Large-scale vibrating coil magnetometer for the magnetic characterization of bulk superconductors.

This work presents the design and validation of a vibrating coil magnetometer for the characterization of the field dependence of the critical current density of centimeter-sized bulk superconductors as an alternative to the destructive methods typically used. The magnetometer is also shown to be capable of measuring the magnetic moment in an applied field of up to 5 T for diverse magnetic materials, such as soft and hard ferromagnets and high-temperature superconducting pellets. The vibrating coil magnetometer was first optimized using finite element simulations and calibrated using a commercial vibrating sample magnetometer. The vibrating coil magnetometer was benchmarked with hysteresis measurements of a Nd2Fe14B disk made with a commercial hysteresisgraph, showing good agreement between the different setups. The magnetic hysteresis of a YBa2Cu3O7-x superconducting pellet was measured at 77 K, showing a penetration field of 1 T and an irreversibility field of 4 T. The field dependent critical current density of the superconductor was then inferred from the magnetic hysteresis measurements and extrapolated at low fields. Finally, the resulting critical current density was used to successfully reproduce the measured magnetization curve of the pellet at 2 T with finite element simulations.

New tree-ring data from Canadian boreal and hemi-boreal forests provide insight for improving the climate sensitivity of terrestrial biosphere models.

Understanding boreal/hemi-boreal forest growth sensitivity to seasonal variations in temperature and water availability provides important basis for projecting the potential impacts of climate change on the productivity of these ecosystems. Our best available information currently comes from a limited number of field experiments and terrestrial biosphere model (TBM) simulations of varying predictive accuracy. Here, we assessed the sensitivity of annual boreal/hemi-boreal forest growth in Canada to yearly fluctuations in seasonal climate variables using a large tree-ring dataset and compared this to the climate sensitivity of annual net primary productivity (NPP) estimates obtained from fourteen TBMs. We found that boreal/hemi-boreal forest growth sensitivity to fluctuations in seasonal temperature and precipitation variables changed along a southwestern to northeastern gradient, with growth limited almost entirely by temperature in the northeast and west and by water availability in the southwest. We also found a lag in growth climate sensitivity, with growth largely determined by the climate during the summer prior to ring formation. Analyses of NPP sensitivity to the same climate variables produced a similar southwest to northeast gradient in growth climate sensitivity for NPP estimates from all but three TBMs. However, analyses of growth from tree-ring data and analyses of NPP from TBMs produced contrasting evidence concerning the key climate variables limiting growth. While analyses of NPP primarily indicated a positive relationship between growth and seasonal temperature, tree-ring analyses indicated negative growth relationships to temperature. Also, the positive effect of precipitation on NPP derived from most TBMs was weaker than the positive effect of precipitation on tree-ring based growth: temperature had a more important limiting effect on NPP than tree-ring data indicated. These mismatches regarding the key climate variables limiting growth suggested that characterization of tree growth in TBMs might need revision, particularly regarding the effects of stomatal conductance and carbohydrate reserve dynamics.

Differential association of insulin resistance with cognitive and somatic symptoms of depression.

AIM: To examine the associations of depressive symptoms with insulin resistance, evaluating somatic and cognitive depressive symptoms separately. METHODS: A total of 328 individuals (mean age 60 years) referred for exercise stress testing, taking part in the Mechanisms and Outcomes of Silent Myocardial Ischemia study, completed the Beck Depression Inventory II. A fasting venous blood sample was collected for assessments of insulin and glucose level; the HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. In principal component analysis, Beck Depression Inventory II items were forced to load onto two components (somatic and cognitive depressive symptoms). Adjusting for age, sex, BMI, medication use, smoking, physical activity, diabetes and cardiovascular disease, general linear model analyses were conducted to examine the associations between the components and log HOMA-IR . RESULTS: Principal component analysis showed that nine items loaded onto a cognitive depressive symptoms component and 10 items loaded onto a somatic depressive symptoms component. When examined separately, both components were significantly associated with log HOMA-IR however, when including both components simultaneously in the model, only somatic depressive symptoms remained significantly associated with log HOMA-IR. Back-transformed, a one-unit change in somatic depressive symptoms was associated with a 1.07 (95% CI 1.002, 1.14) change in HOMA-IR and a one-unit change in cognitive depressive symptoms was associated with a 1.03 (95% CI 0.97, 1.14) change in HOMA-IR. CONCLUSION: Somatic depressive symptoms seem to be more strongly associated with insulin resistance than do cognitive depressive symptoms. Monitoring somatic depressive symptoms may be more appropriate than monitoring cognitive depressive symptoms among depressed individuals with high insulin resistance.

A model for the ultrastructure of bone based on electron microscopy of ion-milled sections.

The relationship between the mineral component of bone and associated collagen has been a matter of continued dispute. We use transmission electron microscopy (TEM) of cryogenically ion milled sections of fully-mineralized cortical bone to study the spatial and topological relationship between mineral and collagen. We observe that hydroxyapatite (HA) occurs largely as elongated plate-like structures which are external to and oriented parallel to the collagen fibrils. Dark field images suggest that the structures ("mineral structures") are polycrystalline. They are approximately 5 nm thick, 70 nm wide and several hundred nm long. Using energy-dispersive X-ray analysis we show that approximately 70% of the HA occurs as mineral structures external to the fibrils. The remainder is found constrained to the gap zones. Comparative studies of other species suggest that this structural motif is ubiquitous in all vertebrates.

Specificity of a back muscle roman chair exercise in healthy and back pain subjects.

PURPOSE: Roman chair exercises are popular for improving back muscle endurance but do not specifically target back muscles. This study aimed to determine whether an adaptation of the Roman chair exercise would induce more fatigue in back muscles than in hip extensors. METHODS: For this study, 16 healthy subjects and 18 patients with nonspecific chronic low back pain performed trunk flexion-extension cycles until exhaustion in a Roman chair with hips flexed at 40°. Surface EMG signals were recorded bilaterally on four back muscles and two hip extensors (gluteus maximus and biceps femoris). Motion analysis of the trunk segments (pelvis, lumbar, and thoracic spines) was also carried out. RESULTS: In both groups, EMG revealed clear evidence of muscle fatigue for the gluteus maximus, less clear evidence of fatigue for the lower back muscles, and motor unit recruitment (without fatigue) for the upper back muscles and biceps femoris. A change of muscle activation pattern was emphasized throughout the exercise bout, with some lower back muscles showing an increase followed by a decrease or leveling off of activation and with upper back muscles showing an increased activation at the end. Kinematic analyses revealed a progressive decrease (11°) in the lumbar range of motion (ROM) and a progressive increase in hip (2°) and thoracic (7°) ROM during the exercise bout. CONCLUSIONS: Roman chairs allow more freedom to change the kinematics of the spine during the exercise (less lumbar and more thoracic motion) to delay lower back muscle fatigue by sharing the load between the lower and upper back muscles. Even with adaptations to reduce hip extensors fatigue, this may make this exercise not as specific as wanted for fatiguing lower back muscles.

Exposure to HIV-1 directly impairs mucosal epithelial barrier integrity allowing microbial translocation.

While several clinical studies have shown that HIV-1 infection is associated with increased permeability of the intestinal tract, there is very little understanding of the mechanisms underlying HIV-induced impairment of mucosal barriers. Here we demonstrate that exposure to HIV-1 can directly breach the integrity of mucosal epithelial barrier, allowing translocation of virus and bacteria. Purified primary epithelial cells (EC) isolated from female genital tract and T84 intestinal cell line were grown to form polarized, confluent monolayers and exposed to HIV-1. HIV-1 X4 and R5 tropic laboratory strains and clinical isolates were seen to reduce transepithelial resistance (TER), a measure of monolayer integrity, by 30-60% following exposure for 24 hours, without affecting viability of cells. The decrease in TER correlated with disruption of tight junction proteins (claudin 1, 2, 4, occludin and ZO-1) and increased permeability. Treatment of ECs with HIV envelope protein gp120, but not HIV tat, also resulted in impairment of barrier function. Neutralization of gp120 significantly abrogated the effect of HIV. No changes to the barrier function were observed when ECs were exposed to Env defective mutant of HIV. Significant upregulation of inflammatory cytokines, including TNF-alpha, were seen in both intestinal and genital epithelial cells following exposure to HIV-1. Neutralization of TNF-alpha reversed the reduction in TERs. The disruption in barrier functions was associated with viral and bacterial translocation across the epithelial monolayers. Collectively, our data shows that mucosal epithelial cells respond directly to envelope glycoprotein of HIV-1 by upregulating inflammatory cytokines that lead to impairment of barrier functions. The increased permeability could be responsible for small but significant crossing of mucosal epithelium by virus and bacteria present in the lumen of mucosa. This mechanism could be particularly relevant to mucosal transmission of HIV-1 as well as immune activation seen in HIV-1 infected individuals.

Specificity of a back muscle exercise machine in healthy and low back pain subjects.

PURPOSE: To determine whether dynamic back muscle endurance exercises in a semisitting position induce more fatigue in back muscles than that in hip extensors in healthy controls as well as in patients with nonspecific chronic low back pain. METHODS: Sixteen healthy volunteers and 18 volunteers with nonspecific chronic low back pain performed trunk flexion-extension cycles until exhaustion at 60% of their strength in a machine designed for back exercise in a semisitting position with knees' angle at 135 degrees . The number of cycles and perceived muscle fatigue (Borg CR-10 scale) at five areas (upper and lower back, gluteus, hamstrings, and quadriceps) were used as fatigue criteria. EMG signals were recorded bilaterally on four back muscles, two hip extensors (gluteus maximus and biceps femoris), and the vastus medialis. The slope values of the instantaneous median frequency values computed over time were retained as EMG indices of fatigue. RESULTS: The number of cycles was equivalent in healthy controls (n = 23 +/- 13) and patients with back pain (n = 27 +/- 16). EMG indices of fatigue disclosed evidence of muscle fatigue in all the back muscles and the vastus medialis, contrary to hip extensors. EMG revealed significantly more muscle fatigue of lower back muscles, which was further corroborated by the Borg scale assessment. No between-group difference was obtained in any EMG comparison. CONCLUSION: These results showed that this type of exercise machine can specifically train the back muscles, and this as much in subjects with nonspecific chronic low back pain as in healthy controls. This has implications for the training of back muscle endurance, especially in patients with back pain for whom poor back muscle endurance is sometimes of concern.

Effect of pelvic stabilization and hip position on trunk extensor activity during back extension exercises on a Roman chair.

OBJECTIVE: To assess the effect of pelvic stabilization and hip position on the electromyographic activity of trunk extensors during Roman chair exercise. A secondary objective was to compare genders. DESIGN: Repeated measures. SUBJECTS: Eleven men and 11 women volunteers. METHODS: Five trunk flexion-extension cycles for 3 Roman chair conditions: (i) pelvis unrestrained; (ii) pelvis restrained; and (iii) hip at 40 degrees flexion. Electromyographic signals were recorded on the back muscles, as well as on the gluteus maximus and biceps femoris. The percentage of electromyographic amplitude relative to the maximal activity was used to assess the level of muscular activation of each muscle group across the exercises. RESULTS: For both genders, the Roman chair conditions did not influence the activity of the back and gluteus muscles. The hip-at-40 degrees-flexion condition significantly reduced the activity of the biceps femoris (average of 4-18%) relative to the other 2 conditions. Gender differences were observed on the activity of the biceps femoris in all Roman chair conditions. CONCLUSION: The hip-at-40 degrees-flexion condition would allow the Roman chair exercise to train the targeted back muscles more specifically by overloading them over a longer duration in order to induce physiological changes.

Pelvic stabilization and semisitting position increase the specificity of back exercises.

PURPOSE: To examine the effect of pelvic stabilization and two lower-limb configurations on the EMG activity of back and hip extensor muscles during a dynamic back extension exercise on a machine and to compare them between sexes. METHODS: Twenty-two healthy volunteers (11 men and 11 women) performed five trunk flexion-extension cycles at 40% of their maximal voluntary contraction (MVC) in a machine designed for back exercise. Two different positions were used: 1) seated position (seat horizontal, knees at 90 degrees ) and 2) semisitting position (seat slightly tilted forward at 15 degrees , knees at 45 degrees of flexion). In each position, three pelvic stabilization conditions were tested: 1) unrestrained (control condition), 2) partially restrained (posteriorly), and 3) totally restrained (posteriorly and anteriorly). EMG signals were recorded bilaterally with 12 pairs of electrodes placed on back muscles as well as on the gluteus maximus and biceps femoris. The muscular activation level, that is, the percentage of EMG amplitude relative to the maximal EMG obtained from MVC, was used to asses the relative contribution of each muscle group across exercises. RESULTS: In both sexes, two main results were found: 1) pelvic stabilization (partially and totally restrained) significantly (P < 0.05) increased the activity of all back muscles (average of 12%) and 2) semisitting position significantly decreased (range = 8-27%) the activity of two hip extensors compared with the seated position. Sex differences were also observed relative to the activity of some back muscles as well as the biceps femoris. CONCLUSIONS: Combining pelvic stabilization and semisitting position in back exercise machines might be a useful way to localize the effects of endurance training at the back muscles and this in both the sexes.

A submaximal test to assess back muscle capacity: evaluation of construct validity.

A functional endurance test more specific to common occupational tasks is proposed for assessing back muscle capacity. The test involves static intermittent contractions (8-s work-rest cycles) using a predefined absolute load (90 Nm) across subjects. Since the test involved an absolute endurance task, it was hypothesized that performance would be influenced by both the strength and relative endurance of the subjects, thus demonstrating the construct validity of this new test. Fifteen males and 17 females were assessed on three different days to allow familiarization and to measure their Strength as well as their absolute and relative endurance. Absolute and relative endurance were defined as the time to reach exhaustion (Tend(abs) and Tend(rel), respectively) during a fatigue protocol including both an absolute (90 Nm) and a relative (40% of individual strength) load (extension moment at the L5/S1 joint). Strength and Tend(rel) each explained an almost equivalent portion of Tend(abs) (total variance explained: 61.5%), thus confirming the construct validity of the functional endurance test. This new test should better identify the back muscle impairments (weakness, fatigability) often observed in chronic low-back-pain patients.

Toward the development of predictive equations of back muscle capacity based on frequency- and temporal-domain electromyographic indices computed from intermittent static contractions.

BACKGROUND CONTEXT: Back muscles capacity is impaired in chronic low back pain patients but no motivation-free test exists to measure it. A functional endurance test (FET) was used to assess capacity of back muscles using surface electromyographic (EMG) indices as outcome measures. PURPOSE: The main objective of the present study was to explore the possibility of combining different types of EMG indices to predict absolute endurance and strength. STUDY DESIGN/SETTING: A cross-sectional study using a repeated measures design in laboratory setting. METHODS: Healthy subjects (44 men and 29 women) performed maximal voluntary contractions (Strength criterion: extension moment at L5/S1) and a fatigue test involving intermittent static extension contractions to exhaustion (Tend endurance criterion: time to reach exhaustion). Surface EMG signals were collected from four pairs of back muscles. From the first 5 minutes (women) or 10 minutes (men) of EMG data, frequency- and temporal-domain analyses were applied to compute various EMG indices. RESULTS: Strength values ranged from 153 to 508Nm, whereas Tend values ranged from 3 to 57 minutes across the subjects. Gender-specific multiple regression equations were developed, using the retained EMG indices from the four electrode sites, to predict Tend (men: R(2)=0.76, error=9%; women: R(2)=0.70, error=17%) and Strength (men: R(2)=0.72, error=9%; women: R(2)=0.25, error=13%). CONCLUSIONS: It appears to be possible to predict the capacity of back muscles using an intermittent and time-limited (submaximal) fatigue task. Frequency- and temporal-domain EMG indices were shown to provide complementary information in this respect. This FET has potential to better infer back muscle capacity for realistic occupational tasks because more specific muscle fatigue mechanisms are involved.

Influence of test position on neck muscle fatigue in healthy controls.

BACKGROUND: It has been suggested that increased fatigue of neck muscles could be related to neck pain. However, studies on the matter present contradicting results which could be explained by the different test positions used. PURPOSE: The purpose of this study was to investigate the influence of test position on muscle fatigue of neck flexor and extensor muscles in healthy controls. METHODS: Twenty-five women without neck pain sustained neck flexion and neck extension isometric contractions at 25% and 75% of their maximal voluntary contraction (MVC) in two test positions: sitting and supine lying. Using surface electromyography, the change over time of the median frequency of the power spectrum (MDF slope) of the myoelectric signal of the sternocleidomastoid and splenius capitis muscles was measured and compared between both positions. RESULTS: At 75% MVC, splenius capitis muscles presented higher fatigue in lying compared to sitting, while sternocleidomastoid demonstrated no difference between positions. No statistically significant effect of test position was found at 25% MVC for both sternocleidomastoid and splenius capitis muscles as they generally did not present myoelectric manifestations of fatigue. CONCLUSION: These results underline the need to standardise the test position when investigating neck muscle fatigue, especially for neck extensors at high loads.

On the use of EMG-ratios to assess the coordination of back muscles.

BACKGROUND: Electromyographic (EMG) amplitude ratios (EMG-ratios) have been proposed to assess back muscle coordination in chronic low back pain patients to avoid the normalization of EMG using maximal contractions. The aim of this study was to test the relevance of this type of EMG analysis. METHODS: Healthy subjects (44 men and 13 women) and patients with chronic low back pain (57 men) performed three 7s static ramp extension contractions ranging from 0% to 100% of the maximal voluntary contraction while standing in a static dynamometer. A subgroup of 20 healthy men also performed 5s step contractions at 10%, 20%, 40%, 60% and 80% of the maximal voluntary contraction. Finally, to assess reliability, another subgroup (n=20 healthy and 20 men with chronic low back pain) performed the protocol three times, on different days. Surface EMG signals were collected from four pairs of back muscles and subcutaneous tissue thickness was measured at the corresponding electrode sites. EMG amplitude values were computed at each 5% force level from 10% to 80% of the maximal voluntary contraction. Then, EMG-ratios were computed between different electrode sites and averaged bilaterally. FINDINGS: All EMG-ratios were affected by the force level and the contraction type (ramp vs step contractions). Statistically significant Pearson's correlations (r=-0.38 to -0.57) were obtained between some EMG-ratios and their corresponding subcutaneous tissue thickness ratios. The reliability of the EMG-ratio variables ranged from moderate to excellent (intra-class correlation coefficients between 0.50 and 0.91). Comparisons between 12 men and 13 women and between 24 healthy men and 57 men with chronic low back pain showed that EMG-ratios were sensitive to sex but not to pain status. Multivariate analyses applied on the EMG-ratios identified clusters of subjects but none of the main clinical variables were able to clearly characterize these clusters. INTERPRETATION: Overall, even though additional research is warranted to further substantiate some important psychometric characteristics of the EMG-ratios as well as their biomechanical and clinical significance, these results support their use for assessing the coordination patterns of back muscles, provided that confounding variables such as the force level, the contraction type, and subcutaneous tissue thickness are accounted for.

The comparison of wavelet- and Fourier-based electromyographic indices of back muscle fatigue during dynamic contractions: validity and reliability results.

The purpose of this study was to compare the electromyographic (EMG) fatigue indices computed from short-time Fourier transform (STFT) and wavelet transform (WAV), by analyzing their criterion validity and test-retest reliability. The effect of averaging spectral estimates within and between repeated contractions (cycles) on EMG fatigue indices was also demonstrated. Thirty-one healthy subjects performed trunk flexion-extension cycles until exhaustion on a Biodex dynamometer. The load was determined theoretically as twice the L5-S1 moment produced by the trunk mass. To assess reliability, 10 subjects performed the same experimental protocol after a two-week interval. EMG signals were recorded bilaterally with 12 pairs of electrodes placed on the back muscles (at L4, L3, L1 and T10 levels), as well as on the gluteus maximus and biceps femoris. The endurance time and perceived muscle fatigue (Borg CR-10 scale) were used as fatigue criteria. EMG signals were processed using STFT and WAV to extract global (e.g, median frequency and instantaneous median frequency, respectively) or local (e.g., intensity contained in 8 frequency bands) information from the power spectrum. The slope values of these variables over time, obtained from regression analyses, were retained as EMG fatigue indices. EMG fatigue indices (STFT vs. WAV) were not significantly different within each muscle, had a variable association (Pearson's r range.: 0.06 to 0.68) with our fatigue criteria, and showed comparable reliability (Intra-class correlation range: 0.00 to 0.88), although they varied between muscles. The effect of averaging, within and between cycles, contributed to the strong association between EMG fatigue indices computed from STFT and WAV. As for EMG spectral indices of muscle fatigue, the conclusion is that both transforms carry essentially the same information.

The assessment of back muscle capacity using intermittent static contractions. Part II: validity and reliability of biomechanical correlates of muscle fatigue.

INTRODUCTION: In a previous paper, standard surface electromyographic (EMG) indices of muscle fatigue, which are based on the lowering of the median or mean frequencies of the EMG power spectrum in time, were applied during an intermittent absolute endurance test and were evaluated relative to criterion validity and test-retest reliability. The aims of this study were to assess mechanical and alternative EMG correlates of muscle fatigue. METHODS: Healthy subjects (44 males and 29 females; age: 20-55 yrs) performed three maximal voluntary contractions (MVC) and an endurance test while standing in a static dynamometer. Surface EMG signals were collected from four pairs of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10). The test, assessing absolute endurance (90 Nm torque), consisted of performing an intermittent extension task to exhaustion. Strength was defined as the peak MVC whereas our endurance criterion was defined as the time to reach exhaustion (Tend) during the endurance test. Mechanical indices quantifying physiological tremor and steadiness were computed from the dynamometer signals (L5/S1 extension moments) along with EMG indices presumably sensitive to variable load sharing between back muscle synergists during the endurance test. RESULTS: Mechanical indices were significantly correlated to Tend (r range: -0.47 to -0.53) but showed deceiving reliability results. Conversely, the EMG indices were correlated to Tend (r range: -0.43 to -0.63) with some of them particularly correlated to Strength (r=-0.72 to -0.81). In addition, their reliability results were acceptable (intra-class correlation coefficient >0.75; standard error of measurement <10% of the mean) in many cases. Finally, several analyses substantiated their physiological relevance. These findings imply that these new EMG indices could be used to predict absolute endurance as well as strength with the use of a single intermittent and time-limited (5-10min) absolute endurance test, a practical way to assess the back capacity of chronic low back pain subjects.

The assessment of back muscle capacity using intermittent static contractions. Part I - Validity and reliability of electromyographic indices of fatigue.

INTRODUCTION: Back muscle capacity is impaired in chronic low back pain patients but no motivation-free test exists to measure it. The aims of this study were to assess the reliability and criterion validity of electromyographic indices of muscle fatigue during an intermittent absolute endurance test. METHODS: Healthy subjects (44 males and 29 females; age: 20-55 yrs) performed three maximal voluntary contractions (MVC) and a fatigue test while standing in a static dynamometer. Surface EMG signals were collected from four pairs of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10). The fatigue test, assessing absolute endurance (90-Nm torque), consisted in performing an intermittent extension task to exhaustion. Strength was defined as the peak MVC whereas our endurance criterion was defined as the time to reach exhaustion (Tend) during the fatigue test. From the first five min (females) or ten min (males) of EMG data, frequency and time-frequency domain analyses were applied to compute various spectral indices of muscle fatigue. RESULTS: The EMG indices were more reliable when computed from the time-frequency domain than when computed from the frequency domain, but showed comparable correlation results (criterion validity) with Tend and Strength. Some EMG indices reached moderate to good correlation (range: 0.64-0.69) with Tend, lower correlations (range: 0.39-0.55) with Strength, and good to excellent between-day test-retest reliability results (intra-class correlation range: 0.75-0.83). The quantification of the spectral content more locally in different frequency bands of the power spectrum was less valid and reliable than the indices computed from the entire power spectrum. Differences observed among muscles were interpreted in light of specific neuromuscular activation levels that were observed during the endurance test. These findings supported the use of an intermittent and time-limited (5-10min) absolute endurance test, that is a practical way to assess the back capacity of chronic low back pain subjects, to assess absolute endurance as well as strength with the use of electromyographic indices of muscle fatigue.

Gender influence on fatigability of back muscles during intermittent isometric contractions: a study of neuromuscular activation patterns.

BACKGROUND: Gender difference in the fatigability of muscles can be attributed to muscle mass (or strength) and associated level of vascular occlusion, substrate utilization, muscle composition, and neuromuscular activation patterns. The purpose of this study was to assess the role of neuromuscular activation patterns to explain gender differences in back muscle fatigability during intermittent isometric tasks. METHODS: Sixteen males and 15 females performed maximal voluntary contractions (Strength) and a fatigue test to exhaustion (fatigue criterion=time to exhaustion), while standing in a static dynamometer measuring L5/S1 extension moment. The fatigue test consisted of repetitions of an 8-s cycle (1.5 s ramp to reach 40% of maximal voluntary contraction +5s plateau at 40% of maximal voluntary contraction +1.5s rest). Surface electromyography signals were collected bilaterally from 4 back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10). FINDINGS: Males were stronger (P<0.05) than females (316, SD 82>196, SD 25 Nm) but showed significantly shorter time-to-exhaustion values (7.1, SD 5.2<13.0, SD 6.1 min.), the latter result being corroborated by electromyographic indices of fatigue. However, the gender effect on time to exhaustion disappeared when accounting for Strength, thus supporting the muscle mass hypothesis. Among the various electromyographic indices computed to assess neuromuscular activation patterns, the amount of alternating activity between homolateral and between contralateral muscles showed a gender effect (females>males). INTERPRETATION: These results support the muscle mass hypothesis as well as the neuromuscular activation hypothesis to explain gender differences in back muscle fatigability.

Insights into abnormal hemostasis in the Quebec platelet disorder from analyses of clot lysis.

BACKGROUND: The Quebec platelet disorder (QPD) is inherited and characterized by delayed-onset bleeding following hemostatic challenge. Other characteristics include increased expression and storage of active urokinase-type plasminogen activator (u-PA) in platelets in the setting of normal to increased u-PA in plasma. There is also consumption of platelet plasminogen activator inhibitor-1 and increased generation of plasmin in platelets accompanied by proteolysis of stored alpha-granule proteins, including Factor V. AIMS AND METHODS: Although fibrinolysis has been proposed to contribute to QPD bleeding, the effects of QPD blood and platelets on clot lysis have not been evaluated. We used thromboelastography (TEG), biochemical evaluations of whole blood clot lysis, assessments of clot ultrastructure, and perfusion of blood over preformed fibrin to gain insights into the disturbed hemostasis in the QPD. RESULTS: Thromboelastography was not sensitive to the increased u-PA in QPD blood. However, there was abnormal plasmin generation in QPD whole blood clots, generated at low shear, with biochemical evidence of increased fibrinolysis. The incorporation of QPD platelets into a forming clot led to progressive disruption of fibrin and platelet aggregates unless drugs were added to inhibit plasmin. In whole blood perfusion studies, QPD platelets showed normal adherence to fibrin, but their adhesion was followed by accelerated fibrinolysis. CONCLUSIONS: The QPD is associated with "gain-of-function" abnormalities that increase the lysis of forming or preformed clots. These findings suggest accelerated fibrinolysis is an important contributor to QPD bleeding.

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease.

Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1,355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.

Detection of exercise-induced myocardial ischemia from symptomatology experienced during testing in men and women.

BACKGROUND AND OBJECTIVES: To examine the capacity of angina and related symptoms experienced during exercise-stress testing to detect the presence of ischemia, controlling for other clinical factors. METHOD: The authors undertook a prospective study of 482 women and 425 men (mean age 58 years) undergoing exercise stress testing with myocardial perfusion imaging. One hundred forty-six women and 127 men reported chest pain, and of these, 25% of women and 66% of men had myocardial perfusion imaging evidence of ischemia during testing. The present article focuses on patients with chest pain during testing. MAIN OUTCOME MEASURES: Outcome measures included chest pain localization, extension, intensity and quality, as well as the presence of various nonpain-related symptoms. Backward logistical regression analyses were performed separately on men and women who had experienced chest pain during testing. RESULTS: Men who described their chest pain as 'heavy' were 4.6 times more likely to experience ischemia during testing (P=0.039) compared with other men, but this pain descriptor only slightly improved accuracy of prediction beyond that provided by control variables. In women, several symptoms added to the sensitivity of the prediction, such as a numb feeling in the face or neck region (OR 4.5; P=0.048), a numb feeling in the chest area (OR 14.6; P=0.003), muscle tension (OR 5.2; P=0.013), and chest pain that was described as hot or burning (OR 4.3; P=0.014). CONCLUSIONS: A more refined evaluation of symptoms experienced during testing was particularly helpful in improving detection of ischemia in women, but not in men. Attention to these symptoms may favour timely diagnosis of myocardial perfusion defects in women.