Personalizing the control law of an upper-limb exoskeleton using EMG signal

Implementing an intuitive control law for an upperlimb exoskeleton dedicated to force augmentation is a challenging issue in the field of human-robot collaboration. The goal of this study is to adapt an EMG-based control system to a user based on individual characteristics. To this aim, a method has been designed to tune the parameters of control using objective criteria, improving user's feedback. The user's response time is used as an objective value to adapt the gain of the controller. The proposed approach was tested on 10 participants during a lifting task. Two different conditions have been used to control the exoskeleton: with a generic gain and with a personalized gain. EMG signals was captured on five muscles to evaluate the efficiency of the conditions and the user's adaptation. Results showed a statistically significant reduction of mean muscle activity of the deltoid between the beginning and the end of each situation (28.6%, standard deviation (SD) 13.5% to 17.2%, SD 7.3%, of Relative Maximal Contraction for the generic gain and from 24.9%, SD 8.5%, to 18%, SD 6.8%, of Relative Maximal Contraction for the personalized gain). When focusing on the first assisted movements, the personalized gain induced a mean activity of the deltoid significantly lower (29%, SD 8.0%, of Relative Maximal Contraction and 37.4%, SD 9.5%, of Relative Maximal Contraction, respectively). Subjective evaluation showed that the system with a personalized gain was perceived as more intuitive, and required less concentration when compared to the system with a generic gain.

Enhanced Vasoconstriction Mediated by α1-Adrenergic Mechanisms in Small Femoral Arteries in Newborn Llama and Sheep Gestated at Low and High Altitudes

The authors previously demonstrated that newborn llama (NBLL) express high levels of α1 adrenergic receptors, which provide a potent vasoconstriction response when compared with newborn sheep (NBSH) gestated at sea level. However, data regarding the impact of chronic gestational hypobaric hypoxia on α-adrenergic vasoconstriction in the neonatal life has not been studied. We evaluated if gestation under chronic hypobaric hypoxia modifies α1-adrenergic vasoconstrictor function in NBLL and NBSH. We compared the vasoconstrictor response induced by potassium and α-adrenergic stimuli in isolated small femoral arteries of NBLL and NBSH gestated at high altitude (HA; 3,600 m) or low altitude (LA; 580 m). The maximal contraction (RMAX) and potency (EC50) to potassium, noradrenaline (NA), and phenylephrine (PHE) were larger in HA-NBLL than LA-NBLL. RMAX to potassium, NA, and PHE were lower in HA-NBSH when compared with LA-NBSH and potency results were similar. Competitive blockade with prazosin showed that RNLL LA/HA have a similar pA2. In contrast, NBSH had increased pA2 values in HA when compared with LA. Finally, small femoral arteries denudated or treated with LNAME in LA and HA lacked NO or endothelium participation in response to PHE stimulation. In contrast, NBSH displayed that denudation or blockade with LNAME support NO or endothelium participation in response to PHE activation. In conclusion, HA chronic hypoxia enhances α1 adrenergic receptor activity in small femoral arteries in NBLL to a higher degree than NBSH, implying a higher vasoconstriction function.

The combination of dantrolene and nimodipine effectively reduces 5-HT-induced vasospasms in diabetic rats

Diabetics have a higher risk of developing cerebral vasospasms (CVSP) after subarachnoid hemorrhagic stroke than non-diabetics. Serotonin (5-HT) is one of the key vasoconstrictors released in the hemorrhagic blood and an important contributor to the etiology of CVSP. The combination of the ryanodine receptor blocker dantrolene and the Ca2+ channel blocker nimodipine significantly reduces phenylephrine (PHE)-induced vascular contraction in both diabetic and nondiabetic rats, but the effectiveness of this drug combination in reducing 5-HT-induced contraction is unknown. Dose–response curves for the 5-HT-induced contraction (from 0.1 nM to 100 µM) were performed on aortic rings from diabetic and non-diabetic rats after a 30-min incubation period with dantrolene, nimodipine, and both drugs in combination. In diabetic rats, 10 μM of dantrolene alone failed to reduce 5-HT-induced maximal contraction (Emax), but 50 μM reduced this parameter by 34% (n = 7, p < 0.05). In non-diabetic rats, by contrast, dantrolene did not modify the vascular response to 5-HT. 50 nM of nimodipine alone, however, reduced this parameter by 57% in diabetic rats (n = 10, p < 0.05), and by 34% in non-diabetic rats (n = 10, p < 0.05). In addition, concomitant administration of dantrolene and nimodipine reduced vascular reactivity to a similar extent in both diabetic (~ 60% reduction, n = 10, p < 0.05) and non-diabetic rats (~ 70% reduction, n = 10, p < 0.05). Moreover, the combination of nimodipine with the higher concentration of dantrolene significantly increased the EC50 values for the 5-HT-induced contraction curves in both diabetics (from 10.31 ± 1.17 µM to 19.26 ± 2.82; n = 10, p < 0.05) and non-diabetic rats (5.93 ± 0.54 µM to 15.80 ± 3.24; n = 10, p < 0.05). These results suggest that simultaneous administration of dantrolene and nimodipine has a synergistic effect in reducing 5-HT-induced vascular contraction under both diabetic and non-diabetic conditions. If our findings with rats are applicable to humans, concomitant administration of these drugs may represent a promising alternative for the management of CVSP in both diabetics and non-diabetics.

EVALUATION OF ANTI-OXYTOCIC ACTIVITY OF ASPARAGUS RACEMOSUS JINISH JOSE DEPARTMENT OF PHARMACOLOGY

Objective: The objective of the study was to evaluate the anti-oxytocic activity of ethanolic extract of Asparagus racemosus root. Methods: Ethanolic extract of A. racemosus root was taken by Soxhlet extraction method. Wistar strain albino non-pregnant female rats of weight 200–300 g were pre-treated with estrogen and were sacrificed to take their uterus. The tissue was then mounted in an organ bath containing de Jalon’s solution. The response of the tissue to various doses of oxytocin alone and then on adding increasing doses of the alcoholic extracts of A. racemosus along with the dose of oxytocin which produces sub-maximal contraction were recorded on a smoked drum. Results: Extract in doses up to 40 mg when given along with oxytocin 0.1 unit produced graded increase in contractions in rat uterus. From 80 mg onward graded blockade of contractions occurred with complete blockade at 200 mg. On complete removal of the extract by thorough washing, it was seen that oxytocin was again able to produce contractions of the rat uterus tissue. Conclusion: The ethanolic extract of A. racemosus root had demonstrated good anti-oxytocic property.

Muscle activation in specific regions of the trapezius during modified Kendall manual muscle tests

Context: Manual muscle tests (MMTs) are often used when assessing shoulder pathologies. For the trapezius, individual MMTs are used to selectively test the upper (UTR), middle (MTR), and lower (LTR) trapezius regions. It is assumed that MMTs for each region preferentially recruit the corresponding muscle fibres and produce a “maximal” contraction; however, it is unknown if this is true. Objective: To determine if maximum voluntary isometric contractions (MVICs) for the upper (UT-MVIC), middle (MT-MVIC), and lower (LT-MVIC) trapezius, adapted from the Kendall MMTs, recruit the corresponding trapezius regions. Design: Cross-Over. Setting: Laboratory. Participants: 20 young, healthy individuals. Intervention: Participants performed three repetitions of each MVIC. High density surface electromyography was collected from the UTR, MTR, and LTR. Main Outcome Measures: Root mean square (excitation) of the UTR, MTR, and LTR. Statistical Analysis: Three, one-way repeated measures ANOVAs. Results: UTR excitation: There was a significant increase in UTR excitation during the LT-MVIC compared to the UT-MVIC (p = .016), and MT-MVIC (p &lt; .001). MTR excitation: There was a significant increase in MTR excitation during the MT-MVIC compared to the UT-MVIC (p = .001), and a significant increase in MTR excitation during the LT-MVIC compared to the UT-MVIC (p &lt; .001). There was also a significant increase in MTR excitation during the LT-MVIC compared to the MT-MVIC (p &lt; .001). LTR excitation: There was a significant increase in LTR excitation during the MT-MVIC (p &lt; .001) and LT-MVIC (p &lt; .001) compared to the UT-MVIC. Conclusions: The UT-MVIC and MT-MVIC do not necessarily recruit the corresponding trapezius regions more than the other MVICs. Rather, the LT-MVIC appears to produce the greatest excitation in all trapezius regions. Additional research is needed; however, clinicians should be aware that maximal contractions may not always recruit the desired musculature when forming a clinical interpretation.

Characterizing Pelvic-Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study

ABSTRACT Objective More than half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to date, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women. Methods Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging. Results Compared to asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, lower coordination and endurance (p ˂ .03). At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions (p ˂ .05), indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions (p ˂ .03), suggesting an elevated tone or altered contractile properties. Conclusions Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research provides therefore a better understanding of the underlying mechanisms of dyspareunia in cancer survivors. Impact Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population.

Abstract 15585: Sex Dimorphism in Prostaglandins’ Role in Thromboxane-dependent Contraction in the Rat Middle Cerebral Artery

Introduction: Recent evidences suggest that sex and estrogen can influence cerebrovascular reactivity. We investigated the role of prostanoids and the estrogen receptor (ER) ex vivo in isolated middle cerebral arteries from male (M-MCA) and female (F-MCA) rats. Methods: MCA segments isolated from 20-week-old male and female Sprague-Dawley rats were mounted on a wire Multi Myograph (DMT) to measure isometric tone. Acetylcholine (ACh) was used to assess endothelium integrity. Concentration response curves to the thromboxane analog U46619 (U4, 10 -11 -10 -5 M) were performed in arteries intact or pre-treated with indomethacin (I,10 -5 M) or the ER antagonist G15 (G, 10 -6 M). Data were acquired with Powerlab 8 (ADInstruments) and recorded with LabChart v8 (ADInstruments). Response to K + was expressed in mN/mm whereas U4 maximal contraction as percent of maximal response to 75mM K + (%K MAX ) and sensitivity as pD 2 (-LogEC 50 ). Results: M-MCA (n=10) and F-MCA (n=13) displayed similar optimal diameters (M vs. F; 214±12 vs. 218±5 μm, p>0.05) and ACh-dependent relaxation (M vs. F; 71±11 vs. 78±10 % pre-constricted tone; 7.3±0.4 vs. 7.2±0.2, p>0.05). A greater contraction to K + was observed in M-MCA (M vs. F; 1±0.2 vs. 0.6±0.1 mN/mm, p<0.05). M- and F-MCA showed similar maximal contraction (M vs. F; 116±6 vs. 109±10 %K MAX ) and sensitivity (M vs. F; 7.2±0.2 vs. 7.3±0.2) to U4. Pre-incubation with Indomethacin lowered maximal response and sensitivity (M vs. M-I; 116±6 vs. 97±5%K MAX, p<0.05; 7.2±0.2 vs. 6.8±0.1, p<0.05) to U4 in M-MCA, with no effect on F-MCA (F vs. F-I; 109±9 vs. 113±7%K MAX ; 7.3±0.2 vs. 7.3±0.2). Pre-treatment with G15 increased U4 sensitivity in M-MCA (M vs. M-G; 7.3±0.2 vs. 7.8±0.2, p<0.05), with no effect in F-MCA (F vs. F-G; 7.3±0.2 vs. 7.4±0.3). Conclusions: Our data demonstrate sex differences in thromboxane-dependent contraction of MCA in middle-aged rats. Hormonal changes during the estrous cycle may contribute to a greater variability of F-MCA responses.

The Role of Losartan as a Potential Neuroregenerative Pharmacological Agent after Aneurysmal Subarachnoid Haemorrhage

Background: Cerebral vasospasm (CVS) remains a major cause of delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (SAH), making it a life-threatening type of stroke with high morbidity and mortality. Endothelin-1 is known as key player mediating a strong vasocontractile effect. Interestingly, losartan restores the impaired vasorelaxative ET(B1) receptor function in a non-competitive direct fashion. With this study, we aimed to investigate a potential losartan-dependent vasodilatory effect vice versa by inhibiting NO release through L-NAME, thus pushing forward concepts to alleviate vasospasm and possibly prevent ischaemia and neurodegeneration. Methods: Cerebral vasospasm was induced by the use of an established double-injection rat model. Sprague-Dawley rats were culled on Day 3 after the ictus, and the vasospastic basilar artery was harvested for isometric investigations of the vessel tone. Ring segments were preincubated with and without L-NAME and/or losartan. Results: Preincubation with L-NAME induced dose-dependent vasoconstriction via endothelin-1 in the non-SAH cohort, which was dose-dependently reduced by losartan. After SAH and dose-dependent endothelin-1 administration, maximal contraction was achieved in the control group without losartan. Furthermore, this maximal contraction was significantly decreased in the losartan group and was reversed by L-NAME. Conclusions: After SAH, losartan was shown to positively influence the ET(B1) receptor pathway in a non-competitive direct agonistic and indirect fashion. Losartan alleviated the maximum contraction triggered by endothelin-1. This effect was resolved due to NO inhibition by L-NAME. Considering this spasmolytic effect of losartan besides its already well-known effects (attenuating cerebral inflammation, restoring cerebral autoregulation and reducing epileptogenic activity) and alleviating early brain injury, losartan seems to have potential as a promising pharmacological agent after SAH.

Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers

IntroductionThe transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividual variation when repeating the block on two separate days.MethodsUltrasound-guided posterior transversus abdominis plane blocks were performed in 16 healthy volunteers and repeated after at least 2 days. Cutaneous sensory block areas and distributions, thresholds for mechanical stimulation, abdominal muscle thicknesses at rest and during maximal contraction, waist circumferences and block duration times were measured on both days. Outcome measurements from the 2 days were compared using a one-sample t-test and intraclass correlation coefficients were calculated for each parameter. Agreement was evaluated visually using Bland-Altman plots.ResultsNone of the mean values of the outcome measurements differed significantly between the 2 days. Intraclass correlation coefficient was 0.75 (moderate-to-good reliability) for lateral abdominal muscle thickness during maximal contraction, but ranges from −0.07 to 0.67 were found for all other outcome measurements (poor-to-moderate reliability).ConclusionWe found a moderate-to-good reproducibility for lateral abdominal muscle thickness during maximal voluntary contraction, but a moderate-to-poor reproducibility for all other block characteristics. However, the cutaneous distribution of the block was still located primarily inferior to a horizontal line through the umbilicus and lateral relative to a vertical line through the anterior superior iliac spine.