Biomedical subjects
Publications and source records attributed to W Herzog.
In a prospective long-term follow-up of 84 patients 21 years after first hospitalisation for anorexia nervosa, we found that 50.6% had achieved a full recovery, 10.4% still met full diagnostic criteria for anorexia nervosa, and 15.6% had died from causes related to anorexia nervosa. Predictors of outcome included physical, social, and psychological variables.
Force depression following muscle shortening was investigated in cat soleus (n=6) at 37 degrees C for a variety of contractile conditions with the aim to test the hypotheses that force depression was independent of the speed of shortening and was directly related to the mechanical work produced by the muscle during shortening. Force depression was similar for tests in which the mechanical work performed by the muscle was similar, independent of the speed of shortening (range of speeds: 4-256mm/s). On the other hand, force depression varied significantly at a given speed of shortening but different amounts of mechanical work, supporting the hypothesis that force depression was not speed - but work dependent. The variations in the mechanical work produced by the muscle during shortening accounted for 87-96% of the variance observed in the force depression following shortening further supporting the idea that the single scalar variable work accounts for most of the observed loss in isometric force after shortening. The results of the present study are also in agreement with the notion that the mechanism underlying force depression might be associated with an inhibition of cross-bridge attachments in the overlap zone formed during the shortening phase, as proposed previously (Herzog and Leonard, 1997. Journal of Bimechanics 30 (9), 865-872; Maréchal and Plaghki, 1979.
The purpose of this study was to determine the influence of speed and distance of muscle shortening on the amount of force depression for voluntary contractions. Two experimental tests were performed. In the first test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions over the range 25-50 degrees. In the second test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions at two speeds: 20 and 240 degrees /s. Knee extensor moments, surface electromyographical (EMG) signals of quadriceps femoris, and interpolated twitch moments were measured during all contractions and were compared with the corresponding values obtained during purely isometric contractions. Force depression following muscle shortening for the voluntary contractions tested in this study did not depend on the distance or the speed of muscle shortening. These results are in contrast to the corresponding results in the literature obtained using artificial electrical stimulation in which force depression was always found to be directly related to the distance of shortening and inversely related to the speed of shortening. The difference in force depression as a function of the distance and speed of muscle shortening between voluntary and artificial electrical stimulation may be associated with changes in activation following the voluntary shortening contractions, whereas activation is controlled and constant in all artificial stimulation protocols.
It is well known that static, non-linear minimization of the sum of the stress in muscles to a certain power cannot predict cocontraction of pairs of one-joint antagonistic muscles. In this report, we prove that for a single joint either all agonistic muscles cocontract or all are silent. For two-joint muscles, we show that lengthening and shortening of muscles corresponds closely to zero force and non-zero force states, respectively. This gives a new physiological interpretation of situations in which cocontraction of pairs of two-joint antagonistic muscles is predicted by these static non-linear optimization approaches.
Mathematical optimization of specific cost functions has been used in theoretical models to calculate individual muscle forces. Measurements of individual muscle forces and force sharing among individual muscles show an intensity-dependent, non-linear behavior. It has been demonstrated that the force sharing between the cat Gastrocnemius, Plantaris and Soleus shows distinct loops that change orientation systematically depending on the intensity of the movement. The purpose of this study was to prove whether or not static, non-linear optimization could inherently predict force sharing loops between agonistic muscles. Using joint moment data from a step cycle of cat locomotion, the forces in three cat ankle plantar flexors (Gastrocnemius, Plantaris and Soleus) were calculated using two popular optimization algorithms and two musculo-skeletal models. The two musculo-skeletal models included a one-degree-of-freedom model that considered the ankle joint exclusively and a two-degree-of-freedom model that included the ankle and the knee joint. The main conclusion of this study was that solutions of the one-degree-of-freedom model do not guarantee force-sharing loops, but the two-degree-of-freedom model predicts force-sharing loops independent of the specific values of the input parameters for the muscles and the musculo-skeletal geometry. The predicted force-sharing loops were found to be a direct result of the loops formed by the knee and ankle moments in a moment-moment graph.
The objective of this work was to increase our understanding of how motor patterns are produced during movement tasks by quantifying adaptations in muscle coordination in response to altered task mechanics. We used pedaling as our movement paradigm because it is a constrained cyclical movement that allows for a controlled investigation of test conditions such as movement speed and effort. Altered task mechanics were introduced using an elliptical chainring. The kinematics of the crank were changed from a relatively constant angular velocity using a circular chainring to a widely varying angular velocity using an elliptical chainring. Kinetic, kinematic and muscle activity data were collected from eight competitive cyclists using three different chainrings--one circular and two different orientations of an elliptical chainring. We tested the hypotheses that muscle coordination patterns (EMG timing and magnitude), specifically the regions of active muscle force production, would shift towards regions in the crank cycle in which the crank angular velocity, and hence muscle contraction speeds, were favorable to produce muscle power as defined by the skeletal muscle power-velocity relationship. The results showed that our hypothesis with regards to timing was not supported. Although there were statistically significant shifts in muscle timing, the shifts were minor in absolute terms and appeared to be the result of the muscles accounting for the activation dynamics associated with muscle force development (i.e. the delay in muscle force rise and decay). But, significant changes in the magnitude of muscle EMG during regions of slow crank angular velocity for the tibialis anterior and rectus femoris were observed. Thus, the nervous system used adaptations to the muscle EMG magnitude, rather than the timing, to adapt to the altered task mechanics. The results also suggested that cyclists might work on the descending limb of the power-velocity relationship when pedaling at 90 rpm and sub-maximal power output. This finding might have important implications for preferred pedaling rate selection.
The purpose of this study was to determine the history dependence of force production during and following stretch-shortening and shortening-stretch cycles in mammalian skeletal muscle. Thirty-three different isometric, stretch, shortening, stretch-shortening and shortening-stretch experiments were preformed in cat soleus (n=8) using previously established methods. Stretch-shortening and shortening-stretch cycles are not commutative with respect to the isometric forces following the length changes. Whereas force depression following shortening is virtually unaffected by previous stretching of the muscle, force enhancement following stretch depends in a dose-dependent manner on the amount of muscle shortening preceding the stretch. The history dependence of isometric force following shortening-stretch cycles can conveniently be modelled using an elastic (compressive and tensile) element that engages at the length of muscle activation. Such an "elastic" mechanism has been proposed by Edman and Tsuchiya (1996) (Edman, K.A. P., Tsuchiya, T., 1996. Strain of passive elements during force enhancement by stretch in frog mucle fibres. Journal of Physiology 490. 1, 191-205) based on experimental observations, and has been implemented theoretically in a rheological model of muscle (Forcinito et al., 1997) (Forcinito, M., Epstein, M., Herzog, W., 1997. Theoretical considerations on myofibril stiffness. Biophysics Journal 72, 1278-1286). The history dependence of isometric force following stretch-shortening cycles appears independent of the stretch preceding the shortening, except perhaps, if stretching occurs at very high speeds (i.e. 6-10 times fibre length per second). The results of this study are hard to reconcile with the two major mechanisms associated with history dependence of force production: sarcomere length non-uniformity (Edman et al., 1993) and stress-induced cross-bridge inhibition (Maréchal and Plaghki, 1979) (Maréchal, G., Plaghki, L., 1979. The deficit of the isometric tetanic tension redeveloped after a relase of frog muscle at a constant velocity. Journal of General Physiology 73, 453-467). It appears that studying the history dependence of force production under more functionally relevant conditions than has been done to date may provide new information that contributes to our understanding of possible mechanisms associated with force depression and force enhancement following muscular length changes.
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Joint degeneration in the early stages of osteoarthritis (OA) may be reflected in changes in structural and material properties in articular cartilage. The aim of the present study was to simulate numerically the contact area and stress distribution in normal and "diseased" cartilage layers for dynamic loading. The initial stages of osteoarthritis were simulated based on an experimental model: the anterior cruciate ligament-transected cat knee. In this model, cartilage layers become thicker, softer, and more permeable than the corresponding healthy cartilage layers within weeks of intervention. In our numerical simulations, the diseased cartilage was modelled by changing the thickness, permeability, shear modulus, and Poisson's ratio of the cartilage in accordance with observations in this experimental model of osteoarthritis. The theoretical model of normal and diseased articular cartilage was based on a biphasic representation of cartilage, and the joint was assumed to be axi-symmetric. It was found that, for a given loading condition, the contact areas increase and peak stresses decrease in the diseased compared to the normal joint. According to our simulations, areas of normal joint contact become unloaded and areas of little or no contact become overloaded in the early stages of osteoarthritis compared to the situation in normal joints. Based on these results, we speculate that OA may be initiated following ACL transection because of an overloading of specific regions of the joint, either because of the altered contact mechanics or the disrupted joint stability, despite a general decrease in the contact pressure.
Over the last 50 years, the nutritional and socioeconomic conditions have dramatically changed in all industrialized countries. As a consequence, there has been a sharp rise in the prevalence of obesity. Simultaneously, social and cultural pressures to maintain a thin body shape have significantly increased. This untoward situation is largely responsible for the steady increase of eating disorders, especially bulimia nervosa and binge-eating disorder, which are common disorders among normal or overweight individuals. Although the criteria for bulimia nervosa were first described in the DSM-III in 1980 (APA, 1980), recent studies have demonstrated that only about 12% of these patients are detected by their GP's. One reason for this low rate of detection may be due to the tendency of patients to conceal their illness from others. It is also possible, however, that general practitioners lack sufficient knowledge about bulimia nervosa, preventing proper identification. To help improve this situation, diagnostic guidelines and therapeutic options were summarized. Binge-eating disorder (BED), which is classified as an "eating disorder not otherwise specified" in the DSM-IV (APA, 1994), has been described as the most relevant eating disorder for overweight individuals. It has been estimated that approximately 20-30% of overweight persons seeking help at weight loss programs are classified as binge eaters. Initial results from these studies suggest that binge eaters may require a modified psychotherapeutic approach which focuses on normalizing disordered eating patterns before attempting weight loss. In addition to the importance of screening for eating disorder behaviors, overweight patients should be assessed for other comorbid conditions, such as depression and anxiety. Further, body image disturbances should be assessed during the evaluation. In the event that comorbid disorders are present, it is recommended that specific psychotherapeutic interventions which target these problems be integrated into the overall weight reduction program.
The aims of this review were to provide some insight into the theoretical problems and questions associated with muscle coordination and control of movement, to consider some of the experimental findings on force-sharing among synergistic muscles, and to discuss some of the practical implications of force-sharing and movement control for optimal performance in sports. Theoretically, the distribution problem is introduced and the problems and difficulties of this approach in making quantitative predictions of force-sharing among muscles is discussed. Experimentally, the force-sharing research in the cat ankle extensor muscles is critically evaluated, and a complete force-sharing picture is given for the soleus and (medial) gastrocnemius for tasks covering a large range of speeds and intensities. In the application section, optimal performance criteria in jumping and cycling are considered. Furthermore, the plasticity of skeletal muscle properties is illustrated using examples from high-performance sports. The review ends with a summary of the topics discussed and suggestions for future research.
This study assessed family perception patterns of interpersonal behavior in families with a daughter diagnosed with an eating disorder 6 years after treatment that used a prospective design. Family perception patterns of patients found to have a poor outcome at followup (n = 15) were compared with patients with a good outcome (n = 23), as well as a control group (n = 36). Using the system of multiple level observation of groups (SYMLOG), all 238 family members evaluated themselves and each other. The index patients with a poor outcome perceived themselves as friendlier and more positive than they were perceived by their families. In comparison to parents of daughters with a good outcome and the control group, parents of daughters in the poor outcome group perceived themselves to be less friendly than their partners perceived them to be. A rigid polarization of the perception of the index patient by family members and a discrepancy in this perception between the index patient and the rest of the family were found to be indicative of a poor prognosis. Implications for treatment based on family perception patterns of interpersonal behavior are discussed.
Experimental evidence suggests that cells are extremely sensitive to their mechanical environment and react directly to mechanical stimuli. At present, it is technically difficult to measure fluid pressure, stress, and strain in cells, and to determine the time-dependent deformation of chondrocytes. For this reason, there are no data in the published literature that show the dynamic behavior of chondrocytes in articular cartilage. Similarly, the dynamic chondrocyte mechanics have not been calculated using theoretical models that account for the influence of cell volumetric fraction on cartilage mechanical properties. In the present investigation, the location- and time-dependent stress-strain state and fluid pressure distribution in chondrocytes in unconfined compression tests were simulated numerically using a finite element method. The technique involved two basic steps: first, cartilage was approximated as a macroscopically homogenized material and the mechanical behavior of cartilage was obtained using the homogenized model; second, the solution of the time-dependent displacements and fluid pressure fields of the homogenized model was used as the time-dependent boundary conditions for a microscopic submodel to obtain average location- and time-dependent mechanical behavior of cells. Cells and extracellular matrix were assumed to be biphasic materials composed of a fluid phase and a hyperelastic solid phase. The hydraulic permeability was assumed to be deformation dependent and the analysis was performed using a finite deformation approach. Numerical tests were made using configurations similar to those of experiments described in the literature. Our simulations show that the mechanical response of chondrocytes to cartilage loading depends on time, fluid boundary conditions, and the locations of the cells within the specimen. The present results are the first to suggest that chondrocyte deformation in a stress-relaxation type test may exceed the imposed system deformation by a factor of 3-4, that chondrocyte deformations are highly dynamic and do not reach a steady state within about 20 min of steady compression (in an unconfined test), and that cell deformations are very much location dependent.
The target article by Dr. Prilutsky is based on three incorrectly derived mathematical rules concerning force-sharing among synergistic muscles associated with a cost function that minimizes the sum of the cubed muscle stresses. Since these derived rules govern all aspects of Dr. Prilutsky's discussion and conclusion and form the basis for his proposed theory of coordination between one-and two-joint muscles, most of what is said in the target article is confusing or misleading at best or factually wrong at worst. The aim of our commentary is to sort right from wrong in Dr. Prilutsky's article within space limitations that do not allow for detailed descriptions of mathematical proofs and explicit discussions of the relevant experimental literature.
BACKGROUND: Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI. OBJECTIVE: The objective of this study was to assess whether conservative low back treatment reduces lower limb MI. STUDY DESIGN: In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP. METHODS: Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured. RESULTS: Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group. CONCLUSIONS: The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.
Knee pathologies are commonly associated with muscle inhibition, an inability to fully activate the knee extensors during voluntary contractions. This inhibition results in knee extensor weakness, and is thought to limit the functional recovery of the knee joint structures. The possible contribution of persistent knee extensor inhibition to osteoarthritis is discussed.
HISTORY AND ADMISSION FINDINGS: A 29-year-old woman had since early childhood been smaller and thinner than her contemporaries. Her weight was now 36.5 kg, height 158 cm. Anorexia nervosa being suspected she was to be admitted to a psychosomatic clinic. A few days before the date she developed respiratory failure which required mechanical ventilation for a month. Physical examination revealed markedly reduced musculature. INVESTIGATIONS: Muscle biopsy and fibroblast culture indicated acid maltase deficiency (glycogen storage disease Type II [Pompe's disease]). Lung functions were markedly reduced, blood gas analysis revealing global respiratory insufficiency. TREATMENT AND COURSE: Intermittent patient-controlled ventilation (at night by intermittent positive pressure ventilation) clearly improved both her general condition and blood gases. CONCLUSIONS: Acid maltase deficiency should be included as a possible cause of the differential diagnosis of anorexia nervosa. This diagnosis should strictly follow the criteria listed in ICD-10 (International Classification of Diseases), but also after exclusion of other causes.