Gearing Up the Human Ankle-Foot System to Reduce Energy Cost of Fast Walking.

During locomotion, the human ankle-foot system dynamically alters its gearing, or leverage of the ankle joint on the ground. Shifting ankle-foot gearing regulates speed of plantarflexor (i.e., calf muscle) contraction, which influences economy of force production. Here, we tested the hypothesis that manipulating ankle-foot gearing via stiff-insoled shoes will change the force-velocity operation of plantarflexor muscles and influence whole-body energy cost differently across walking speeds. We used in vivo ultrasound imaging to analyze fascicle contraction mechanics and whole-body energy expenditure across three walking speeds (1.25, 1.75, and 2.0 m/s) and three levels of foot stiffness. Stiff insoles increased leverage of the foot upon the ground  (p < 0.001), and increased dorsiflexion range-of-motion (p < 0.001). Furthermore, stiff insoles resulted in a 15.9% increase in average force output (p < 0.001) and 19.3% slower fascicle contraction speed (p = 0.002) of the major plantarflexor (Soleus) muscle, indicating a shift in its force-velocity operating region. Metabolically, the stiffest insoles increased energy cost by 9.6% at a typical walking speed (1.25 m/s, p = 0.026), but reduced energy cost by 7.1% at a fast speed (2.0 m/s, p = 0.040). Stiff insoles appear to add an extra gear unavailable to the human foot, which can enhance muscular performance in a specific locomotion task.

Assessment of Permanent Selective His Bundle Pacing in Left Ventricular Synchronization Using 3-D Speckle Tracking Echocardiography.

The study described here aimed to evaluate left ventricular (LV) systolic mechanical synchronization during permanent selective His bundle pacing (SHBP) using 3-D speckle-tracking echocardiography post-operatively and 6 mo after pacemaker implantation in 62 patients randomly assigned to SHBP (n = 32) or right ventricular apical pacing (RVAP, n = 30). A standard apex four-chamber view was exposed and was transformed into full-volume mode under 3-D echocardiography. Three-dimensional speckle-tracking echocardiography was analyzed offline. The primary endpoint was LV mechanical synchronization post-operatively and during the 6-mo follow-up. Significant LV dyssynchrony was detected while evaluating the maximum time difference and standard deviation of 16-segment systolic time to peak 3-D strain at 1 wk and 6 mo. The pacing thresholds were significantly higher in the SHBP than in the RVAP group throughout follow-up. The R-wave amplitude was significantly lower in the SHBP group than with RVAP. The pacing parameters during SHBP were as stable as during conventional RVAP during the mid-term follow-up. In conclusion, 3-D speckle-tracking echocardiography is feasible and provides a more convenient method for evaluating LV synchrony.

Changes in fascicle length from rest to maximal voluntary contraction affect the assessment of voluntary activation.

The purpose of this study was to investigate the effect of the differences between the actual fascicle length during a voluntary contraction and the fascicle length at rest of the triceps surae muscle on the determination of the voluntary activation (VA) by using the interpolated twitch technique. Twelve participants performed isometric voluntary maximal (MVC) and submaximal (20%, 40%, 60% and 80% MVC) contractions at two different ankle angles (75 degrees and 90 degrees ) under application of the interpolated twitch technique. Two ultrasound probes were used to determine the fascicle length of soleus, gastrocnemius medialis and gastrocnemius lateralis muscles. Further, the MVCs and the twitches were repeated for six more ankle angles (85 degrees , 95 degrees , 100 degrees , 105 degrees , 110 degrees and 115 degrees ). The VA of the triceps surae muscle were calculated (a) using the rest twitch force (RTF) measured during the same trial as the interpolated twitch force (ITF; traditional method) and (b) using the RTF at an ankle angle where the fascicle length showed similar values between ITF and RTF (fascicle length consideration method). The continuous changes in fascicle length from rest to MVC affect the accuracy of the assessment of the VA. The traditional method overestimates the assessment of the VA on average 4% to 12%, especially at 90 degrees ankle angle (i.e. short muscle length). The reason for this influence is the unequal force-length potential of the muscle at twitch application by the measure of ITF and RTF. These findings provide evidence that the fascicle length consideration method permits a more precise prediction (an improvement of 4-12%) of the voluntary contraction compared to the traditional method.

Assessment of atrioventricular nodal physiology in the mouse.

Transgenic mice are increasingly being utilized for understanding cardiac electrophysiologic abnormalities. However, little is known about the normal atrioventricular nodal and infraHisian physiology in the mouse because of the prior inability to record a His-bundle deflection. We present the first comprehensive examination of the murine atrioventricular nodal and His-Purkinje systems employing His-bundle recordings. Normal, healthy, male C57BL/6J mice (n = 48) underwent an in vivo electrophysiology study using a 2 F octapolar electrode catheter. Effective refractory periods were determined during premature atrial and ventricular stimulation. The PR interval measured 44 +/- 6 ms with a mean sinus cycle length of 185 +/- 42 ms. Baseline AH intervals were 36 +/- 5 ms and HV intervals were 10 +/- 2 ms. At a pacing cycle length of 140 ms the atrioventricular nodal effective refractory period (AVNERP) and atrial effective refractory period (AERP) were 86 +/- 19 ms and 57 +/- 17 ms, respectively. The mean AV Wenckebach and 2:1 paced cycle length were 103 +/- 14 ms and 84 +/- 13 ms, respectively. Premature atrial stimulation curves were asymptotic without discontinuity. A subset of nine mice was studied after administration of isoproterenol. The sinus cycle length, AVNERP and AERP decreased significantly from baseline measurements. This method establishes a practical and feasible technique to record in vivo His-bundle electrograms in the mouse to assess atrioventricular nodal and infraHisian physiology. Use of this model will allow for the examination of abnormalities of atrioventricular nodal and infraHisian conduction in transgenic murine models.

Intraoperative recording of the His bundle electrogram in man. An assessment of its precision.

To estimate the effect of distance between the electrode and the signal source on the amplitude of the His bundle electrogram (HBE) recorded during open heart surgery, a specially designed probe, containing six pairs of closely spaced (1 mm) electrodes was placed on the endocardial surface of the right atrium such that each electrode pair was parallel to the course of the His bundle. The amplitude of the HBE recorded through electrodes closest to the His bundle ranged from 0.76 to 2.44 mV, at 1mm from 0.38 to 1.13 mV, at 2mm from 0.27 to 0.86 mV, and at 3 mm from 0.2 to 0.44 mV. Maximal amplitude of HBE decreased by 57% at 1mm, 73% at 2 mm, and 82% at 3mm. The percent decrease was initially rapid, then declined more slowly at distances greater than 1 mm, resembling in form data obtained previously in animal studies by different techniques. Since the maximum HBE was greater than 1.0 mV in nine of 11 patients, and equal to or greater than 1.0 mV in only two of 11 patients at 1 mm, and less than 1.0 mV in all patients 2.0 mm from the maximal HBE, the anatomic location of the His bundle can be estimated from HBE amplitude. Intracardiac electrograms, recorded through closely spaced bipolar electrodes during open heart surgery, afford clinically useful precision in locating the specialized conduction tissue of the heart.