Objective. To characterize the distribution of error in knee joint proprioception, quadriceps force accuracy and steadiness, and muscle strength in patients with knee osteoarthritis (OA). Special attention was paid to eccentric strength. Methods. We compared knee OA patients (n ‫؍‬ 20: 15 women, 5 men) with age-and sex-matched, symptom-free adults. Knee pain and mobility were assessed with standard tests. Knee joint proprioception was measured with a repositioning test. Quadriceps force accuracy and steadiness were determined during a force target-tracking task. Maximal voluntary quadriceps force was measured during eccentric, isometric, and concentric contractions. Results. OA patients had knee pain, needed 67% more time to complete 4 functional tasks, and produced 82% more proprioception errors (all P < 0.05). About 80% of this error was due to overshooting the target and 68% of the overshooting error occurred at 2 of the 5 least flexed knee joint positions. OA patients had 89% more errors in accurately matching target forces during submaximal quadriceps contractions and in the same tasks, OA patients also produced these forces with 155% more variability (all P < 0.05). OA patients had especially weakened ability to produce maximal voluntary eccentric strength. Conclusion. Quadriceps dysfunction in knee OA includes impaired proprioception, especially in the more extended knee joint positions; impaired ability to accurately and steadily control submaximal force; and impaired eccentric strength. These results have implications for designing exercise and rehabilitation programs for patients with knee OA.

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Unaccustomed, eccentrically biased exercise induces trauma to muscle and/or connective tissue. Tissue damage activates an acute inflammatory response. Inflammation requires the effective interaction of different physiological and biological systems. Much of this is coordinated by the de novo synthesis of families of protein molecules, cytokines. The purpose of the present paper was to determine changes in blood levels of various cytokines in response to exercise-induced muscle damage that was effected using high-intensity eccentric exercise. Six healthy, untrained, college-age male subjects were required to perform the eccentric phase of a bench press and a leg curl (4 sets, 12 repetitions/set) at an intensity equivalent to 100% of their previously determined one-repetition maximum. Samples of blood were drawn at the following times: before exercise and 1.5, 6, 12, 24, 48, 72, 96, 120, and 144 h after exercise. These samples were analyzed for interleukins (IL): IL-1beta, IL-6, and IL-10; tumor necrosis factor-alpha; colony stimulating factors (CSF): granulocyte-CSF, macrophage-CSF, and GM-CSF; for cell adhesion molecules (CAM): P- and E-selectin, and intercellular cell adhesion molecule (ICAM-1), and vascular cell adhesion molecule (VCAM-1). Results were analyzed using a repeated-measures analysis of variance (P = 0.05). Compared to baseline values, IL-1beta was reduced (P = 0.03) at 6, 24, and 96-144 h after exercise; IL-6 was elevated (P = 0.01) at 12, 24, and 72 h after exercise; IL-10 was elevated (P = 0.009) between 72 and 144 h after exercise; M-CSF was elevated (P = 0.005) at 12 and 48-144 h after exercise; and P-selectin was reduced (P = 0.01) between 24 and 144 h after exercise. It is concluded that when high-intensity eccentric exercise is compared to strenuous endurance exercise, post-exercise changes in cytokines do occur, but they are generally of a smaller magnitude, and occur at a later time period after the termination of exercise.

OBJECTIVE:Preterm infants are prone to hypothermia immediately following birth. Among other factors, excessive evaporative heat loss and the relatively cool ambient temperature of the delivery room may be important contributors. Most infants <29 weeks gestation had temperatures <36.41C on admission to our neonatal unit (NICU). Therefore we conducted a randomized, controlled trial to evaluate the effect of placing these infants in polyurethane bags in the delivery room to prevent heat loss and reduce the occurrence of hypothermia on admission to the NICU. METHODS:After parental consent was obtained, infants expected to be <29 weeks gestation were randomized to intervention or control groups just prior to their birth. Infants randomized to the intervention group were placed in polyurethane bags up to their necks immediately after delivery before being dried. They were then resuscitated per NRP guidelines, covered with warm blankets, and transported to the NICU, where the bags were removed and rectal temperatures were recorded. Control infants were resuscitated, covered with warm blankets, and transported without being placed in polyurethane bags. Delivery room temperatures were recorded so this potentially confounding variable could be assessed. RESULTS:Intervention patients were less likely than control patients to have temperature < 36.41C on admission , 44 vs 70% ( p<0.01) and the intervention group had a higher mean admission temperature, 36.51C vs 36.01C ( p<0.003). This effect remained significant ( p<0.0001) when delivery room temperature was controlled in analysis. Warmer delivery room temperatures (Z261C) were associated with higher admission temperatures in both intervention and control infants, but only the subgroup of intervention patients born in warmer delivery rooms had a mean admission temperature >36.41C. CONCLUSIONS:Placing infants <29 weeks gestation in polyurethane bags in the delivery room reduced the occurrence of hypothermia and increased their NICU admission temperatures. Maintaining warmer delivery rooms helped but was insufficient in preventing hypothermia in most of these vulnerable patients without the adjunctive use of the polyurethane bags.

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