Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patient.

BACKGROUND: Polypharmacy, frailty and malnutrition are known predictors of adverse outcomes in dialysis patients. Little has reported about their interaction and composite prognostic values. We aimed to describe the interaction between polypharmacy, frailty, nutrition, hospitalization, and survival in peritoneal dialysis patients. METHODS: In this prospective cohort study, we recruited 573 peritoneal dialysis patients. Drug burden was measured by medication number and daily pill load. Frailty and nutrition were assessed by the validated Frailty Score (FQ) and Subjective Global Assessment (SGA) respectively. All patients were followed for two years. Primary outcome was all-cause mortality. Secondary outcomes were fall and fracture episodes, hospitalization, change in FQ and SGA. RESULTS: At baseline, each patient took 7.5 ± 2.6 medications with 15.5 ± 8.5 tablets per day. Medication number, but not daily pill load predicted baseline FQ (p = 0.004) and SGA (p = 0.03). Over 2 years, there were 69 fall and 1,606 hospitalization episodes. In addition, 148 (25.8%) patients died, while FQ and SGA changed by 0.73 ± 4.23 and -0.07 ± 1.06 respectively in survivors. Medication number (hospitalization: p = 0.02, survival: p = 0.005), FQ (hospitalization: p < 0.001; survival: p = 0.01) predicted hospitalization and survival. Medication number also predicted fall episodes (p = 0.02) and frailty progression (p = 0.002). Daily pill load did not predict any of these outcomes. CONCLUSIONS: Drug burden is high in peritoneal dialysis patients, and it carries important prognostic implication. Medication number but not pill load significantly predicted onset and progression of frailty, malnutrition, fall, hospitalization, and mortality.

Effects of enhanced recovery after surgery practices on postoperative recovery and length of stay after unilateral primary total hip or knee arthroplasty in a private hospital.

INTRODUCTION: Enhanced recovery after surgery (ERAS) practices improve postoperative recovery and reduce postoperative length of stay (LOS) in patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our study investigated whether these promising results could be reproduced in a private hospital setting. METHODS: In total, 228 patients were included in the study cohort: the conventional group comprised 117 patients from 2012 to 2014, while the ERAS group comprised 111 patients from 2017 to 2018. All patients had undergone unilateral primary THA or TKA at a private hospital in Hong Kong. The outcome was postoperative LOS; factors affecting LOS were also investigated. RESULTS: No significant differences were found in any baseline parameters between the two groups of patients. The mean LOS was significantly shorter in the ERAS group than in the conventional group (3.28 ± 1.04 vs 5.16 ± 2.06 days, P<0.001). Moreover, a significantly greater proportion of patients could be discharged on or before postoperative day 3 in the ERAS group, compared with the conventional group (77.5% vs 13.7%, P<0.001). A significant difference in LOS was observed between general ward and private ward patients (3.06 ± 0.59 vs 3.66 ± 1.46 days, P=0.003). Sex, age, and nature of surgery (TKA vs THA) did not have significant effects on LOS. CONCLUSIONS: The ERAS practices yielded a significant improvement in postoperative LOS, compared to conventional practices, among patients who underwent unilateral primary THA or TKA in a private hospital.

Single-cell RNA sequencing identifies molecular targets associated with poor in vitro maturation performance of oocytes collected from ovarian stimulation.

STUDY QUESTION: What is the transcriptome signature associated with poor performance of rescue IVM (rIVM) oocytes and how can we rejuvenate them? SUMMARY ANSWER: The GATA-1/CREB1/WNT signalling axis was repressed in rIVM oocytes, particularly those of poor quality; restoration of this axis may produce more usable rIVM oocytes. WHAT IS KNOWN ALREADY: rIVM aims to produce mature oocytes (MII) for IVF through IVM of immature oocytes collected from stimulated ovaries. It is not popular due to limited success rate in infertility treatment. Genetic aberrations, cellular stress and the absence of cumulus cell support in oocytes could account for the failure of rIVM. STUDY DESIGN, SIZE, DURATION: We applied single-cell RNA sequencing (scRNA-seq) to capture the transcriptomes of human in vivo oocytes (IVO) (n = 10) from 7 donors and rIVM oocytes (n = 10) from 10 donors. The effects of maternal age and ovarian responses on rIVM oocyte transcriptomes were also studied. In parallel, we studied the effect of gallic acid on the maturation rate of mouse oocytes cultured in IVM medium with (n = 84) and without (n = 85) gallic acid. PARTICIPANTS/MATERIALS, SETTING, METHODS: Human oocytes were collected from donors aged 28-41 years with a body mass index of <30. RNA extraction, cDNA generation, library construction and sequencing were performed in one preparation. scRNA-seq data were then processed and analysed. Selected genes in the rIVM versus IVO comparison were validated by quantitative real-time PCR. For the gallic acid study, we collected immature oocytes from 5-month-old mice and studied the effect of 10-µM gallic acid on their maturation rate. MAIN RESULTS AND THE ROLE OF CHANCE: The transcriptome profiles of rIVM/IVO oocytes showed distinctive differences. A total of 1559 differentially expressed genes (DEGs, genes with at least 2-fold change and adjusted P < 0.05) were found to be enriched in metabolic processes, biosynthesis and oxidative phosphorylation. Among these DEGs, we identified a repression of WNT/ß-catenin signalling in rIVM when compared with IVO oocytes. We found that oestradiol levels exhibited a significant age-independent correlation with the IVO mature oocyte ratio (MII ratio) for each donor. rIVM oocytes from women with a high MII ratio were found to have over-represented cellular processes such as anti-apoptosis. To further identify targets that contribute to the poor clinical outcomes of rIVM, we compared oocytes collected from young donors with a high MII ratio with oocytes from donors of advanced maternal age and lower MII ratio, and revealed that CREB1 is an important regulator. Thus, our study identified that GATA-1/CREB1/WNT signalling was repressed in both rIVM oocytes versus IVO oocytes and in rIVM oocytes of lower versus higher quality. Consequently we investigated gallic acid, as a potential antioxidant substrate in human rIVM medium, and found that it increased the mouse oocyte maturation rate by 31.1%. LARGE SCALE DATA: Raw data from this study can be accessed through GSE158539. LIMITATIONS, REASONS FOR CAUTION: In the rIVM oocytes of the high- and low-quality comparison, the number of samples was limited after data filtering with stringent selection criteria. For the oocyte stage identification, we were unable to predict the presence of oocyte spindle, so polar body extrusion was the only indicator. WIDER IMPLICATIONS OF THE FINDINGS: This study showed that GATA-1/CREB1/WNT signalling was repressed in rIVM oocytes compared with IVO oocytes and was further downregulated in low-quality rIVM oocytes, providing us the foundation of subsequent follow-up research on human oocytes and raising safety concerns about the clinical use of rescued oocytes. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the Collaborative Research Fund, Research Grants Council, C4054-16G, and Research Committee Funding (Research Sustainability of Major RGC Funding Schemes), The Chinese University of Hong Kong. The authors have no conflicts of interest to declare.

Paradoxical emboli from left superior vena cava causing recurrent brain abscess.

Persistent left superior vena cava is a rare but well-recognised condition. We describe a case of persistent left superior vena cava draining directly into the left atrium, with a fixed anatomical right-to-left shunt and paradoxical embolic events causing recurrent brain abscess. Surgical ligation was curative.

Silicon nanopillar substrates for enhancing signal intensity in DNA microarrays.

The use of ordered, high-aspect ratio nanopillar arrays on the surface of silicon-based chips to enhance signal intensity in DNA microarrays is reported. These nanopillars consisting either of a single silicon dioxide substrate or a dual silicon/silicon dioxide substrate are fabricated using deep-UV lithography followed by reactive ion etching. These pillar type arrays provide a three-dimensional high surface-density platform that increases the immobilization capacity of captured probes, enhances target accessibility and reduces background noise interference in DNA microarrays, leading to improved signal-to-noise ratios, sensitivity and specificity. Consequently, it was found that the use of such nanopillars enhanced the hybridization signals by up to seven times as compared to silicon dioxide thin film substrates. In addition, hybridization of synthetic targets to capture probes that contained a single-base variation showed that the perfect matched duplex signals on dual-substrate nanopillars can be up to 23 times higher than the mismatched duplex signals, allowing the targets to be unambiguously identified. These results suggest that the nanopillars, particularly the dual-substrate pillars, are able to enhance the hybridization signals and discrimination power in nucleic acids-based detection, providing an alternative platform for improving the performance of DNA microarrays.

Effects of polymer, organic solvent and mixing strength on integrity of proteins and liposomes encapsulated in polymeric microspheres fabricated by the double emulsion process.

The double emulsion process has commonly been applied to encapsulate water-soluble bioactive agents into polymeric microspheres. However, the integrity of many of these agents may be destroyed by the highly energetic procedures such as sonication that are routinely used to produce stable water-in-oil (w/o) emulsion. The aim of this research was to pursue the possibility of replacing the sonication by a mild emulsification procedure such as vortex mixing, with the use of certain materials to help to obtain stable w/o emulsion. The following materials were examined: poly(lactide-co-ethylene glycol) (PELA) as the polymer, ethyl acetate and acetone as the solvents, poly(vinyl alcohol) (PVA) and d-alpha tocopheryl polyethylene glycol 1000 succinate (Vitamin E TPGS) as the emulsifiers in w/o emulsion. The experimental results, with human serum albumin (HSA) as the encapsulated agent, showed that, when vortex mixing was used, these materials could significantly improve w/o emulsion stability and help to obtain satisfactory encapsulation effects, i.e. high encapsulation efficiency (EE) and low initial release burst. A delicate structure, i.e. liposomes, which is very sensitive to sonication, was then incorporated into microspheres by the 'modified double emulsion process'. It was found that the liposomes were intact and the encapsulation effects were good. Therefore, it can be concluded that the modified double emulsion process could be advantageous for the encapsulation of delicate substances.

Transoesophageal acoustic quantification for evaluation of cardiac function during laparoscopic surgery.

Pneumoperitoneum may be poorly tolerated in patients with marginal cardiopulmonary function. Transoesophageal echocardiography is a relatively non-invasive technique that can track changes in left ventricular cavity area using acoustic quantification and has been found to provide a reliable, real-time estimation of left ventricular function. We evaluated mid-papillary fractional area change during pneumoperitoneum in 17 healthy adult patients (group 1) and 17 with hypertension and/or ischaemic heart disease (group 2) undergoing laparoscopic cholecystectomy. Peritoneal insufflation led to significant (p < 0.01) decreases in fractional area change and an increase in mean blood pressure. There was no significant change in heart rate. Patients with cardiovascular disease who had a > 30% decrease in fractional area change following carbon dioxide insufflation (group 2B) were given an intravenous infusion of glyceryl trinitrate. In groups 1 and 2A, fractional area change improved slightly with head-up tilt and continued to improve over the course of surgery. Glyceryl trinitrate led to a significant increase in fractional area change and a decrease in mean blood pressure back to baseline values. We conclude that peritoneal insufflation of carbon dioxide results in a significant increase in cardiac workload that is well tolerated in patients with no cardiovascular disease. Coexisting cardiovascular disease can result in even more pronounced impairment of cardiac function, which may not be predictable by clinical assessment or adequately determined by routine monitoring. We recommend the use of transoesophageal acoustic quantification as a monitor in these patients and the administration of glyceryl trinitrate to ameliorate myocardial stress.

Functional roles of abdominal and back muscles during isometric axial rotation of the trunk.

Electromyographic (EMG) studies have shown that a large number of trunk muscles are recruited during axial rotation. The functional roles of these trunk muscles in axial rotation are multiple and have not been well investigated. In addition, there is no information on the coupling torque at different exertion levels during axial rotation. The aim of the study was to investigate the functional roles of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus during isometric right and left axial rotation at 100%, 70%, 50% and 30% maximum voluntary contractions (MVC) in a standing position. The coupling torques in sagittal and coronal planes were measured during axial rotation to examine the coupling nature of torque at different levels of exertions. Results showed that the coupled sagittal torque switches from nil to flexion at maximum exertion of axial rotation. Generally, higher EMG activities were shown at higher exertion levels for all the trunk muscles. Significant differences in activity between the right and left axial rotation exertions were demonstrated in external oblique, internal oblique, latissimus dorsi and iliocostalis lumborum while no difference was shown in rectus abdominis and multifidus. These results demonstrated the different functional roles of trunk muscles during axial rotation. This is important considering that the abdominal and back muscles not only produce torque but also maintain the spinal posture and stability during axial rotation exertions. The changing coupling torque direction in the sagittal plane when submaximal to maximal exertions were compared may indicate the complex nature of the kinetic coupling of trunk muscles.

Range of motion and lordosis of the lumbar spine: reliability of measurement and normative values.

STUDY DESIGN: Repeated measures for intratester reliability were performed. OBJECTIVES: To investigate the intratester reliability of a new measurement technique that evaluates lumbar range of motion in three planes using a pelvic restraint device, and to examine the reliability of lumbar lordosis measurement by inclinometer technique. Preliminary normative data on lumbar range of motion and lumbar lordosis were collected for comparison with the findings of previous studies. SUMMARY OF BACKGROUND DATA: Various noninvasive measurement methods have been developed for recording lumbar range of motion. However, pelvic movement was not effectively restricted during the use of these measurement techniques. The use of the pelvic restraint device to measure lumbar range of motion has not been investigated previously. Very few studies have investigated the reliability of quantifying lumbar lordosis by the inclinometer technique. METHODS: Normative values were measured in 35 healthy men, and 12 of these subjects were included for the reliability study. Pelvic motion was limited by the pelvic restraint device during lumbar range of motion measurement in standing. An inclinometer was used for evaluation of lumbar flexion, extension, lateral flexion, and lumbar lordosis, whereas a lumbar rotameter was used to measure axial rotation. RESULTS: Good intratester reliability was shown in the lumbar range of motion and lordosis measurement. Most of the intraclass correlation coefficient and Pearson's r values (accompanied with nonsignificant paired t tests) were greater than 0.9, and most of the intrasubject coefficients of variation were less than 10%. The values of lumbar range of motion in three planes and lumbar lordosis found in the current study were comparable with those from most of the previous studies on these measurements in the normal population. CONCLUSIONS: Inclinometer and lumbar rotameter measurements with the use of a pelvic restraint device are reliable for measuring lumbar spine range of motion. Use of the inclinometer technique to record lumbar lordosis also is a reliable measure.

Molecular and cellular basis of pattern formation during vertebrate limb development.

The body plan is generated by cells and tissues that become arranged precisely in the embryo. This process, termed pattern formation, involves cell interactions in which a particular group of cells produce signals that specify new cell types or patterns of differentiation in responding cells. These patterning signals emanate from very discrete centers called "organizer centers," such as the Hensen's node or Spemann organizer, the midbrain-hindbrain junction, the notochord, or in the case of the limb, the zone of polarizing activity (ZPA) or the apical ectodermal ridge (AER). The developing vertebrate limb is an ideal model system for the study of pattern formation because, in addition to surgical manipulations, molecular manipulations are now feasible. In this review we summarize early experiments that established, by means of surgical manipulations, the different organizer centers of the vertebrate limb: the ectoderm covering the limb bud, the apical ectodermal ridge, the zone of polarizing activity, and the distal mesoderm (progress zone) underlying the AER. We then describe the domains of expression of various genes present during the development of the limb and discuss some of the functional approaches (overexpression and lack of function studies) undertaken to ascertain their role in limb outgrowth. The knowledge acquired in the last few years has had an enormous impact not only on our view of how limbs develop (perhaps now one of the most approachable vertebrate model systems) but also in a more general sense of how the embryo is organized in space and time.

Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain.

Back muscles are important to the stability of the lumbar spine. Muscle fiber composition may give some indication of the functional capacity of these muscles. This review explores the relationship between muscle fiber composition and functional capacity of back muscles. The reference values for the type and size of the muscle fibers found in the back musculature of healthy subjects and patients with back pain are also presented. A high percentage of type I fibers, which are larger in size than type II fibers, has been found in back muscles at the thoracic and lumbar levels. This is in accordance with the postural function of these muscles. The diameter of type II fibers is smaller in females than males, which may partly explain the lesser strength and greater endurance capacity of back muscles in females. Due to the limited amount of pertinent data, no conclusive evidence is available regarding age-related changes in muscle fiber composition in the musculature of the back. In patients with lumbar disorders, pathological changes and selective atrophy of type II fibers are seen, and these can be changed with adequate exercises. Further research is suggested to address issues related to gender, age, back pain, and exercise and their effects on the apparent back muscle fiber composition.

Muscle fibre orientation of abdominal muscles and suggested surface EMG electrode positions.

The ability of surface electrodes to accurately detect the activity of a particular muscle relies not only on their being placed over the muscle but also on their position in relation to muscle fibre orientation. For optimal pick-up of electromyographic (EMG) signals, surface electrodes are best aligned in parallel with the fibre orientation of the underlying muscle. This study aimed to measure muscle fibre orientation and other parameters of muscle morphology of the abdominal muscles in relation to palpable bony landmarks. Thirty-seven embalmed cadavers (19 males and 18 females) were examined. Results showed that the fibres of obliquus externus abdominis were about 4 degrees more vertical than the lower edge of the eighth rib. Below the rib cage, the muscle fibres of obliquus externus abdominis were approximately 5 degrees closer to vertical than a reference line between the most inferior point of the costal margin and the contralateral pubic tubercle. In the anterolateral abdominal wall area below the anterior superior iliac spine (ASIS), the obliquus internus abdominis was superficial being covered only by the aponeurosis of obliquus externus abdominis. At the level of ASIS, the muscle fibres of obliquus internus abdominis were almost horizontally orientated but at 2 cm below ASIS were aligned about 6 degrees inferomedially to the horizontal. The muscle fibres of upper rectus abdominis were 2 degrees inferolateral to the midline while the lower rectus abdominis muscle fibres deviated inferomedially from the midline by about 8 degrees. The appropriate surface electrode placements which follows the muscle fibre orientation of the obliquus externus abdominis, obliquus internus abdominis and rectus abdominis have been suggested.

Transgenic mice expressing human ApoB95 and ApoB97. Evidence that sequences within the carboxyl-terminal portion of human apoB100 are important for the assembly of lipoprotein.

The structural features of apolipoprotein (apo) B that are important for its covalent linkage to apo(a) to form lipoprotein(a) (Lp(a)) are incompletely understood. Although apoB100 cysteine 4326 is required for the disulfide linkage with apo(a), other structural features, aside from a single free cysteine residue, must be important for apoB's initial interaction with apo(a) and for facilitating the formation of the disulfide bond. To determine if sequences carboxyl-terminal to cysteine 4326 affect the efficiency of Lp(a) formation, we used "pop-in, pop-out" gene targeting in a human apoB yeast artificial chromosome to introduce nonsense mutations into exon 29 of the apoB gene. The mutant yeast artificial chromosomes, which coded for the truncated versions of human apoB, apoB95, and apoB97, were then used to express these mutant forms of apoB in transgenic mice. As judged by in vitro assays of Lp(a) formation, apoB95 (4330 amino acids) formed a small amount of Lp(a) but did so slowly. In contrast, apoB97 (4397 amino acids) formed Lp(a) rapidly, although not quite as rapidly as the full-length apoB100 (4536 amino acids). These results were supported by an analysis of double-transgenic mice expressing both human apo(a) and either apoB95 or apoB97. In mice expressing both apoB95 and apo(a), there was only a trace amount of Lp(a) in the plasma, and most of the apo(a) was free, whereas in mice expressing both apoB97 and apo(a), virtually all of the apo(a) was bound to apoB97 in the form of Lp(a). These results show that sequences carboxyl-terminal to apoB95 (amino acids 4331-4536) are not absolutely required for Lp(a) formation, but this segment of the apoB molecule, particularly residues 4331-4397, is necessary for the efficient assembly of Lp(a).

Electromyographic amplitude and frequency changes in the iliocostalis lumborum and multifidus muscles during a trunk holding test.

BACKGROUND AND PURPOSE: Muscle endurance is an important variable to measure in the assessment of back muscle function. This study investigated the electromyographic (EMG) activity and fatigue patterns of iliocostalis lumborum and multifidus muscles during a trunk holding test. SUBJECTS: Sixteen male subjects (mean age = 24.2 years, SD = 4.2, range = 20.6-31.9) without low back pain or known pathology were recruited in the study. METHODS: Surface EMG electrodes were used to record the activity of iliocostalis lumborum and mutifidus muscles during a 60-second isometric contraction. To reflect the activity level and fatigue rate of the muscles. EMG amplitude (root mean square [RMS] values) and a frequency variable (median frequency [MF]) were measured. RESULTS: The multifidus muscle displayed a higher level of activity, initial MF, and normalized MF slope than did the iliocostalis lumborum muscle. There was no difference, however, in the normalized RMS slope between the two muscles. The correlations between the normalized MF slope and the RMS slope of the two muscles were nonsignificant. CONCLUSION AND DISCUSSION: This study shows that monitoring frequency changes of the EMG signals may enable therapists to quantify the fatigue changes of individual muscles during the trunk holding test. The higher fatigue rate shown in the multifidus muscle compared with the iliocostalis lumborum muscle may be due to the higher activity level of the multifidus muscle during te trunk holding contraction. This greater activity of the multifidus muscle during the contraction might be explained by the functional differences between these two muscles.

Transgenic mice that overexpress mouse apolipoprotein B. Evidence that the DNA sequences controlling intestinal expression of the apolipoprotein B gene are distant from the structural gene.

An 87-kilobase (kb) P1 bacteriophage clone (p649) spanning the mouse apolipoprotein (apo) B gene was used to generate transgenic mice that express high levels of mouse apoB. Plasma levels of apoB, low density lipoprotein cholesterol, and low density lipoprotein triglycerides were increased, and high density lipoprotein cholesterol levels were decreased in the transgenic mice, compared with nontransgenic littermate controls. Although p649 contained 33 kb of 5'-flanking sequences and 11 kb of 3'-flanking sequences, the tissue pattern of transgene expression was different from that of the endogenous apoB gene. RNA slot blots and RNase protection analysis indicated that the transgene was expressed in the liver but not in the intestine, whereas the endogenous apoB gene was expressed in both tissues. To confirm the absence of transgene expression in the intestine, the mouse apoB transgenic mice were mated with the apoB knockout mice, and transgenic mice that were homozygous for the apoB knockout mutation were obtained. Because of the absence of transgene expression in the intestine, those mice lacked all intestinal apoB synthesis, resulting in a marked accumulation of fats within the intestinal villus enterocytes. The current studies, along with prior studies of human apoB transgenic animals, strongly suggest that the DNA sequence element(s) controlling intestinal expression of the apoB gene is located many kilobases from the structural gene.

Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects.

OBJECTIVE AND DESIGN: To investigate the reliability (within-day and between-days) of measurements of electromyographic (EMG) power spectral values in measurement of the fatigue rate of the back muscles. METHODS: Twelve healthy male subjects were tested in the unsupported trunk holding position for 60 seconds. Two trials were performed on each of two separate sessions 3 days apart. Surface recording electrodes were placed over the iliocostalis lumborum and multifidus and a branched electrode technique was used to decrease cross-talk. OUTCOME MEASURES: Median frequency (MF) was extracted from the EMG signals by fast Fourier transform. Initial MF and the MF slope over time were computed from linear regression analysis. The reliability of the initial MF and the MF slope of the iliocostalis lumborum and multifidus was examined by Pearson's product moment correlation coefficients (Pearson's r), paired t tests, and a one-way analysis of variance (ANOVA) from which intrasubject coefficients of variation (CVintra) and intraclass correlation coefficients (ICC) were derived. RESULTS: For the initial MF, within-day and between-days reliability of the iliocostalis lumborum and multifidus were good (Pearson's r = .79-.94 nonsignificant paired t test, CVintra = 6.5% to 8.5%, ICC = .79-.93). The MF slope showed moderate variability for the iliocostalis lumborum (Pearson's r = .39-.55, nonsignificant paired t test, CVintra = 33.0% to 48.7%, ICC = .37-.56) while better reliability was found for the multifidus (Pearson's r = .77-.87, nonsignificant paired t test, CVintra = 25.8% to 27.5%, ICC = .78-.82). CONCLUSION: The present study indicated that the trunk holding test with the use of EMG power spectral analysis can be a reliable method to measure the fatigue rate of the back muscles if adequate measures are employed to minimize cross-talk. The better reliability of monitoring the fatigue rate of the multifidus may lead to its future use as a clinical measure.

Clinical applications of power spectral analysis of electromyographic investigations in muscle function.

Electromyographic (EMG) power spectral analysis of the electrical signals produced by a contracting muscle is emerging as a useful clinical tool. It has the potential to measure objectively the fatigue rate of individual muscles during an exertion. This technical note gives a simple introduction to the spectral changes of the EMG signals during fatigue. It outlines the technical aspects of EMG investigations including the data collection, signal analysis and its interpretation. The clinical applications, its present limitations and future applications are also given. The correct use and interpretation of the power spectral analysis in the clinical environment is important for its further development as a clinical measurement.