European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch.

BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. RESULTS: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. CONCLUSIONS: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

Experimental study of a novel hybrid constructed wetland for water reuse and its application in Southern China.

A new type of hybrid constructed wetland (CW), consisting of both vertical-baffled flow wetland (VBFW) and horizontal subsurface flow wetland (HSFW), has been deployed in Southern China to naturally accelerate the removal of organic matter and nitrogen. The hybrid CW system is characterised by a combination of continuous baffled flow vertical wetland and 'S' pattern horizontal subsurface flow wetland with natural aeration ditches to increase the concentration of dissolved oxygen in the HSFW bed. An internal circulatory system from the HSFW effluent back to the VBFW may optionally be operated to enhance the biological denitrification effect. Cyperus alternifolius is the main macrophyte in the wetland bed. The performance of the hybrid CW was studied with a pilot-scale system and three full-scale systems for municipal sewage treatment in Southern China. The results suggest that this new hybrid CW can achieve removal efficiencies of chemical oxygen demand, suspended solids, ammonia nitrogen, total nitrogen, and total phosphorus of better than 83.6, 95.0, 71.7, 64.5 and 68.1% respectively, with a specific wetland bed area of 0.70-0.93 m(2) PE(-1). The mean effluent concentrations of these parameters would meet the regulatory discharge limits for wastewater treatment systems (GB18918, 2002) and reuse in the context of agricultural irrigation solutions in China.

Anaerobic biodegradation of estrogens--hard to digest.

Although many publications are available on the fate of estrone (E1), 17beta-estradiol (E2) and 17alpha-ethynylestradiol (EE2) during aerobic wastewater treatment, little is published on their fate under strictly anaerobic conditions. Present research investigated the digestibility of E1 and EE2, using digested pig manure, granular UASB sludge, UASB-septic tank sludge and activated sludge as inocula. Besides, actual concentrations were measured in a UASB septic tank treating black water. Under anaerobic conditions E1 is reduced to E2 but the extent of this reduction depends on type of inoculum. No significant loss of the sum of E1 and E2 and of EE2 was observed. Adsorption was responsible for a 32-35% loss of E1 and E2 from the liquid phase in the UASB septic tank and the effluent still contained considerable concentrations of respectively 4.02 microg/l and 18.79 microg/l for E1 and E2 with a large fraction present in conjugated form. No EE2 was detected in the UASB effluent.

Fate of oestrogens during anaerobic blackwater treatment with micro-aerobic post-treatment.

The fate of oestrone (E1), 17beta-oestradiol (E2) and 17alpha-ethynyloestradiol (EE2) was investigated in a concentrated blackwater treatment system consisting of an UASB septic tank, with micro-aerobic post-treatment. In UASB septic tank effluent a (natural) total concentration of 4.02 microg/L E1 and 18.69 microg/L E2, comprising the sum of conjugated (>70% for E1 and >80% for E2) and unconjugated forms, was measured. During post-treatment the unconjugated oestrogens were removed to below 1 microg/L. A percentage of 77% of the measured unconjugated E1 and 82% of E2 was associated with particles >1.2 microm in the final effluent implying high sorption affinity of both compounds. When spiking the UASB septic tank effluent with E1, E2, EE2 and the sulphate conjugate of E2, removal in the micro-aerobic post-treatment was >99% for both E2 and EE2 and 83% for E1. The lower removal value for E1 was a result of (slow) deconjugation during the treatment, and in the final effluent still 40% of E1 and 99% of E2 was present in conjugated form. The latter was the result of incomplete deconjugation of the spiked E2(3S) in the post-treatment system.

Enhanced primary treatment of concentrated black water and kitchen residues within DESAR concept using two types of anaerobic digesters.

Anaerobic digestion of concentrated domestic wastewater streams--black or brown water, and solid fraction of kitchen waste is considered as a core technology in a source separation based sanitation concept (DESAR--decentralised sanitation and reuse). A simple anaerobic digester can be implemented for an enhanced primary treatment or, in some situations, as a main treatment. Two reactor configurations were extensively studied; accumulation system (AC) and UASB septic tank at 15, 20 and 25 degrees C. Due to long retention times in an AC reactor, far stabilisation of treated medium can be accomplished with methanisation up to 60%. The AC systems are the most suitable to apply when the volume of waste to be treated is minimal and when a direct reuse of a treated medium in agriculture is possible. Digested effluent contains both liquid and solids. In a UASB septic tank, efficient separation of solids and liquid is accomplished. The total COD removal was above 80% at 25 degrees C. The effluent contains COD and nutrients, mainly in a soluble form. The frequency of excess sludge removal is low and sludge is well stabilised due to a long accumulation time.

Anaerobic biodegradability and digestion in accumulation systems for concentrated black water and kitchen organic-wastes.

The feasibility of two accumulation-systems (AC) for anaerobic digestion and storage of concentrated black water with (AC1) or without (AC2) urine + kitchen organic-wastes was investigated. The waste(water) was collected by two vacuum toilet/transport systems. The influent-total COD of the AC2 (53,000 mg/L) was more concentrated by four times than that of the AC1. The suspended COD represented the major part (71-73%) of influent total COD of the two systems. The batch-experiments results showed a high anaerobic biodegradability of the waste(water) (> 85%). The AC systems demonstrated stable performance. There was no inhibition effect of NH4 and VFA concentration decreased in time. Total COD removal of 58% was achieved in both systems, after 105 days at 20 degrees C. Moreover, if only the supernatant in AC1 is withdrawn and the settled sludge stays for the next runs, only 20% of the influent total COD will be in the supernatant. In AC2, 74% of influent ortho-P was removed by precipitation. Therefore, the settled sludge in the AC2 had a high total-P concentration of 1,300 mg/L. The C:N:P ratios of the supernatant and the sludge were 26:13:1 and 35:4.5:1, respectively, in the AC1, and were 28:14:1 and 32:2.4:1, respectively, in AC2.

On-line signal quality estimation of multichannel surface electromyograms.

When multichannel surface-electromyography (MCSEMG) systems are used, there is a risk of recording low-quality signals. Such signals can be confusing for analysis and interpretation and can be caused by power-line interference, motion artifacts or poor electrode-skin contact. Usually, the electrode-skin impedance is measured to estimate the quality of the contact between the electrodes and the skin. However, this is not always practical, and the contact can change over short time-scales. A fast method is described to estimate the quality of individual signals of monopolar MCSEMG recordings based on volume conduction of myo-electric signals. The characteristics of the signals were described using two descriptor variables. Outliers (extreme data points) were detected in the two-dimensional distributions of the descriptor variables using a non-parametric technique, and the quality of the signals was estimated by their outlier probabilities. The method's performance was evaluated using 1 s long signals visually classified as very poor (G 1), poor (G2) or good quality (G3). Recordings from different subjects, contraction levels and muscles were used. An optimum threshold at 0.05 outlier probability was proposed and resulted in classification accuracies of 100% and > 70% for G I and G2 signals, respectively, whereas <5% of the G3 signals were classified as poor. In conclusion, the proposed method estimated MCSEMG signal quality with high accuracy, compared with visual assessment, and is suitable for on-line implementation. The method could be applied to other multichannel sensor systems, with an arbitrary number of descriptor variables, when their distributions can be assumed to lie within a certain range.

Simultaneous estimation of muscle fibre conduction velocity and muscle fibre orientation using 2D multichannel surface electromyogram.

The paper presents a new approach for simultaneous estimation of muscle fibre conduction velocity (MFCV) and muscle fibre orientation (MFO) for motor units (MUs) in two-dimensional (2D) multichannel surface electromyography recordings. This is an important tool for detecting changes and abnormalities in muscle function and structure. In addition, simultaneous estimation of MFO and MFCV avoids the necessity of manual electrode alignment. The proposed method detected propagating MU action potentials (MUAPs) in a running time window as moving components in amplitude maps. Thereafter, estimations were obtained by fitting a three-dimensional function to these maps. The performance was evaluated using synthetic MU signals at 10 dB SNR and authentic biceps brachii measurements. Results demonstrated MFCV and MFO estimates with standard deviations of less than 0.05 m s(-1) and 1 degrees for simulated signals, and less than 0.2 m s(-1) and 4 degrees for experimental data. However, standard deviations as low as 0.12 m s(-1) and 1.6 degrees from real signals were demonstrated. It was concluded that the method performs as well as, or better than, linear array multichannel methods when individual propagating MUAPs can be identified, even if electrodes are not aligned with fibre direction.

Performance of UASB septic tank for treatment of concentrated black water within DESAR concept.

Separation of wastewater streams produced in households according to their origin, degree of pollution and affinity to a specific treatment constitutes a starting point in the DESAR concept (decentralised sanitation and reuse). Concentrated black water and kitchen waste carry the highest load of organic matter and nutrients from all waste(water)streams generated from different human activities. Anaerobic digestion of concentrated black water is a core technology in the DESAR concept. The applicability of the UASB septic tank for treatment of concentrated black water was investigated under two different temperatures, 15 and 25 degrees C. The removal of total COD was dependent on the operational temperature and attained 61 and 74% respectively. A high removal of the suspended COD of 88 and 94% respectively was measured. Effluent nutrients were mainly in the soluble form. Precipitation of phosphate was observed. Effective sludge/water separation, long HRT and higher operational temperature contributed to a reduction of E. coli. Based on standards there is little risk of contamination with heavy metals when treated effluent is to be applied in agriculture as fertiliser.

Possible mechanisms of muscle cramp from temporal and spatial surface EMG characteristics.

In this study, the initiation and development of muscle cramp are investigated. For this, we used a 64-channel surface electromyogram (EMG) to study the triceps surae muscle during both cramp and maximal voluntary contraction (MVC) in four cramp-prone subjects and during cramp only in another four cramp-prone subjects. The results show that cramp presents itself as a contraction of a slowly moving fraction of muscle fibers, indicating that either the spatial arrangement of the motoneurons and muscle fibers is highly related or that cramp spreads at a level close to the muscle. Spectral analyses of the EMG and peak-triggered average potentials show the presence of extremely short potentials during cramp compared with during MVC. These results can also be interpreted in two ways. Either the motoneurons fire with enlarged synchronization during MVC compared with cramp, or smaller units than motor units are active, indicating that cramp is initiated close to or even at the muscle fiber level. Further research is needed to draw final conclusions.

Role of tendon properties on the dynamic performance of different isometric muscles.

The effect of the tendon's viscoelastic stiffness on the dynamic performance of muscles with different architecture was determined using the cat's medial gastrocnemius and extensor digitorum longus. Dynamic response models were derived under sinusoidal contraction-relaxation in the range of 0.4-6.0 Hz and between 20 and 80% of the muscles' maximal isometric tension, manipulated by orderly recruitment-derecruitment of motor units together with firing rate increase-decrease. It was shown that, for isometric contractions at the muscle's optimum length, the dynamic response of the muscles was not significantly different before and after dissection of the tendon. Therefore the conclusion that under these conditions the tendon acts like a stiff force transmitter without significantly modifying the muscle's performance was confirmed and extended to muscles with different architecture.

Automatic decomposition electromyography in idiopathic inflammatory myopathies.

Automatic decomposition electromyography (ADEMG) is a commercially available software package with installed reference values that enables the objective measurement of motor unit action potentials (MUAPs). To assess the diagnostic yield of this package in idiopathic inflammatory myopathies (IIM) we performed bicepts brachii ADEMG in 17 patients with polymyositis, dermatomyositis and inclusion body myositis. Results were compared with those in 12 controls, and with the results of conventional EMG of the biceps and other muscles. Decreased mean values for MUAP duration occurred significantly more frequently in IIM patients than in controls; other MUAP characteristics did not differ. In IIM patients, decreased mean amplitude and increased mean number of turns occurred significantly less frequently on ADEMG than did corresponding abnormalities on conventional biceps EMG. Decreased mean values for duration and amplitude, and increased mean values for number of turns were seen significantly less often on ADEMG than corresponding abnormalities on conventional EMG of four different, individually chosen muscles. Overall evaluation of ADEMG resulted in a diagnosis of "possible myopathy" in 1 and "probable myopathy" in 8 patients, whereas overall evaluation of conventional EMG led to a diagnosis "suggestive of IIM" in 13 patients. We conclude that, although measurement of mean MUAP duration might be valuable in IIM diagnosis, our results do not favour the use of biceps brachii ADEMG and the installed reference values for the diagnosis of IIM. We suggest modifications to improve ADEMG's applicability.

Near- and far-fields: source characteristics and the conducting medium in neurophysiology.

It is possible to appreciate the production of far-field potentials by considering constant current dipolar source voltage distributions in bounded volumes, especially when they are stretched in one direction, e.g., a cylinder. An essentially nondeclining voltage is detected when the recording electrodes are on opposite sides of, and relatively far from, the dipolar source. This voltage maintains its (a) latency, (b) amplitude, (c) morphology, and (d) polarity even if recordings are performed a whole body length away. These four criteria define far-field potentials. A propagating action potential (AP) can be conceptualized as a linear quadrupole or the summation of two dipoles "back-to-back" (+ - - +). The far-field components of the summated dipoles cancel resulting in the anticipated triphasic waveform for APs with only near-field characteristics, not meeting the first three criteria above. Far-field potentials can be transiently generated when any propagating AP constitutes a net "real" or "virtual" dipolar source. "Real" dipolar sources can occur if an AP encounters the termination of excitable tissue, an alteration in conduction velocity, curvature in excitable tissue resulting in a change in propagation direction, or an abrupt change in resistance of the excitable tissue. Virtual dipolar sources may be produced if an AP encounters a change in the size or shape of the extracellular medium or a transition in extracellular conductivity.

Surface EMG models: properties and applications.

After a general introduction on the kind of models and the use of models in the natural sciences, the main body of this paper reviews potential properties of structure based surface EMG (sEMG) models. The specific peculiarities of the categories (i) source description, (ii) motor unit structure, (iii) volume conduction, (iv) recording configurations and (v) recruitment and firing behaviour are discussed. For a specific goal, not all aspects conceivable have to be part of a model description. Therefore, finally an attempt is made to integrate the 'question level' and the 'model property level' in a matrix providing direction to the development and application of sEMG models with different characteristics and varying complexity. From this overview it appears that the least complex are models describing how the morphological muscle features are reflected in multi-channel EMG measurements. The most challenging questions in terms of model complexity are related to supporting the diagnosis of neuromuscular disorders.

Adaptive spatial filtering of multichannel surface electromyogram signals.

Spatial filtering of surface electromyography (EMG) signals can be used to enhance single motor unit action potentials (MUAPs). Traditional spatial filters for surface EMG do not take into consideration that some electrodes could have poor skin contact. In contrast to the traditional a priori defined filters, this study introduces an adaptive spatial filtering method that adapts to the signal characteristics. The adaptive filter, the maximum kurtosis filter (MKF), was obtained by using the linear combination of surrounding channels that maximises kurtosis. The MKF and conventional filters were applied to simulated EMG signals and to real EMG signals recorded with an electrode grid to evaluate their performance in detecting single motor units. The MKF was compared with conventional spatial filtering methods. Simulated signals, with different levels of spatially correlated noise, were used for comparison. The influence of one electrode with poor skin contact was also investigated. The MKF was found to be considerably better at enhancing a single MUAP than conventional methods for all levels of spatial correlation of the noise. For a spatial correlation of 0.97 of the noise, the improvement in the signal-to-noise ratio, where a MUAP could be detected, was at least 6dB. With a simulated poor skin contact for one electrode, the improvement over the other methods was at least 19 dB.

Co-digestion of concentrated black water and kitchen refuse in an accumulation system within the DESAR (decentralized sanitation and reuse) concept.

Co-digestion of concentrated black water and kitchen refuse within the DESAR concept was the objective of this pilot research. The digestion took place in two, non-mixed accumulation reactors (AC1 and AC2) inoculated with digested primary sludge from a WWTP at a temperature of 20 degrees C for a period of around 150 days. Reactor AC1 was fed with a mixture of faeces, urine and kitchen refuse in the equivalent amount that one individual generates per day. The AC2 was fed with a mixture of faeces and kitchen refuse in the equivalent amount that two individuals produce per day. Some contribution of urine to AC2 was not to be avoided. Detailed characterisation of waste(water) was performed. The performance of the stratified reactor was followed by monitoring the reactor content for several reactors' heights as well as being based on the biogas production. In general the system exposed good process stability. The methanisation of 34 and 61% was obtained for AC1 and AC2 respectively. The biogas yield was 26.5 and 50.8 L/p/d for the respective reactors. Proper choice of inoculum as well as good buffering capacity did not lead to accumulation of VFA and an inhibitive effect due to relatively high ammonium concentration. The chosen process is a promising technology showing good process stability especially for high strength influent.

Fate of hormones and pharmaceuticals during combined anaerobic treatment and nitrogen removal by partial nitritation-anammox in vacuum collected black water.

Vacuum collected black (toilet) water contains hormones and pharmaceuticals in relatively high concentrations (µg/L to mg/L range) and separate specific treatment has the potential of minimizing their discharge to surface waters. In this study, the fate of estrogens (natural and synthetical hormones) and pharmaceuticals (paracetamol, metoprolol, propranolol, cetirizine, doxycycline, tetracycline, ciprofloxacin, trimethoprim, carbamazepine, ibuprofen and diclofenac) in the anaerobic treatment of vacuum collected black water followed by nitrogen removal by partial nitritation-anammox was investigated. A new analytical method was developed to detect the presence of several compounds in the complex matrix of concentrated black water. Detected concentrations in black water ranged from 1.1 µg/L for carbamazepine to >1000 µg/L for paracetamol. Anaerobic treatment was only suitable to remove the majority of paracetamol (>90%). Metoprolol was partly removed (67%) during aerobic treatment. Deconjugation could have affected the removal efficiency of ibuprofen as concentrations even increased during anaerobic treatment and only after the anammox treatment 77% of ibuprofen was removed. The presence of persistent micro-pollutants (diclofenac, carbamazepine and cetirizine), which are not susceptible for biodegradation, makes the application of advanced physical and chemical treatment unavoidable.

Duration of differential activations is functionally related to fatigue prevention during low-level contractions.

The aim of this study was to investigate the importance of duration of differential activations between the heads of the biceps brachii on local fatigue during prolonged low-level contractions. Fifteen subjects carried out isometric elbow flexion at 5% of maximal voluntary contraction (MVC) for 30 min. MVCs were performed before and at the end of the prolonged contraction. Surface electromyographic (EMG) signals were recorded from both heads of the biceps brachii. Differential activation was analysed based on the difference in EMG amplitude (activation) between electrodes situated at the two heads. Differential activations were quantified by the power spectral median frequency of the difference in activation between the heads throughout the contraction. The inverse of the median frequency was used to describe the average duration of the differential activations. The relation between average duration of the differential activations and the fatigue-induced reduction in maximal force was explored by linear regression analysis. The main finding was that the average duration of differential activation was positively associated to relative maximal force at the end of the 30 min contraction (R(2)=0.5, P<0.01). The findings of this study highlight the importance of duration of differential activations for local fatigue, and support the hypothesis that long term differential activations prevent fatigue during prolonged low-level contractions.

Motor unit synchronization during fatigue: described with a novel sEMG method based on large motor unit samples.

The amount of documented increase in motor unit (MU) synchronization with fatigue and its possible relation with force tremor varies largely, possibly due to inhomogeneous muscle activation and methodological discrepancies and limitations. The aim of this study was to apply a novel surface electromyographical (EMG) descriptor for MU synchronization based on large MU populations to examine changes in MU synchronization with fatigue at different sites of a muscle and its relation to tremor. Twenty-four subjects performed an isometric elbow flexion at 25% of maximal voluntary contraction until exhaustion. Monopolar EMG signals were recorded using a grid of 130 electrodes above the biceps brachii. Changes in MU synchronization were estimated based on the sub-band skewness of EMG signals and tremor by the coefficient of variation in force. The synchronization descriptor was dependent on recording site and increased with fatigue together with tremor. There was a general association between these two parameters, but not between their fluctuations. These results are in agreement with other surface EMG studies and indicate that the novel descriptor can be used to attain information of synchronization between large MU populations during fatigue that cannot be retrieved with intra-muscular EMG.