Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade

Menezes CC, Peceguini LAM, Silva ED, Simoes CM Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade. Background and objectives: Neuromuscular blockers (NMB) have been used for more than half of a century in anesthesia and have always been a challenge for anesthesiologists. Until recently, the reversal of nondepolarizing neuromuscular blockers had only one option: the use of anticholinesterase agents. However, in some situations, such as deep neuromuscular blockade after high doses of relaxant, the use of anticholinesterase agents does not allow adequate reversal of neuromuscular blockade: Recently, sugammadex, a gamma-cyclodextrin, proved to be highly effective for reversal of NMB induced by steroidal agents. Case report: A female patient who underwent an emergency exploratory laparotomy after rapid sequence intubation with rocuronium 1.2 mg.kg(-1). At the end of surgery, the pat ent received neostigmine reversal of NMB. However, neuromuscular junction monitoring did not show the expected recovery, presenting residual paralysis. Sugammadex 2 mg.kg(-1) was used and the patient had complete reversal of NMB in just 2 minutes time. Conclusion: Adequate recovery of residual neuromuscular blockade is required for full control of the pharynx and respiratory functions in order to prevent complications. Adequate recovery can only be obtained by neuromuscular junction monitoring with TOF ratio greater than 0.9. Often, the reversal of NMB with anticholinesterase drugs may not be completely reversed. However, in the absence of objective monitoring this diagnosis is not possible. The case illustrates the diagnosis of residual NMB even after reversal with anticholinesterase agents, resolved with the administration of sugammadex, a safe alternative to reverse the NMB induced by steroidal non-depolarizing agents.

Extraocular Muscles in Patients With Infantile Nystagmus Adaptations at the Effector Level

Objective: To test the hypothesis that the extraocular muscles (EOMs) of patients with infantile nystagmus have muscular and innervational adaptations that may have a role in the involuntary oscillations of the eyes. Methods: Specimens of EOMs from 10 patients with infantile nystagmus and postmortem specimens from 10 control subjects were prepared for histologic examination. The following variables were quantified: mean myofiber cross-sectional area, myofiber central nucleation, myelinated nerve density, nerve fiber density, and neuromuscular junction density. Results: In contrast to control EOMs, infantile nystagmus EOMs had significantly more centrally nucleated myofibers, consistent with cycles of degeneration and regeneration. The EOMs of patients with nystagmus also had a greater degree of heterogeneity in myofiber size than did those of controls, with no difference in mean myofiber cross-sectional area. Mean myelinated nerve density, nerve fiber density, and neuromuscular junction density were also significantly decreased in infantile nystagmus EOMs. Conclusions: The EOMs of patients with infantile nystagmus displayed a distinct hypoinnervated phenotype. This represents the first quantification of changes in central nucleation and myofiber size heterogeneity, as well as decreased myelinated nerve, nerve fiber, and neuromuscular junction density. These results suggest that deficits in motor innervation are a potential basis for the primary loss of motor control.

Effects of strength and power training on neuromuscular adaptations and jumping movement pattern and performance

Effects of strength and power training on neuromuscular adaptations and jumping movement pattern and performance. J Strength Cond Res 26(12): 3335-3344, 2012-This study aimed at comparing the effects of strength and power training (ST and PT) regimens on neuromuscular adaptations and changes on vertical jump performance, kinetics, and kinematics parameters. Forty physically active men (178.2 +/- 7.0 cm; 75.1 +/- 8.6 kg; 23.6 +/- 3.5 years) with at least 2 years of ST experience were assigned to an ST (n = 14), a PT (n = 14), or a control group (C; n = 12). The training programs were performed during 8 weeks, 3 times per week. Dynamic and isometric maximum strength, cross-sectional area, and muscle activation were assessed before and after the experimental period. Squat jump (SJ) and countermovement jump (CMJ) performance, kinetics, and kinematics parameters were also assessed. Dynamic maximum strength increased similarly (p < 0.05) for the ST (22.8%) and PT (16.6%) groups. The maximum voluntary isometric contraction increased for the ST and PT groups (p < 0.05) in the posttraining assessments. There was a main time effect for muscle fiber cross-sectional area (p < 0.05), but there were no changes in muscle activation. The SJ height increased, after ST and PT, because of a faster concentric phase and a higher rate of force development (p < 0.05). The CMJ height increased only after PT (p < 0.05), but there were no significant changes in its kinetics and kinematics parameters. In conclusion, neuromuscular adaptations were similar between the training groups. The PT seemed more effective than the ST in increasing jumping performance, but neither the ST nor the PT was able to affect the SJ and the CMJ movement pattern (e.g., timing and sequencing of joint extension initiation).

Ultrastructural features of the myotendinous junction of the sternomastoid muscle in Wistar rats: from newborn to aging

The myotendinous junction (MTJ) is a major area for transmitting force from the skeletal muscle system and acts in joint position and stabilization. This study aimed to use transmission electron microscopy to describe the ultrastructural features of the MTJ of the sternomastoid muscle in Wistar rats from newborn to formation during adulthood and possible changes with aging. Ultrastructural features of the MTJ from the newborn group revealed pattern during development with interactions between muscle cells and extracellular matrix elements with thin folds in the sarcolemma and high cellular activity evidenced through numerous oval mitochondria groupings. The adult group had classical morphological features of the MTJ, with folds in the sarcolemma forming long projections called finger-like processes and sarcoplasmic invaginations. Sarcomeres were aligned in series, showing mitochondria near the Z line in groupings between collagen fiber bundles. The old group had altered finger-like processes, thickened in both levels of sarcoplasmic invaginations and in central connections with the lateral junctions. We conclude that the MTJ undergoes intense activity from newborn to its formation during adulthood. With increasing age, changes to the MTJ were observed in the shapes of the invaginations and finger-like processes due to hypoactivity, potentially compromising force transmission and joint stability. Microsc. Res. Tech. 75:12921296, 2012. (C) 2012 Wiley Periodicals, Inc.

Effects of strength and power training on neuromuscular variables in older adults

The purpose of this study was to compare the neuromuscular adaptations produced by strength-training (ST) and power-training (PT) regimens in older individuals. Participants were balanced by quadriceps cross-sectional area (CSA) and leg-press 1-repetition maximum and randomly assigned to an ST group (n = 14; 63.6 +/- 4.0 yr, 79.7 +/- 17.2 kg, and 163.9 +/- 9.8 cm), a PT group (n = 16; 64.9 +/- 3.9 yr. 63.9 +/- 11.9 kg, and 157.4 +/- 7.7 cm), or a control group (n = 13; 63.0 +/- 4.0 yr, 67.2 +/- 10.8 kg, and 159.8 +/- 6.8 cm). ST and PT were equally effective in increasing (a) maximum dynamic and isometric strength (p < .05), (b) increasing quadriceps muscle CSA (p < .05), and (c) decreasing electrical mechanical delay of the vastus lateralis muscle (p < .05). There were no significant changes in neuromuscular activation after training. The novel finding of the current study is that PT seems to be an attractive alternative to regular ST to maintain and improve muscle mass.

The breathing pattern and the ventilatory response to aquatic and aerial hypoxia and hypercarbia in the frog Pipa carvalhoi

Anuran amphibians are known to exhibit an intermittent pattern of pulmonary ventilation and to exhibit an increased ventilatory response to hypoxia and hypercarbia. However, only a few species have been studied to date. The aquatic frog Pipa carvalhoi inhabits lakes, ponds and marshes that are rich in nutrients but low in O-2. There are no studies of the respiratory pattern of this species and its ventilation during hypoxia or hypercarbia. Accordingly, the aim of the present study was to characterize the breathing pattern and the ventilatory response to aquatic and aerial hypoxia and hypercarbia in this species. With this purpose, pulmonary ventilation (V-1) was directly measured by the pneumotachograph method during normocapnic normoxia to determine the basal respiratory pattern and during aerial and aquatic hypercarbia (5% CO2) and hypoxia (5% O-2). Our data demonstrate that P. carvalhoi exhibits a periodic breathing pattern composed of single events (single breaths) of pulmonary ventilation separated by periods of apnea. The animals had an enhanced V-1 during aerial hypoxia, but not during aquatic hypoxia. This increase was strictly the result of an increase in the breathing frequency. A pronounced increase in V-1 was observed if the animals were simultaneously exposed to aerial and aquatic hypercarbia, whereas small or no ventilatory responses were observed during separately administered aerial or aquatic hypercarbia. P. carvalhoi primarily inhabits an aquatic environment. Nevertheless, it does not respond to low O-2 levels in water, although it does so in air. The observed ventilatory responses to hypercarbia may indicate that this species is similar to other anurans in possessing central chemoreceptors. (C) 2012 Elsevier Inc. All rights reserved.

Maximal strength, number of repetitions , and total volume are differently affected by static-ballistic, and proprioceptive neuromuscular facilitation stretching

Barroso, R, Tricoli, V, dos Santos Gil, S, Ugrinowitsch, C, and Roschel, H. Maximal strength, number of repetitions, and total volume are differently affected by static-, ballistic-, and proprioceptive neuromuscular facilitation stretching. J Strength Cond Res 26(9): 2432-2437, 2012-Stretching exercises have been traditionally incorporated into warm-up routines before training sessions and sport events. However, the effects of stretching on maximal strength and strength endurance performance seem to depend on the type of stretching employed. The objective of this study was to compare the effects of static stretching (SS), ballistic stretching (BS), and proprioceptive neuromuscular facilitation (PNF) stretching on maximal strength, number of repetitions at a submaximal load, and total volume (i.e., number of repetitions 3 external load) in a multiple-set resistance training bout. Twelve strength-trained men (20.4 +/- 4.5 years, 67.9 +/- 6.3 kg, 173.3 +/- 8.5 cm) volunteered to participate in this study. All of the subjects completed 8 experimental sessions. Four experimental sessions were designed to test maximal strength in the leg press (i.e., 1 repetition maximum [1RM]) after each stretching condition (SS, BS, PNF, or no-stretching [NS]). During the other 4 sessions, the number of repetitions performed at 80% 1RM was assessed after each stretching condition. All of the stretching protocols significantly improved the range of motion in the sit-and-reach test when compared with NS. Further, PNF induced greater changes in the sit-and-reach test than BS did (4.7 +/- 1.6, 2.9 +/- 1.5, and 1.9 +/- 1.4 cm for PNF, SS, and BS, respectively). Leg press 1RM values were decreased only after the PNF condition (5.5%, p < 0.001). All the stretching protocols significantly reduced the number of repetitions (SS: 20.8%, p < 0.001; BS: 17.8%, p = 0.01; PNF: 22.7%, p < 0.001) and total volume (SS: 20.4%, p < 0.001; BS: 17.9%, p = 0.01; PNF: 22.4%, p < 0.001) when compared with NS. The results from this study suggest that, to avoid a decrease in both the number of repetitions and total volume, stretching exercises should not be performed before a resistance training session. Additionally, strength-trained individuals may experience reduced maximal dynamic strength after PNF stretching.

Demographic processes in the montane Atlantic rainforest: Molecular and cytogenetic evidence from the endemic frog Proceratophrys boiei

Historical climatic refugia predict genetic diversity in lowland endemics of the Brazilian Atlantic rainforest. Yet, available data reveal distinct biological responses to the Last Glacial Maximum (LGM) conditions across species of different altitudinal ranges. We show that species occupying Brazil's montane forests were significantly less affected by LGM conditions relative to lowland specialists, but that pre-Pleistocene tectonics greatly influenced their geographic variation. Our conclusions are based on palaeoclimatic distribution models, molecular sequences of the cytochrome b, 16S, and RAG-1 genes, and karyotype data for the endemic frog Proceratophrys boiei. DNA and chromosomal data identify in P. boiei at least two broadly divergent phylogroups, which have not been distinguished morphologically. Cytogenetic results also indicate an area of hybridization in southern Sao Paulo. The location of the phylogeographic break broadly matches the location of a NW-SE fault, which underwent reactivation in the Neogene and led to remarkable landscape changes in southeastern Brazil. Our results point to different mechanisms underpinning diversity patterns in lowland versus montane tropical taxa, and help us to understand the processes responsible for the large number of narrow endemics currently observed in montane areas of the southern Atlantic forest hotspot. (C) 2011 Elsevier Inc. All rights reserved.

Bioenergetics and neuromuscular determinants of the time to exhaustion at velocity corresponding to (V) over dotO(2)max in recreational long-distance runners

Bertuzzi, R, Bueno, S, Pasqua, LA, Acquesta, FM, Batista, MB, Roschel, H, Kiss, MAPDM, Serrao, JC, Tricoli, V, and Ugrinowitsch, C. Bioenergetics and neuromuscular determinants of the time to exhaustion at velocity corresponding to (V) over dotO(2)max in recreational long-distance runners. J Strength Cond Res 26(8): 2096-2102, 2012-The purpose of this study was to investigate the main bioenergetics and neuromuscular determinants of the time to exhaustion (T-lim) at the velocity corresponding to maximal oxygen uptake in recreational long-distance runners. Twenty runners performed the following tests on 5 different days: (a) maximal incremental treadmill test, (b) 2 submaximal tests to determine running economy and vertical stiffness, (c) exhaustive test to measured the T-lim, (d) maximum dynamic strength test, and (e) muscle power production test. Aerobic and anaerobic energy contributions during the T-lim test were also estimated. The stepwise multiple regression method selected 3 independent variables to explain T-lim variance. Total energy production explained 84.1% of the shared variance (p = 0.001), whereas peak oxygen uptake ((V) over dotO(2)peak) measured during T-lim and lower limb muscle power ability accounted for the additional 10% of the shared variance (p = 0.014). These data suggest that the total energy production, (V) over dotO(2)peak, and lower limb muscle power ability are the main physiological and neuromuscular determinants of T-lim in recreational long-distance runners.

Junction Field Effect on the Retention Time for One-Transistor Floating-Body RAM

One-transistor floating-body random access memory retention time distribution is investigated on silicon-on-insulator UTBOX devices. It is shown that the average retention time can be improved by two to three orders of magnitude by reducing the body-junction electric field. However, the retention time distribution, which is mainly caused by the generation-recombination center density variation, remains similar.

The effect of a Lucia jig for 30 minutes on neuromuscular re-programming, in normal subjects

The Lucia jig is a technique that promotes neuromuscular reprogramming of the masticatory system and allows the stabilization of the mandible without the interference of dental contacts, maintaining the mandible position in harmonic condition with the musculature in normal subjects or in patients with temporomandibular dysfunction (TMD). This study aimed to electromyographically analyze the activity (RMS) of the masseter and temporal muscles in normal subjects (control group) during the use of an anterior programming device, the Lucia jig, in place for 0, 5, 10, 20 and 30 minutes to demonstrate its effect on the stomatognathic system. Forty-two healthy dentate individuals (aged 21 to 40 years) with normal occlusion and without parafunctional habits or ternporomandibular dysfunction (RDC/TMD) were evaluated on the basis of the electromyographic activity of the masseter and temporal muscles before placement of a neuromuscular re-programming device, the Lucia jig, on the upper central incisors. There were no statistically significant differences (p < 0.05) in the electromyographic activity of the masticatory muscles in the different time periods. The Lucia jig changed the electromyographic activity by promoting a neuromuscular reprogramming. In most of the time periods, it decreased the activation of the masticatory muscles, showing that this device has wide applicability in dentistry. The use of a Lucia jig over 0, 5, 10, 15, 20 and 30 minutes did not promote any statistically significant increase in muscle activity despite differences in the data, thus showing that this intra-oral device can be used in dentistry.

A Novel Method of Evaluating Ureteropelvic Junction Obstruction: Dynamic Near Infrared Fluorescence Imaging Compared to Standard Modalities to Assess Urinary Obstruction in a Swine Model

Purpose: Dynamic near infrared fluorescence imaging of the urinary tract provides a promising way to diagnose ureteropelvic junction obstruction. Initial studies demonstrated the ability to visualize urine flow and peristalsis in great detail. We analyzed the efficacy of near infrared imaging in evaluating ureteropelvic junction obstruction, renal involvement and the anatomical detail provided compared to conventional imaging modalities. Materials and Methods: Ten swine underwent partial or complete unilateral ureteral obstruction. Groups were survived for the short or the long term. Imaging was performed with mercaptoacetyltriglycine diuretic renogram, magnetic resonance urogram, excretory urogram, ultrasound and near infrared imaging. Scoring systems for ureteropelvic junction obstruction were developed for magnetic resonance urogram and near infrared imaging. Physicians and medical students graded ureteropelvic junction obstruction based on magnetic resonance urogram and near infrared imaging results. Results: Markers of vascular and urinary dynamics were quantitatively consistent among control renal units. The same markers were abnormal in obstructed renal units with significantly different times of renal phase peak, start of pelvic phase and start of renal uptake. Such parameters were consistent with those obtained with mercaptoacetyltriglycine diuretic renography. Near infrared imaging provided live imaging of urinary flow, which was helpful in identifying the area of obstruction for surgical planning. Physicians and medical students categorized the degree of obstruction appropriately for fluorescence imaging and magnetic resonance urogram. Conclusions: Near infrared imaging offers a feasible way to obtain live, dynamic images of urine flow and ureteral peristalsis. Qualitative and quantitative parameters were comparable to those of conventional imaging. Findings support fluorescence imaging as an accurate, easy to use method of diagnosing ureteropelvic junction obstruction.

Relationship of aerobic and neuromuscular indexes with specific actions in judo

Objective. - The aim of this study was to verify the relationship of aerobic and neuromuscular indexes with specific situations in judo. Method. - Eighteen male judokas took part in the study. The following assessments were performed: vertical jump (CMJ) on a force platform; Special Judo Fitness Test (SJFT) to obtain the number of throws and percentage of the maximal heart rate (%HRmax) one minute after the test; match simulation to obtain the peak blood lactate (LACmax) and the percentage of the blood lactate removal (BLR); incremental test to obtain the velocity at the anaerobic threshold (vAT) and peak velocity (PV) reached in the test. Results. - A significant correlation was observed between the number of throws in the SJFT, the vAT (r = 0.60; P < 0.01), PV (r = 0.70; P < 0.01) and CMJ (r = 0.74; P < 0.01). A significant inverse correlation was found between the LACmax and vAT (r = -0.59; P = 0.01). Conclusions. - It can be concluded that the performance in the SJFT was determined by the aerobic capacity and power and the muscle power. Athletes with greater aerobic ability (vAT) presented lower blood lactate accumulation after the match. (c) 2011 Elsevier Masson SAS. All rights reserved.

Multiple Quaternary Refugia in the Eastern Guiana Shield Revealed by Comparative Phylogeography of 12 Frog Species

The Guiana Shield (GS) is one of the most pristine regions of Amazonia and biologically one of the richest areas on Earth. How and when this massive diversity arose remains the subject of considerable debate. The prevailing hypothesis of Quaternary glacial refugia suggests that a part of the eastern GS, among other areas in Amazonia, served as stable forested refugia during periods of aridity. However, the recently proposed disturbance-vicariance hypothesis proposes that fluctuations in temperature on orbital timescales, with some associated aridity, have driven Neotropical diversification. The expectations of the temporal and spatial organization of biodiversity differ between these two hypotheses. Here, we compare the genetic structure of 12 leaf-litter inhabiting frog species from the GS lowlands using a combination of mitochondrial and nuclear sequences in an integrative analytical approach that includes phylogenetic reconstructions, molecular dating, and Geographic Information System methods. This comparative and integrated approach overcomes the well-known limitations of phylogeographic inference based on single species and single loci. All of the focal species exhibit distinct phylogeographic patterns highlighting taxon-specific historical distributions, ecological tolerances to climatic disturbance, and dispersal abilities. Nevertheless, all but one species exhibit a history of fragmentation/isolation within the eastern GS during the Quaternary with spatial and temporal concordance among species. The signature of isolation in northern French Guiana (FG) during the early Pleistocene is particularly clear. Approximate Bayesian Computation supports the synchrony of the divergence between northern FG and other GS lineages. Substructure observed throughout the GS suggests further Quaternary fragmentation and a role for rivers. Our findings support fragmentation of moist tropical forest in the eastern GS during this period when the refuge hypothesis would have the region serving as a contiguous wet-forest refuge.

The Dependence of Retention Time on Gate Length in UTBOX FBRAM With Different Source/Drain Junction Engineering

The floating-body-RAM sense margin and retention-time dependence on the gate length is investigated in UTBOX devices using BJT programming combined with a positive back bias (so-called V th feedback). It is shown that the sense margin and the retention time can be kept constant versus the gate length by using a positive back bias. Nevertheless, below a critical L, there is no room for optimization, and the memory performances suddenly drop. The mechanism behind this degradation is attributed to GIDL current amplification by the lateral bipolar transistor with a narrow base. The gate length can be further scaled using underlap junctions.