1
|
Deschrevel J, Maes K, Andries A, Beukelaer ND, Corvelyn M, Costamagna D, Campenhout AV, Wachter ED, Desloovere K, Agten A, Vandenabeele F, Nijs S, Gayan-Ramirez G. Fine-needle percutaneous muscle microbiopsy technique as a feasible tool to address histological analysis in young children with cerebral palsy and age-matched typically developing children. PLoS One 2023; 18:e0294395. [PMID: 37992082 PMCID: PMC10664906 DOI: 10.1371/journal.pone.0294395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
Cerebral palsy (CP) is a heterogeneous group of motor disorders attributed to a non-progressive lesion in the developing brain. Knowledge on skeletal muscle properties is important to understand the impact of CP and treatment but data at the microscopic levels are limited and inconsistent. Currently, muscle biopsies are collected during surgery and are restricted to CP eligible for such treatment or they may refer to another muscle or older children in typically developing (TD) biopsies. A minimally invasive technique to collect (repeated) muscle biopsies in young CP and TD children is needed to provide insights into the early muscle microscopic alterations and their evolution in CP. This paper describes the protocol used to 1) collect microbiopsies of the medial gastrocnemius (MG) and semitendinosus (ST) in CP children and age-matched TD children, 2) handle the biopsies for histology, 3) stain the biopsies to address muscle structure (Hematoxylin & Eosin), fiber size and proportion (myosin heavy chain), counting of the satellite cells (Pax7) and capillaries (CD31). Technique feasibility and safety as well as staining feasibility and measure accuracy were evaluated. Two microbiopsies per muscle were collected in 56 CP (5.8±1.1 yr) and 32 TD (6±1.1 yr) children using ultrasound-guided percutaneous microbiopsy technique. The biopsy procedure was safe (absence of complications) and well tolerated (Score pain using Wong-Baker faces). Cross-sectionally orientated fibers were found in 86% (CP) and 92% (TD) of the biopsies with 60% (CP) and 85% (TD) containing more than 150 fibers. Fiber staining was successful in all MG biopsies but failed in 30% (CP) and 16% (TD) of the ST biopsies. Satellite cell staining was successful in 89% (CP) and 85% (TD) for MG and in 70% (CP) and 90% (TD) for ST biopsies, while capillary staining was successful in 88% (CP) and 100% (TD) of the MG and in 86% (CP) and 90% (TD) for the ST biopsies. Intraclass coefficient correlation showed reliable and reproducible measures of all outcomes. This study shows that the percutaneous microbiopsy technique is a safe and feasible tool to collect (repeated) muscle biopsies in young CP and TD children for histological analysis and it provides sufficient muscle tissue of good quality for reliable quantification.
Collapse
Affiliation(s)
- Jorieke Deschrevel
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Karen Maes
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Anke Andries
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| | - Nathalie De Beukelaer
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Leuven, Belgium
| | - Marlies Corvelyn
- Department of Development and Regeneration, Stem Cell Biology and Embryology Unit, KU Leuven, Leuven, Belgium
| | - Domiziana Costamagna
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Stem Cell Biology and Embryology Unit, KU Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eva De Wachter
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Leuven, Belgium
| | - Anouk Agten
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Frank Vandenabeele
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Vandenabeele F, Stevens S, Snijders T, Stessel B, Dubois J, van Loon LJC, Lambrichts I, Agten A. Observations of nemaline bodies in muscle biopsies of critically ill patients infected with SARS-CoV-2. Microscopy (Oxf) 2023; 72:388-394. [PMID: 36574223 DOI: 10.1093/jmicro/dfac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 10/10/2023] Open
Abstract
Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who have been admitted to the intensive care unit (ICU) often face months of physical disability after discharge. To optimize recovery, it is important to understand the role of musculoskeletal alterations in critically ill patients infected with SARS-CoV-2. The main aim of the present study was to describe the presence and morphology of nemaline bodies found in the skeletal muscle tissue from critically ill patients infected with SARS-CoV-2. In n = 7 patients infected with SARS-CoV-2, ultrastructural characteristics of vastus lateralis muscle obtained on days 1-3 and days 5-8 following ICU admission were investigated in more detail with electron microscopy. Those muscle biopsies consistently showed variable degrees of myofiber necrosis and myofibrillar disorganization. In 4/7 (57%) patients on days 5-8, the Z-line material accumulated into nemaline bodies with a typical lattice-like appearance at higher magnification, similar to that found in nemaline myopathy. This study is the first to describe the disintegration of myofibrils and the accumulation of Z-line material into nemaline bodies in the skeletal muscle tissue obtained from critically ill coronavirus disease-19 patients following ICU admission, which should be interpreted primarily as a non-specific pathological response of extreme myofibrillar disintegration associated with myofiber necrosis.
Collapse
Affiliation(s)
- Frank Vandenabeele
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, Diepenbeek 3590, Belgium
| | - Sjoerd Stevens
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, Diepenbeek 3590, Belgium
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Stadsomvaart 11, Hasselt 3500, The Netherlands
| | - Tim Snijders
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Stadsomvaart 11, Hasselt 3500, The Netherlands
| | - Björn Stessel
- Department of Anaesthesiology, Jessa Hospital, Universiteitssingel 50, Maastricht 6229 ER, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Building C, Diepenbeek 3590, Belgium
| | - Jasperina Dubois
- Department of Anaesthesiology, Jessa Hospital, Universiteitssingel 50, Maastricht 6229 ER, Belgium
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Stadsomvaart 11, Hasselt 3500, The Netherlands
| | - Ivo Lambrichts
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Building C, Diepenbeek 3590, Belgium
| | - Anouk Agten
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, Diepenbeek 3590, Belgium
- U-RISE-UHasselt Research Group on Innovative and Society-Engaged Education, School for Educational Studies, Hasselt University, Wetenschapspark 24, Diepenbeek 3590, Belgium
| |
Collapse
|
3
|
Verbrugghe J, Agten A, Stevens S, Vandenabeele F, Roussel N, Verbunt J, Goossens N, Timmermans A. High intensity training improves symptoms of central sensitization at six-month follow-up in persons with chronic nonspecific low back pain: Secondary analysis of a randomized controlled trial. Braz J Phys Ther 2023; 27:100496. [PMID: 36963161 PMCID: PMC10060179 DOI: 10.1016/j.bjpt.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/22/2022] [Accepted: 02/22/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors. OBJECTIVE To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP. METHODS This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale). RESULTS Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success. CONCLUSION HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress.
Collapse
Affiliation(s)
- Jonas Verbrugghe
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Anouk Agten
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Sjoerd Stevens
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Frank Vandenabeele
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Jeanine Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands
| | - Nina Goossens
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| |
Collapse
|
4
|
Ruytinx P, Vandormael P, Quaden D, Luyten E, Geusens P, Vanhoof J, Agten A, Vandenabeele F, de Vlam K, Somers V. Antibodies of the immunoglobulin a isotype to novel antigens in early axial spondyloarthritis. Front Med (Lausanne) 2023; 9:1072453. [PMID: 36844956 PMCID: PMC9945964 DOI: 10.3389/fmed.2022.1072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction There is an unmet need for biomarkers to identify patients with axial spondyloarthritis (axSpA). Increasing evidence suggest the presence of autoantibodies in a subset of axSpA patients. The aim of this study was to identify novel IgA antibodies in early axSpA patients and to determine their diagnostic potential in combination with previously determined IgG antibodies against UH (Hasselt University)-axSpA-IgG antigens. Methods An axSpA cDNA phage display library constructed from axSpA hip synovium, was used to screen for novel IgA antibodies in plasma from early axSpA patients. The presence of these antibodies against novel UH-axSpA-IgA antigens was determined in two independent axSpA cohorts, in healthy controls and in patients with chronic low back pain. Results We identified antibodies to 7 novel UH-axSpA-IgA antigens, of which 6 correspond to non-physiological peptides and 1 to the human histone deacetylase 3 (HDAC3) protein. IgA antibodies against 2 of these 7 novel UH-axSpA-IgA antigens and IgG antibodies against 2 of the previously identified antigens were significantly more present in early axSpA patients from the UH cohort (18/70, 25.7%) and the (Bio)SPAR cohort (26/164, 15.9%), compared to controls with chronic low back pain (2/66, 3%). Antibodies to this panel of 4 antigens were present in 21.1% (30/142) of patients with early axSpA from the UH and (Bio)SPAR cohorts. The positive likelihood ratio for confirming early axSpA using antibodies to these 4 UH-axSpA antigens was 7.0. So far, no clinical correlation between the novel identified IgA antibodies and inflammatory bowel disease could be identified. Discussion In conclusion, screening an axSpA cDNA phage display library for IgA reactivity resulted in the identification of 7 novel UH-axSpA-IgA antigens, of which 2 show promising biomarker potential for the diagnosis of a subset of axSpA patients, in combination with previously identified UH-axSpA-IgG antigens.
Collapse
Affiliation(s)
- Pieter Ruytinx
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Patrick Vandormael
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Dana Quaden
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Elien Luyten
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium
| | - Piet Geusens
- ReumaClinic, Genk, Belgium,Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Anouk Agten
- UHasselt, Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Diepenbeek, Belgium
| | - Frank Vandenabeele
- UHasselt, Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Diepenbeek, Belgium
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center (SBE), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Veerle Somers
- UHasselt, Department of Immunology and Infection, Biomedical Research Institute, Diepenbeek, Belgium,*Correspondence: Veerle Somers,
| |
Collapse
|
5
|
Stevens S, Agten A, Snijders T, Plazier M, Bamps S, Assieker T, Betz M, Timmermans A, van Loon L, Vandenabeele F. Skeletal Muscle Fibre Characteristics of the Lumbar Multifidus Muscle in Patients Undergoing Microdiscectomy for Unilateral Lumbar Disc Herniation. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.03.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Wu Q, Vanerum M, Agten A, Christiansen A, Vandenabeele F, Rigo JM, Janssen R. Certainty-Based Marking on Multiple-Choice Items: Psychometrics Meets Decision Theory. Psychometrika 2021; 86:518-543. [PMID: 33928520 DOI: 10.1007/s11336-021-09759-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/15/2021] [Indexed: 06/12/2023]
Abstract
When a response to a multiple-choice item consists of selecting a single-best answer, it is not possible for examiners to differentiate between a response that is a product of knowledge and one that is largely a product of uncertainty. Certainty-based marking (CBM) is one testing format that requires examinees to express their degree of certainty on the response option they have selected, leading to an item score that depends both on the correctness of an answer and the certainty expressed. The expected score is maximized if examinees truthfully report their level of certainty. However, prospect theory states that people do not always make rational choices of the optimal outcome due to varying risk attitudes. By integrating a psychometric model and a decision-making perspective, the present study looks into the response behaviors of 334 first-year students of physiotherapy on six multiple-choice examinations with CBM in a case study. We used item response theory to model the objective probability of students giving a correct response to an item, and cumulative prospect theory to estimate their risk attitudes when students choose to report their certainty. The results showed that with the given CBM scoring matrix, students' choices of a certainty level were affected by their risk attitudes. Students were generally risk averse and loss averse when they had a high success probability on an item, leading to an under-reporting of their certainty. Meanwhile, they were risk seeking in case of small success probabilities on the items, resulting in the over-reporting of certainty.
Collapse
Affiliation(s)
- Qian Wu
- Center for Educational Effectiveness and Evaluation, KU Leuven, Dekenstraat 2, bus 3773, 3000, Leuven, Belgium
| | | | | | - Andrés Christiansen
- Center for Educational Effectiveness and Evaluation, KU Leuven, Dekenstraat 2, bus 3773, 3000, Leuven, Belgium
| | | | | | - Rianne Janssen
- Center for Educational Effectiveness and Evaluation, KU Leuven, Dekenstraat 2, bus 3773, 3000, Leuven, Belgium.
| |
Collapse
|
7
|
Quaden D, Vandormael P, Ruytinx P, Geusens P, Corten K, Vanhoof J, Liesenborgs J, van Reeth F, Agten A, Vandenabeele F, de Vlam K, Somers V. Antibodies Against Three Novel Peptides in Early Axial Spondyloarthritis Patients From Two Independent Cohorts. Arthritis Rheumatol 2020; 72:2094-2105. [PMID: 32638516 DOI: 10.1002/art.41427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to identify novel autoantibodies in axial spondyloarthritis (SpA) and determine their diagnostic potential in patients with early axial SpA and controls from 2 independent cohorts. METHODS An axial SpA complementary DNA phage display library was used to screen for novel IgG antibodies in plasma from patients with early axial SpA. The presence of these antibodies against novel peptides (i.e., peptides identified in an early axial SpA cohort from Hasselt University, designated UH-axSpA) was determined by enzyme-linked immunosorbent assay in 76 patients with early axial SpA, 75 controls with nonspecific chronic low back pain, 60 patients with rheumatoid arthritis, and 94 healthy controls from the UH cohort. Antibody reactivity to these novel peptides was further validated in 174 patients with axial SpA (of whom 79 had early axial SpA) from the University Hospitals Leuven (Bio)SPAR (Spondyloarthritis [Biologics]) cohort. RESULTS We identified antibodies to 9 novel UH-axSpA peptides, corresponding to randomly formed peptides and to a novel axial SpA autoantigen, double homeobox protein 4. Antibodies to 3 UH-axSpA peptides with the highest positive likelihood ratio (LR) for a diagnosis of axial SpA were present in significantly more patients with early axial SpA from the UH and (Bio)SPAR cohorts (14.2% [22/155]) compared to controls with chronic low back pain (5% [4/75]), resulting in 95% specificity. The positive LR for confirming axial SpA using antibodies to these 3 UH-axSpA peptides was 2.7, which is higher than the LR obtained with the currently used laboratory marker C-reactive protein. Testing for antibodies to these 3 UH-axSpA peptides in patients with chronic low back pain increased the posttest probability of a diagnosis of axial SpA from 79% to 91%. CONCLUSION Antibodies to 3 UH-axSpA peptides could provide a novel tool in the diagnosis of a subset of axial SpA patients.
Collapse
Affiliation(s)
| | | | | | - Piet Geusens
- UH, Hasselt, Belgium and ReumaClinic, Genk, Belgium, and Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Stevens S, Agten A, Timmermans A, Vandenabeele F. Unilateral changes of the multifidus in persons with lumbar disc herniation: a systematic review and meta-analysis. Spine J 2020; 20:1573-1585. [PMID: 32325246 DOI: 10.1016/j.spinee.2020.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible mediator in the pathophysiology of disc herniation and influences the course of pain and disability after both surgical or nonsurgical treatment. To potentially improve treatment, it may be important to assess multifidus muscle morphology in patients diagnosed with a LDH. OBJECTIVE A systematic literature review and meta-analysis regarding the multifidus morphology in patients diagnosed with a LDH was conducted to assess the differences in multifidus muscle morphology between persons with LDH and healthy controls, and between the involved and the uninvolved side within subjects experiencing unilateral LDH. METHODS A systematic search was conducted of articles published up to and including November 2019 using the Pubmed, Web of Science, EMBASE, and MEDLINE Ovid search engines. The articles obtained from this search were screened based on title and abstract using the predetermined eligibility criteria. Included full text articles were assessed for their methodologic quality using the modified Downs and Black checklist. Heterogeneous data regarding multifidus muscle morphology was included in the descriptive analysis; data that was homogenous was included in the meta-analysis. RESULTS We identified 3,176 articles. Based on the screening for inclusion/exclusion criteria, 18 articles were included. Studies were either cross sectional or case-control studies assessing side-to-side differences or comparing patients diagnosed with a LDH to a healthy control group. Nine studies investigated whole muscle atrophy, six looked at muscle fat infiltration, seven studies assessed microscopic muscle properties including muscle fiber size, distribution, and muscle fibrosis. From the 18 articles, 10 were included in the meta-analysis. In the meta-analysis, a comparison was made between side-to-side differences for muscle fiber size, distribution, and whole muscle size. Descriptive analysis showed increased fat infiltration and atrophy (muscle and individual fiber) of the multifidus muscle when comparing side-to-side differences or comparing cases to controls. Meta-analysis showed a significant decrease in type I and II muscle fiber size (p=.002, .01, respectively) combined with a significant increase in the number of type I muscle fibers (p=.008) at the side of LDH. Regarding whole muscle size, no significant differences were found. CONCLUSIONS This study shows the presence of ipsilateral multifidus muscle changes in persons with unilateral LDH.
Collapse
Affiliation(s)
- Sjoerd Stevens
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Agoralaan building A, 3590 Diepenbeek, Belgium.
| | - Anouk Agten
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Agoralaan building A, 3590 Diepenbeek, Belgium
| | - Annick Timmermans
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Agoralaan building A, 3590 Diepenbeek, Belgium
| | - Frank Vandenabeele
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Agoralaan building A, 3590 Diepenbeek, Belgium
| |
Collapse
|
9
|
Agten A, Stevens S, Verbrugghe J, Eijnde BO, Timmermans A, Vandenabeele F. The lumbar multifidus is characterised by larger type I muscle fibres compared to the erector spinae. Anat Cell Biol 2020; 53:143-150. [PMID: 32647082 PMCID: PMC7343561 DOI: 10.5115/acb.20.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
The metabolic capacity of a muscle is one of the determinants of muscle function. Muscle fiber type characteristics give an indication about this metabolic capacity. Therefore it might be expected that the lumbar multifidus (MF) as a local stabilizer contains higher proportions of slow type I fibers, compared to the erector spinae (ES) as a global mobilizer. The aim of this study is to determine the muscle fiber characteristics of the ES and MF to provide insight into their structural and metabolic characteristics, and thereby the functional capacity of both muscles. Muscle fiber type characteristics in the ES and MF were investigated with an immunofluorescence staining of the myosin heavy chain isoforms. In both the ES and MF, type I muscle fibers are predominantly present. The cross-sectional area (CSA) of type I muscle fibers is significantly larger in the lumbar MF compared to the ES. However, the mean muscle fiber type percentage for type I was not significantly different, which resulted in an insignificant difference in relative cross-sectional area (RCSA) for type I. No significant differences were found for all other muscle fiber types. This may indicate that the MF displays muscle fiber type characteristics that tend to be more appropriate to maintain stability of the spine. However, because we could not demonstrate significant differences in RCSA between ES and MF, we cannot firmly state that there are functional differences between the ES an MF based only on structural characteristics.
Collapse
Affiliation(s)
- Anouk Agten
- Department of Rehabilitation Sciences and Physiotherapy, Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Sjoerd Stevens
- Department of Rehabilitation Sciences and Physiotherapy, Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Jonas Verbrugghe
- Department of Rehabilitation Sciences and Physiotherapy, Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Bert O Eijnde
- Department of Cardio and Internal Systems, Hasselt University, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Annick Timmermans
- Department of Rehabilitation Sciences and Physiotherapy, Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Frank Vandenabeele
- Department of Rehabilitation Sciences and Physiotherapy, Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| |
Collapse
|
10
|
Verbrugghe J, Agten A, Stevens S, Hansen D, Demoulin C, O Eijnde B, Vandenabeele F, Timmermans A. Exercise Intensity Matters in Chronic Nonspecific Low Back Pain Rehabilitation. Med Sci Sports Exerc 2020; 51:2434-2442. [PMID: 31269004 DOI: 10.1249/mss.0000000000002078] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP. OBJECTIVE To compare the effects of a high-intensity ET program with a similar moderate-intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP. METHODS In a randomized controlled trial, persons with CNSLBP performed a 12-wk ET program (24 sessions, 1.5 h per session, twice per week) at high-intensity training (HIT) or moderate-intensity training (MIT). Questionnaires to assess disability (Modified Oswestry Index [MODI]), pain intensity (Numeric Pain Rating Scale), and function (Patient Specific Functioning Scale), a cardiopulmonary exercise test to assess exercise capacity (V˙O2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program. RESULTS Thirty-eight participants (HIT: n = 19, MIT: n = 19) were included (mean age, 44.1 yr, SD = 9.8, 12 males). Groups did not differ at baseline. Between group differences (P < 0.01) in favor of HIT were found for MODI, V˙O2max, and cycling time. Within group improvements (P < 0.01) were found in both groups on MODI (HIT:-64%, MIT:-33%), Numeric Pain Rating Scale (HIT, -56%; MIT, -39%), Patient-Specific Functioning Scale (HIT:+37%, MIT:+39%), V˙O2max (HIT:+14, MIT:+4%), cycling time (HIT:+18%, MIT:+13%), and back muscle strength (HIT:+10%, MIT:+14%). CONCLUSIONS High-intensity training proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity.
Collapse
Affiliation(s)
- Jonas Verbrugghe
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| | - Anouk Agten
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| | - Sjoerd Stevens
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM.,Jessa Hospital, Hasselt, BELGIUM
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, BELGIUM
| | - Bert O Eijnde
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| | - Frank Vandenabeele
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| | - Annick Timmermans
- REVAL-Rehabilitation Research Center, BIOMED, Hasselt University, Hasselt, BELGIUM
| |
Collapse
|
11
|
Verbrugghe J, Agten A, Stevens S, Eijnde BO, Vandenabeele F, Roussel N, De Baets L, Timmermans A. Disability, kinesiophobia, perceived stress, and pain are not associated with trunk muscle strength or aerobic capacity in chronic nonspecific low back pain. Phys Ther Sport 2020; 43:77-83. [PMID: 32126515 DOI: 10.1016/j.ptsp.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate to which extent disability, psychological and pain-related factors are associated with the outcomes of an isometric trunk muscle strength test and a cardiopulmonary exercise test in persons with chronic nonspecific low back pain (CNSLBP). DESIGN Cross-sectional study. SETTING REVAL Rehabilitation Research Center (Hasselt, Belgium). PARTICIPANTS Persons with CNSLBP. MAIN OUTCOME MEASURES Questionnaires concerning disability, patient specific functioning, kinesiophobia, perceived stress, pain intensity, and central sensitization were recorded. Outcomes of an isometric trunk strength test (maximum back and abdominal torque) and cardiopulmonary exercise test (VO2max) were assessed. Multivariate linear regression models determined factors explaining outcome variance. RESULTS Data of 101 persons (39 males, mean age: 44.2y (SD = 9.6)) was assessed. Neither disability, nor psychological, nor pain-related factors were associated with the assessments. Variance in back muscle strength (R2 = 0.44, F = p < 0.01), abdominal muscle strength (R2 = 0.68, F = p < 0.01), and aerobic capacity (R2 = 0.76, F = p < 0.01) could only be explained through the included demographics covariates (age, gender, weight). CONCLUSION This study highlighted the lack of biopsychosocial factors in explaining variance in outcomes of abdominal and back strength, and aerobic capacity in persons with CNSLBP with characteristics as depicted in the current sample. This information supports the valid interpretation of the outcomes of these assessments.
Collapse
Affiliation(s)
- Jonas Verbrugghe
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Anouk Agten
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Sjoerd Stevens
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Bert O Eijnde
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Frank Vandenabeele
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Liesbet De Baets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| |
Collapse
|
12
|
Agten A, Stevens S, Verbrugghe J, Timmermans A, Vandenabeele F. Biopsy samples from the erector spinae of persons with nonspecific chronic low back pain display a decrease in glycolytic muscle fibers. Spine J 2020; 20:199-206. [PMID: 31563580 DOI: 10.1016/j.spinee.2019.09.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) in Western Europe was classified as having the highest disability and overall burden among 291 studied conditions. For an extensive period of time, evidence related to morphological changes (eg, atrophy and fat infiltration) of the paraspinal muscles in persons with LBP has accumulated. Despite this evidence, there is limited knowledge on muscle fiber type composition of these muscles, and their relation to LBP. PURPOSE The aim of the study is to investigate differences in muscle fiber type composition between persons with nonspecific chronic low back pain (NSCLBP) and healthy controls for the lumbar erector spinae (ES) and multifidus (MF) muscle. STUDY DESIGN AND SETTING A cross-sectional study took place in the REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium. PATIENT SAMPLE Twenty persons with NSCLBP (age: 44.5±7.42) and 18 healthy controls (age: 39.89±7.90) participated in this study. OUTCOME MEASURES The primary outcome measure was paraspinal muscle fiber type composition. Secondary outcomes consisted of physiologic measures (maximal aerobic capacity and back muscle strength) and functional measures (activity level). METHODS Biopsy samples were taken from the lumbar ES and MF muscle at the L4 spinal level. These samples were stained using immunofluorescent antibodies against myosin heavy chains. In each sample, number and size (CSA) of type I, I/IIa, IIa, IIa/x, and IIx muscle fibers were quantified. From these data the relative cross-sectional fiber areas (RCSA) were calculated. To analyze differences in fiber type composition between healthy persons and persons with NSCLBP, a repeated measurements analysis of variance was used. Secondary outcome measures were analyzed using a Student's t test, and Wilcoxon test. This study was supported by the research fund of Hasselt University without potential conflict of interest. RESULTS There were no significant differences between both groups regarding anthropometric data. There were no significant between group differences for CSA in the ES. Persons with NSCLBP displayed a nonsignificant (p=.0978) increase in the number of type I muscle fibers, and a significant decrease (p=.0019) in the number of type IIx muscle fibers in the ES muscle. Persons with NSCLBP also displayed a trend toward a higher (p=.0596) RCSA for type I fibers and a significantly lower RCSA for type IIx fibers (p=.0411). There were no significant between group differences within the MF. Regarding the secondary outcome measures, there was a significant between group difference in activity level (p=.0004) and isokinetic back muscle strength (p=.0342). CONCLUSIONS This is the first study to examine muscle fiber type characteristics in both the ES and MF muscle of persons with NSCLBP. Based on muscle fiber characteristics, the paraspinal muscles of persons with NSCLBP seems to display a larger oxidative potential based on an increase of the number type I fibers at the expense of type IIx glycolytic fibers.
Collapse
Affiliation(s)
- Anouk Agten
- Hasselt University, Rehabilitation Research Center, Faculty of Rehabilitation Sciences and Physiotherapy, Agoralaan building A, 3590 Diepenbeek, Belgium.
| | - Sjoerd Stevens
- Hasselt University, Rehabilitation Research Center, Faculty of Rehabilitation Sciences and Physiotherapy, Agoralaan building A, 3590 Diepenbeek, Belgium
| | - Jonas Verbrugghe
- Hasselt University, Rehabilitation Research Center, Faculty of Rehabilitation Sciences and Physiotherapy, Agoralaan building A, 3590 Diepenbeek, Belgium
| | - Annick Timmermans
- Hasselt University, Rehabilitation Research Center, Faculty of Rehabilitation Sciences and Physiotherapy, Agoralaan building A, 3590 Diepenbeek, Belgium
| | - Frank Vandenabeele
- Hasselt University, Rehabilitation Research Center, Faculty of Rehabilitation Sciences and Physiotherapy, Agoralaan building A, 3590 Diepenbeek, Belgium
| |
Collapse
|
13
|
Stevens S, Agten A, Wisanto E, Monaco ML, Verbrugghe J, Timmermans A, Lambrichts I, Vandenabeele F. Chondroid metaplasia of paraspinal connective tissue in the degenerative spine. Anat Cell Biol 2019; 52:204-207. [PMID: 31338238 PMCID: PMC6624339 DOI: 10.5115/acb.2019.52.2.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022] Open
Abstract
A 51-year-old male was routinely biopsied during a paraspinal muscle study. The biopsy sample was taken from the right erector spinae muscle at the fourth lumbar vertebra. The patient had no history of (diagnosed) major back trauma. The obtained sample was histologically analyzed (hematoxylin and eosin, safranin O), and complementary magnetic resonance imaging was performed. The biopsied sample contained chondroid tissue. Based on its location, the biopsy sample was appointed as chondroid metaplasia. Although chondroid metaplasia is not uncommon in humans, this is the first report of chondroid metaplasia within the paraspinal connective tissue. We propose a novel mechanism to explain the paraspinal chrondrogenic changes, related to spinal degeneration.
Collapse
Affiliation(s)
- Sjoerd Stevens
- Hasselt University, Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Anouk Agten
- Hasselt University, Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Erika Wisanto
- Department of Pathology, Jessa Hospital, Hasselt, Belgium
| | - Melissa Lo Monaco
- Department of Veterinary Medicine, Integrated Veterinary Research Unit-Namur Research Institute for Life Science (IVRU-NARILIS), Faculty of Sciences, University of Namur, Namur, Belgium.,Department of Morphology, Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Jonas Verbrugghe
- Hasselt University, Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Annick Timmermans
- Hasselt University, Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Ivo Lambrichts
- Department of Morphology, Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Frank Vandenabeele
- Hasselt University, Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.,Department of Morphology, Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| |
Collapse
|
14
|
Verbrugghe J, Agten A, O Eijnde B, Olivieri E, Huybrechts X, Seelen H, Vandenabeele F, Timmermans A. Feasibility of high intensity training in nonspecific chronic low back pain: A clinical trial. J Back Musculoskelet Rehabil 2018. [PMID: 29526840 DOI: 10.3233/bmr-170810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although low to moderate intensity exercise therapy is a predominant part of rehabilitation in nonspecific chronic low back pain (NSCLBP), effect sizes are small and optimal exercise modalities/intensities are unclear. Conversely, effects of high intensity training have not yet been investigated in this population. OBJECTIVE The aim of this study is to investigate the feasibility of high intensity training (HIT) and to explore the magnitude of the effects of a HIT program on exercise capacity and disease related outcome measures compared to conventional therapy for persons with NSCLBP. METHODS In this non-randomized controlled feasibility study, treatment satisfaction, adherence, disability, pain, physical activity, body composition, exercise capacity and self-reported motivation, were assessed in persons with NSCLBP, before (PRE) and after (POST) 6 weeks (12 sessions, 1.5 hours/session, 2 x/week) of high intensity cardiovascular (100% VO2Max) and high load resistance (80% 1RM) training (HIT, n= 10) and compared to average intensity/load (60% VO2max) conventional physical therapy (CON, n= 10). RESULTS At PRE, CON and HIT did not differ, except for gender ratio and lean mass. Compared to CON, HIT retained motivation to rehabilitate better (HIT: +3%; CON: -25%) and had higher therapy adherence (+16%) during the study course. No adverse events were noted in both groups. Whereas disability reduced in both groups (HIT: -10.4%; CON: -8.3%), peak workload (+7.0%), time to exhaustion (+9.5%), and activity level (+5.6%) only improved in HIT. CONCLUSIONS High intensity exercise therapy appears to be a feasible rehabilitation approach in NSCLBP. Outcomes improved following the HIT protocol, warranting the investigation of its effectiveness in future large scale RCT studies.
Collapse
Affiliation(s)
- Jonas Verbrugghe
- Hasselt University, REVAL - Rehabilitation Research Center, BIOMED, Hasselt, Belgium
| | - Anouk Agten
- Hasselt University, REVAL - Rehabilitation Research Center, BIOMED, Hasselt, Belgium
| | - Bert O Eijnde
- Hasselt University, REVAL - Rehabilitation Research Center, BIOMED, Hasselt, Belgium
| | - Enzo Olivieri
- Department of Rehabilitation and Physical Medicine, Jessa Ziekenhuis, Hasselt, Belgium
| | - Xavier Huybrechts
- Department of Rehabilitation and Physical Medicine, Jessa Ziekenhuis, Hasselt, Belgium
| | - Henk Seelen
- Adelante - Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Frank Vandenabeele
- Hasselt University, REVAL - Rehabilitation Research Center, BIOMED, Hasselt, Belgium
| | - Annick Timmermans
- Hasselt University, REVAL - Rehabilitation Research Center, BIOMED, Hasselt, Belgium
| |
Collapse
|
15
|
Agten A, Verbrugghe J, Stevens S, Boomgaert L, O Eijnde B, Timmermans A, Vandenabeele F. Feasibility, accuracy and safety of a percutaneous fine-needle biopsy technique to obtain qualitative muscle samples of the lumbar multifidus and erector spinae muscle in persons with low back pain. J Anat 2018; 233:542-551. [PMID: 30033540 DOI: 10.1111/joa.12867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 12/12/2022] Open
Abstract
The lumbar muscular system, in particular the lumbar multifidus muscle (LM) and the erector spinae muscle (ES), plays an important role in stabilizing and mobilizing the lumbar spine. Based on the topography, the lumbar paraspinal muscles can be classified into local and global muscles. LM is part of the local system, whereas ES is part of the global system. Therefore, it is interesting to investigate the muscle fibre type composition in both muscles. There is accumulating evidence that nonspecific chronic low back pain is associated with lumbar muscle dysfunction. To further elucidate this lumbar paraspinal muscle dysfunction, it is important to understand the structural characteristics of individual muscle fibres of LM and ES. Muscle fibre type composition can be investigated in muscle tissue samples. So far, muscle samples are taken by using invasive procedures that are not well tolerated. The aim of this article was to evaluate the feasibility, accuracy and safety of a percutaneous fine-needle biopsy technique to obtain muscle samples from LM and ES in persons with nonspecific chronic low back pain and to evaluate the feasibility of performing immunofluorescence analysis of myosin heavy chain isoform expression to investigate muscle fibre type composition. Preliminary investigations in cadavers were performed to determine the optimal vertebral level and puncture site to obtain muscle samples of LM and ES through a single skin puncture. In 15 persons with nonspecific chronic low back pain, muscle samples of LM and ES were taken under local anaesthesia with the percutaneous fine-needle biopsy technique, preceded by determination of the puncture site with ultrasonography. Muscle fibre type composition was investigated using immunofluorescence analysis of myosin heavy chain expression. The subjects reported little or no pain and were willing to repeat the procedure. The obtained muscle tissue contained transverse-sectioned muscle fibres in which muscle fibre contractile characteristics of the paraspinal muscles could be evaluated with immunofluorescence analysis of the myosin heavy chains. We can conclude that percutaneous microbiopsy appears to be feasible and accurate, and safe to use to obtain muscle tissue from the paraspinal muscles. The use of ultrasonography to determine the puncture site is necessary to ensure biopsy of the correct muscles and to ensure the safety of the procedure.
Collapse
Affiliation(s)
- Anouk Agten
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium
| | - Jonas Verbrugghe
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium
| | - Sjoerd Stevens
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium
| | | | - Bert O Eijnde
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium
| | - Frank Vandenabeele
- Rehabilitation Research Center, Faculty of Medicine and Life Sciences, BIOMED Biomedical Research Institute, UHasselt - Hasselt University, Diepenbeek, Belgium.,Department of Morphology, Faculty of Medicine and Life Sciences, UHasselt - Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
16
|
Verbrugghe J, Agten A, Stevens S, Eijnde B, Vandenabeele F, Timmermans A. Effects of high intensity training on pain, disability, exercise capacity and muscle strength in persons with nonspecific chronic low back pain: Preliminary RCT results. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Thomas D, Maes K, Agten A, Heunks L, Dekhuijzen R, Decramer M, Van Hees H, Gayan-Ramirez G. Time course of diaphragm function recovery after controlled mechanical ventilation in rats. J Appl Physiol (1985) 2013; 115:775-84. [PMID: 23845980 DOI: 10.1152/japplphysiol.00302.2012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Controlled mechanical ventilation (CMV) is known to result in rapid and severe diaphragmatic dysfunction, but the recovery response of the diaphragm to normal function after CMV is unknown. Therefore, we examined the time course of diaphragm function recovery in an animal model of CMV. Healthy rats were submitted to CMV for 24-27 h (n = 16), or to 24-h CMV followed by either 1 h (CMV + 1 h SB, n = 9), 2 h (CMV + 2 h SB, n = 9), 3 h (CMV + 3 h SB, n = 9), or 4-7 h (CMV + 4-7 h SB, n = 9) of spontaneous breathing (SB). At the end of the experiment, the diaphragm muscle was excised for functional and biochemical analysis. The in vitro diaphragm force was significantly improved in the CMV + 3 h SB and CMV + 4-7 h SB groups compared with CMV (maximal tetanic force: +27%, P < 0.05, and +59%, P < 0.001, respectively). This was associated with an increase in the type IIx/b fiber dimensions (P < 0.05). Neutrophil influx was increased in the CMV + 4-7 h SB group (P < 0.05), while macrophage numbers remained unchanged. Markers of protein synthesis (phosphorylated Akt and eukaryotic initiation factor 4E binding protein 1) were significantly increased (±40%, P < 0.001, and ±52%, P < 0.01, respectively) in the CMV + 3 h SB and CMV + 4-7 h SB groups and were positively correlated with diaphragm force (P < 0.05). Finally, also the maximal specific force generation of skinned single diaphragm fibers was increased in the CMV + 4-7 h SB group compared with CMV (+45%, P < 0.05). In rats, reloading the diaphragm for 3 h after CMV is sufficient to improve diaphragm function, while complete recovery occurs after longer periods of reloading. Enhanced muscle fiber dimensions, increased protein synthesis, and improved intrinsic contractile properties of diaphragm muscle fibers may have contributed to diaphragm function recovery.
Collapse
Affiliation(s)
- Debby Thomas
- Respiratory Muscle Research Unit, Laboratory of Pneumology and Respiratory Division, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Thomas D, Maes K, Agten A, Decramer M, Gayan‐Ramirez G. Time course of diaphragm function recovery after mechanical ventilation in an animal model. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.lb595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Agten A, Maes K, Thomas D, Decramer M, Gayan‐Ramirez G. Bortezomib partially protects the rat diaphragm from ventilator‐induced diaphragm dysfunction. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.lb586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anouk Agten
- Respiratory Muscle Research UnitLaboratory of Pneumology and Respiratory DivisionKULeuvenLeuvenBelgium
| | - Karen Maes
- Respiratory Muscle Research UnitLaboratory of Pneumology and Respiratory DivisionKULeuvenLeuvenBelgium
| | - Debby Thomas
- Respiratory Muscle Research UnitLaboratory of Pneumology and Respiratory DivisionKULeuvenLeuvenBelgium
| | - Marc Decramer
- Respiratory Muscle Research UnitLaboratory of Pneumology and Respiratory DivisionKULeuvenLeuvenBelgium
| | - Ghislaine Gayan‐Ramirez
- Respiratory Muscle Research UnitLaboratory of Pneumology and Respiratory DivisionKULeuvenLeuvenBelgium
| |
Collapse
|
20
|
Agten A, Maes K, Smuder A, Powers SK, Decramer M, Gayan-Ramirez G. N-Acetylcysteine protects the rat diaphragm from the decreased contractility associated with controlled mechanical ventilation*. Crit Care Med 2011; 39:777-82. [DOI: 10.1097/ccm.0b013e318206cca9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
21
|
Maes K, Agten A, Smuder A, Powers SK, Decramer M, Gayan-Ramirez G. Corticosteroid effects on ventilator-induced diaphragm dysfunction in anesthetized rats depend on the dose administered. Respir Res 2010; 11:178. [PMID: 21156051 PMCID: PMC3009634 DOI: 10.1186/1465-9921-11-178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 12/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High dose of corticosteroids has been previously shown to protect against controlled mechanical ventilation (CMV)-induced diaphragmatic dysfunction while inhibiting calpain activation. Because literature suggests that the calpain inhibiting effect of corticosteroid depends on the dose administered, we determined whether lower doses of corticosteroids would also provide protection of the diaphragm during CMV. This may be important for patients undergoing mechanical ventilation and receiving corticosteroids. METHODS Rats were assigned to controls or to 24 hours of CMV while being treated at the start of mechanical ventilation with a single intramuscular administration of either saline, or 5 mg/kg (low MP) or 30 mg/kg (high MP) of methylprednisolone. RESULTS Diaphragmatic force was decreased after CMV and this was exacerbated in the low MP group while high MP rescued this diaphragmatic dysfunction. Atrophy was more severe in the low MP group than after CMV while no atrophy was observed in the high MP group. A significant and similar increase in calpain activity was observed in both the low MP and CMV groups whereas the high dose prevented calpain activation. Expression of calpastatin, the endogenous inhibitor of calpain, was decreased in the CMV and low MP groups but its level was preserved to controls in the high MP group. Caspase-3 activity increased in all CMV groups but to a lesser extent in the low and high MP groups. The 20S proteasome activity was increased in CMV only. CONCLUSIONS Administration of 30 mg/kg methylprednisolone during CMV protected against CMV-induced diaphragm dysfunction while 5 mg/kg was more deleterious. The protective effect is due mainly to an inhibition of the calpain system through preservation of calpastatin levels and to a lesser extent to a caspase-3 inhibition.
Collapse
Affiliation(s)
- Karen Maes
- Respiratory Muscle Research Unit, Laboratory of Pneumology and Respiratory Division, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
22
|
Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care 2010; 14:R127. [PMID: 20594319 PMCID: PMC2945090 DOI: 10.1186/cc9094] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 05/06/2010] [Accepted: 07/01/2010] [Indexed: 11/10/2022]
Abstract
Introduction Respiratory muscle weakness is an important risk factor for delayed weaning. Animal data show that mechanical ventilation itself can cause atrophy and weakness of the diaphragm, called ventilator-induced diaphragmatic dysfunction (VIDD). Transdiaphragmatic pressure after magnetic stimulation (TwPdi BAMPS) allows evaluation of diaphragm strength. We aimed to evaluate the repeatability of TwPdi BAMPS in critically ill, mechanically ventilated patients and to describe the relation between TwPdi and the duration of mechanical ventilation. Methods This was a prospective observational study in critically ill and mechanically ventilated patients, admitted to the medical intensive care unit of a university hospital. Nineteen measurements were made in a total of 10 patients at various intervals after starting mechanical ventilation. In seven patients, measurements were made on two or more occasions, with a minimum interval of 24 hours. Results The TwPdi was 11.5 ± 3.9 cm H2O (mean ± SD), indicating severe respiratory muscle weakness. The between-occasion coefficient of variation of TwPdi was 9.7%, comparable with data from healthy volunteers. Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi (R = 0.69; P = 0.038). This association was also found for cumulative time on pressure control (R = 0.71; P = 0.03) and pressure-support ventilation (P = 0.05; R = 0.66) separately, as well as for cumulative dose of propofol (R = 0.66; P = 0.05) and piritramide (R = 0.79; P = 0.01). Conclusions Duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force, which is compatible with the concept of VIDD. The observed decline may also be due to other potentially contributing factors such as sedatives/analgesics, sepsis, or others.
Collapse
Affiliation(s)
- Greet Hermans
- Medical Intensive Care Unit, General Internal Medicine, University Hospitals Leuven, Herestraat 49, B3000 Leuven, Belgium.
| | | | | | | | | |
Collapse
|
23
|
Maes K, Agten A, Smuder A, Powers SK, Decramer M, Gayan‐Ramirez G. Protective effect of methylprednisolone on ventilator‐induced diaphragm dysfunction is dose dependent. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.801.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Maes
- Laboratory of PneumologyKULeuvenLeuvenBelgium
| | - Anouk Agten
- Laboratory of PneumologyKULeuvenLeuvenBelgium
| | - Ashley Smuder
- Department of applied physiology and kinesiologyUniversity of FloridaGainesvilleFL
| | - Scott K Powers
- Department of applied physiology and kinesiologyUniversity of FloridaGainesvilleFL
| | | | | |
Collapse
|
24
|
Affiliation(s)
- Anouk Agten
- Laboratory of PneumologyKU LeuvenLeuvenBelgium
| | - Karen Maes
- Laboratory of PneumologyKU LeuvenLeuvenBelgium
| | - Ashley Smuder
- Department of applied physiology and kinesiologyUniversity of FloridaGainesvilleFL
| | - Scott K Powers
- Department of applied physiology and kinesiologyUniversity of FloridaGainesvilleFL
| | | | | |
Collapse
|
25
|
Maes K, Agten A, Smuder A, Powers SK, Decramer M, Gayan-Ramirez G. Protective effect of methylprednisolone on ventilator-induced diaphragm dysfunction is dose dependent. Crit Care 2010. [PMCID: PMC2934408 DOI: 10.1186/cc8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
26
|
Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force. Crit Care 2010. [PMCID: PMC2934261 DOI: 10.1186/cc8443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
27
|
Agten A, Maes K, Smuder A, Powers SK, Decramer M, Gayan-Ramirez G. N-acetylcysteine attenuates ventilator-induced diaphragm dysfunction in rats. Crit Care 2010. [PMCID: PMC2934027 DOI: 10.1186/cc8435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Testelmans D, Crul T, Maes K, Agten A, Crombach M, Decramer M, Gayan-Ramirez G. Atrophy and hypertrophy signalling in the diaphragm of patients with COPD. Eur Respir J 2009; 35:549-56. [DOI: 10.1183/09031936.00091108] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|