Intermuscular force transmission between human plantarflexor muscles in vivo

The exact mechanical function of synergist muscles within a human limb in vivo is not well described. Recent studies indicate the existence of a mechanical interaction between muscle actuators that may have functional significance and further play a role for injury mechanisms. The purpose of the present study was to investigate if intermuscular force transmission occurs within and between human plantarflexor muscles in vivo. Seven subjects performed four types of either active contractile tasks or passive joint manipulations: passive knee extension, voluntary isometric plantarflexion, voluntary isometric hallux flexion, passive hallux extension, and selective percutaneous stimulation of the gastrocnemius medialis (MG). In each experiment plantar- and hallux flexion force and corresponding EMG activity were sampled. During all tasks ultrasonography was applied at proximal and distal sites to assess task-induced tissue displacement (which is assumed to represent loading) for the plantarflexor muscles [MG, soleus (SOL), and flexor hallucis longus (FHL)]. Selective MG stimulation and passive knee extension resulted in displacement of both the MG and SOL muscles. Minimal displacement of the triceps surae muscles was seen during passive hallux extension. Large interindividual differences with respect to deep plantarflexor activation during voluntary contractions were observed. The present results suggest that force may be transmitted between the triceps surae muscles in vivo, while only limited evidence was provided for the occurrence of force transfer between the triceps surae and the deeper-lying FHL.     

Level of subject-specific detail in musculoskeletal models affects hip moment arm length calculation during gait in pediatric subjects with increased femoral anteversion

Biomechanical parameters of gait such as muscle's moment arm length (MAL) and muscle-tendon length are known to be sensitive to anatomical variability. Nevertheless, most studies rely on rescaled generic models (RGMo) constructed from averaged data of cadaveric measurements in a healthy adult population. As an alternative, deformable generic models (DGMo) have been proposed. These models integrate a higher level of subject-specific detail by applying characteristic deformations to the musculoskeletal geometry. In contrast, musculoskeletal models based on magnetic resonance (MR) images (MRMo) reflect the involved subject's characteristics in every level of the model. This study investigated the effect of the varying levels of subject-specific detail in these three model types on the calculated hip MAL during gait in a pediatric population of seven cerebral palsy subjects presenting aberrant femoral geometry. Our results show large percentage differences in calculated MAL between RGMo and MRMo. Furthermore, the use of DGMo did not uniformly reduce inter-model differences in calculated MAL. The magnitude of these percentage differences stresses the need to take these effects into account when selecting the level of subject-specific detail one wants to integrate in musculoskeletal. Furthermore, the variability of these differences between subjects and between muscles makes it very difficult to a priori estimate their importance for a biomechanical analysis of a certain muscle in a given subject.     

Longer moment arm results in smaller joint moment development, power and work outputs in fast motions

Effects of moment arm length on kinetic outputs of a musculoskeletal system (muscle force development, joint moment development, joint power output and joint work output) were evaluated using computer simulation. A skeletal system of the human ankle joint was constructed: a lower leg segment and a foot segment were connected with a hinge joint. A Hill-type model of the musculus soleus (m. soleus), consisting of a contractile element and a series elastic element, was attached to the skeletal system. The model of the m. soleus was maximally activated, while the ankle joint was plantarflexed/dorsiflexed at a variation of constant angular velocities, simulating isokinetic exercises on a muscle testing machine. Profiles of the kinetic outputs (muscle force development, joint moment development, joint power output and joint work output) were obtained. Thereafter, the location of the insertion of the m. soleus was shifted toward the dorsal/ventral direction by 1cm, which had an effect of lengthening/shortening the moment arm length, respectively. The kinetic outputs of the musculoskeletal system during the simulated isokinetic exercises were evaluated with these longer/shorter moment arm lengths. It was found that longer moment arm resulted in smaller joint moment development, smaller joint power output and smaller joint work output in the larger plantarflexion angular velocity region (>120 degrees/s). This is because larger muscle shortening velocity was required with longer moment arm to achieve a certain joint angular velocity. Larger muscle shortening velocity resulted in smaller muscle force development because of the force-velocity relation of the muscle. It was suggested that this phenomenon should be taken into consideration when investigating the joint moment-joint angle and/or joint moment-joint angular velocity characteristics of experimental data.     

Relationship between muscle length and moment arm on EMG activity of human triceps surae muscle.

PURPOSE: The purpose of this experiment was to evaluate the effects of both muscle length and moment arm (MA) on the electromyographic (EMG) and force output of the triceps surae (TS) muscle. RELEVANCE: It is well recognized that changes in muscle length affect both the muscle's force generating capacity as well as its twitch speed. This relationship is well established in animal preparations. Contrary to animal experiments where length can be directly manipulated in isolated muscles, human experiments require that all muscle length changes be secondary to changes in a joint angle. Such experimental manipulations therefore produce changes in not only muscle length, but also in the muscle's MA. The relative effect of muscle length and MA changes on muscle EMG has not been determined in previous experiments. METHODS: This study was executed in two phases. First, using fresh human cadaver lower limbs, data were gathered describing the relationship between knee and ankle angle changes for maintenance of a constant TS muscle length, while its MA at the ankle joint has been changed. In the second phase of the study, results obtained from phase one were applied to 10 healthy adult human subjects to measure the EMG (surface and fine wire) activity of TS at three different conditions: when both length and MA were shortened, when muscle length was decreased given a constant MA and when MA was shortened given a constant muscle length. RESULTS: A significant increase in muscle activity was found as both the length and MA of TS muscle were shortened. A similar pattern of increased muscle activity was observed when the MA was shortened given a constant muscle length. No significant change in TS activity was found when muscle length was shortened, given a constant MA at the ankle joint. CONCLUSIONS: The findings of this study indicate that changes in the Achilles tendon MA predominate over the muscle length variations in determining the level of TS activity when generating plantar flexion torque.     

Variation in the human Achilles tendon moment arm during walking

The Achilles tendon (AT) moment arm is an important determinant of ankle moment and power generation during locomotion. Load and depth-dependent variations in the AT moment arm are generally not considered, but may be relevant given the complex triceps surae architecture. We coupled motion analysis and ultrasound imaging to characterize AT moment arms during walking in 10 subjects. Muscle loading during push-off amplified the AT moment arm by 10% relative to heel strike. AT moment arms also varied by 14% over the tendon thickness. In walking, AT moment arms are not strictly dependent on kinematics, but exhibit important load and spatial dependencies.     

Muscle moment arm and normalized moment contributions as reference data for musculoskeletal elbow and wrist joint models

A geometric musculoskeletal model of the elbow and wrist joints was developed to calculate muscle moment arms throughout elbow flexion/extension, forearm pronation/supination, wrist flexion/extension and radial/ulnar deviation. Model moment arms were verified with data from cadaver specimen studies and geometric models available in the literature. Coefficients of polynomial equations were calculated for all moment arms as functions of joint angle, with special consideration to coupled muscles as a function of two joint angles. Additionally, a “normalized potential moment (NPM)” contribution index for each muscle across the elbow and wrist joints in four degrees-of-freedom was determined using each muscle's normalized physiological cross-sectional area (PCSA) and peak moment arm (MA). We hypothesize that (a) a geometric model of the elbow and wrist joints can represent the major attributes of MA versus joint angle from many literature sources of cadaver and model data and (b) an index can represent each muscle's normalized moment contribution to each degree-of-freedom at the elbow and wrist. We believe these data serve as a simple, yet comprehensive, reference for how the primary 16 muscles across the elbow and wrist contribute to joint moment and overall joint performance.     

Correlation between sperm creatine phosphokinase activity and sperm concentrations in normospermic and oligospermic men

Toward the development of biochemical probes for the assessment of sperm function we have measured the activities of sperm creatine-N-phosphotransferase (CPK). There was a highly significant inverse correlation (P < 0.001 in all comparisons) between sperm CPK activities and sperm concentrations in specimens of normospermic and oligospermic men with > 30 million sperm/ml (0.106 ± 0.01 SEM, Nequals;90, expressed as CPK U/100 million sperm), 20–30 million sperm/ml (0.333 ± 0.07 SEM, Nequals;30) and 10–20 million sperm/ml (0.583 ± 0.12 SEM, Nequals;30) when compared with the CPK values of the < 10 million/ml specimens (2.242 ± 0.46 SEM, Nequals;30). Furthermore, the distribution of CPK activities within these four groups showed that 96%, 67%, 43%, and 4% of the samples, respectively, were in the < 0.250 CPK U/100 million sperm normal range (mean + 2 SD of the > 30 million sperm/ml group). However, there was no relationship between sperm CPK activities and the values of sperm motility (P > 0.15) or morphology (Pequals;0.38) in the samples. The migrated sperm fractions (significantly improved in motility and velocity parameters) showed CPK activities lower than the initial semen specimens (P < 0.01, Nequals;150). In fact, in some oligospermic men the CPK activities of the migrated sperm fractions were within the range of normospermic samples. The data suggest that sperm CPK values in the initial specimens and the degree of improvement in the migrated sperm fractions reflect the relative concentrations of a “normal” sperm subpopulation. We propose that CPK activities and similar objective biochemical parameters may be important in predicting sperm quality and the fertilizing potential of oligospermic men.     

Prostate cancer in elderly men

Due to increasing life expectancy and the introduction of prostate-specific antigen (PSA) screening, a rising number of elderly men are diagnosed with prostate cancer. Besides PSA serum levels and Gleason score, age is considered to be a key prognostic factor in terms of treatment decisions. In men older than 70 years, treatment without curative intent may deprive the frail patient of years of life. Modern radical prostatectomy techniques are associated with low perioperative morbidity, excellent clinical outcome, and documented long-term disease control. Thus, radical prostatectomy should be considered because local treatment of organ-confined prostate cancer potentially cures disease. The huge extent of PSA screening programs may lead to overdiagnosis of prostate cancer. Not every man who is diagnosed with prostate cancer will develop clinically significant disease. This has led to the concept of expectant management for screen-detected, small-volume, low-grade disease, with the intention of providing therapy for those men with disease progression.     

The contraction-induced increase in Achilles tendon moment arm: A three-dimensional study

The present study aimed to re-examine the influence of the isometric plantarflexors contraction on the Achilles tendon moment arm (ATMA) and the factors influencing the ATMA in three-dimensions. A series of coronal magnetic resonance images of the right ankle were recorded at foot positions of 10° of dorsiflexion, neutral position, and 10° of plantarflexion for the rest condition and the plantarflexors contraction condition at 30% maximal voluntary effort. The shortest distance between the talocrural joint axis and the line of action of the Achilles tendon force projected to the orthogonal plane of the talocrural joint axis was determined as the ATMA. The ATMA determined in the contraction condition was significantly greater by 8 mm than that determined in the rest condition. The talocrural joint axis was displaced anteriorly by 3 mm and distally by 2 mm due to the muscle contraction. As the same time, the line of action of the Achilles tendon force was displaced posteriorly by 5 mm and medially by 2 mm. These linear displacements of the talocrural joint axis and the line of action of the Achilles tendon force accounted for the difference in the ATMAs between the two conditions by 35.9 and 62.4%, respectively. These angular displacements accounted for the total of 0.4% increase in the ATMA. These results confirm the previous findings reported in two-dimensional studies and found that the linear displacement of the line of action of the Achilles tendon force is the primary source of the contraction-induced increase in the ATMA.     

Real-time knee adduction moment feedback for gait retraining through visual and tactile displays

The external knee adduction moment (KAM) measured during gait is an indicator of tibiofemoral joint osteoarthritis progression and various strategies have been proposed to lower it. Gait retraining has been shown to be an effective, noninvasive approach for lowering the KAM. We present a new gait retraining approach in which the KAM is fed back to subjects in real-time during ambulation. A study was conducted in which 16 healthy subjects learned to alter gait patterns to lower the KAM through visual or tactile (vibration) feedback. Participants converged on a comfortable gait in just a few minutes by using the feedback to iterate on various kinematic modifications. All subjects adopted altered gait patterns with lower KAM compared with normal ambulation (average reduction of 20.7%). Tactile and visual feedbacks were equally effective for real-time training, although subjects using tactile feedback took longer to converge on an acceptable gait. This study shows that real-time feedback of the KAM can greatly increase the effectiveness and efficiency of subject-specific gait retraining compared with conventional methods.     

Muscle oxygenation during incremental arm and leg exercise in men and women

The purpose of this study was to compare the rates of muscle deoxygenation in the exercising muscles during incremental arm cranking and leg cycling exercise in healthy men and women. Fifteen men and 10 women completed arm cranking and leg cycling tests to exhaustion in separate sessions in a counterbalanced order. Cardiorespiratory measurements were monitored using an automated metabolic cart interfaced with an electrocardiogram. Tissue absorbency was recorded continuously at 760 nm and 850 nm during incremental exercise and 6 min of recovery, with a near infrared spectrometer interfaced with a computer. Muscle oxygenation was calculated from the tissue absorbency measurements at 30%, 45%, 60%, 75% and 90% of peak oxygen uptake (V˙O₂) during each exercise mode and is expressed as a percentage of the maximal range observed during exercise and recovery (%Mox). Exponential regression analysis indicated significant inverse relationships (P < 0.01) between %Mox and absolute V˙O₂ during arm cranking and leg cycling in men (multiple R = −0.96 and −0.99, respectively) and women (R =−0.94 and −0.99, respectively). No significant interaction was observed for the %Mox between the two exercise modes and between the two genders. The rate of muscle deoxygenation per litre of V˙O₂ was 31.1% and 26.4% during arm cranking and leg cycling, respectively, in men, and 26.3% and 37.4% respectively, in women. It was concluded that the rate of decline in %Mox for a given increase in V˙O₂ between 30% and 90% of the peak V˙O₂ was independent of exercise mode and gender. Accepted: 31 March 1998     

Seminiferous tubule involution in elderly men

The observation of different types of seminiferous tubules (from tubules with normal spermatogenesis to sclerosed tubules) in aging human testes points to the progressive stages of tubular involution in elderly men. The tubules with hypospermatogonesis (reduced number of elongated spermatids) show numerous morphological anomalies in the germ cells, including multinucleated cells. Abnormal germ cells degenerate, causing Steroli cell vacuolation. These vacuoles correspond to dilations of the extracellular spaces resulting from the premature exfoliation of germ cells. Degenerating cells that are phagocytized by Sertoli cells lead to an accumulation of lipid droplets in the Sertoli cell cytoplasm. The loss of germ cells begins with spermatids, but progressively affects the preceding germ cell types, and tubules with maturation arrested at the level of spermatocytes or spermatogonia are observed. Simultaneously, an enlargement of the tunica propria occurs. This leads to the formation of sclerosed tubules, some of which display a low seminiferous epithelium consisting of a few cells--including lipid-loaded Sertoli cells and both Ap and Ad spermatogonia--and others, showing complete sclerosis, are devoid of seminiferous epithelium. The development of tubular involution is similar to that reported after experimental ischemia, which also seems to cause nonspecific effects on the testis such as multinucleate cells, vacuoles, and increased lipids in Sertoli cells.     

Altered control strategy between leading and trailing leg increases knee adduction moment in the elderly while descending stairs

The aim of the study was to examine the external knee adduction moments in a group of older and younger adults while descending stairs and thus the possibility of an increased risk of knee osteoarthritis due to altered knee joint loading in the elderly. Twenty-seven older and 16 younger adults descended a purpose-built staircase. A motion capture system and a force plate were used to determine the subjects' 3D kinematics and ground reaction forces (GRF) during locomotion. Calculation of the leg kinematics and kinetics was done by means of a rigid, three-segment, 3D leg model. In the initial portion of the support phase, older adults showed a more medio-posterior GRF vector relative to the ankle joint, leading to lower ankle joint moments (P<0.05). At the knee, the older adults demonstrated a more medio-posterior directed GRF vector, increasing in knee flexion and adduction in the second part of the single support phase (P<0.05). Further, GRF magnitude was lower in the initial and higher in the mid-portions of the support phase for the elderly (P<0.05). The results show that older adults descend stairs by using the trailing leg before the initiation of the double support phase more compared to the younger ones. The consequence of this altered control strategy while stepping down is a more medially directed GRF vector increasing the magnitude of external knee adduction moment in the elderly. The observed changes between leading and trailing leg in the elderly may cause a redistribution of the mechanical load at the tibiofemoral joint, affecting the initiation and progression of knee osteoarthritis in the elderly.     

Association between hemoglobin A1c and carotid atherosclerosis in rural community-dwelling elderly Japanese men

Background

Recent studies have reported an association between both higher and lower levels of hemoglobin A1c (HbA1c) and higher mortality of diabetes patients. Like diabetes, carotid atherosclerosis is a well known lifestyle-related disease. However, no studies have yet reported an association between HbA1c levels and carotid atherosclerosis.

Methods

We conducted a cross-sectional study of 1,150 Japanese elderly men aged ≥60 years who were undergoing general health checkups. Carotid atherosclerosis was defined as a carotid intima-media thickness (CIMT) ≥1.1 mm. Since body mass index (BMI) is regarded as a cardiovascular risk factor that exerts a strong influence on both HbA1c levels and carotid atherosclerosis, we performed a stratified analysis of this risk based on BMI.

Results

Using the intermediate HbA1c quintile as a reference group, the groups in the lowest HbA1c quintiles showed a significantly higher risk of carotid atherosclerosis in patients with low BMI (≤23 kg/m²) vs. no increased risk in those with high BMI (>23 kg/m²). The association of HbA1c with carotid atherosclerosis became slightly stronger when these analyses were limited to subjects who were not taking glucose-lowering medications or medications for hyperlipidemia and cardiovascular disease. After adjusting for classical cardiovascular risk factors, adjusted odds ratios (ORs) for carotid atherosclerosis were 1.36 (0.84 to 2.20) for total subjects, 2.29 (1.12 to 4.66) for low-BMI groups, and 0.68 (0.33 to 1.41) for high-BMI groups.

Conclusions

Lower HbA1c level is a significant risk factor for carotid atherosclerosis in rural community-dwelling elderly Japanese men with low, but not high BMI, particularly in those not taking glucose-lowering medication.