulator is useful for studies of pain, both for clinic and basic research. We propose to use a pinch stimulator that can not only generate a quantitative, reproducible noxious pinch but also simultaneously provide a synchronous external trigger signal, which is essential for acquisition of evoked potentials.     

Respiratory responses to ventilatory loading following low cervical spinal cord injury

This study compared the respiratory responses to ventilatory loading in 8 normal subjects and 11 quadriplegic patients with low cervical spinal cord transection. Progressive hypercapnia was produced by rebreathing. Rebreathing trials were carried out with no added load and with inspiratory resistive loads of 5 and 16 cmH2O. l-1 X s. Measurements were made of ventilation and of diaphragmatic electromyographic activity. Base-line hypercapnic ventilatory responses were significantly lower than normal in the quadriplegic patients, but the effects of resistive loading on the ventilatory responses were comparable in the two groups. The change in peak moving-average diaphragmatic electrical activity (DI peak) for a given change in CO2 partial pressure (PCO2) and DI peak at PCO2 55 Torr increased significantly with resistive loading both in the normal subjects and the quadriplegic patients. In the normal subjects, but not in the quadriplegic patients, inspiratory duration increased progressively with increasing resistance. The increase in DI peak during ventilatory loading in the normal subjects was a consequence of inspiratory prolongation. In contrast, in the quadriplegic patients during breathing against the larger resistive load, there was a significant increase in the average rate of rise (DI peak divided by the time from onset to peak) of diaphragmatic activity. The change in DI rate of rise for a given change in PCO2 increased to 137 +/- 13% (SE), and the DI rate of rise at PCO2 55 Torr increased to 128 +/- 8% (SE) of control values. These results indicate that compensatory increases in diaphragmatic activation during ventilatory loading occur in quadriplegic patients in whom afferent feedback from rib cage receptors is disrupted.     

The influence of anthropometric characteristics to the handgrip and pinch strength in 6-10-year old children

The aim of the study was to investigate the relationships between handgrip and pinch strength values with basic body (body height, body mass, BMI) and with specific hand anthropometric parameters (fingers spans, lengths and perimeters) in prepubertal children. Body height, body mass and five fingers spans, lengths and perimeters were measured in 461 6-10 year old Estonian children according to Visnapuu & Jürim?e (2007). BMI was calculated (kg/m2). The maximal handgrip strength of the right and left hand was measured with hand dynamometer. The right and left key and tip pinch were measured with a pinch gauge. Body height, as a rule, in combination with BMI, was the strongest predictor of handgrip strength, especially in older children (about 40-60 % of the total variance, R2 x 100). From the hand anthropometry, the most important span parameter was FS2 (see explanations in the methods), which explained about 10-50% (R2 x 100) of the total variance. In older groups, the FS1 and FS3 were added to the models. From the length parameters, the most important was IFL, which in younger groups together with MFL explained 10-30% of the total variance, and in older groups the addition of RFL increased the influence to 45% (R2 x 100). From the perimeters, the most important one was P2 which explained the variability of the handgrip strength in younger groups by 15-30% (R2 x 100) and in older groups together with P3 and P4 even 30-40%. In children, the basic anthropometric parameters (body height and BMI) contribute more to the prediction of handgrip strength than the specific anthropometric parameters. With increasing age the contribution of basic and specific hand anthropometry increases and the relation between anthropometry and handgrip strength is stronger in boys compared with girls. The relation of basic and hand anthropometry to the tip and key pinch strength is relatively low.     

The natural killer cell response to exercise in spinal cord injured individuals

In order to evaluate exercise-induced changes in natural killer (NK) and other immunocompetent cells in spinal cord injured individuals, immunological competent blood cells and stress hormones were followed in five paraplegic and six quadriplegic subjects in relation to 30 min electrically stimulated cycling exercise. The leukocyte and lymphocyte concentrations increased during exercise. In the recovery period, the concentration of neutrophils increased, whereas the lymphocytes decreased. The percentage and concentration of NK cells increased during exercise in the paraplegic group and returned to pre-exercise level 2 h after, whereas no changes were seen in these measures for the quadriplegic group. No changes in activated CD38+ NK cells appeared. Unstimulated and interferon-alpha or interleukin-2 stimulated NK cell activity increased during exercise and returned to pre-exercise level 2 h after with no distinction between paraplegics and quadriplegics. The concentrations of plasma growth hormone and catecholamines increased during exercise, with the rise in epinephrine being more pronounced in paraplegic than in quadriplegic subjects, indicating a difference between the groups in sympathetic nervous system integrity. The sympathoadrenal activity is concluded to be responsible for recruitment of NK cells to the blood during exercise.     

Cardiovascular effects of vasopressin following V(1) receptor blockade compared to effects of nitroglycerin

Studies to more clearly determine the mechanisms associated with arginine vasopressin (AVP)-induced vasodilation were performed in normal subjects and in quadriplegic subjects with impaired efferent sympathetic responses. Studies to compare the effects of AVP with the hemodynamic effects of nitroglycerin, an agent that primarily affects venous capacitance vessels, were also performed in normal subjects. Incremental infusions of AVP following V(1)-receptor blockade resulted in equivalent reductions in systemic vascular resistance (SVRI) in normal and in quadriplegic subjects. However, there were major differences in the effect on mean arterial pressure (MAP), which was reduced in quadriplegic subjects but did not change in normal subjects. This difference in MAP can be attributed to a difference in the magnitude of increase in cardiac output (CI), which was twofold greater in normal than in quadriplegic subjects. These observations are consistent with AVP-induced vasodilation of arterial resistance vessels with reflex sympathetic enhancement of CI and are clearly different from the hemodynamic effects of nitroglycerin, i.e., reductions in MAP, CI, and indexes of cardiac preload, with only minor changes in SVRI.     

Measuring pad-pad pinch strength in a non-human primate: Macaca fascicularis.

The primary purpose of this study was to establish a methodology for determining and perhaps predicting (via regression analysis of anthropometric measures) Macaca fascicularis isometric pinch strength for a specific task. The larger purpose of this work was to properly scale a pinching task for the monkeys in order to study dose-response relationships in a non-human primate model for carpal tunnel syndrome. Three female and one male macaque (n = 4) of varying size and age were trained to perform a left-handed pad–pad pinch. The task required 60° of wrist flexion at a static pinching distance of 3 cm between the thumb and fingers. Subjects were trained for a period of 20-weeks. After that time, an analysis of performance gradients found that they had each reached a plateau in their force output. Pinch strength for the four animals ranged from 29.4 to 59.8 N. Regression analysis revealed that body mass (kg) and wrist circumference (cm) were both predictive of pinch strength, exhibiting adjusted R² values of 0.93 (p = 0.024) and 0.96 (p = 0.015), respectively. Thus, the results suggest that maximal pinch strength could be acceptably estimated in future subjects using either the wrist circumference or the body mass measures, as both were strong predictors of pad–pad pinch strength.     

Steady-state response of quadriplegic subjects to inspiratory resistive load

Normal subjects preserve tidal volume (VT) in the face of added inspiratory resistance by increasing maximal amplitude and duration of the rising phase of respiratory driving pressure (DP) and by changing the shape of this phase to one that is more concave to the time axis. To explore the possible role of chest wall afferents in mediating these responses, we determined averaged DP in eight quadriplegic subjects during steady-state unloaded breathing and while breathing through an inspiratory resistance (8.5 cmH2O X 1(-1) X s). As with normal subjects, quadriplegics preserved VT (loaded VT = 106% control) by utilizing all three mechanisms. However, prolongation of the inspiratory duration derived from the DP waveform (+22% vs. +42%) and shape response were significantly less in the quadriplegic subjects. Shape response was completely absent in subjects with C4 lesions. The results provide strong evidence that respiratory muscle spindles are responsible for shape response and that changes in afferent feedback from the chest wall play an important role in mediating inspiratory prolongation.     

Measuring pad–pad pinch strength in a non-human primate: Macaca fascicularis

The primary purpose of this study was to establish a methodology for determining and perhaps predicting (via regression analysis of anthropometric measures) Macaca fascicularis isometric pinch strength for a specific task. The larger purpose of this work was to properly scale a pinching task for the monkeys in order to study dose-response relationships in a non-human primate model for carpal tunnel syndrome. Three female and one male macaque (n = 4) of varying size and age were trained to perform a left-handed pad–pad pinch. The task required 60° of wrist flexion at a static pinching distance of 3 cm between the thumb and fingers. Subjects were trained for a period of 20-weeks. After that time, an analysis of performance gradients found that they had each reached a plateau in their force output. Pinch strength for the four animals ranged from 29.4 to 59.8 N. Regression analysis revealed that body mass (kg) and wrist circumference (cm) were both predictive of pinch strength, exhibiting adjusted R² values of 0.93 (p = 0.024) and 0.96 (p = 0.015), respectively. Thus, the results suggest that maximal pinch strength could be acceptably estimated in future subjects using either the wrist circumference or the body mass measures, as both were strong predictors of pad–pad pinch strength.     

A biomechanical analysis of applied pinch force during periodontal scaling

One of the factors associated with the high prevalence of upper extremity musculoskeletal disorders, such as carpal tunnel syndrome, among dental practitioners is the repeated high pinch force applied during periodontal scaling. The goal of this study was to determine the relationship between the pinch force applied during periodontal scaling and the forces generated at the tip of the tool. A linear biomechanical model that incorporated tool reaction forces and a calculated safety margin was created to predict the pinch force applied by experienced and inexperienced dentists during periodontal scaling. Six dentists and six dental students used an instrumented scaling tool while performing periodontal scaling on patients. Thumb pinch force was measured by a pressure sensor, while the forces developed at the instrument tip were measured by a six-axis load cell. A biomechanical model was used to calculate a safety factor and to predict the applied pinch force. For experienced dentists, the model was moderately successful in predicting pinch force (R(2)=0.59). For inexperienced dentists, the model failed to predict peak pinch force (R(2)=0.01). The mean safety margin was higher for inexperienced (4.88+/-1.58) than experienced (3.35+/-0.55) dentists, suggesting that students apply excessive force during scaling.     

The accuracy of perception of a pinch grip force in older adults

The fact that humans can execute accurate movements and generate precise muscle forces is very important for hand function. Target-tracking tasks or target-matching tasks are often executed under combined visual and somatosensory feedback. When visual feedback is removed, subjects have to depend on their perception of force. The objective of the present study was to estimate the effects of aging on the perception of a pinch force produced by the thumb and index finger. In a first set of trials, young (n = 12, age = 25.3 +/- 2.4 years) and elderly (n = 12, age = 71.5 +/- 3.3 years) healthy individuals were asked to reproduce pinch forces which were equivalent to 5%, 20%, and 40% of their maximal pinch force (MPF). Prior to the execution of these trials, the subjects were familiarized with the force levels by matching targets displayed on a screen. They were then asked to reproduce each of these forces without any visual or verbal feedback. The results showed a larger error in the reproduced force for the elderly subjects when compared with the young adults. However, this larger error was mainly due to an initial overshoot in the force to be reproduced, followed by a gradual decrease towards the appropriate force. This transient overshoot was rarely seen in the performance of the younger subjects. In a second set of trials, the same subjects were asked to produce a pinch force of 5%, 20%, and 40% of MPF with 1 hand using visual feedback. They were also instructed to simultaneously apply a comparable pinch force with the other hand (without any feedback). For both young and older adults, the pinch forces produced by the 2 hands were the same. In addition, in both blocks of trials, hand dominance had no effects on the performance for all subjects. These results suggest that normal aging affects the production of force based on sensorimotor memory rather more than it affects comparative outputs from central descending commands.     

Size,but not sex,predicts pinch force and exoskeleton mechanical properties in crayfish of the genus Faxonius

Studies of animal weaponry and defensive structures rarely take into consideration their underlying mechanical properties. We measured the compressive strength and thickness of the exoskeleton of the claw (chela) in two North American crayfish species, Faxonius virilis and F. limosus. We performed similar measures on the carapace, a body region not directly involved in agonistic contests. Males of both species generated significantly stronger maximum pinch forces than females. However, these differences can be attributed to differences in claw size between the sexes. The thickness (ultrastructure) of the claw exoskeleton was a significant predictor of its compressive strength and likely explained the difference in compressive strength we observed between the two species. Neither claw thickness nor claw compressive strength was correlated with maximum pinch force. Additionally, we found that crayfish body size was a strong predictor of carapace compressive strength and thickness, whereas sex was not. The claw had greater compressive strength and thickness than the corresponding values for the carapace. Our study shows that the mechanical properties of the crayfish exoskeleton are largely a function of size and highlights the need to integrate mechanical properties into studies of animal morphology and performance.     

Pinch skin grafting or porcine dermis in venous ulcers: a randomised clinical trial.

Chronic venous ulcers are common, and even with effective compression or elevation large ulcers may take months to heal. Pinch skin grafting may allow healing from epithelial islands throughout the surface area of the ulcer, and a prospective randomised trial was therefore conducted comparing this treatment with porcine dermis dressings. Most patients were treated as outpatients, 25 ulcers being randomised to treatment with pinch skin grafts and 28 to treatment with porcine dermis. Though the groups were well matched, the mean healing rate in the first week was 15 cm2 for pinch skin grafts compared with 3.5 cm2 with porcine dermis (p less than 0.02). By life table analysis 64% of ulcers treated by pinch grafts were healed at six weeks and 74% by 12 weeks compared with 29% and 46% of ulcers, respectively, treated with porcine dermis dressings (chi2 = 4.1; p less than 0.05). All ulcers that failed to heal within 12 weeks included an area posterior to the medial malleolus, where local compression may have been inadequate. Pinch skin grafting improves the rate of healing in large venous ulcers and is a simple technique that may be performed as an outpatient procedure under local anaesthesia.     

Physical provocation potentiates aggression in male rats receiving anabolic androgenic steroids

Anabolic androgenic steroids (AAS) have been linked to indiscriminant and unprovoked aggression and violence. We employed a brief tail pinch to examine the effects of different AAS on intermale aggression in gonadally intact male rats in response to a mild physical provocation. Animals received 5 mg/kg testosterone propionate (TP), nandrolone (ND), or stanozolol (ST) 5 days/week. Controls received vehicle injections. After 12 weeks, rats were tested for aggression while treatments continued. Animals were paired with either gonadally intact or castrated opponents and were tested in the subject rat's home cage, the opponents's home cage, and a neutral cage. Aggression was tested during tail pinch of the subject rat and during tail pinch of the opponent rat. In TP-treated males, tail pinch significantly enhanced aggression in all social and environmental conditions compared to intact controls. TP treatment also significantly enhanced aggression when the opponents were tail pinched. Tail pinch did not increase aggression in ND-treated males, and aggression was significantly lower than controls in ST-treated males. As expected, cell nuclear androgen receptor binding was significantly elevated by the high dose of TP. Our results show that while AAS alone does not induce the indiscriminate and unprovoked aggression characteristic of 'roid rage, TP heightens the animals sensitivity to     

Unusual electrostatic effects on binding of C1q to anionic liposomes: role of anionic phospholipid domains and their line tension.

The binding of 125I-C1q to anionic liposomes was studied as a function of protein concentration, pH, ionic strength, and anionic lipid composition. The maximum amount of protein bound per micromole of lipid was very sensitive to electrostatic factors, increasing strongly with decreased pH and ionic strength or increased anionic lipid content. The apparent association constant was independent of these electrostatic factors, however, in marked contrast to studies on basic peptide binding to anionic lipid vesicles. Microscopic observations of large unilamellar liposomes containing fluorescently labeled C1q or phosphatidylglycerol demonstrated, under conditions causing strong electrostatic interactions, that C1q and anionic lipids colocalized into domains whose radii of curvature were higher than that of the surrounding lipid. These domains were observed to bud and pinch off into brightly fluorescent vesicles. We propose a model for all of these observations in which the line tension or edge energy at the boundary of the domain resists its increase in circumference as the domain grows by electrostatic effects on binding, eventually resulting in vesiculation. We propose that under favorable electrostatic conditions, as larger domains form the edge energy balances the increases in the electrostatic contribution to binding, resulting in a net binding energy independent of electrostatic factors.     

EEG evaluation of reflex testing as assessment of depth of pentobarbital anaesthesia in the rat

Electroencephalography (EEG) was applied to evaluate the validity of the paw pinch reflex as an indicator of anaesthetic depth in rats which are anaesthetized with a single intraperitoneal dose of pentobarbital. After induction of the anaesthesia, characterized by the rapid loss of the animals' ability to maintain upright posture, the EEG of 10 out of 11 rats was dominated by paroxysmal (burst suppression) activity, associated with unconsciousness. In seven out of 11 rats, the paw pinch reflex was lost after onset of paroxysmal electroencephalographic activity. However, the paw pinch reflex remained present in four out of 11 animals, demonstrating that the response is independent of cortical activity. In five out of seven rats, the EEG still showed paroxysmal activity when the paw pinch reflex was regained. However, in two other rats the EEG returned to a pattern similar to that shown by awake animals, 4 and 21 min respectively, before the reflex was regained. These data indicate that in the pentobarbital-anaesthetized rat, presence of the paw pinch reflex is not related to the level of depression of electrical activity in the cerebral cortex, and consequently is probably not related to the level of consciousness. Based upon these findings it is concluded that the paw pinch reflex is unreliable as a sole indicator of anaesthetic depth.     

Typewriter Control for an Aphasic Quadriplegic Patient

New equipment was developed to enable an aphasic quadriplegic patient to communicate with other people. The patient was completely quadriplegic except for slight movement in the right hand and minimal movement of the left fingers. The equipment translated Morse code, which the patient had to learn, into either (1) a visual display to communicate with visitors, or (2) an electric typewriter input to permit correspondence. This case demonstrates how properly applied research can yield results of value in ameliorating the lot of patients with major physical afflictions or crippling illnesses.     

Estimation of conditions evoking fracture in finger bones under pinch loading based on finite element analysis

A finger finite element (FE) model was created from CT images of a Japanese male in order to obtain a shape-biofidelic model. Material properties and articulation characteristics of the model were taken from the literature. To predict bone fracture and realistically represent the fracture pattern under various loading conditions, the ESI-Wilkins-Kamoulakos rupture model in PAM-CRASH (ESI Group S.A., Paris, France) was utilized in this study with parameter values of the rupture model determined by compression testing and simulation of porcine fibula. A finger pinch simulation was then conducted to validate the finger FE model. The force-displacement curve and fracture load from the pinch simulation was compared to the result of finger pinch test using cadavers. Simulation results are coincident with the test result, indicating that the finger FE model can be used in an analysis of finger bone fracture during pinch accident. With this model, several pinch simulations were conducted with different pinching object’s stiffness and pinching energy. Conditions for evoking finger bone fracture under pinch loading were then estimated based on these results. This study offers a novel method to predict possible hazards of manufactured goods during the design process, thus finger injury due to pinch loading can be avoided.     

Respiratory load-compensating mechanisms in muscular dystrophy

First-breath ventilatory responses to graded elastic and resistive loads were obtained from 15 people with Duchenne muscular dystrophy (DMD), 5 people with facioscapulohumeral MD (FSH), 3 people with Becker MD, and 3 people with limb-girdle MD. For each load tidal volumes from different individuals ranged from relatively small to comparatively large values, indicating a correspondingly wide range of end-inspiratory efforts; strong tidal volume defenders generally employed longer inspirations and higher mean inspiratory airflows than did weak tidal volume defenders; and individual frequency responses were mediated by changes in inspiratory and/or expiratory timing. Thus the loaded breathing responses of people with MD are qualitatively the same as those of quadriplegic and able-bodied people. Quantitatively, however, the DMD group generated considerably larger tidal volumes than did the FSH group during both elastic and resistive loading. These larger tidal volumes were achieved by both longer inspirations (a neurally mediated phenomenon) and higher mean inspiratory airflows (a mechanically and/or neurally mediated phenomenon). These findings, which could not be attributed to differences in respiratory motor function, suggest that there are differences between the respiratory sensory and/or central functions in the Duchenne and facioscapulohumeral types of MD.