The TREAT-NMD Duchenne Muscular Dystrophy Registries: Conception, Design, and Utilization by Industry and Academia.

Duchenne muscular dystrophy (DMD) is an X-linked genetic disease, caused by the absence of the dystrophin protein. Although many novel therapies are under development for DMD, there is currently no cure and affected individuals are often confined to a wheelchair by their teens and die in their twenties/thirties. DMD is a rare disease (prevalence <5/10,000). Even the largest countries do not have enough affected patients to rigorously assess novel therapies, unravel genetic complexities, and determine patient outcomes. TREAT-NMD is a worldwide network for neuromuscular diseases that provides an infrastructure to support the delivery of promising new therapies for patients. The harmonized implementation of national and ultimately global patient registries has been central to the success of TREAT-NMD. For the DMD registries within TREAT-NMD, individual countries have chosen to collect patient information in the form of standardized patient registries to increase the overall patient population on which clinical outcomes and new technologies can be assessed. The registries comprise more than 13,500 patients from 31 different countries. Here, we describe how the TREAT-NMD national patient registries for DMD were established. We look at their continued growth and assess how successful they have been at fostering collaboration between academia, patient organizations, and industry.

Innovations in hypoxic training

Athletes seem compelled to include some forms of altitude training in their preparation expecting additional performance gains compared to equivalent training at sea-level. For the general population, altitude training often only consists in spending weeks at altitude to enhance red blood cell production, hemoglobin mass and thus oxygen delivery to the muscles. Over the past two decades, intermittent hypoxic training (IHT), that is, a method where athletes live at or near sea-level but train in hypobaric hypoxia (HH, real altitude) or normobaric hypoxia (NH, simulated altitude) was shown to induce exclusive adaptations directly at the muscular level that may support performance improvements. Our work first demonstrated significant differences between exposure and exercise in HH vs. NH that may help disentangling hypoxia and hypobaria for athletes or mountaineers who use NH to prepare for altitude competitions or expeditions. Second, we produced a comprehensive review of the strikingly poor and controversial benefits of IHT for performance enhancement in team or racket sports. Using evidence of peripheral muscular adaptations with the recruitment of fast-twitch fibers playing a major role, we then developed and assessed the potential of a new training method in hypoxia based on the repetitions of "all-out" sprints interspersed with incomplete recovery periods, the so called "repeated sprint training in hypoxia" (RSH). We have consequently shown RSH to delay fatigue when sprints with incomplete recoveries are repeated until exhaustion both in cycling and cross-country ski double poling. We definitely outlined RSH as a promising training strategy and proposed new studies to judge the efficacy of RSH in team sports and determine the specific mechanisms that may enhance team game results. In conclusion, our work allowed updating the panorama over the contemporary hypoxic training possibilities. It provides an overview of the current scientific knowledge about intermittent hypoxic training and repeated sprint training in hypoxia (RSH). This will benefit athletes and teams in intermittent sports looking to include a hypoxic stimulus to their training to gain a specific competitive edge.

Fatigue and Residual Stress Investigation of Composite Prestressed Steel Beams, HR-74, 1963

Two composite, prestressed, steel beams, fabricated by slightly different methods, were fatigue tested to destruction. Stresses and deflections were measured at regular intervals, and the behavior of each beam as failure progressed was recorded. Residual stresses were then evaluated by testing segments of each beam. An attempt was made to assess the effects of the residual stresses on fatigue strength.

Fatigue Behavior of Air-Entrained Concrete, HR-183, 1977

When a material fails under a number of repeated loads, each smaller than the ultimate static strength, a fatigue failure is said to have taken place. Many studies have been made to characterize the fatigue behavior of various engineering materials. The results of some of these studies have proved invaluable in the evaluation and prediction of the fatigue strength of structural materials. Considerable time and effort has gone into the evaluation of the fatigue behavior of metals. These early studies were motivated by practical considerations: The first fatigue tests were performed on materials that had been observed to fail after repeated loading of a magnitude less than that required for failure under the application of a single load. Mine-hoist chains, railway axles, and steam engine parts were among the first structural components to be recognized as exhibiting fatigue behavior. Since concrete is usually subjected to static loading rather than cyclic loading, need for knowledge of the fatigue behavior of concrete has lagged behind that of metals. One notable exception to this, however, is in the area of highway and airfield pavement design. Due to the fact that the fatigue behavior of concrete must be understood in the design of pavements and reinforced concrete bridges, highway engineers have provided the motivation for concrete fatigue studies since the 1920's.

Fatigue Behavior of Air-Entrained Concrete: Phase II, HR-197, 1979

When a material fails under a number of repeated loads, each smaller than the ultimate static strength, a fatigue failure is said to have taken place. Many studies have been made to characterize the fatigue behavior of various engineering materials. The results of some of these studies have proved invaluable in the evaluation and prediction of the fatigue strength of structural materials. Considerable time and effort have gone into the evaluation of the fatigue behavior of metals. These early studies were motivated by practical considerations: the first fatigue tests were performed on materials that had been observed to fail after repeated loading of a magnitude less than that required for failure under the application of a single load. Mine-hoist chains (1829), railway axles (1852), and steam engine parts were among the first structural components to be recognized as exhibiting fatigue behavior. Since concrete is usually subjected to static loading rather than cyclic loading, need for knowledge of the fatigue behavior of concrete has lagged behind that of metals. One notable exception to this, however, is in the area of highway and airfield pavement design. Due to the fact that the fatigue behavior of concrete must be understood in the design of pavements and reinforced concrete bridges, highway engineers have provided the motivation for concrete fatigue studies since the 1920s.

Statines et effets indésirables musculaires [Statins and muscular side-effects]

Statins are effective in the treatment of hypercholesterolemia for primary and secondary prevention of cardiovascular disease. While most side effects of statins are mild and transient, muscular symptoms are relatively common (5 to 10% of patients), but rarely serious (myositis, rhabdomyolysis). In cases of myopathy, the severity of symptoms and the determination of CK (creatine kinase) determine whether discontinuation of statin is necessary. Alternative strategies are also suggested. This article reviews suggestions on the management of these complaints that are a challenge in clinical practice.

Fatigue and weight loss predict survival on circadian chemotherapy for metastatic colorectal cancer.

BACKGROUND: Chemotherapy-induced neutropenia has been associated with prolonged survival selectively in patients on a conventional schedule (combined 5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX2]) but not on a chronomodulated schedule of the same drugs administered at specific circadian times (chronoFLO4). The authors hypothesized that the early occurrence of chemotherapy-induced symptoms correlated with circadian disruption would selectively hinder the efficacy of chronotherapy. METHODS: Fatigue and weight loss (FWL) were considered to be associated with circadian disruption based on previous data. Patients with metastatic colorectal cancer (nâeuro0/00=âeuro0/00543) from an international phase 3 trial comparing FOLFOX2 with chronoFLO4 were categorized into 4 subgroups according to the occurrence of FWL or other clinically relevant toxicities during the initial 2 courses of chemotherapy. Multivariate Cox models were used to assess the role of toxicity on the time to progression (TTP) and overall survival (OS). RESULTS: The proportions of patients in the 4 subgroups were comparable in both treatment arms (Pâeuro0/00=âeuro0/00.77). No toxicity was associated with TTP or OS on FOLFOX2. The median OS on FOLFOX2 ranged from 16.4 (95% confidence limits [CL], 7.2-25.6 months) to 19.8 months (95% CL, 17.7-22.0 months) according to toxicity subgroup (Pâeuro0/00=âeuro0/00.45). Conversely, FWL, but no other toxicity, independently predicted for significantly shorter TTP (Pâeuro0/00<âeuro0/00.0001) and OS (Pâeuro0/00=âeuro0/00.001) on chronoFLO4. The median OS on chronoFLO4 was 13.8 months (95% CL, 10.4-17.2 months) or 21.1 months (95% CL, 19.0-23.1 months) according to presence or absence of chemotherapy-induced FWL, respectively. CONCLUSIONS: Early onset chemotherapy-induced FWL was an independent predictor of poor TTP and OS only on chronotherapy. Dynamic monitoring to detect early chemotherapy-induced circadian disruption could allow the optimization of rapid chronotherapy and concomitant improvements in safety and efficacy.

Anàlisi d'un treball de força explosiva combinant màquines vibratòries i màquines inercials

L’objectiu d’aquest estudi és comparar els efectes de dos mitjans de treball sobre la força explosiva en 9 atletes de nivell autonòmic i nacional (19,6 ± 2,6 anys, 1,76 ± 7 m i 68,9 ± 3,5 kg) que entrenaren durant el període competitiu, 6 setmanes amb una freqüència de 2 cops per setmana, seguint una periodització creixent. Els subjectes varen ser dividits en 3 grups de 3 atletes cada un, però utilitzant diferents mitjans d’entrenament: el grup experimental combinant la plataforma vibratòria i les màquines inercials (1), amb un temps d’exposició a la vibració de 30’’, a una intensitat de 45 Hz i una amplitud de 5 mm amb una pausa d’1’. I de 3 sèries de 8 repeticions executades a màxima velocitat en la fase concèntrica i controlant aquesta en la fase excèntrica, amb una pausa de 3’ en les màquines io-io. El grup experimental de pesos lliures (2), va realitzar 4 exercicis: ½ squat, pliometria (CEE), multisalts horitzontals i acceleracions, seguint les pautes d’un treball de força explosiva proposat per Badillo i Gorostiaga (1995). I un grup control (3), que no realitzà cap entrenament de força. Abans i després del període d’intervenció és realitzaren els següents tests: salt sense contramoviment (SJ) i salt amb contramoviment (CMJ). Els resultats indicaren que el grup (1), (2) i (3) disminuïren significativament el SJ i el CMJ. Es conclou que l’entrenament, tant en el de combinació d’estímuls vibratoris amb màquines inercials com el de pesos lliures pareix ser un mitja que s’ha de controlar i perioditzar molt bé ja que en el període competitiu l’atleta acumula uns nivells de fatiga tant muscular com fisiològics molt superiors que en altres períodes de la temporada.

Entrenament d'un ciclista esprinter mitjançant la força explosiva: avaluació dels efectes d'un entrenament específic

La principal fita dels ciclistes ha estat sempre l’entrenament per millorar les seves condicions i prestacions fisiològiques. Al llarg dels anys, el ciclisme com pràcticament tot l’esport s’ha anat modernitzant, no només tecnològicament. Això ha provocat l’aparició d’especialistes, corredors destinats a destacar, només en unes determinades condicions, per sobre els demés. Una d’aquestes condicions més restringides son les arribades massives, terreny dels anomenats esprinters, els quals brillen per sobre els demés degut a la seva potència, velocitat punta i arrancada. L’entrenament d’aquesta tipologia d’especialitat ha deixat entreveure varies ambigüitats i algunes problemàtiques de fonament teòric. L’esprint en el ciclisme es dona després d’un gran desgast de les reserves energètiques i de fatiga muscular. Per tant, entrenar-lo amb blocs de velocitat no té lògica. Tampoc es una opció viable el recurs que molts equips utilitzen: agafar corredors joves de la pista, i que la seva genètica (fibres ràpides) i les seves característiques de pistard1 facin la resta, perquè al pas dels anys perden aquesta exclusivitat. Aquest estudi es proposa buscar una manera de treballar i potenciar l’esprint del ciclista a partir de la força explosiva, garantint preservar les condicions aeròbiques per tal de que no perjudiqui per altra banda la seva resistència. Per tal d’aconseguir-ho, s’efectuaran uns tests. Un focalitzat en mesurar les prestacions en un esprint dels subjectes. L’altra es basarà en avaluar la força explosiva d’aquets, a partir de salts verticals. Un cop obtinguts els resultats de la primera tanda, els subjectes seran sotmesos a un entrenament combinat de sobrecàrrega, per tal de observar, en la segona tanda, si els resultats son significatius. Com a conclusió, es podria destacar el fet de millora en la majoria d’aspectes en tots els tests per part de tots els subjectes, i que probablement, hi ha una correlació significativa entre la força explosiva i la capacitat per esprintar, tot i que s’haurien de corroborar els resultats amb una mostra més gran.

EEG windowed statistical wavelet scoring for evaluation and discrimination of muscular artifacts

EEG recordings are usually corrupted by spurious extra-cerebral artifacts, which should be rejected or cleaned up by the practitioner. Since manual screening of human EEGs is inherently error prone and might induce experimental bias, automatic artifact detection is an issue of importance. Automatic artifact detection is the best guarantee for objective and clean results. We present a new approach, based on the time–frequency shape of muscular artifacts, to achieve reliable and automatic scoring. The impact of muscular activity on the signal can be evaluated using this methodology by placing emphasis on the analysis of EEG activity. The method is used to discriminate evoked potentials from several types of recorded muscular artifacts—with a sensitivity of 98.8% and a specificity of 92.2%. Automatic cleaning ofEEGdata are then successfully realized using this method, combined with independent component analysis. The outcome of the automatic cleaning is then compared with the Slepian multitaper spectrum based technique introduced by Delorme et al (2007 Neuroimage 34 1443–9).

The Flexural Fatigue Strength of Prestressed Steel I-Beams, HR-73, 1962

The purpose of this investigation was to study the flexural fatigue strength of two prestressed steel I-beams which had previously been fabricated in connection with a jointly sponsored project under the auspices of the Iowa State Highway Commission. The beams were prestressed by deflecting them under the action of a concentrated load at the center of a simple span, then welding unstressed high strength steel plates to the top and bottom flanges to retain a predetermined amount of prestress. The beams were rolled sections of A36 steel and the plates were USS "T-1" steel. Each of the two test specimens were subjected to an identical repeated loading until a fatigue failure occurred. The loading was designed to produce stresses equivalent to those which would have occurred in a simulated bridge and amounted to 84 percent of a standard H-15 live load including impact. One of the beams sustained 2,469,100 repetitions of load to failure and the other sustained 2,756,100 cycles. Following the fatigue tests, an experimental study was made to determine the state of stress that had been retained in the prestressed steel beams. This information, upon which the calculated stresses of the test could be superimposed, provided a method of correlating the fatigue strength of the beams with the fatigue information available on the two steels involved.

Effects of salbutamol on the contractile properties of human skeletal muscle before and after fatigue.

AIM: The study examined the effects of an oral acute administration of the beta2-agonist salbutamol (Sal) (6 mg) vs. placebo on muscle strength and fatigability in 12 non-asthmatic recreational male athletes in a randomized double-blind protocol. METHODS: Contractile properties of the right quadriceps muscle were measured during electrical stimulations, i.e. twitch, 1-s pulse trains at 20 (P(20) ) and 80 Hz (P(80) ) and during maximal voluntary isometric contraction (MVIC) before (PRE) and after (POST) a fatigue-producing protocol set by an electromyostimulation (30 contractions, frequency: 75 Hz, on-off ratio: 6.25-20s). In addition, the level of muscle voluntary activation was measured. RESULTS: In PRE and POST conditions, the peak torque (PT) of twitch, P(80) and MVIC were not modified by the treatment. The PT in POST P(20) was slightly, although not significantly, less affected by fatigue in Sal compared with placebo condition. Moreover, twitch half-relaxation time at PRE was smaller under Sal than under placebo (P < 0.05). No significant changes in the degree of voluntary activation were observed with Sal treatment in PRE or POST condition. CONCLUSION: Although these findings did not exclude completely an effect of Sal on peripheral factors of human skeletal muscle, oral acute administration of the beta2-agonist Sal seems to be without any relevant ergogenic effect on muscle contractility and fatigability in non-asthmatic recreational male athletes.

Continuous monitoring and quantification of multiple parameters of daily physical activity in ambulatory Duchenne muscular dystrophy patients.

Multiple motor function and strength assessment tools exist for the evaluation of neuromuscular diseases, but most do not directly assess functional ability in the patients' daily physical activity in their home environment. In this study our aim was to assess: 1) the feasibility and accuracy of physical activity monitoring during two days in a home environment of five DMD patients using a non-commercialized monitor containing a 3D accelerometer and a gyroscope, 2) if a difference in the physical activity parameters could be measured before and one month after starting prednisolone. We reliably quantified the time spend sitting, standing, lying, walking, the number of steps taken, the cadence, the number of walking episodes and their duration as well as how these were distributed over the day. Parameters possibly reflecting endurance, such as the duration of the walking episodes or the succession of two or three walking episodes lasting more than 30 s were the most improved after prednisolone treatment. This degree of detailed determination of physical activity in a home environment has not been previously reported in neuromuscular disorders to our knowledge and some of the reported parameters are potential new outcome measures in clinical trials.

Macular dystrophy associated with the mitochondrial DNA A3243G mutation: pericentral pigment deposits or atrophy? Report of two cases and review of the literature.

BACKGROUND: The A3243G point mutation in mitochondrial DNA (mtDNA) is associated with MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) and MIDD syndromes (maternally inherited diabetes and deafness). Both MELAS and MIDD patients can present with visual symptoms due to a retinopathy, sometimes before the genetic diagnosis is made. CASE PRESENTATION: Patient 1: 46 year-old woman with diabetes mellitus and hearing loss was referred for an unspecified maculopathy detected during screening evaluation for diabetic retinopathy. Visual acuity was 20/20 in both eyes. Fundus examination showed bilateral macular and peripapillary hyperpigmented/depigmented areas.Patient 2: 45 year-old woman was referred for recent vision loss in her left eye. History was remarkable for chronic fatigue, migraine and diffuse muscular pain. Visual acuity was 20/20 in her right eye and 20/30 in her left eye. Fundus exhibited several nummular perifoveal islands of retinal pigment epithelium atrophy and adjacent pale deposits in both eyes.Retinal anatomy was investigated with autofluorescence, retinal angiography and optical coherence tomography. Retinal function was assessed with automated static perimetry, full-field and multifocal electroretinography and electro-oculography. Genetic testing of mtDNA identified a point mutation at the locus 3243. CONCLUSION: Observation of RPE abnormalities in the context of suggestive systemic findings should prompt mtDNA testing.