Apoyado por el NIH subvención # R01HL088045. Los Dres. Eddy Fan y Kho Michelle son cada uno apoyado por una concesión de beca de los Institutos Canadienses de Investigación en Salud.

1. Introducción Durante la prueba muscular manual (MMT), cada grupo muscular se pone a prueba bilateral. Para fines de demostración, sólo un lado se pone a prueba en este video para cada uno de los 6 grupos de músculos. Una mano del examinador aplica resistencia o palpa el músculo o el tendón de la contracción, mientras que la otra mano estabiliza la extremidad se está probando para mantenerlo en la posición de prueba. La prueba se repite si el paciente no entiende las instrucciones o no se aplican el máximo esfuerzo. 2. Clasificación sigue el Consejo de Investigación Médica (MRC) del sistema (Tabla 1) 1. La Figura 1 muestra un algoritmo para el sistema músculo MRC puntuación fuerza. Si el tema es que falta un miembro, tiene un tono, o no puede ser colocado en la posición correcta de pruebas, la fuerza muscular se clasifica como &quot;imposibles de evaluar&quot;. Si el paciente tiene una contractura fija, pero por lo demás se puede realizar la prueba, el músculo se clasifica. Dispositivos médicos, como catéteres y drenajes, y la ventilación mecánica por lo general no impiden la prueba muscular, a menos que una articulación se inmoviliza para asegurar el correcto funcionamiento de un dispositivo. <img src="/files/ftp_upload/2632/2632fig1.jpg" alt="Figura 1"/> Figura 1. Algoritmo Manual de Pruebas musculares 3. Procedimiento <ol><li> Para cada músculo examinado, el examinador se para al lado se está probando, y el paciente está sentado en posición vertical y en condiciones de permitir un movimiento completo de la articulación contra la gravedad. El examinador demuestra el movimiento deseado contra la gravedad. El examinador pide al paciente que repita el movimiento. </li><li> Si el paciente puede moverse a través del rango deseado del movimiento contra la gravedad, el examinador de los intentos de aplicar la resistencia en la posición de las pruebas mientras se dice &quot;Espera, no me deja empujar hacia abajo&quot; o &quot;Espera, no me dejan doblar que &quot;(Figura 2). Si el paciente no tolera la resistencia, la puntuación de los músculos es de grado 3. Si el paciente tolera una cierta resistencia, la puntuación es de grado 4, y la resistencia total, grado 5. </li><li> Si el paciente no puede moverse contra la gravedad, el paciente se coloca de nuevo para permitir el movimiento de la extremidad con la gravedad eliminada. Si el apoyo a la extremidad, el examinador no proporciona ni la asistencia ni la resistencia al movimiento voluntario del paciente. Esto elimina la gravedad de posicionamiento dependerá de cada prueba muscular. Si el paciente no puede completar por lo menos rango parcial de movimiento con gravedad eliminada, el músculo o tendón que se observa y / o palpación de la contracción. </li><li> Para un paciente postrado en la cama que no pueden sentarse en una cama colocada en la posición de la silla o al borde de la cama, posiciones alternas para las pruebas de las extremidades inferiores están incluidos en este protocolo. </li></ol> 4. Abducción de hombro <ol><li> Prueba de posición - el brazo del lado al nivel del hombro. El examinador demuestra el movimiento, y luego dice: &quot;Levanta el brazo hacia el lado a la altura del hombro.&quot; La mano da la resistencia tiene un contorno en el brazo del paciente por encima del codo. La otra mano estabiliza el hombro por encima de la articulación del hombro. El examinador &quot;¡Alto, no dejes que me empuje hacia abajo.&quot; Para evaluar los grados 3, 4 ó 5, consulte la sección 3.2. </li><li> Si más débil que la de grado 3, el paciente en decúbito supino con los brazos a los lados. El examinador apoya el brazo por encima del codo y la muñeca para asegurarse de que el hombro no rotar externamente (a su vez hacia el exterior). El paciente intenta mover el brazo hacia un lado. El examinador: &quot;Trate de mover el brazo hacia un lado&quot;. Grado 2 se asigna si el paciente se mueve con gravedad eliminada. </li><li> Si más débil que la de grado 2, el examinador &quot;Trate de mover el brazo hacia un lado&quot; y palpa el músculo deltoides medio, como se ha demostrado, para la contracción, y las puntuaciones de Grado 1 ó 0 según se define previamente. </li><li> MMT hombro puede llevar a cabo con catéteres venosos centrales (por ejemplo, subclavia y yugular) en el lugar, incluidos los utilizados para la diálisis. (Figura 2) </li></ol> Las restantes evaluaciones se completarán de forma similar a anteriores posiciones de prueba específicos para el paciente y el examinador, y las instrucciones específicas para el movimiento del paciente. 5. Flexión del codo <ol><li> Posición de la prueba - el antebrazo en supinación y flexión poco más de 90 grados. Instrucciones verbales: &quot;Doble el codo un poco más de 90 grados&quot;. La mano da la resistencia tiene un contorno sobre la superficie de flexión del antebrazo proximal a la muñeca. Por otra parte, el examinador se aplica contraria ahuecando la palma sobre la cara anterior superior del hombro. El examinador dice: &quot;Un momento No dejes que me empuje hacia abajo.&quot; Grados y las puntuaciones 3, 4, o 5, según se ha descrito anteriormente. </li><li> Si más débil que la de grado 3, el hombro está abducido a 90 grados. El examinador apoya el brazo under el codo y, si es necesario, la muñeca también. El antebrazo se gira con el pulgar hacia el techo. Con el codo extendido, el paciente intenta flexionar el codo. El examinador: &quot;Trate de doblar el codo.&quot; 2 calificación se asigna si el paciente puede flexionar el codo. </li><li> Si más débil que la de grado 2, el antebrazo supinado y se ubica en el lado en unos 45 grados de flexión del codo. El examinador &quot;Trate de doblar el codo&quot;, palpa el tendón del bíceps y los resultados, ya sea de grado 1 ó 0. </li></ol> 6. Extensión de la muñeca <ol><li> Posición de la prueba - el brazo a un lado, el codo flexionado a 90 grados con el antebrazo en pronación y la muñeca en extensión completa. Instrucciones verbales: &quot;Doble la muñeca hacia arriba tanto como sea posible.&quot; La resistencia del examinador mano dando se coloca sobre el dorso de la mano del paciente justo distal a la muñeca. Por otra parte, el examinador apoya antebrazo del paciente. El examinador dice: &quot;Un momento No dejes que me empuje hacia abajo.&quot; Grados y las puntuaciones 3, 4 o 5. </li><li> Si más débil que la de grado 3, el codo flexionado a 90 grados y el antebrazo con el pulgar vuelto hacia el techo. El antebrazo y la muñeca son apoyados por el examinador. El examinador: &quot;Doble su mano hacia mí&quot;. 2 calificación se asigna si el paciente puede extender la muñeca. </li><li> Si más débil que la de grado 2, el examinador &quot;doblar su muñeca hacia mí&quot; y palpa los dos tendones extensores, una a cada lado de la muñeca, como se ha demostrado, y los resultados como de grado 1 ó 0. El examinador tiene cuidado de no palpar los tendones en el centro de la muñeca. </li><li> Esta prueba no se realizará si hay un catéter arterial radial ipsilateral en su lugar. </li></ol> 7. Flexión de la cadera <ol><li> Posición de la prueba - de estar con la cadera flexionada y completamente la rodilla doblada. El paciente puede colocar sus manos sobre la cama o una mesa para la estabilidad. Instrucciones verbales: &quot;Levante su rodilla tan alto como sea posible.&quot; La resistencia del examinador mano dando se coloca en la parte superior del muslo proximal a la rodilla. Por otro lado ofrece una estabilidad en el lado de la cadera. El examinador dice: &quot;Un momento No dejes que me empuje hacia abajo.&quot; Grados y las puntuaciones 3, 4 o 5. </li><li> Si más débil que la de grado 3, el paciente se acuesta en el lado que no se está probando. Por ejemplo, el paciente se acuesta en el lado derecho para poner a prueba la cadera izquierda. El examinador se coloca detrás del paciente con un brazo sosteniendo la pierna se está probando con la mano de apoyo debajo de la rodilla. La otra mano mantiene la alineación del tronco en la cadera. El examinador: &quot;Trae tu rodilla hacia el pecho.&quot; 2 calificación se asigna si el paciente puede flexionar la cadera. </li><li> Si más débil que la de grado 2, el paciente en decúbito supino. El examinador le pregunta: &quot;¿Puedo tocar tu pierna aquí?&quot; (Apuntando a la cara interna de la articulación de la cadera). Con el permiso del paciente, el examinador &quot;doblar la cadera&quot; y palpa el tendón del músculo psoas-ilíaco, como lo demuestra, y los resultados como de grado 1 ó 0. </li><li> En un paciente postrado en cama, los grados 5, 4 y 3, se probarán con la cama en la posición de la silla, o la cabeza de la cama elevada medida de lo posible. Las almohadas se colocan debajo de la rodilla para flexionar la cadera a 90 grados. El examinador asegura que el pie se levanta de la cama cuando se le pide al paciente que levante la rodilla de la cama. Grados 2 y 1 se anotó como se describió anteriormente. </li><li> Esta prueba se puede realizar en pacientes con intactos y se asegura así catéteres intravasculares femoral. </li></ol> 8. Extensión de la rodilla <ol><li> Posición de la prueba - sentado en posición vertical con la rodilla totalmente extendida a 0 grados. Evitar la hiperextensión de rodilla. Instrucciones verbales, &quot;enderezar la rodilla&quot;. La mano da la resistencia tiene un contorno en la parte superior de la pierna justo por encima de los tobillos. La otra mano se coloca debajo del muslo encima de la rodilla. El examinador dice: &quot;¡Alto. No me deja doblegar&quot; y Grados puntuaciones 3, 4 o 5. </li><li> Si más débil que la de grado 3, el paciente se acuesta en el lado no de pruebas. El examinador se coloca detrás del paciente a nivel de la rodilla. La pierna no se está probando puede ser doblado para la estabilidad. Una cuna del brazo de la pierna se está probando en todo el muslo con la mano apoyando la parte inferior de la rodilla. La otra mano sostiene la pierna arriba del tobillo. El examinador: &quot;enderezar la rodilla.&quot; Grado 2 se asigna si el paciente puede extender la rodilla (Figura 3). </li><li> Si más débil que la de grado 2, el paciente está en decúbito supino y el examinador: &quot;Empuje la parte posterior de la rodilla hacia abajo&quot; o &quot;Apretar el casquillo de la rodilla&quot; y palpa el tendón del cuádriceps, y los resultados como de grado 1 ó 0. </li><li> Para el paciente postrado en cama, en la puntuación de los grados 3, 4 y 5, el paciente se coloca en la misma forma que para la flexión de la cadera y la clasificación como se describió anteriormente para la extensión de la rodilla (Figura 4). </li></ol> 9. Dorsiflexión del tobillo <ol><li> Posición de la prueba - sentado, con el talón en el suelo, el pie en su totalidad dorsiflexion, y los zapatos y calcetines eliminado. Instrucciones verbales: &quot;Doble el pie hacia arriba tanto como sea posible.&quot; Los dedos de los pies están relajados durante la prueba. La mano da la resistencia es ahuecada sobre la parte superior del pie proximal de los dedos del pie. Por otro lado tiene un contorno alrededor de la parte delantera de la pierna justo por encima de los tobillos. El examinador dice: &quot;Espera, no me deja empujar hacia abajo&quot; y para la grado 3, 4 o 5. </li><li> Si más débil que la de grado 3, pero no hay rango parcial de movimiento contra la gravedad, asignar grado 2. </li><li> Si más débil que la de grado 2, se palpa el tendón tibial anterior, y la puntuación como Grado 1 ó 0. </li><li> El paciente postrado en la cama se pone a prueba en posición supina, con la pierna extendida y una almohada debajo de la rodilla. </li><li> Esta prueba por lo general se puede aplicar con un catéter intravascular pedal intacto y seguro. Tenga cuidado de no desplazar el catéter. </li></ol> 10. Los resultados representativos: MMT usando este protocolo tiene una excelente confiabilidad entre los evaluadores cuando se aplica con ambos sobrevivientes SDRA y patentes simulado. Aseguramiento de la calidad de los 19 becarios de examinar 12 grupos musculares demostrado un coeficiente de correlación intraclase (95% intervalo de confianza [IC]) de 0.99 (0.97 a 1.00) 8 Acuerdo (kappa, IC 95%). Para la detección de debilidad clínicamente significativo (es decir, compuestos MRC puntuación &lt;80% del máximo) fue de 1,00 (0,55 hasta 1,00). Estudios anteriores han demostrado alta confiabilidad entre los evaluadores con accidente cerebrovascular, esclerosis lateral amiotrófica (ELA), síndrome de Guillain-Barre, y otros pacientes en estado crítico 12-14. <img src="/files/ftp_upload/2632/2632fig2.jpg" alt="Figura 2"/> Figura 2. UCI del paciente con una contractura en abducción del hombro izquierdo. MMT con la izquierda la línea arterial radial, la monitorización cardiaca y la diálisis continua a través de un catéter yugular interna derecha. El paciente se coloca para los grados del hombro secuestro MMT 3, 4 y 5. <img src="/files/ftp_upload/2632/2632fig3.jpg" alt="Figura 3"/> Figura 3. Postrado en la cama en la UCI de pacientes con un catéter yugular interna derecha para diálisis continua. El paciente se coloca en el lado derecho de la extensión de rodilla de grado 2 MMT. <img src="/files/ftp_upload/2632/2632fig4.jpg" alt="Figura 4"/> Figura 4. Postrado en la cama en la UCI del paciente con una contractura en flexión de la rodilla izquierda. Se coloca al paciente en decúbito supino con una almohada debajo de la rodilla de la rodilla de los grados de extensión MMT 3, 4 y 5. <table border="1"><tbody><tr><td colspan="2"> Tabla 1. Manual Muscle Test 3 </th></tr><tr><td> Grado </td><td> Prueba muscular manual </td></tr><tr><td> 5 </td><td> Movimiento contra la gravedad y la resistencia completa </td></tr><tr><td> 4 </td><td> Movimiento contra la gravedad y la resistencia de algunos </td></tr><tr><td> 3 </td><td> Completa la gama de pruebas disponibles del movimiento contra la gravedad, pero no tolera la resistencia </td></tr><tr><td> 2 </td><td> El paciente completa la gama total o parcial de movimiento con gravedad eliminada </td></tr><tr><td> 1 </td><td> Contractilidad leve sin ningún tipo de movimiento </td></tr><tr><td> 0 </td><td> No hay evidencia de la contractilidad (parálisis completa) </td></tr></tbody></table>

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En función de los criterios de diagnóstico, 9 - 87% de los pacientes en la UCI desarrollan complicaciones neuromusculares, que son asociadas a la ventilación mecánica prolongada, el aumento de la estancia hospitalaria y el tiempo de rehabilitación, y potencialmente asociados con el aumento de la mortalidad 1,2,16-18 reevaluación periódica de los músculos. fuerza, mediante un método fiable que minimiza la variabilidad inter-evaluador es útil para detectar cambios en el tiempo. Una limitación importa...

manual muscle testing:  a method of measuring extremity muscle strength applied to critically ill patients

Los sobrevivientes del síndrome de distrés respiratorio agudo (SDRA) y otras causas de enfermedad grave a menudo tienen debilidad generalizada, disminución de la tolerancia del ejercicio, y el nervio persistente y alteraciones musculares después del alta hospitalaria. 1.6 El uso de un protocolo explícito de un enfoque estructurado para la formación y la garantía de calidad del personal de investigación, prueba muscular manual (TMM) es un método muy fiable para valorar la fuerza, mediante un examen clínico estandarizado para los pacientes después de SDRA, y puede ser completado con los pacientes con ventilación mecánica que pueden tolerar sentado en la cama y son capaces de seguir dos órdenes. 7, 8 Este video muestra un protocolo para el MMT, que se ha enseñado al personal de investigación ≥ 43 que han realizado&gt; 800 evaluaciones en&gt; 280 sobrevivientes de SDRA. Modificaciones para el paciente postrado en cama están incluidos. Cada músculo se ha probado con técnicas específicas para el posicionamiento, la estabilización, la resistencia, y la palpación de cada puntuación de los seis puntos ordinal escala del Medical Research Consejo 7,9-11 tres superiores y tres inferiores músculos de las extremidades se clasifican en este protocolo:. Abducción del hombro , la flexión del codo, extensión de la muñeca, flexión de la cadera, extensión de la rodilla y la flexión dorsal del tobillo. Estos músculos fueron elegidos con base en el método estándar para evaluar a los pacientes de la UCI-adquirido debilidad utilizado en las publicaciones anteriores. 1,2.

Watch this Scientific Journal Video about Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients at JoVE.com

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Los sobrevivientes del síndrome de distrés respiratorio agudo (SDRA) y enfermedad grave con frecuencia desarrollan a largo plazo la debilidad muscular. La prueba muscular manual (TMM) es un examen clínico estandarizado utilizado para medir la fuerza de los grupos periféricos del músculo esquelético. Este vídeo demuestra MMT con los 6 puntos de la escala de Investigación Médica del Consejo.

Pruebas musculares manuales: un método para medir fuerza de las extremidades muscular aplicada a los pacientes críticos

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

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Medicine

80.4K vistas.  Johns Hopkins University. Los sobrevivientes del síndrome de distrés respiratorio agudo (SDRA) y enfermedad grave con frecuencia desarrollan a largo plazo la debilidad muscular. La prueba muscular manual (TMM) es un examen clínico estandarizado utilizado para medir la fuerza de los grupos periféricos del músculo esquelético. Este vídeo demuestra MMT con los 6 puntos de la escala de Investigación Médica del Consejo.

Video: Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Measuring the Strength of Mice

Kondziela7 devised the inverted screen test and published it in 1964. It is a test of muscle strength using all four limbs. Most normal mice easily score maximum on this task; it is a quick but insensitive gross screen, and the weights test described in this article will provide a finer measure of muscular strength.
There are also several strain gauge-based pieces of apparatus available commercially that will provide more graded data than the inverted screen test, but their cost may put them beyond the reach of many laboratories which do not specialize in strength testing. Hence in 2000 a cheap and simple apparatus was devised by the author. It consists of a series of chain links of increasing length, attached to a "fur collector" a ball of fine wire mesh sold for preventing limescale build up in hard water areas. An accidental observation revealed that mice could grip these very tightly, so they proved ideal as a grip point for a weight-lifting apparatus. A common fault with commercial strength meters is that the bar or other grip feature is not thin enough for mice to exert a maximum grip. As a general rule, the thinner the wire or bar, the better a mouse can grip with its small claws.
This is a pure test of strength, although as for any test motivational factors could potentially play a role. The use of scale collectors, however, seems to minimize motivational problems as the motivation appears to be very high for most normal young adult mice.

Deficits in muscular strength occur in many clinical conditions such as motor neuron disease. The inverted screen and weight lifting tests described here measure strength in mice almost exclusively, with minimal influence of factors such as coordination.

La medición de la fuerza de ratones

Kondziela7 devised the inverted screen test and published it in 1964. It is a test of muscle strength using all four limbs. Most normal mice easily score ...

Investigación

Medicina

Method to Measure Tone of Axial and Proximal Muscle

The control of tonic muscular activity remains poorly understood. While abnormal tone is commonly assessed clinically by measuring the passive resistance of relaxed limbs1, no systems are available to study tonic muscle control in a natural, active state of antigravity support. We have developed a device (Twister) to study tonic regulation of axial and proximal muscles during active postural maintenance (i.e. postural tone). Twister rotates axial body regions relative to each other about the vertical axis during stance, so as to twist the neck, trunk or hip regions. This twisting imposes length changes on axial muscles without changing the body's relationship to gravity. Because Twister does not provide postural support, tone must be regulated to counteract gravitational torques. We quantify this tonic regulation by the restive torque to twisting, which reflects the state of all muscles undergoing length changes, as well as by electromyography of relevant muscles. Because tone is characterized by long-lasting low-level muscle activity, tonic control is studied with slow movements that produce "tonic" changes in muscle length, without evoking fast "phasic" responses. Twister can be reconfigured to study various aspects of muscle tone, such as co-contraction, tonic modulation to postural changes, tonic interactions across body segments, as well as perceptual thresholds to slow axial rotation. Twister can also be used to provide a quantitative measurement of the effects of disease on axial and proximal postural tone and assess the efficacy of intervention.

We have developed a device (Twister) to study the regulation of tonic muscle activity during active postural maintenance. Twister measures torsional resistance and muscular responses in standing subjects during twisting of the body axis. The device can be flexibly configured to study various aspects of tonic control across the neck, trunk, and/or hips.

Método para medir el tono del músculo axial y proximal

The control of tonic muscular activity remains poorly understood.  While abnormal tone is commonly assessed clinically by measuring the passive resistance ...

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases in children and adults. These antibodies have been used to guide diagnosis and treatment. Cell-based assays have improved the detection of antibodies in patient serum. They are based on the surface expression of brain antigens on eukaryotic cells, which are then incubated with diluted patient sera followed by fluorochrome-conjugated secondary antibodies. After washing, secondary antibody binding is then analyzed by flow cytometry. Our group has developed a high-throughput flow cytometry live cell-based assay to reliably detect antibodies against specific neurotransmitter receptors. This flow cytometry method is straight forward, quantitative, efficient, and the use of a high-throughput sampler system allows for large patient cohorts to be easily assayed in a short space of time. Additionally, this cell-based assay can be easily adapted to detect antibodies to many different antigenic targets, both from the central nervous system and periphery. Discovering additional novel antibody biomarkers will enable prompt and accurate diagnosis and improve treatment of immune-mediated disorders.

Over the recent years, live cell-based assays have been used successfully to detect antibodies against surface and conformational antigens. Here, we describe a method using high-throughput flow cytometry enabling the analysis of large cohorts of patients. Detection of novel antibodies will improve diagnosis and treatment of immune-mediated disorders.

Ensayo de alto rendimiento basado en células citometría de flujo para detectar anticuerpos a la N-metil-D-aspartato receptor o dopamina-2 del receptor en suero humano

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases ...

Bladder Smooth Muscle Strip Contractility as a Method to Evaluate Lower Urinary Tract Pharmacology

We describe an in vitro method to measure bladder smooth muscle contractility, and its use for investigating physiological and pharmacological properties of the smooth muscle as well as changes induced by pathology. This method provides critical information for understanding bladder function while overcoming major methodological difficulties encountered in in vivo experiments, such as surgical and pharmacological manipulations that affect stability and survival of the preparations, the use of human tissue, and/or the use of expensive chemicals. It also provides a way to investigate the properties of each bladder component (i.e. smooth muscle, mucosa, nerves) in healthy and pathological conditions.
The urinary bladder is removed from an anesthetized animal, placed in Krebs solution and cut into strips. Strips are placed into a chamber filled with warm Krebs solution. One end is attached to an isometric tension transducer to measure contraction force, the other end is attached to a fixed rod. Tissue is stimulated by directly adding compounds to the bath or by electric field stimulation electrodes that activate nerves, similar to triggering bladder contractions in vivo. We demonstrate the use of this method to evaluate spontaneous smooth muscle contractility during development and after an experimental spinal cord injury, the nature of neurotransmission (transmitters and receptors involved), factors involved in modulation of smooth muscle activity, the role of individual bladder components, and species and organ differences in response to pharmacological agents. Additionally, it could be used for investigating intracellular pathways involved in contraction and/or relaxation of the smooth muscle, drug structure-activity relationships and evaluation of transmitter release.
The in vitro smooth muscle contractility method has been used extensively for over 50 years, and has provided data that significantly contributed to our understanding of bladder function as well as to pharmaceutical development of compounds currently used clinically for bladder management.

This manuscript presents a simple, yet powerful, in vitro method for evaluating smooth muscle contractility in response to pharmacological agents or nerve stimulation. Main applications are drug screening and understanding tissue physiology, pharmacology,&#160;and pathology.

Vejiga contractilidad del músculo liso de Gaza como un método para evaluar tracto urinario inferior Farmacología

We describe an in vitro method to measure bladder smooth muscle contractility, and its use for investigating physiological and pharmacological properties ...

Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is estimated to contribute to 19- 25% of all clinical cases of acute kidney injury (AKI) in critically ill patients. AKI detection has historically relied on metrics such as serum creatinine (sCr) or blood urea nitrogen (BUN) which are demonstrably inadequate in full assessment of nephrotoxicity in the early phase of renal dysfunction. Currently, there is no robust diagnostic method to accurately detect hemodynamic alteration in the early phase of AKI while such alterations might actually precede the rise in serum biomarker levels. Such early detection can help clinicians make an accurate diagnosis and help in in decision making for therapeutic strategy. Rats were treated with Cisplatin to induce AKI. Nephrotoxicity was assessed for six days using high-frequency sonography, sCr measurement and upon histopathology of kidney. Hemodynamic evaluation using 2D and Color-Doppler images were used to serially study nephrotoxicity in rats, using the sonography. Our data showed successful drug-induced kidney injury in adult rats by histological examination. Color-Doppler based sonographic assessment of AKI indicated that resistive-index (RI) and pulsatile-index (PI) were increased in the treatment group; and peak-systolic velocity (mm/s), end-diastolic velocity (mm/s) and velocity-time integral (VTI, mm) were decreased in renal arteries in the same group. Importantly, these hemodynamic changes evaluated by sonography preceded the rise of sCr levels. Sonography-based indices such as RI or PI can thus be useful predictive markers of declining renal function in rodents. From our sonography-based observations in the kidneys of rats that underwent AKI, we showed that these noninvasive hemodynamic measurements may consider as an accurate, sensitive and robust method in detecting early stage kidney dysfunction. This study also underscores the importance of ethical issues associated with animal use in research.

Early stage hemodynamic dysfunction is critical to the development of kidney disease. Yet, detection methodologies are limited. Recent advances in sonography provide a noninvasive, accurate option for early detection of kidney injury. This study outlines a step-by-step, sonographic methodology for detecting kidney dysfunction using a drug-induced nephrotoxicity rat model.

La detección precoz de la disfunción renal hemodinámico inducido por medicamentos Usando tecnología ecográfica en ratas

The kidney normally functions to maintain hemodynamic homeostasis and is a major site of damage caused by drug toxicity. Drug-induced nephrotoxicity is ...

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. 
During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). 
The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. 
The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains.

Coronary flow reserve (CFR) is useful for assessment of myocardial oxygen demand and evaluation of cardiovascular risk. This study establishes a step-by-step transthoracic Doppler echocardiographic (TTDE) method for longitudinal monitoring of the changes in CFR, as measured from coronary artery in mice, under the experimental pressure overload of aortic banding.

Evaluación Ultrasonido base de la arteria coronaria de flujo y la reserva coronaria Utilizando la sobrecarga Modelo Presión en ratones

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Children with sickle cell anemia (SCA) may be at risk of cerebral vasculopathy and strokes, which can be prevented by chronic transfusion programs. Repeated transfusions of packed red blood cells (PRBCs) is currently the simplest and most used technique for chronic transfusion programs. However, iron overload is one of the major side effects of this therapy. More developed methods exist, notably the apheresis of RBC (erythrapheresis), which is currently the safest and most efficient method. However, it is costly, complicated, and cannot be implemented everywhere, nor is it suitable for all patients. Manual exchange transfusions combine one or more manual phlebotomies with a PRBC transfusion.
At the Reference Center of Sickle Cell Disease, we set up a continuous method of manual exchange transfusion that is feasible for all hospital settings, demands no specific equipment, and is widely applicable. In terms of HbS decrease, stroke prevention, and iron overload prevention, this method showed comparable efficiency to erythrapheresis. In cases where erythrapheresis is not available, this method can be a good alternative for patients and care centers.

We have outlined a method of continuous manual exchange transfusion for the treatment of sickle cell disease in patients. This safe protocol was designed to effectively limit iron overload in patients in need of chronic transfusions and can be used extensively without any special equipment.

Transfusión manual continua para pacientes con enfermedad de células falciformes: un método eficaz para evitar la sobrecarga de hierro

Children with sickle cell anemia (SCA) may be at risk of cerebral vasculopathy and strokes, which can be prevented by chronic transfusion programs. ...

Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in elderly people performing short-term resistance training (RET). Supervised progressive resistance training for 1 h three times a week over 8 weeks was performed by RET participants (71&#177;1 years, range 65-80). Compared to a control group without training, the RET showed improvements on the measures used to indicate strength, power, glucose tolerance, and several parameters of muscle aerobic capacity. Strength training was performed in a gym with only robust fitness equipment. An isokinetic dynamometer for knee extensor strength permitted the measurement of concentric, eccentric, and static strength, which increased for the RET group (8-12% post- versus pre-test). The power (rate of force development, RFD) at the initial 0-30 ms also showed an increase for the RET group (52%). A glucose tolerance test with frequent blood glucose measurements showed improvements only for the RET group in terms of blood glucose values after 2 h (14%) and the area under the curve (21%). The blood lipid profile also improved (8%). From muscle biopsy samples prepared using histochemistry, the amount of fiber type IIa increased, and a trend towards a decrease in IIx in the RET group reflected a change to a more oxidative profile in terms of fiber composition. Western blot (to determine the protein content related to the signaling for muscle protein synthesis) showed a rise of 69% in both Akt and mTOR in the RET group; this also showed an increase in mitochondrial proteins for OXPHOS complex II and citrate synthase (both ~30%) and for complex IV (90%), in only the RET group. We demonstrate that this type of progressive resistance training offers various improvements (e.g., strength, power, aerobic capacity, glucose tolerance, and plasma lipid profile).

The effect of short-term resistance training on elderly people was investigated through the simultaneous use of several methods. Compared to a control group, many improvements were seen, including on muscle aerobic capacity, glucose tolerance, strength, power, and muscle quality (i.e., protein involved in cell signaling and muscle fiber type composition).

Mejora de la Fuerza, Potencia, Capacidad Aeróbica Muscular y Tolerancia a la Glucosa a través del Entrenamiento de Fuerza Progresiva a Corto Plazo entre Ancianos

This protocol describes the simultaneous use of a broad span of methods to examine muscle aerobic capacity, glucose tolerance, strength, and power in ...

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include supporting mastication and deglutition, as well as taste-sensing and phonetics. Accordingly, the strength and volume of the tongue can impact the ability of vertebrates to accomplish basic activities such as feeding, communicating, and breathing. Human patients with sleep apnea have enlarged tongues, characterized by reduced muscle tone and increased intramuscular fat that can be visualized and quantified by magnetic resonance imaging (MRI). The abilities to measure force generation and viscoelastic properties of the tongue constitute important tools for obtaining functional information to correlate with imaging data. Here, we present techniques for measuring tongue force production in anesthetized Zucker rats via electrical stimulation of the hypoglossal nerves and for determining the viscoelastic properties of the tongue by applying passive Lissajous force/deformation curves.

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

We describe a surgical procedure in an anesthetized rat model for determining the muscle tone and viscoelastic properties of the tongue. The procedure involves specific stimulation of the hypoglossal nerves and application of passive Lissajous force/deformation curves to the muscle.

Evaluación in vivo de las propiedades mecánicas y viscoelásticas de la lengua de rata

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include ...

Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations

Many hamstring injuries that occur during physical activity occur while the muscles are lengthening, during eccentric hamstring muscle actions. Opposite of these eccentric hamstring actions are concentric quadriceps actions, where the larger and likely stronger quadriceps straighten the knee. Therefore, to stabilize the lower limbs during movement, the hamstrings must eccentrically combat against the strong knee-straightening torque of the quadriceps. As such, eccentric hamstring strength expressed relative to concentric quadricep strength is commonly referred to as the &#34;functional ratio&#34; as most movements in sports require simultaneous concentric knee extension and eccentric knee flexion. To increase the strength, resiliency, and functional performance of the hamstrings, it is necessary to test and train the hamstrings at different eccentric speeds. The main purpose of this work is to provide instructions for measuring and interpreting eccentric hamstring strength. Techniques for measuring the functional ratio using isokinetic dynamometry are provided and sample data will be compared. Additionally, we briefly describe how to address hamstring strength deficiencies or unilateral strength differences using exercises that specifically focus on increasing eccentric hamstring strength.

The hamstrings are a group of muscles that are sometimes problematic for athletes, resulting in soft tissue injury in the lower limbs. To prevent such injuries, functional training of the hamstrings requires intensive eccentric contractions. Additionally, hamstring function should be tested in relation to quadricep function at different contraction speeds.

Los desequilibrios musculares: Pruebas y entrenamiento de fuerza funcional excéntrico isquiotibiales en poblaciones deportivas

Many hamstring injuries that occur during physical activity occur while the muscles are lengthening, during eccentric hamstring muscle actions. Opposite ...