Developmental changes in diaphragm muscle function in the preterm and postnatal lamb.

RATIONALE: The preterm diaphragm is structurally and functionally immature, potentially contributing to an increased risk of respiratory distress and failure. We investigated developmental changes in contractile function and susceptibility to fatigue of the costal diaphragm in the fetal lamb to understand factors contributing to the risk of developing diaphragm dysfunction and respiratory disorders. We hypothesized that the functional capacity of the diaphragm will vary with maturational stage as will its susceptibility to fatigue. METHODS: Lambs were studied at 75, 100, 125, 145, 154, 168, and 200 days postconceptional age (term = 147 days). Lambs were euthanized (sodium pentobarbitone, 100 mg/kg) either at delivery or immediately prior to post-mortem for postnatal lambs. Contractile function was assessed on longitudinal strips of intact muscle fibers and the remaining tissue frozen in liquid nitrogen for analysis of myosin heavy chain (MHC) mRNA expression and protein content. RESULTS: Fetal development of diaphragm function was characterized by a significant increase in maximum specific force, increased susceptibility to fatigue, reduced twitch contraction times, and a progressive increase in MHCI and MHCII protein content. Postnatally, there was a progressive decrease in the susceptibility to fatigue that coincided with an increase in the MHC I:II protein ratio. CONCLUSION: These data indicate that the functional capacity of the diaphragm varies with maturational age and may be an important determinant of the susceptibility to preterm respiratory failure.

The L-type Ca(2+) channel as a therapeutic target in heart disease.

The L-type Ca(2+) channel plays a critical role in cardiac function as the main route for entry of calcium into cardiac myocytes. It is essential to excitability as it shapes the long plateau phase of the cardiac action potential that is unique to cardiac ventricular myocytes. It is necessary for contraction as it triggers the release of calcium from sarcoplasmic reticulum stores for actin-myosin interaction. The L-type Ca(2+) channel also regulates cytoplasmic calcium levels. It is well recognised that an increase in intracellular calcium is involved in the activation of growth-promoting signal pathways. Recently reactive oxygen species have been implicated in the activation of signal pathways and the development of pathological hypertrophy. There is now evidence that implicates activation of the L-type Ca(2+) channel with persistent alterations in calcium homeostasis and cellular reactive oxygen species production as a possible trigger of cardiac hypertrophy. A number of different approaches have been used to modify channel function with the view to preventing ischemia-reperfusion injury, cardiac hypertrophy or cardiac failure providing good evidence that the L-type Ca(2+) channel may be an efficacious target in the prevention of cardiac pathology.

Effects of calcitonin gene-related peptide on rat soleus muscle excitability: mechanisms and physiological significance.

Intense exercise causes a large loss of K(+) from contracting muscles. The ensuing elevation of extracellular K(+) ([K(+)](o)) has been suggested to cause fatigue by depressing muscle fiber excitability. In isolated muscles, however, repeated contractions confer some protection against this effect of elevated K(+). We hypothesize that this excitation-induced force-recovery is related to the release of the neuropeptide calcitonin gene-related peptide (CGRP), which stimulates the muscular Na(+)-K(+) pumps. Using the specific CGRP antagonist CGRP-(8-37), we evaluated the role of CGRP in the excitation-induced force recovery and examined possible mechanisms. Intact rat soleus muscles were stimulated to evoke short tetani at regular intervals. Increasing extracellular K(+) ([K(+)](o)) from 4 to 11 mM decreased force to approximately 20% of initial force (P < 0.001). Addition of exogenous CGRP (10(-9) M), release of endogenous CGRP with capsaicin, or repeated electrical stimulation recovered force to 50-70% of initial force (P < 0.001). In all cases, force recovery could be almost completely suppressed by CGRP-(8-37). At 11 mM [K(+)](o), CGRP (10(-8) M) did not alter resting membrane potential or conductance but significantly improved action potentials (P < 0.001) and increased the proportion of excitable fibers from 32 to 70% (P < 0.001). CGRP was shown to induce substantial force recovery with only modest Na(+)-K(+) pump stimulation. We conclude that the excitation-induced force recovery is caused by a recovery of excitability, induced by local release of CGRP. The data suggest that the recovery of excitability partly was induced by Na(+)-K(+) pump stimulation and partly by altering Na(+) channel function.

Use of fetal fibronectin in the management of preterm labour in Nunavut.

OBJECTIVES: To manage suspected preterm labour in the Baffin Region of Nunavut safely and more conservatively utilizing the Fetal Fibronectin Assay. STUDY DESIGN: Chart Review. METHODS: The trial of Fetal Fibronectin took place in the Baffin Region of Nunavut. An initial chart review of all admissions for "false labour" to Baffin Regional Hospital was performed. An analysis of the cases was done to determine when the women delivered and whether they had been Medevaced. The Fetal Fibronectin test was implemented at five sites in the Baffin Region and data on each use of the assay were collected by the laboratory at Baffin Regional Hospital. A review of the data for the first 13 months of the trial was then done. RESULTS: The test was used 38 times between July 2004 and September 2005. There were 31 negative results. Most of the cases with negative results were managed conservatively, with a total of 18 Medevacs avoided. There were no false negative tests. Cost savings for avoided Medevacs were in the order of $200,000. CONCLUSIONS: The Fetal Fibronectin Assay has proven to be a valuable adjunct in the management of suspected preterm labour in Nunavut.

Energy conservation attenuates the loss of skeletal muscle excitability during intense contractions.

High-frequency stimulation of skeletal muscle has long been associated with ionic perturbations, resulting in the loss of membrane excitability, which may prevent action potential propagation and result in skeletal muscle fatigue. Associated with intense skeletal muscle contractions are large changes in muscle metabolites. However, the role of metabolites in the loss of muscle excitability is not clear. The metabolic state of isolated rat extensor digitorum longus muscles at 30 degrees C was manipulated by decreasing energy expenditure and thereby allowed investigation of the effects of energy conservation on skeletal muscle excitability. Muscle ATP utilization was reduced using a combination of the cross-bridge cycling blocker N-benzyl-p-toluene sulfonamide (BTS) and the SR Ca2+ release channel blocker Na-dantrolene, which reduce activity of the myosin ATPase and SR Ca2+-ATPase. Compared with control muscles, the resting metabolites ATP, phosphocreatine, creatine, and lactate, as well as the resting muscle excitability as measured by M-waves, were unaffected by treatment with BTS plus dantrolene. Following 20 or 30 s of continuous 60-Hz stimulation, BTS-plus-dantrolene-treated muscles showed a 25% lower ATP utilization compared with control muscles. Furthermore, the ability of muscles to maintain excitability during high-frequency stimulation was significantly improved in BTS-plus-dantrolene-treated muscles, indicating a strong link between metabolites, energetic state, and the excitability of the muscle.

Effect of ADP on slow-twitch muscle fibres of the rat: implications for muscle fatigue.

Slow-twitch mechanically skinned fibres from rat soleus muscle were bathed in solutions mimicking the myoplasmic environment but containing different [ADP] (0.1 microm to 1.0 mm). The effect of ADP on sarcoplasmic reticulum (SR) Ca2+-content was determined from the magnitude of caffeine-induced force responses, while temporal changes in SR Ca2+-content allowed determination of the effective rates of the SR Ca2+-pump and of the SR Ca2+-leak. The SR Ca2+-pump rate, estimated at pCa (-log10[Ca2+]) 7.8, was reduced by 20% as the [ADP] was increased from 0.1 to 40 microm, with no further alteration when the [ADP] was increased to 1.0 mm. The SR Ca2+-leak rate constant was not altered by increasing [ADP] from 0.1 to 40 microm, but was increased by 26% when the [ADP] was elevated to 1.0 mm. This ADP-induced SR Ca2+-leak was insensitive to ruthenium red but was abolished by 2,5-di(tert-butyl)-1,4-hydroquinone (TBQ), indicating that the leak pathway is via the SR Ca2+-pump and not the SR Ca2+-release channel. The decrease in SR Ca2+-pump rate and SR Ca2+-leak rate when [ADP] was increased led to a 40% decrease in SR Ca2+-loading capacity. Elevation of [ADP] had only minor direct effects on the contractile apparatus of slow-twitch fibres. These results suggest that ADP has only limited depressing effects on the contractility of slow-twitch muscle fibres. This is in contrast to the marked effects of ADP on force responses in fast-twitch muscle fibres and may contribute to the fatigue-resistant nature of slow-twitch muscle fibres.

Ionic mechanisms of excitation-induced regulation of Na+-K+-ATPase mRNA expression in isolated rat EDL muscle.

This study investigated the effects of electrical stimulation on Na+-K+-ATPase isoform mRNA, with the aim to identify factors modulating Na+-K+-ATPase mRNA in isolated rat extensor digitorum longus (EDL) muscle. Interventions designed to mimic exercise-induced increases in intracellular Na+ and Ca2+ contents and membrane depolarization were examined. Muscles were mounted on force transducers and stimulated with 60-Hz 10-s pulse trains producing tetanic contractions three times at 10-min intervals. Ouabain (1.0 mM, 120 min), veratridine (0.1 mM, 30 min), and monensin (0.1 mM, 30 min) were used to increase intracellular Na+ content. High extracellular K+ (13 mM, 60 min) and the Ca2+ ionophore A-23187 (0.02 mM, 30 min) were used to induce membrane depolarization and elevated intracellular Ca2+ content, respectively. Muscles were analyzed for Na+-K+-ATPase alpha1-alpha3 and beta1-beta3 mRNA (real-time RT-PCR). Electrical stimulation had no immediate effect on Na+-K+-ATPase mRNA; however at 3 h after stimulation, it increased alpha1, alpha2, and alpha3 mRNA by 223, 621, and 892%, respectively (P = 0.010), without changing beta mRNA. Ouabain, veratridine, and monensin increased intracellular Na+ content by 769, 724, and 598%, respectively (P = 0.001) but did not increase mRNA of any isoform. High intracellular K+ concentration elevated alpha1 mRNA by 160% (P = 0.021), whereas A-23187 elevated alpha3 mRNA by 123% (P = 0.035) but reduced beta1 mRNA by 76% (P = 0.001). In conclusion, electrical stimulation induced subunit-specific increases in Na+-K+-ATPase mRNA in isolated rat EDL muscle. Furthermore, Na+-K+-ATPase mRNA appears to be regulated by different stimuli, including cellular changes associated with membrane depolarization and increased intracellular Ca2+ content but not increased intracellular Na+ content.

N-Benzyl-p-toluene sulphonamide allows the recording of trains of intracellular action potentials from nerve-stimulated intact fast-twitch skeletal muscle of the rat.

In skeletal muscle, the intracellular recording of trains of action potentials is difficult owing to the movement of the muscle upon stimulation. A potential tool for the removal of muscle movement is the cross-bridge cycle blocker, N-benzyl-p-toluene sulphonamide (BTS), although the effects of BTS on the passive and active membrane properties of intact muscle fibres are not known. Rat extensor digitorum longus (EDL) muscle was used to show that 50 mum BTS reduced tetanic force to approximately 10% of control force, without markedly altering muscle excitability. Incubation with BTS did not alter intracellular K+ content or Na+-K+ pump activity, but produced minor decreases in intracellular Na+ content (7%), resting 22Na+ influx (14%) and excitation-induced 22Na+ influx (29%). Despite these alterations to Na+ fluxes, BTS did not impair muscle excitability, since membrane conductance, resting membrane potential (RMP), rheobase current and the amplitude, overshoot and maximum rate of depolarization of the action potential were all unaltered. However, BTS did induce a small (8%) decrease in the maximum rate of repolarization of the action potential and an increase in the refractory period. The minor effects of BTS on muscle membrane properties did not compromise the ability of the muscle to propagate action potentials, even during tetanic stimulation. In conclusion, BTS can be used successfully to reduce contractility, allowing the intracellular recording of action potentials during both twitch and tetanic contraction of nerve-stimulated muscle, thus making it an excellent tool for the study of electrophysiology in fast-twitch skeletal muscle.

Na+-K+ pump stimulation restores carbacholine-induced loss of excitability and contractility in rat skeletal muscle.

Intense exercise results in increases in intracellular Na+ and extracellular K+ concentrations, leading to depolarization and a loss of muscle excitability and contractility. Here, we use carbacholine to chronically activate the nicotinic acetylcholine (nACh) receptors to mimic the changes in membrane permeability, chemical Na+ and K+ gradients and membrane potential observed during intense exercise. Intact rat soleus muscles were mounted on force transducers and stimulated electrically to evoke short tetani at regular intervals. Carbacholine produced a 2.6-fold increase in Na+ influx that was tetrodotoxin (TTX) insensitive, but abolished by tubocurarine, resulting in a significant 36% increase in intracellular Na+, and 8% decrease in intracellular K+ content. The mid region, near the motor end plate, had much larger alterations than the more distal regions of the muscle, and showed a larger membrane depolarization from -73 +/- 1 to -60 +/- 1 mV compared with -64 +/- 1 mV. Carbacholine (10(-4) M) significantly reduced tetanic force to 31 +/- 3% of controls, which underwent significant recovery upon application of Na+-K+ pump stimulators: salbutamol (10(-5) M), adrenaline (10(-5) M) and calcitonin gene-related peptide (CGRP; 10(-7) M). The force recovery with salbutamol was accompanied by a recovery of intracellular Na+ and K+ contents, and a small but significant 4-5 mV recovery of membrane potential. Similar results were obtained using succinylcholine (10(-4) M), indicating that Na+-K+ pump stimulation may prevent or restore succinylcholine-induced hyperkalaemia. The stimulation of the Na+-K+ pump allows muscle to partially recover contractility by regaining excitability through electrogenically driven repolarization of the muscle membrane.

Effects of ADP on action potential-induced force responses in mechanically skinned rat fast-twitch fibres.

Mechanically skinned muscle fibres from the extensor digitorum longus (EDL) muscle of the rat were electrically stimulated in solutions mimicking the myoplasmic environment in the resting muscle fibre but containing different [ADP] of < 0.1 microm, 40 microm and 1.0 mm, to investigate the effects of myoplasmic ADP on the twitch response. The amplitude of the twitch response markedly and gradually decreased by 47 +/- 6% (n=9) as [ADP] was increased from < 0.1 microm to 40 microm without changing [Ca2+] in the myoplamsic solution (50 nm). The times for the twitch to rise from 10 to 90% (Trise,10-90) and to decrease from 90 to 10% (Tfall,90-10) initially increased by 8 and 21% and then decreased by 16 and 30% (compared to controls), respectively, at steady state. When [ADP] was raised from < 0.1 microm to 1.0 mm and fibres were electrically stimulated, the first response was biphasic and very prolonged (by at least a factor of 10) but of an amplitude similar to that in the control solution. The following twitch response and the steady state twitch responses were much reduced in size by about a factor of 6 and more prolonged by about 40% compared to control responses. All these ADP effects were fully reversible and appear to be predominantly due to several ADP-dependent alterations in SR Ca2+ handling properties (ADP-dependent decrease in SR Ca2+ capacity together with an increase in Ca2+ binding to the SR pump sites facing the myoplasm). The ADP-dependent effects on the contractile apparatus and Ca2+ regulatory system were relatively minor. Taken together, the results demonstrate that ADP accumulation is likely to play a crucial role in metabolic fatigue of skeletal muscle and can explain the marked reduction in the amplitude and the slower time course of the twitch response during fatigue as well as the elevation of myoplasmic [Ca2+] in fatigued fibres at rest.

Effects of ADP on sarcoplasmic reticulum function in mechanically skinned skeletal muscle fibres of the rat.

1. The sarcoplasmic reticulum (SR) Ca(2+) content (expressed in terms of endogenous SR Ca(2+) content under physiologically resting conditions and measured from caffeine-induced force responses) and the effective rates of the SR Ca(2+) pump and SR Ca(2+) leak (measured from the temporal changes in SR Ca(2+) content) were determined in mechanically skinned skeletal muscle fibres of the rat at different [ADP] (< 0.10 microM to 1.04 mM). 2. The estimated SR Ca(2+) pump rate at 200 nM Ca(2+) did not change when [ADP] increased from below 0.10 microM to 10 microM but decreased by about 30 % when [ADP] increased from 10 microM to 1.04 mM. 3. The rate constant of SR Ca(2+) leak increased markedly with rising [ADP] when [Ca(2+)] in solution was 200 nM (apparent dissociation constant Kd(ADP) = 64 +/- 27 microM). Decreasing the [Ca(2+)] in solution from 200 nM to < 10 nM significantly increased the leak rate constant at all [ADP]. The SR Ca(2+) leak rate constant could be significantly reduced by blocking the SR Ca(2+) pump with 2,5-di(tert-butyl)-1,4-hydroquinone (TBQ). 4. The decrease in the SR Ca(2+) pump rate and the increase in the rate constant of SR Ca(2+) leak when the [ADP] increased from < 0.10 microM to 1.04 mM caused a 4.4-fold decrease in SR Ca(2+) loading ability at 200 nM Ca(2+). 5. The results can be fully explained by a mechanism whereby the presence of ADP causes a marked increase in the ADP-sensitive fraction of the phosphorylated pump protein, which can act as a Ca(2+)-Ca(2+) exchanger and demonstrates that ADP is an important modulator of SR function in skeletal muscle.

Residents' exposure to aboriginal health issues. Survey of family medicine programs in Canada.

OBJECTIVE: To determine whether Canadian family medicine residency programs currently have objectives, staff, and clinical experiences for adequately exposing residents to aboriginal health issues. DESIGN: A one-page questionnaire was developed to survey the details of teaching about and exposure to aboriginal health issues. SETTING: Family medicine programs in Canada. PARTICIPANTS: All Canadian family medicine program directors in the 18 programs (16 at universities and two satellite programs) were surveyed between October 1997 and March 1998. MAIN OUTCOME MEASURES: Whether programs had teaching objectives for exposing residents to aboriginal health issues, whether they had resource people available, what elective and core experiences in aboriginal health were offered, and what types of experiences were available. RESULTS: Response rate was 100%. No programs had formal, written curriculum objectives for residency training in aboriginal health issues, although some were considering them. Some programs, however, had objectives for specific weekend or day sessions. No programs had a strategy for encouraging enrollment of residents of aboriginal origin. Eleven programs had at least one resource person with experience in aboriginal health issues, and 12 had access to community-based aboriginal groups. Core experiences were all weekend seminars or retreats. Elective experiences in aboriginal health were available in 16 programs, and 11 programs were active on reserves. CONCLUSIONS: Many Canadian family medicine programs give residents some exposure to aboriginal health issues, but most need more expertise and direction on these issues. Some programs have unique approaches to teaching aboriginal health care that could be shared. Formalized objectives derived in collaboration with other family medicine programs and aboriginal groups could substantially improve the quality of education in aboriginal health care in Canada.

Medical teaching program in a rural northern hospital.

Canada has a population of over 100,000 Aboriginal people who live in remote northern communities. Their culture and health care needs differ substantially from those of Canadian urban and rural non-Aboriginal populations. The health care delivery system is largely based on primary care nurses supported by family physicians. In Canada there is a dearth of training opportunities for medical practitioners interested in such a northern practice. The University of Toronto Sioux Lookout Program is based in the Sioux Lookout Zone Hospital, the busiest Aboriginal hospital in Canada. The program trains family practice residents, pediatric residents, and medical students from the University of Toronto, as well as graduate nurses preparing for northern primary care practice. Training focuses on exposure to Aboriginal culture and health care problems particular to our patient population. Enhanced understanding of northern Aboriginal life and improved recruitment of health care professionals are important goals of the teaching program.

Defective colour vision can impede information acquisition from redundantly colour-coded video displays.

Earlier findings showed that redundant colour coding decreased response times and reduced errors in carrying out various tasks that required information acquisition from the video display of an electronic flight instrument system. The results of this experiment showed that observers with defective colour vision have slower response times and higher error rates than normal observers for some of the tasks and that their performance is similar to that of colour-normal observers for a monochrome display. However, they were not disadvantaged when blue was used to colour code the target feature. Protanopes were shown to be especially disadvantaged in responding to a red 'fail' message.