Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

Muscle strength but not functional capacity is associated with plasma interleukin-6 levels of community-dwelling elderly women

The association of plasma interleukin-6 (IL-6) levels, muscle strength and functional capacity was investigated in a cross-sectional study of community-dwelling elderly women from Belo Horizonte, Brazil. Elderly people who present controlled chronic diseases with no negative impact on physical, psychosocial and mental functionality are considered to be community-dwelling. Psychological and social stress due to unsuccessfully aging can represent a risk for immune system disfunctions. IL-6 levels, isokinetic muscle strength of knee flexion/extension, and functional tests to determine time required to rise from a chair and gait velocity were measured in 57 participants (71.21 ± 7.38 years). Serum levels of IL-6 were measured in duplicate and were performed within one single assay (mouse monoclonal antibody against IL-6; High-Sensitivity, Quantikine®, R & D Systems, USA; intra-assay coefficient of variance = 6.9-7.4%; interassay coefficient of variance = 9.6-6.5%; sensitivity = 0.016-0.110 pg/mL; mean = 0.039 pg/mL). Muscle strength was assessed with the isokinetic dynamometer Biodex System 3 Pro®. After the Shapiro-Wilk normality test was applied, correlations were investigated using Spearman and Kruskal-Wallis tests. Post hoc analysis was performed using the Dunn test. A significant negative correlation was observed between plasma IL-6 levels (1.95 ± 1.77 pg/mL) and muscle strength for knee flexion (70.70 ± 21.14%; r = -0.265; P = 0.047) and extension (271.84 ± 67.85%; r = -0.315; P = 0.017). No significant correlation was observed between IL-6 levels and the functional tests (time to rise from a chair = 14.65 ± 2.82 s and gait velocity = 0.95 ± 0.14 m/s). These results suggest that IL-6 is associated with reduced muscle strength.

Low-frequency fatigue at maximal and submaximal muscle contractions

Skeletal muscle force production following repetitive contractions is preferentially reduced when muscle is evaluated with low-frequency stimulation. This selective impairment in force generation is called low-frequency fatigue (LFF) and could be dependent on the contraction type. The purpose of this study was to compare LFF after concentric and eccentric maximal and submaximal contractions of knee extensor muscles. Ten healthy male subjects (age: 23.6 ± 4.2 years; weight: 73.8 ± 7.7 kg; height: 1.79 ± 0.05 m) executed maximal voluntary contractions that were measured before a fatigue test (pre-exercise), immediately after (after-exercise) and after 1 h of recovery (after-recovery). The fatigue test consisted of 60 maximal (100%) or submaximal (40%) dynamic concentric or eccentric knee extensions at an angular velocity of 60°/s. The isometric torque produced by low- (20 Hz) and high- (100 Hz) frequency stimulation was also measured at these times and the 20:100 Hz ratio was calculated to assess LFF. One-way ANOVA for repeated measures followed by the Newman-Keuls post hoc test was used to determine significant (P < 0.05) differences. LFF was evident after-recovery in all trials except following submaximal eccentric contractions. LFF was not evident after-exercise, regardless of exercise intensity or contraction type. Our results suggest that low-frequency fatigue was evident after submaximal concentric but not submaximal eccentric contractions and was more pronounced after 1-h of recovery.

Fatigue in a cohort of geriatric patients with and without Parkinson's disease

We evaluated the frequency of fatigue in geriatric patients with and without Parkinson's disease (PD) and correlated it with depression and excessive daytime sleepiness. We evaluated 100 patients from Hospital São Paulo, 50 with PD from the Neurologic Outpatient Clinic and 50 with non-neurologic diseases or oncologic diseases from the Geriatric Outpatient Clinic (controls). All patients who scored 28 or more on the Fatigue Severity Scale (FSS) were considered to have fatigue. Also, all patients were submitted to a structured interview to diagnose depression by the criteria of the American Psychiatric Association (DSM-IV, 4th version) and were evaluated by the Modified Impact of Fatigue Scale and the Epworth Sleepiness Scale (ESE) to detect excessive daytime sleepiness. Demographic and disease details of all PD patients were recorded and the patients were examined and rated by the Unified Parkinson's Disease Rating Sale (UPDRS) and Hoehn-Yahr staging. Frequency of fatigue (FSS ≥28) was 70% for PD and 22% for controls. Twenty of 35 PD patients with fatigue had concomitant depression. Compared to controls, PD patients were found more frequently to have depression by DSM-IV criteria (44 vs 8%, respectively) and excessive daytime sleepiness by the ESE (44 vs 16%), although only depression was associated with fatigue. Fatigue was more frequent among depressed PD and control patients and was not correlated with PD duration or with UPDRS motor scores. ESE scores did not differ between patients with or without fatigue.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Strength and power training did not modify cardiovascular responses to aerobic exercise in elderly subjects

Resistance training increases muscle strength in older adults, decreasing the effort necessary for executing physical tasks, and reducing cardiovascular load during exercise. This hypothesis has been confirmed during strength-based activities, but not during aerobic-based activities. This study determined whether different resistance training regimens, strength training (ST, constant movement velocity) or power training (PT, concentric phase performed as fast as possible) can blunt the increase in cardiovascular load during an aerobic stimulus. Older adults (63.9 ± 0.7 years) were randomly allocated to: control (N = 11), ST (N = 13, twice a week, 70-90% 1-RM) and PT (N = 15, twice a week, 30-50% 1-RM) groups. Before and after 16 weeks, oxygen uptake (VO2), systolic blood pressure (SBP), heart rate (HR), and rate pressure product (RPP) were measured during a maximal treadmill test. Resting SBP and RPP were similarly reduced in all groups (combined data = -5.7 ± 1.2 and -5.0 ± 1.7%, respectively, P < 0.05). Maximal SBP, HR and RPP did not change. The increase in measured VO2, HR and RPP for the increment in estimated VO2 (absolute load) decreased similarly in all groups (combined data = -9.1 ± 2.6, -14.1 ± 3.9, -14.2 ± 3.0%, respectively, P < 0.05), while the increments in the cardiovascular variables for the increase in measured VO2 did not change. In elderly subjects, ST and PT did not blunt submaximal or maximal HR, SBP and RPP increases during the maximal exercise test, showing that they did not reduce cardiovascular stress during aerobic tasks.

The acute effects of strength, endurance and concurrent exercises on the Akt/mTOR/p70S6K1 and AMPK signaling pathway responses in rat skeletal muscle

The activation of competing intracellular pathways has been proposed to explain the reduced training adaptations after concurrent strength and endurance exercises (CE). The present study investigated the acute effects of CE, strength exercises (SE), and endurance exercises (EE) on phosphorylated/total ratios of selected AMPK and Akt/mTOR/p70S6K1 pathway proteins in rats. Six animals per exercise group were killed immediately (0 h) and 2 h after each exercise mode. In addition, 6 animals in a non-exercised condition (NE) were killed on the same day and under the same conditions. The levels of AMPK, phospho-Thr172AMPK (p-AMPK), Akt, phospho-Ser473Akt (p-Akt), p70S6K1, phospho-Thr389-p70S6K1(p-p70S6K1), mTOR, phospho-Ser2448mTOR (p-mTOR), and phospho-Thr1462-TSC2 (p-TSC2) expression were evaluated by immunoblotting in total plantaris muscle extracts. The only significant difference detected was an increase (i.e., 87%) in Akt phosphorylated/total ratio in the CE group 2 h after exercise compared to the NE group (P = 0.002). There were no changes in AMPK, TSC2, mTOR, or p70S6K1 ratios when the exercise modes were compared to the NE condition (P ≥ 0.05). In conclusion, our data suggest that low-intensity and low-volume CE might not blunt the training-induced adaptations, since it did not activate competing intracellular pathways in an acute bout of strength and endurance exercises in rat skeletal muscle.

Intercostal and forearm muscle deoxygenation during respiratory fatigue in patients with heart failure: potential role of a respiratory muscle metaboreflex

The purpose of this study was to determine the effect of respiratory muscle fatigue on intercostal and forearm muscle perfusion and oxygenation in patients with heart failure. Five clinically stable heart failure patients with respiratory muscle weakness (age, 66±12 years; left ventricle ejection fraction, 34±3%) and nine matched healthy controls underwent a respiratory muscle fatigue protocol, breathing against a fixed resistance at 60% of their maximal inspiratory pressure for as long as they could sustain the predetermined inspiratory pressure. Intercostal and forearm muscle blood volume and oxygenation were continuously monitored by near-infrared spectroscopy with transducers placed on the seventh left intercostal space and the left forearm. Data were compared by two-way ANOVA and Bonferroni correction. Respiratory fatigue occurred at 5.1±1.3 min in heart failure patients and at 9.3±1.4 min in controls (P<0.05), but perceived effort, changes in heart rate, and in systolic blood pressure were similar between groups (P>0.05). Respiratory fatigue in heart failure reduced intercostal and forearm muscle blood volume (P<0.05) along with decreased tissue oxygenation both in intercostal (heart failure, -2.6±1.6%; controls, +1.6±0.5%; P<0.05) and in forearm muscles (heart failure, -4.5±0.5%; controls, +0.5±0.8%; P<0.05). These results suggest that respiratory fatigue in patients with heart failure causes an oxygen demand/delivery mismatch in respiratory muscles, probably leading to a reflex reduction in peripheral limb muscle perfusion, featuring a respiratory metaboreflex.

Effect of heat input on the mechanical properties of welded joints in high strength steels

Experiments were carried out to determine the properties of the welded joints in 8mm thick high-strength steels produced by quenching and tempering and thermomechanical rolling with accelerated cooling (tensile strength 821–835 MPa). The dependence of the strength, elongation, hardness, impact energy and crack opening displacement on the heat input in the range 1.0–0.7 kJ mm21 was determined. The results show that the dependence of the strength of the welded joints decreases and that of the elongation increases. The heat input has only a slight effect on the impact energy and crack opening displacement in the heat-affected zone.

The effect of relative humidity on tensile strength and water vapor permeability in chitosan, fish gelatin and transglutaminase edible films

Abstract Composite films of chitosan, fish gelatin and microbial transglutaminase (MTgase) were developed. Films were produced by the casting method and dried at room temperature for 30 h, conditioned for 7 days at 30 °C at a relative humidity (RH) from 11 to 90%, and characterized. Chitosan:fish gelatin films in different proportions (100:0, 75:25, 50:50) with MTgase, were subjected to tensile properties and water vapor transmission (WVT) testing. The results showed that tensile strength decreased with an increase in RH and with an increase in gelatin content. Percent of elongation also increased with increasing RH and gelatin concentration. Water vapor transmission showed an increase proportional to an increase in RH with the presence of gelatin being unfavorable for reducing WVT. Results in this work allowed studying the effect of relative humidity on tensile and water vapor properties of chitosan and fish gelatin films.

Simulation and material calibration of ultra high strength steel (UHSS) S960 welded joint under static tensile test utilizing finite element method (FEM)

The aim of this work was to calibrate the material properties including strength and strain values for different material zones of ultra-high strength steel (UHSS) welded joints under monotonic static loading. The UHSS is heat sensitive and softens by heat due to welding, the affected zone is heat affected zone (HAZ). In this regard, cylindrical specimens were cut out from welded joints of Strenx® 960 MC and Strenx® Tube 960 MH, were examined by tensile test. The hardness values of specimens’ cross section were measured. Using correlations between hardness and strength, initial material properties were obtained. The same size specimen with different zones of material same as real specimen were created and defined in finite element method (FEM) software with commercial brand Abaqus 6.14-1. The loading and boundary conditions were defined considering tensile test values. Using initial material properties made of hardness-strength correlations (true stress-strain values) as Abaqus main input, FEM is utilized to simulate the tensile test process. By comparing FEM Abaqus results with measured results of tensile test, initial material properties will be revised and reused as software input to be fully calibrated in such a way that FEM results and tensile test results deviate minimum. Two type of different S960 were used including 960 MC plates, and structural hollow section 960 MH X-joint. The joint is welded by BöhlerTM X96 filler material. In welded joints, typically the following zones appear: Weld (WEL), Heat affected zone (HAZ) coarse grained (HCG) and fine grained (HFG), annealed zone, and base material (BaM). Results showed that: The HAZ zone is softened due to heat input while welding. For all the specimens, the softened zone’s strength is decreased and makes it a weakest zone where fracture happens while loading. Stress concentration of a notched specimen can represent the properties of notched zone. The load-displacement diagram from FEM modeling matches with the experiments by the calibrated material properties by compromising two correlations of hardness and strength.

Weldability of high strength aluminium alloys

The need for reduced intrinsic weight of structures and vehicles in the transportation industry has made aluminium research of interest. Aluminium has properties that are favourable for structural engineering, including good strength-to-weight ratio, corrosion resistance and machinability. It can be easily recycled saving energy used in smelting as compared to steel. Its alloys can have ultimate tensile strength of up to 750 MPa, which is comparable to steel. Aluminium alloys are generally weldable, however welding of high strength alloys like the 7xxx series pose considerable challenges. This paper presents research on the weldability of high strength aluminium alloys, principally the 7xxx series. The weldability with various weld processes including MIG, TIG, and FSW, is discussed in addition to consideration of joint types, weld defects and recommendations for minimizing or preventing weld defects. Experimental research was carried out on 7025-T6 and AW-7020 alloys. Samples were welded, and weld cross sections utilized in weld metallurgy studies. Mechanical tests were carried out including hardness tests and tensile tests. In addition, testing was done for the presence of Al2O3 on exposed aluminium alloy. It was observed that at constant weld heat input using a pulsed MIG system, the welding speed had little or no effect on the weld hardness. However, the grain size increased as the filler wire feed rate, welding current and welding speed increased. High heat input resulted in lower hardness of the weld profile. Weld preheating was detrimental to AW- 7020 welds; however, artificial aging was beneficial. Acceptable welds were attained with pulsed MIG without the removal of the Al2O3 layer prior to welding. The Al2O3 oxide layer was found to have different compositions in different aluminium alloys. These findings contribute useful additional information to the knowledge base of aluminium welding. The application of the findings of this study in welding will help reduce weld cost and improve high strength aluminium structure productivity by removing the need for pre-weld cleaning. Better understanding of aluminium weld metallurgy equips weld engineers with information for better aluminium weld design.

Effects of Fabrication Processes on the Behavior of S960 Ultra High Strength Steel (UHSS)

Strenx® 960 MC is a direct quenched type of Ultra High Strength Steel (UHSS) with low carbon content. Although this material combines high strength and good ductility, it is highly sensitive towards fabrication processes. The presence of stress concentration due to structural discontinuity or notch will highlight the role of these fabrication effects on the deformation capacity of the material. Due to this, a series of tensile tests are done on both pure base material (BM) and when it has been subjected to Heat Input (HI) and Cold Forming (CF). The surface of the material was dressed by laser beam with a certain speed to study the effect of HI while the CF is done by bending the specimen to a certain angle prior to tensile test. The generated results illustrate the impact of these processes on the deformation capacity of the material, specially, when the material has HI experience due to welding or similar processes. In order to compare the results with those of numerical simulation, LS-DYNA explicit commercial package has been utilized. The generated results show an acceptable agreement between experimental and numerical simulation outcomes.

Ultralujan teräksen kaarijuotto

Tässä diplomityössä tutkitaan ultralujan rakenneteräksen kaarijuotolla valmistettujen liitosten väsymiskestävyyttä. Tutkittavat liitokset ovat kuormaa kantamattomia X-liitoksia. Tutkinnassa vertaillaan puhtaasti juottamalla valmistettua liitosta hitsauksen ja juoton kombinaatioliitokseen, jossa pohjapalkona toimivan hitsin rajaviivalle on juotettu lisäpalko. Kaarijuottoa esitellään yleisesti liittämismenetelmänä. Ultralujaa rakenneterästä esitellään yleisesti ja tarkastellaan sen metallurgista käyttäytymistä sekä juotettaessa, että hitsattaessa. Tutkimuksessa tehtiin kaikkiaan 21 väsytystestiä. Väsytystestit muodostuivat kolmesta eri koekappalesarjasta. Ensimmäisen ja toisen sarjan koekappaleet tehtiin juottamalla, eri lisäaineilla. 3. sarjassa pienat hitsattiin, jonka jälkeen hitsin rajaviivalle tehtiin juotto. Kappaleiden geometriat mitattiin ennen testejä, ja osasta kappaleista mitattiin jäännösjännitykset. Kappaleista otettiin hieitä, joista tehtiin kovuusmittaukset ja suoritettiin makro- ja mikrotason tarkastelua liitosprosessin lämmöntuonnin vaikutuksesta. Väsytyskokeiden perusteella kappaleille määritettiin nimelliset ja rakenteelliset väsymisluokat. Tuloksista piirrettiin S-N –käyrät. Liitoksista tehtiin FEA-mallit, joista määritettiin liitoksen rajaviivalle muodostuva jännitys ja 2. sarjan koekappaleiden laskennalliset kestoiät. 1. sarjan juotoksissa oli ongelmana juotoksen tarttuvuus teräksen pintaan. 2. sarjan koetulokset olivat kaikkein parhaita. 3. sarjan kombinaatioliitokset ylsivät kohtalaisiin väsymisluokkiin. 2. sarjan koetulosten perusteella kaarijuotossa on potentiaalia ultralujan rakenneteräksen liittämismenetelmänä. Jatkotutkimuksen tarve on kuitenkin laaja. Tämä työ osoitti, että kaarijuottaminen voi olla vaativa liittämisprosessi, sillä toimiakseen se vaatii varsin tarkat parametrit, ja lisäksi prosessi on melko herkkä olosuhdemuutoksille.

Investigation of the fatigue performance of welded duplex stainless steel

Diplomityössä tutkitaan hitsatun duplex-teräksen, laatu: EN 1.4462 (Outokumpu laatu 2205) väsymislujuutta. Tutkimusmetodologia noudattaa sekä kokeellisia että laskennallisia menetelmiä. Kokeelliset menetelmät sisältävät hitsatun teräksen väsytystestaukset laboratoriossa, hitsausten jälkikäsittelyt (HiFIT) sekä perusaineelle ja hitseille tehtävät metallurgiset tutkimukset. Väsytyskokeista saatavia tuloksia verrataan kansainvälisen hitsausinstituutin (IIW) vahvistamiin rakennekohtaisiin standardeihin sekä kirjallisuudessa esiintyviin tutkimustuloksiin. Laskennalliset menetelmät sisältävät vertailulaskelmia tehollisen lovijännityksen (ENS) menetelmää hyödyntäen. Tehollisen lovijännityksen menetelmässä liitoksissa vaikuttavat teholliset lovijännitykset selvitetään elementtimenetelmän (FEM) avulla. Tulokset vahvistavat, että hitsauksella ja hitsausten jälkikäsittelyllä on suuri merkitys rakenteen kestoikään. Suurin osa väsytyskokeiden tuloksista osoitti parempia väsymiskestävyyden arvoja kuin rakennekohtaiset standardit, mutta liitosten liitosvirheiden todettiin heikentävän väsytyskestävyyttä. Jälkikäsittelyiden todettiin parantavan liitosten väsymiskestävyyden tuloksia ja todettiin tulosten olevan hyödynnettävissä mitoituksessa.