A novel method for measuring electromechanical delay of the vastus medialis obliquus and vastus lateralis

Compression Elastography and Shear Wave Ultrasound Elastography for Measurement of Brain Elasticity in Full-Term and Premature Neonates: A Prospective Study

OBJECTIVES

To investigate the brain tissue elasticity in normal term and premature neonates using compression elastography and shear wave elastography.

METHODS

This prospective observational study enrolled term and premature neonates admitted to the Third Affiliated Hospital of Guangzhou Medical University between July 2019 and December 2020.

RESULTS

A total of 106 neonates, including 65 premature neonates and 41 term neonates, were enrolled. The elastic modulus of the frontal white matter in males was significantly lower than in females (11.67 ± 0.98 versus 12.25 ± 1.31, P = .030), but the shear wave velocity of the thalamus in males was significantly lower than in females (1.18 ± 0.13 versus 1.82 ± 0.10, P < .001). There was no significant correlation between real-time body weight and brain tissue elasticity including elastic modulus and shear wave velocity. But, the shear wave velocity of parietal white matter (r = 0.319, P = .014) and thalamus (r = -0.268, P = .040) and the elastic modulus of parietal white matter (r = 0.356, P = .006) were correlated with corrected gestational age.

CONCLUSIONS

Clinicians may consider using elastography to determine brain tissue elasticity in term and preterm neonates.

Hyperthermia reduces electromechanical delay via accelerated electrochemical processes

The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (D_m; i.e., delay between stimulation and muscle fascicle motion), and mechanical (T_m; i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26°C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50°C, 18% relative humidity, after ∼127 min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0 ± 0.6°C in HOT vs. 34.0 ± 0.8°C in CON (P < 0.001). EMD was shorter (9.4 ± 0.8 ms) in HOT than in CON (10.8 ± 0.6 ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0 ± 0.8 ms vs. 5.5 ± 0.9 ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance.NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5°C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.

Progress in the Application of Ultrasound Elastography for Brain Diseases

Ultrasound (US) can be used to evaluate the brain structure and nervous system damage. Patients with neurologic symptoms need rapid, noninvasive imaging with high spatial resolution and tissue contrast. Magnetic resonance imaging is currently the most sensitive and specific imaging method for evaluating neuropathologic conditions. This approach does present some challenges, such as the need to transport patients who may be seriously ill to the magnetic resonance imaging suite and the need for patients to remain for a considerable time. Cranial US provides a very valuable imaging method for clinicians, which can make a rapid diagnosis and evaluation without ionizing radiation. The main disadvantage of cranial US is its low sensitivity and specificity for subtle/early lesions. In recent years, with the rapid development of anatomic and functional US technology, the practicability of US diagnosis and intervention has been greatly improved. Ultrasound elastography may have the potential to improve the sensitivity and specificity of various cranial nerve conditions. Ultrasound elastography has received considerable critical attention, and an increasing number of studies have recognized its critical role in evaluating brain diseases. At present, US elastography has been applied to the evaluation of traumatic brain injury, ischemic stroke, intraoperative brain tumors, and hypoxic ischemic encephalopathy. The latest animal experiments and human clinical trial developments in the applications of US elastography for brain diseases are summarized in this review.

Whole-Body Vibration Improves Early Rate of Torque Development in Individuals With Anterior Cruciate Ligament Reconstruction

Pamukoff, DN, Pietrosimone, B, Ryan, ED, Lee, DR, Brown, LE, and Blackburn, JT. Whole body vibration improves early rate of torque development in individuals with anterior cruciate ligament reconstruction. J Strength Cond Res 31(11): 2992-3000, 2017-The purpose of this study was to compare the effect of whole-body vibration (WBV) and local muscle vibration (LMV) on early and late quadriceps rate of torque development (RTD), and electromechanical delay (EMD) in individuals with anterior cruciate ligament reconstruction (ACLR). Twenty individuals with ACLR were recruited for this study. Participants performed isometric squats while being exposed to WBV, LMV, or no vibration (control) in a randomized order during separate visits. Early and late quadriceps RTD and EMD were assessed during a maximal voluntary isometric knee extension before and immediately after WBV, LMV, or control. There was a significant condition by time interaction for early RTD (p = 0.045) but not for late RTD (p = 0.11) or EMD of the vastus medialis (p = 0.15), vastus lateralis (p = 0.17), or rectus femoris (p = 0.39). Post hoc analyses indicated a significant increase in early RTD after WBV (+5.59 N·m·s·kg; 95% confidence interval, 1.47-12.72; p = 0.007). No differences were observed in the LMV or control conditions, and no difference was observed between conditions at posttest. The ability to rapidly produce knee extension torque is essential to physical function, and WBV may be appropriate to aid in the restoration of RTD after ACLR.

Evaluation of Neonatal Brain Parenchyma Using 2-Dimensional Shear Wave Elastography

OBJECTIVES

The aim of this study was to evaluate the stiffness of the neonatal brain using 2-dimensional shear wave elastography in term and preterm neonates and to investigate possible stiffness differences between groups.

METHODS

A total of 83 neonates, including 44 term and 39 preterm, were included in the study. Shear wave elastographic measurements of the thalamus and occipital periventricular white matter were conducted via the anterior fontanel. The Pearson correlation coefficient was used to determine the association between the birth week and stiffness values of the thalamus and periventricular white matter. A receiver operating characteristic analysis was applied to determine the power of the stiffness of the thalamus and periventricular white matter in predicting a significant preterm classification. P < .05 was considered significant.

RESULTS

The brain parenchymal stiffness values measured from both the thalamus and periventricular white matter were found to be significantly lower in the preterm group compared with the term group. The periventricular white matter stiffness values were found to be lower than thalamus stiffness values in both groups. According to the receiver operating characteristic curve, the optimal cutoff values for determining prematurity were defined to be less than 8.28 kPa for the mean thalamus stiffness and less than 6.59 kPa for the periventricular white matter.

CONCLUSIONS

This study shows that differences between brain stiffness values in preterm and term neonates can be shown by using 2-dimensional shear wave elastography, and the results may be reference points for evaluating neonatal brain stiffness in research on patients with various illnesses.

An Experimental Study of the Potential Biological Effects Associated with 2-D Shear Wave Elastography on the Neonatal Brain

2-D Shear wave elastography (SWE) imaging is widely used in clinical practice, and some researchers have applied this technique in the evaluation of neonatal brains. However, the immediate and long-term impacts of dynamic radiation force exposure on the neonatal central nervous system remain unknown. In this study, we exposed neonatal mice to 2-D SWE scanning for 10 min, 20 min and 30 min under diagnostic mode (mechanical index [MI]: 1.3; thermal index [TI]: 0.5), respectively. For the control group, the neonatal mice were sham irradiated for 30 min with the machine powered off. Their brains were collected and analyzed using histologic staining and western blot analysis at 24 h and 3 mo after the 2-D SWE scanning. The Morris water maze (MWM) test was used to assess learning and memory function of the mice at 3 mo of age. The results indicated that using 2-D SWE in evaluating brains of neonatal mice does not cause detectable histologic changes, nor does it have long-term effects on their learning and memory abilities. However, the PI3 K/AKT/mTOR pathway was disturbed when the 2-D SWE scanning lasted for more than 30 min, and the expression of p-PKCa was suppressed by 10 min or more in 2-D SWE scanning. Although these injuries may be self-repaired as the mice grow, more attention should be paid to the scanning duration when applying 2-D-SWE elastography in the assessment of neonatal brains.

Electromechanical delay of the vastus medialis obliquus and vastus lateralis in individuals with patellofemoral pain syndrome

STUDY DESIGN

Case-control study.

OBJECTIVE

To examine electromechanical delay (EMD) of the vastus medialis obliquus (VMO) and the vastus lateralis (VL) in individuals with patellofemoral pain syndrome (PFPS).

BACKGROUND

EMD is a mechanical property of muscles related to protective reflex and sports performance. The time duration of the EMD can be shortened with strength training and, conversely, can be lengthened secondary to immobilization. However, it is unclear if EMD between various components of the quadriceps is affected in individuals with PFPS.

METHODS

Twenty-six individuals with PFPS and 26 healthy volunteers were studied. The VMO and VL were electrically stimulated to evoke muscle twitches. Ultrasound was used to assess patellar movement elicited by the muscle twitch. The time from the onset of electrical stimulation to the onset of patellar movement was measured as the EMD. The EMDs of the VMO and VL were compared between groups using a mixed-model analysis of variance.

RESULTS

Subsequent to a significant interaction (P<.001), post hoc analysis indicated that the EMD of the VMO was longer (PFPS, 37.3 ± 0.7 milliseconds; control, 25.9 ± 0.7 milliseconds; P<.001) and the EMD of the VL was shorter (PFPS, 18.4 ± 0.5 milliseconds; control, 25.1 ± 0.5 milliseconds; P<.001) in the PFPS group. Therefore, in the individuals with PFPS, the EMD of the VMO was significantly longer than that of the VL (P<.001), which was not the case for those in the control group (P = .20).

CONCLUSION

The mechanical properties of the VMO and VL may be altered in patients with PFPS.J Orthop Sports Phys Ther 2012;42(9):791-796, Epub 2 August 2012. doi:10.2519/jospt.2012.3973.

Electromechanical delay in ballistic movement of superior limb: comparison between karate athletes and nonathletes

The aim of the study was to analyze electromechanical delay in a ballistic movement of the superior limb. 10 male karate athletes and 9 nonathletes (without karate experience) performed a motor skill as fast and powerfully as possible, with impact on a makiwara (karate training instrument). For each participant, 10 choku-zuki performances were analyzed. Kinematics and surface electromyographic (EMG) activity of the anterior and posterior portions of deltoid, pectoralis major, latissimus dorsi, triceps brachii, and biceps brachii were recorded. Athletes had significantly shorter delay in arm flexion agonist muscles and significantly higher delay in arm flexion antagonist muscles and in forearm extension agonists. Results suggest that enhanced performance in athletes was mainly due to motor learning.

Electromechanical delay revisited using very high frame rate ultrasound

Electromechanical delay (EMD) represents the time lag between muscle activation and muscle force production and is used to assess muscle function in healthy and pathological subjects. There is no experimental methodology to quantify the actual contribution of each series elastic component structures that together contribute to the EMD. We designed the present study to determine, using very high frame rate ultrasound (4 kHz), the onset of muscle fascicles and tendon motion induced by electrical stimulation. Nine subjects underwent two bouts composed of five electrically evoked contractions with the echographic probe maintained over 1) the gastrocnemius medialis muscle belly (muscle trials) and 2) the myotendinous junction of the gastrocnemius medialis muscle (tendon trials). EMD was 11.63 ± 1.51 and 11.67 ± 1.27 ms for muscle trials and tendon trials, respectively. Significant difference ( P < 0.001) was found between the onset of muscle fascicles motion (6.05 ± 0.64 ms) and the onset of myotendinous junction motion (8.42 ± 1.63 ms). The noninvasive methodology used in the present study enabled us to determine the relative contribution of the passive part of the series elastic component (47.5 ± 6.0% of EMD) and each of the two main structures of this component (aponeurosis and tendon, representing 20.3 ± 10.7% and 27.6 ± 11.4% of EMD, respectively). The relative contributions of the synaptic transmission, the excitation-contraction coupling, and the active part of the series elastic component could not be directly quantified with our results. However, they suggest a minor role of the active part of the series elastic component that needs to be confirmed by further experiments.