Recycled pulp and paper sludge, potential source of cellulose: feasibility assessment and characterization.

The pulp and paper industry stands out as an example of a technology based on a renewable resource, cellulose. The sludge, however, poses major environmental and public health problems. To effectively manage the sludge wastes, it is critical to fully evaluate its composition, possible environmental impacts, and the total amount of exploitable renewable resources. The study established the pH of the sludge to be 7.32 ± 0.98, an electrical conductivity (1.84 mS/cm), nitrogen concentration (2.65 ± 0.21%), and total organic matter (41.23 ± 3.11%). The cellulosic content was established to be 74.07 ± 2.71% which contributes to 53.07 ± 1.23% water holding capacity (WHC). The most abundant elements were C and O, followed by Cl, Si, Al, and Mg, with lower concentrations of S, Si, K, and iron. The polycyclic aromatic compounds (PAHs) levels ranged from 0.29 to 322.56 ng.g-1 with 1-methyl pyrene posting the highest concentration (322.56 ng.g-1. XRD peaks at 17.10°, 23.86°, 30.14°, and 36.57°, which imply the existence of CaCO3. SEM indicated that the sludge was majorly comprised of fibers materials with average particle sizes of 280 micrometers. TGA/DTG analysis showed that the sludge had the greatest cellulose and hemicellulose (64.7 wt. %).

Emergency medicine in the United States:a systemic review / 世界急诊医学杂志（英文）

BACKGROUND: Fifty years of our history in developing and advancing emergency medicine into an independent medical specialty will surely provide emergency medicine colleagues from all over the world with valuable suggestions and guidance. DATA SOURCES: This systemic review is based on the author's extensive experience through active involvement in the national and international development of emergency medicine. RESULTS: Emergency physicians in the U.S. emergency departments and sometimes other settings provide urgent and emergency care to patients of all ages, including definitive diagnosis of emergent conditions, prolonged stabilization of patients when necessary, airway management, and life-saving procedures using rapid sequence intubation and sedation. They use a multitude of diagnostic technologies including laboratory studies, bedside ultrasound and other sophisticated radiology, such as CT scan, and MRI. CONCLUSION: In the U.S., emergency medicine fits extremely well into the overall medical system, and is clearly the most efficient way to provide emergency patient care.

Women's needs for CAM information to manage menopausal symptoms.

OBJECTIVE: To identify the information needs of women regarding complementary and alternative medicine (CAM) treatment options to alleviate menopausal symptoms. METHODS: Self-administered questionnaires were mailed to women responding to notices posted in family physicians' offices and a women's health center. Survey questions addressed preferred topics, formats and sources of information; experiences with information searching; and what signified good, trustworthy information. RESULTS: The women in this study (n = 413) indicated several challenges including a lack of time to gather information, gaps in, and lack of, relevant information, and poor information quality. They expressed interest in information about the menopausal process, conventional and CAM treatment options, and the safety of treatments. Personal consultation with health-care professionals was the preferred way for obtaining information. The majority of women preferred evidence-based information but there was also a substantial number of women who chose to rely on 'softer' evidence such as personal accounts. These results suggested two different subgroups; however, the data indicate that these are not mutually exclusive since many respondents showed a preference for both types of information. CONCLUSIONS: Women feel they are not sufficiently informed to make safe decisions regarding CAM treatment options to alleviate menopausal symptoms. Family physicians are a trusted information source and have an important role in providing women with that information. Brochures containing evidence-based information and a list of newsletters or books that include personal accounts, available in physician's offices and during personal consultations at women's health centers, are offered as a possible solution. A website is another possibility for distributing this information.

Knee extensor torque and quadriceps femoris EMG during perceptually-guided isometric contractions.

The aim of this study was to examine superficial quadriceps femoris (QF) EMG and torque at perceived voluntary contraction efforts. Thirty subjects (15 males, 15 females) performed 9, 5 s, sub-maximal contractions at prescribed levels of perceived voluntary effort at points 1-9 on an 11-point scale (0-10), in a random order. Surface electromyograms (EMG) of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscles, as well as QF peak torque (PT), average torque (AT), and torque coefficient of variation (C.V.), were sampled. The raw EMG signals were full-wave rectified and integrated over the middle three s of each contraction. The sampled EMG signals, and PT and AT at each perceived exertion level were normalized to the average of three maximal voluntary contractions. The normalized EMG and torque values at each perceived exertion level were then compared to equivalent percent values (i.e., 10% at a perceived level of 1). The results demonstrated that at all perceived exertion levels, with the exception of the RF at a level of 2 which was equivalent to 20%, and the VL and RF muscles at a level 1 in which activation was greater than 10%, activation was significantly less than the equivalent percent value at each point on the scale. VM EMG was found to be less than the VL and RF from contraction levels 3-9. PT was shown to be less than the equivalent percent values at contraction levels 6-9. The AT was found to be lower than the expected percent value at perceived effort levels 2-9. Torque C.V. was not found to be different across the range of perceived effort. The major findings of this study suggested that humans over-estimate voluntary QF muscle torque when guided by perceptual sensations. It is also suggested that the produced EMG signals revealed a reliance on the VL muscle for knee extensor torque generation at sub-maximal levels.

Back muscle fatigability is associated with knee extensor inhibition in subjects with low back pain.

STUDY DESIGN: Cross-sectional study of 25 male golfers with chronic low back pain and 16 healthy controls of similar age. OBJECTIVES: To assess the association between functional capacity of the back extensors and the quadriceps muscles. SUMMARY OF BACKGROUND DATA: Chronic low back pain has been shown to lead to changes in muscle activation patterns of the abdominals and the gluteus maximus. The effect of chronic low back pain on lower limb function has not been investigated. METHODS: Back extensor endurance was assessed by a Biering-Sørensen test; surface EMG was measured bilaterally on the erector spinae at T12 and L4--L5. Muscle inhibition in the quadriceps was assessed by applying an electrical twitch to the maximally contracted muscle. The associations between holding time, decrease in EMG median frequency (i.e., the slope of the regression line on median frequency vs. time), and muscle inhibition were compared for study participants with chronic low back pain and controls. RESULTS: Mean back extensor holding times were 88 +/- 30 seconds for study participants with chronic low back pain and 92 +/- 17 seconds for controls. Both groups showed bilaterally similar decreases in EMG median frequency at L4--L5 and T12; however, the slopes were significantly steeper at L4--L5 than T12. Study participants with chronic low back pain with poor back endurance had significantly higher muscle inhibition compared with study participants with chronic low back pain with good back endurance, whereas such an association was not evident in healthy controls. CONCLUSIONS: In golfers with chronic low back pain reduced back endurance was associated with significant inhibition of the knee extensors, indicating that this muscle group cannot be activated to a full extent. These findings suggest a possible association between back extensor fatigability and knee extensor dysfunction in male golfers with chronic low back pain.

Connexins 40 and 43 are differentially regulated within the kidneys of rats with renovascular hypertension.

BACKGROUND: Connexin 40 (Cx40) is a gap junction protein expressed in endothelial cells of vessels, endocardium, and conducting cells of the His-Purkinje system of heart. Its distribution in the kidney remains to be fully investigated. METHODS: To address this distribution, we generated rabbit antibodies directed to a polypeptide comprising amino acids 231 to 330 of the carboxy-terminal domain of rodent Cx40, which specifically recognizes this protein at gap junctions. RESULTS: Immunolabeling and in situ hybridization of kidney sections showed that Cx40 and its transcript were coexpressed by most endothelial cells of vessels and glomeruli, as well as by renin-secreting cells. This distribution contrasted with that of Cx43, which was expressed in some tubules of medulla and sparse endothelial cells. Cx40 and Cx43 expression were investigated further in a renin-dependent model of hypertension, in which rats showed an increase in arterial mean blood pressure four weeks after clipping one renal artery [two kidney, one-clip (2K1C) model]. Northern blot analysis of polyA+ RNA demonstrated that, compared with sham-operated animals, the hypertensive 2K1C animals featured an increase in Cx40 mRNA expression in both left (clipped) and right (unclipped) kidneys. In contrast, Cx43 mRNA expression was only increased in the latter organ. Antibodies confirmed that the levels of Cx40 were actually increased in the kidneys of hypertensive animals (Western blots) and this was caused, at least in part, by enhanced expression of this protein in the renin-secreting cells of the afferent arteriole (immunofluorescence). CONCLUSIONS: Cell-to-cell communication mediated by Cx40 may be implicated in the function of renin-secreting cells, hence participating in the control of blood pressure.

Effect of number of stimuli and timing of twitch application on variability in interpolated twitch torque.

Application of a supramaximal electrical twitch to the voluntarily contracted muscle is used to assess the level of muscle activation. Large variability in the interpolated twitch torque (ITT) has been observed when repeated stimulations are performed. It is hypothesized that this variability in ITT is caused by the stochastic nature of the timing of twitch application relative to pulses of voluntary excitation trains. Two experiments were performed on 12 subjects each to test this hypothesis. For the first experiment, a single twitch was superimposed on a train stimulation at different time intervals relative to the train pulses. For the second experiment, single, double, triple, or quadruple twitches were applied on a voluntarily contracted muscle. The ITT critically depended on the time point of twitch application: a single pulse applied 5 ms before a train pulse consistently evoked higher ITTs than all other stimulation conditions. Furthermore, variability of the ITT decreased as the number of applied twitches increased. The results support the hypothesis that a large part of the variability in the ITT may be caused by the timing of the superimposed twitch relative to the motor unit trains. The variability may be reduced by increasing the number of superimposed twitches.

Detecting necrotic neurons with fluoro-jade stain.

Fluoro-jade, a novel stain for detection of neuropathic lesions by fluorescence microscopy, was validated on the models of toxic neuropathy induced with 3-acetylpyridine (3-AP) or with acrylamide (ACR). Groups of male and female albino rats of Wistar strain were either exposed to a single administration of 80 mg/kg i.p. 3-AP followed 5 hours later by 300 mg/kg of nicotinamide i.p. and examined at days 3 and 15, or to 15 daily doses of 30 mg/kg p.o. ACR and examined at day 15. Following in-life behavioral observations and measurements, the rats were fixed by perfusion with formalin. Additional animals treated with same dose of 3-AP and nicotinamide were submitted to purposeful autolysis for 4 or 16 hours before immersion fixation with formalin on test day 3. In-life observations showed in 3-AP-treated animals signs of severe general toxicity, sensorimotor dysfunction and decreased motor activity starting shortly after the treatment and persisting throughout the observation period. ACR-treated rats started to develop abnormal gait on test day 8 and by day 15 developed reduced grip strength, increased landing footsplay and decreased motor activity. Fluoro-jade, applied to paraffin sections of the nervous system, detected selectively and sensitively the necrotic neurons in the brain, especially those in the inferior olivary nucleus of animals treated with 3-AP, at test day 3, as well as the necrotic Purkinje cells in the cerebellum of ACR-treated animals at test day 15. Chromatolytic neurons in the dorsal root ganglia of ACR-treated animals did not stain positively, indicating that this kind of reversible neuronal remodeling is not detectable using fluoro-jade. Necrotic neurons were still stained by fluoro-jade after 4 hour autolysis, but following 16 hour autolysis the results became false negative. There was no false positive fluorescence in fresh or autolytic tissues, except that emitted by red blood cells in unperfused specimens. The study confirmed the validity of fluoro-jade as a stain suitable for detecting necrotic neurons in toxicological safety studies.

Does muscle inhibition after knee injury increase the risk of osteoarthritis?

Knee pathologies are commonly associated with muscle inhibition, an inability to fully activate the knee extensors during voluntary contractions. This inhibition results in knee extensor weakness, and is thought to limit the functional recovery of the knee joint structures. The possible contribution of persistent knee extensor inhibition to osteoarthritis is discussed.

Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis.

BACKGROUND: Evidence suggests that spinal manipulation is an effective treatment for mechanical neck and low-back pain (LBP). Treatment efficacy is important to establish for these symptoms because combined they account for a considerable amount of disability and substantial associated direct and indirect costs to society. OBJECTIVE: The purpose of this study was to examine the outcome of patients undergoing chiropractic treatment for mechanical neck or LBP. DESIGN AND SETTING: A retrospective, outcome-based analysis was done for patients seeking care at a private chiropractic practice over a 1-year period. A total of 512 files were reviewed, with 119 patients selected for inclusion. Patients were included if their chief symptom was uncomplicated mechanical neck or LBP. Diagnoses included cervical, lumbar, or sacroiliac joint sprain/strain (International Code of Diagnostics version 9 [ICD-9] code: 847.1, 847.3, 846.1, respectively), discogenic LBP (ICD-9: 722.1), and headaches (ICD-9: 784.0) because many patients with neck pain presented with concomitant headaches. Disability and pain were measured with the modified Oswestry scale (for the patients with LBP), Neck Disability Index, and an 11-box visual analogue pain scale before and after treatment. Treatment consisted of spinal manipulation, various soft-tissue techniques, home-care instructions, and ergonomic and return-to-activity advice, including rehabilitative exercises. Patients received an average of 12 treatments over a 4-week period. Statistical analysis was performed on pretreatment and posttreatment values for both disability and pain. Stratification was based on duration (acute/subacute, chronic, acute exacerbation of a chronic condition) and severity (mild, moderate, or severe) of symptoms. RESULTS: Statistically significant reductions in disability and pain scores were achieved in all groups. An average 52.5% and 52.9% reduction in pain and disability, respectively, was achieved in the low-back group. The chronic LBP group realized a less statistically significant reduction of pain and disability (19.7% and 19.8%, respectively) than the acute/subacute (66.8% and 62.5%) or the chronic/recurrent group (56. 5% and 63.4%). The differences were statistically significant. Patients with neck pain had an average 53.8% and 48.4% reduction in their pain and disability, respectively. Patients with concomitant neck pain and headaches had statistically significant higher pretreatment and posttreatment disability and pain scores than those with only neck pain. There was no statistically significant difference in outcomes between groups stratified according to pain intensity. CONCLUSIONS: Patients attending a private chiropractic clinic for treatment of mechanical neck pain or LBP had statistically significant reductions in their pain-related disability after treatment. These results indicate that chiropractic manipulation is beneficial for the treatment of mechanical neck pain and LBP. However, care must be taken when drawing conclusions from these outcomes. The study design does not account for the natural history of low back- or neck pain-related disability and therefore does not allow for claims of treatment efficacy. In addition, it has been suggested that patients presenting to medical doctors with these symptoms have significant overlying comorbidity when compared with patients presenting to a chiropractor.

Effects of speed and distance of muscle shortening on force depression during voluntary contractions.

The purpose of this study was to determine the influence of speed and distance of muscle shortening on the amount of force depression for voluntary contractions. Two experimental tests were performed. In the first test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions over the range 25-50 degrees. In the second test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions at two speeds: 20 and 240 degrees /s. Knee extensor moments, surface electromyographical (EMG) signals of quadriceps femoris, and interpolated twitch moments were measured during all contractions and were compared with the corresponding values obtained during purely isometric contractions. Force depression following muscle shortening for the voluntary contractions tested in this study did not depend on the distance or the speed of muscle shortening. These results are in contrast to the corresponding results in the literature obtained using artificial electrical stimulation in which force depression was always found to be directly related to the distance of shortening and inversely related to the speed of shortening. The difference in force depression as a function of the distance and speed of muscle shortening between voluntary and artificial electrical stimulation may be associated with changes in activation following the voluntary shortening contractions, whereas activation is controlled and constant in all artificial stimulation protocols.

Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial.

BACKGROUND: Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI. OBJECTIVE: The objective of this study was to assess whether conservative low back treatment reduces lower limb MI. STUDY DESIGN: In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP. METHODS: Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured. RESULTS: Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group. CONCLUSIONS: The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.

Force depression in human quadriceps femoris following voluntary shortening contractions.

The purpose of this study was to investigate whether the isometric muscle force, redeveloped following maximal-effort voluntary shortening contractions in human skeletal muscle, is smaller than the purely isometric muscle force at the corresponding length. Isometric knee extensor moments, surface electromyographic (EMG) signals of quadriceps femoris, and interpolated twitch moments (ITMs) were measured while 10 subjects performed purely isometric knee extensor contractions at a 60 degrees knee angle and isometric knee extensor contractions at a 60 degrees knee angle preceded by maximal-effort voluntary shortening of the quadriceps muscles. It was found that the knee extensor moments were significantly decreased for the isometric-shortening-isometric contractions compared with the isometric contractions for the group as a whole, whereas the corresponding EMG and ITM values were the same. This study is the first to demonstrate force depression following muscle shortening for voluntary contractions. We concluded that force depression following muscle shortening is an actual property of skeletal muscle rather than a stimulation artifact and that force depression during voluntary contraction is not accompanied by systematic changes in muscle activation as evaluated by EMG and ITM.

Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain.

BACKGROUND: Evidence exists that conservative rehabilitation protocols fail to achieve full recovery of muscle strength and function after joint injuries. The lack of success has been attributed to the high amount of muscle inhibition found in patients with pathologic conditions of the knee joint. Clinical evaluation shows that anterior knee pain is typically associated with sacroiliac joint dysfunction, which may contribute to the muscle inhibition observed in this patient group. OBJECTIVE: To assess whether sacroiliac joint manipulation alters muscle inhibition and strength of the knee extensor muscles in patients with anterior knee pain. DESIGN AND SETTING: The effects of sacroiliac joint manipulation were evaluated in patients with anterior knee pain. The manipulation consisted of a high-velocity low-amplitude thrust in the side-lying position aimed at correcting sacroiliac joint dysfunction. Before and after the manipulation, torque, muscle inhibition, and muscle activation for the knee extensor muscles were measured during isometric contractions using a Cybex dynamometer, muscle stimulation, and electromyography, respectively. PARTICIPANTS: Eighteen patients (mean age, 30.5 +/- 13.0 years) with either unilateral (n = 14) or bilateral (n = 4) anterior knee pain. RESULTS: Patients showed substantial muscle inhibition in the involved and the contralateral legs as estimated by the interpolated twitch technique. After the manipulation, a decrease in muscle inhibition and increases in knee extensor torques and muscle activation were observed, particularly in the involved leg. In patients with bilateral anterior knee pain, muscle inhibition was decreased in both legs after sacroiliac joint adjustment. CONCLUSIONS: Spinal manipulation might offer an interesting alternative treatment for patients with anterior knee pain and muscle inhibition. Because this clinical outcome study was of descriptive nature rather than a controlled design, biases might have occurred. Thus the results have to be verified in a randomized, controlled, double-blinded trial before firm conclusions can be drawn or recommendations can be made.

Quadriceps femoris and hamstring muscle function in a person with an unstable knee.

BACKGROUND AND PURPOSE: The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency. CASE DESCRIPTION: The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait. OUTCOMES: Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed. DISCUSSION: Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.

One-year changes in hind limb kinematics, ground reaction forces and knee stability in an experimental model of osteoarthritis.

Long-term changes in the three-dimensional external loading, hind limb kinematics and knee stability were assessed in an anterior cruciate ligament (ACL)-transected cat model of osteoarthritis (OA). Seven skeletally mature cats (mean mass 4.6+/-1.4 kg) were studied before ACL transection (ACLT) and at 1 and 3 weeks, and at 3, 6, 9 and 12 months following ACLT. One week following ACLT, significant changes from the normal locomotion pattern were observed: peak vertical and anterior posterior ground reaction forces were decreased, particularly the peak posterior forces in the early phase of stance. Furthermore, knee angles were reduced by about 15 degrees throughout the whole gait cycle, while ankle and hip angles were reduced at paw off in the experimental compared to the contralateral hind limbs. Ground reaction forces and hind limb kinematics recovered to near pre-surgical patterns over the one year period assessed. ACLT was also associated with an increased knee instability which improved over time. X-rays suggested that there was a continued degeneration in the experimental knee over the one year period; there was osteophyte formation at the joint margins and an increase in cartilage thickness throughout the joint. It was speculated that the more flexed knee angles and the reduced anterior-posterior ground reaction forces in the ACL-transected compared to the intact hind limb represent an adaptive strategy aimed at avoiding excessive anterior displacement of the tibia in the early phase of stance. The recovery of the locomotion pattern with time might be related to the corresponding improvement of knee stability.

Moving a graveyard: how one school prepared the way for continuous curriculum renewal.

From 1991 to 1996, the faculty at the University of Florida College of Medicine initiated several significant changes in its curriculum. These changes, included the introduction of early clinical experience in primary care settings; the enhancement of active learning experiences in small-group settings; production and use of computer-based interactive learning materials; increased clinical teaching in the ambulatory care training in an interdisciplinary primary care clerkship; effective course and faculty evaluation; establishment and use of an assessment center for instruction and performance-based evaluations utilizing standardized patients; creation of a medical education center as the focal point for logistics support of the teaching faculty and education data handling; creation of a faculty development program; and initiation of mission-based budgeting based on the faculty's teaching effort and quality. Because the faculty were relatively conservative, it was important to identify variables that would facilitate the introduction of changes and those that might hinder it. The following factors were most important: interest and support by the dean and clearly defined delegation of authority to an associate dean; introduction of a mission-based budgeting process that allocates education funds on the basis of faculty teaching effort and its quality; a clear understanding of the empowerment of the curriculum committee; and an identification of the principles that should guide educational planning and implementation. These efforts are considered the beginning of the continuous renewal needed to respond to information networking, scientific and technological innovations, and the fundamental changes in health care delivery. As these changes have taken place, a shift toward greater institutional control of the educational program leading to the MD degree has been evident.

Inhibition of the quadriceps muscles in elite male volleyball players.

Inhibition of the quadriceps muscles was assessed in 13 elite male volleyball players using the interpolated twitch technique. This technique involves applying an electrical stimulus to the voluntarily contracted quadriceps muscles to estimate the number of motor units not fully activated during the contraction. Knee extensor moments and muscle inhibition were measured during isometric contractions at knee angles of 30 degrees and 60 degrees from full extension. A medical history of knee joint injury and pain experienced in the knee during testing were assessed. Previous knee joint injury did not affect the knee extensor moments, but produced a difference in muscle inhibition: muscle inhibition in legs with previous injuries was significantly lower than muscle inhibition in legs with no previous injury. Moderate pain in the knee during testing did not affect muscle inhibition, but was associated with reduced knee extensor moments. We consider that the loss in knee extensor moments associated with pain might be caused by atrophy of the quadriceps muscles as a consequence of the disrupted training routine. The lower muscle inhibition in volleyball players with previous injury suggested that the intense rehabilitation programme that these athletes undergo after knee injury improves muscle activation. As a result, athletes with previous knee joint injuries were able to produce the same knee extensor moments as athletes with no previous injury, probably because of their ability to recruit the available motor units more completely. This recruitment may compensate for the possible loss in muscle mass encountered during the period of injury and detraining.

Quadriceps inhibition following arthroscopy in patients with anterior knee pain.

OBJECTIVES: This study was aimed at investigating muscle strength and quadriceps inhibition in patients with unilateral anterior knee pain syndrome. DESIGN: Functional assessments were made before an arthroscopic knee surgery and 6 weeks and 6 months following the surgical intervention. BACKGROUND: Traumatic knee injuries have been associated with severe muscle inhibition of the knee extensor muscles. Muscle inhibition is a serious hindrance in the rehabilitation process and prevents full functional recovery of the affected joint. METHODS: 30 patients participated in the study. Isometric quadriceps strength was measured using a KinCom dynamometer. Muscle inhibition was assessed using the interpolated twitch technique which requires applying a single electrical twitch to the femoral nerve during a maximal isometric knee extensor contraction. Pain was assessed with a 100 mm visual analogue pain scale. RESULTS: Pre-surgery, substantial muscle inhibition and pain was observed in the affected leg compared with the contralateral leg. Over the 6 month period there was a decrease in pain and muscle inhibition, although the decrease in muscle inhibition failed to reach statistical significance. Muscle strength showed a decrease 6 weeks post-surgery followed by an increase 6 months following surgery compared with pre-surgical values. CONCLUSIONS: The arthroscopic intervention was successful in reducing pain in patients with unilateral anterior knee pain syndrome. However, muscle inhibition was still substantial 6 months following surgery and was significantly higher in the affected and contralateral limb than in normal subjects.

Material and functional properties of articular cartilage and patellofemoral contact mechanics in an experimental model of osteoarthritis.

The purposes of this study were to determine the in situ functional and material properties of articular cartilage in an experimental model of joint injury, and to quantify the corresponding in situ joint contact mechanics. Experiments were performed in the anterior cruciate ligament (ACL) transected knee of the cat and the corresponding, intact contralateral knee, 16 weeks following intervention. Cartilage thickness, stiffness, effective Young's modulus, and permeability were measured and derived from six locations of the knee. The total contact area and peak pressures in the patellofemoral joint were obtained in situ using Fuji Pressensor film, and comparisons between experimental and contralateral joint were made for corresponding loading conditions. Total joint contact area and peak pressure were increased and decreased significantly (alpha=0.01), respectively, in the experimental compared to the contralateral joint. Articular cartilage thickness and stiffness were increased and decreased significantly (alpha=0.01), respectively, in the experimental compared to the contralateral joint in the four femoral and patellar test locations. Articular cartilage material properties (effective Young's modulus and permeability) were the same in the ACL-transected and intact joints. These results demonstrate for the first time the effect of changes in articular cartilage properties on the load transmission across a joint. They further demonstrate a substantial change in the joint contact mechanics within 16 weeks of ACL transection. The results were corroborated by theoretical analysis of the contact mechanics in the intact and ACL-transected knee using biphasic contact analysis and direct input of cartilage properties and joint surface geometry from the experimental animals. We conclude that the joint contact mechanics in the ACL-transected cat change within 16 weeks of experimental intervention.