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At least 703 records · Page 39Linked to original sources
PubMed1997

Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture.

STUDY DESIGN: This study examined the coactivation of trunk flexor and extensor muscles in healthy individuals. The experimental electromyographic data and the theoretical calculations were analyzed in the context of mechanical stability of the lumbar spine. OBJECTIVES: To test a set of hypotheses pertaining to healthy individuals: 1) that the trunk flexor-extensor muscle coactivation is present around a neutral spine posture, 2) that the coactivation is increased when the subject carries a load; and 3) that the coactivation provides the needed mechanical stability to the lumbar spine. SUMMARY OF BACKGROUND DATA: Theoretically, antagonistic trunk muscle coactivation is necessary to provide mechanical stability to the human lumbar spine around its neutral posture. No experimental evidence exists, however, to support this hypothesis. METHODS: Ten individuals executed slow trunk flexion-extension tasks, while six muscles on the right side were monitored with surface electromyography: external oblique, internal oblique, rectus abdominis, multifidus, lumbar erector spinae, and thoracic erector spinae. Simple, but realistic, calculations of spine stability also were performed and compared with experimental results. RESULTS: Average antagonistic flexor-extensor muscle coactivation levels around the neutral spine posture as detected with electromyography were 1.7 +/- 0.8% of maximum voluntary contraction for no external load trials and 2.9 +/- 1.4% of maximum voluntary contraction for the trials with added 32-kg mass to the torso. The inverted pendulum model based on static moment equilibrium criteria predicted no antagonistic coactivation. The same model based on the mechanical stability criteria predicted 1.0% of maximum voluntary contraction coactivation of flexors and extensors with zero load and 3.1% of maximum voluntary contraction with a 32-kg mass. The stability model also was run with zero passive spine stiffness to simulate an injury. Under such conditions, the model predicted 3.4% and 5.5% of maximum voluntary contraction of antagonistic muscle coactivation for no extra load and the added 32 kg, respectively. CONCLUSIONS: This study demonstrated that antagonistic trunk flexor-extensor muscle coactivation was present around the neutral spine posture in healthy individuals. This coactivation increased with added mass to the torso. Using a biomechanical model, the coactivation was explained entirely on the basis of the need for the neuromuscular system to provide the mechanical stability to the lumbar spine.

Adult↗
PubMed1997

The effects of padded surfaces on the risk for cervical spine injury.

STUDY DESIGN: This is an in vitro study comparing cervical spine injuries produced in rigid head impacts and in padded head impacts. OBJECTIVES: To test the hypothesis that deformable impact surfaces pose a greater risk for cervical spine injury than rigid surfaces using a cadaver-based model that includes the effects of the head and torso masses. SUMMARY OF BACKGROUND DATA: It is widely assumed that energy-absorbing devices that protect the head from injury also reduce the risk for neck injury. However, this has not been demonstrated in any experimental or epidemiologic study. On the contrary, some studies have shown that padded surfaces have no effect on neck injury risk, and others have suggested that they can increase risk. METHODS: Experiments were performed on 18 cadaveric cervical spines to test 6 combinations of impact angle and impact surface padding. The impact surface was oriented at -15 degrees (posterior impact), 0 degree (vertex impact), or +15 degrees (anterior impact). The impact surface was either a 3-mm sheet of lubricated Teflon or 5 cm of polyurethane foam. RESULTS: Impacts onto padded surfaces produced significantly larger neck impulses (P = 0.00023) and a significantly greater frequency of cervical spine injuries than rigid impacts (P = 0.0375). The impact angle was also correlated with injury risk (P < 0.00001). CONCLUSIONS: These experiments suggest that highly deformable, padded contact surfaces should be used carefully in environments where there is the risk for cervical spine injury. The results also suggest that the orientation of the head, neck, and torso relative to the impact surface is of equal if not greater importance in neck injury risk.

Adult↗
PubMed2000

Stability of myelomeningocele spines treated with the mayfield two-stage anterior and posterior fusion technique.

STUDY DESIGN: Retrospective review of the results of operative treatment for paralytic thoracolumbar lordoscoliosis in six consecutive myelomeningocele patients treated with the Mayfield two-stage combined anterior and posterior fusion and instrumentation technique. OBJECTIVES: To assess the long-term stability of myelomeningocele spines treated with the Mayfield technique. SUMMARY OF BACKGROUND DATA: An initial description of the technique by Mayfield and an early study of the evolution of the two-stage combined anterior and posterior instrumented fusion of paralytic lordoscoliosis in myelomeningocele spines are available. METHODS: Study of the six individual patients showed that the mean age at the time of surgery was 13 years and 8 months (range, 9 years 9 months to 15 years 10 months). At the time of surgery, the major lumbosacral curve averaged 81 degrees (range, 52-137 degrees ), pelvic obliquity was 28 degrees (range, 1-48 degrees ), torso decompensation was 2.8 cm (range, 0-6.0 cm), thoracic kyphosis was 60 degrees (range, 25-93 degrees ), lumbar lordosis was 106 degrees (range, 55-151 degrees ), and sacral anteflexion was 78 degrees (range, 22-117 degrees ). The mean duration of follow-up evaluation was 13 years 5 months (range, 8 years 10 months to 16 years 11 months). RESULTS: Clinical and radiographic evaluation showed that immediately after surgery, the lumbosacral curve was corrected to an average of 25 degrees and at last follow-up evaluation was 25 degrees, for a final correction of 69%. Pelvic obliquity was corrected to 7 degrees, 5 degrees at last follow-up evaluation, for a 82% correction. Torso decompensation was corrected to 1.4 cm initially and finally to 0.3 cm, for an 89% correction. Kyphosis was corrected to 52 degrees, finally to 50 degrees (17% decrease); lordosis to 73 degrees and finally to 67 degrees (37 degrees decrease); and sacral anteflexion corrected to 51 degrees and finally to 56 degrees (28% decrease). In one patient, the tip of the longest rod displaced from the uppermost hook and was replaced with maintenance of correction. Another patient had dehiscence of the pelvic portion of the posterior wound, with secondary bacterial contamination, and healed by secondary intention. CONCLUSIONS: The Mayfield technique effectively corrected and stabilized these difficult myelomeningocele spinal deformities, using distraction against square-holed hooks seated on the sacral alae, which contain the best-quality bone in these hypoplastic pelves.

Adolescent↗
PubMed2000

Effects of a lifting belt on spine moments and muscle recruitments after unexpected sudden loading.

STUDY DESIGN: Ten men and eight women participated in a repeated-measures experiment in which sudden loads were applied unexpectedly to a container held in the hands. Three independent variables were investigated: lifting belt use, preload, and load symmetry. OBJECTIVES: To determine whether a lifting belt would help protect the spine in sudden symmetric and asymmetric loading situations. SUMMARY OF BACKGROUND DATA: Unexpected loading events have long been associated with the onset of back pain. Based on work showing that lifting belts restrict motion of the torso, the hypothesis was that a lifting belt would stiffen the spine, thereby protecting its supporting tissues. METHODS: A weight, equal to 7.5% of the subjects' trunk extension force, was allowed to fall 1 m before the bottom of a box held by blindfolded subjects was pulled. Kinetic and kinematic data, obtained from two force plates and a magnetic motion measurement system, were used in a three-dimensional, dynamic, linked-segment biomechanical model to calculate spine moments. Electromyogram data were simultaneously obtained from eight trunk muscles. RESULTS: The belt reduced the forward bending of the spine during the symmetric loadings. In the men, the belt also reduced the forward flexion moment acting on the spine. The belt restricted lateral bending in the women and men, when the box was preloaded. The peak electromyogram amplitudes from posterior contralateral erector spinae and latissimus dorsi muscles increased during the asymmetric loadings, whereas three ipsilateral muscles were less active. CONCLUSIONS: The conflicting moment and electromyographic results, combined with the influence of load symmetry, preload, and gender make the benefits of the lifting belt difficult to delineate. Although the data support the hypothesis that the belt stiffens the torso's response to sudden loading, the effects are small, and considerable individual differences exist. The findings show that during unexpected sudden loading, a belt may reduce the net external moment loading. At the same time the belt appears to alter the muscle response strategy so that the belt's overall effect on an individual's safety is hard to determine.

Adult↗
PubMed2000

Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion.

STUDY DESIGN: In vitro study to determine occupational radiation exposure during lumbar fluoroscopy. OBJECTIVES: To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. SUMMARY OF BACKGROUND DATA: Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon. METHODS: Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter. RESULTS: The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver. CONCLUSION: Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.

Bone Screws↗
PubMed2002

Internal loads in the cervical spine during motor vehicle rear-end impacts: the effect of acceleration and head-to-head restraint proximity.

STUDY DESIGN: This study used rigid-body and finite-element models of forces in the cervical spine resulting from a rear-end motor vehicle impact based on data from 26 volunteer experiments. OBJECTIVES: To define the magnitudes and directions of internal forces acting on the cervical spine during rear-end impact, and to determine the effects of increasing the impact acceleration and the initial position of the occupant's head with respect to the head restraint. SUMMARY OF BACKGROUND DATA: In a number of studies using volunteers or cadavers, the kinematics of the occupant during a rear-end impact related to "whiplash" of the cervical spine have been reported. Few studies have described the mechanism by which internal spine forces are produced and how they may be affected by interaction of the occupant with the seat and head restraint during impact. METHODS: From a companion study on the response of 26 volunteers to rear-end impact, experimental data on head and torso accelerations were developed. Rigid-body mathematical dynamic modeling of a 50th-percentile male was implemented, along with a finite-element seat model, lap belt, and shoulder belt. The model was first subjected to a rear-impact pulse similar to that used in the volunteer study, first with a peak of 3.5 G, then with a peak up to 12 G. Initial head-to-head restraint distance in the model was varied from 1 to 12.5 cm. RESULTS: The major cervical spine forces were upper and lower neck shear causing intervertebral relative anterior displacements. Increasing the peak acceleration magnitude caused increased neck shear force magnitudes. With the head initially positioned closer to the head restraint, the time difference between the occurrences of the peak upper and lower neck shear forces was smaller; the C7-T1 intervertebral shear displacements were reduced; the head moved more in phase with the torso; extension of the head and neck was reduced; and late head flexion was increased. CONCLUSIONS: In this simulation, anterior shear was the major internal force acting in the cervical spine during rear-end impact. Increasing impact acceleration magnitude directly increased shear force. When the head was initially closer to the head restraint, the magnitude of the shear force was unaffected, but the time difference between its occurrences in the upper and lower neck was decreased and intervertebral translations were reduced. These results suggest how the seat could be improved to reduce peals forces and the time differences between them.

Acceleration↗
PubMed2002

Spine loading as a function of gender.

STUDY DESIGN: In vivo laboratory studies were conducted to investigate the spine loads imposed on men and women during a series of lifting tasks that varied in the degree of lifting control required by the subject. OBJECTIVE: To identify and understand differences in spine loading and musculoskeletal control strategies between men and women performing lifts of varying task complexity. SUMMARY OF BACKGROUND DATA: Few studies have examined differences in spine loading as a function of individual factors such as subject gender. Furthermore, no biomechanical studies have attempted to quantify and understand how differences in anthropometry between genders might influence muscle recruitment and subsequent spine loads. Because the modern workplace seldom discriminates between genders in job assignments, it is important to understand how differences in spine loading and potential low back disorder risk might be associated with gender differences. METHODS: For this study, 140 subjects participated in two separate experiments requiring different degrees of musculoskeletal motion control during sagittal plane lifting. The two experiments consisted of 35 men and 35 women performing lifts in which motion was isolated to the torso and 35 men and 35 women completing whole-body free-dynamic whole body lifts. An electromyography-assisted model was used to evaluate spine loading under these conditions. RESULTS: Absolute spine compression generally was greater for the men. Under the highly controlled (isolated torso) conditions, most differences were attributed solely to differences in body mass. Under a whole-body free-dynamic condition, significant differences in muscle coactivations resulted in greater relative compression and anterior-posterior shear spine loading for the women. CONCLUSIONS: Differences in spine loadings as a function of gender under the more controlled lifting conditions were primarily a function of different body masses. However, loading pattern differences existed between the genders under whole-body free-dynamic conditions as a result of kinematic compensations and increases in muscle cocontraction, with women generally experiencing greater relative loads. When spine tolerance differences are considered, one would expect that females would be at greater risk of musculoskeletal overload during lifting tasks.

Abdomen↗
PubMed1999

Injuries in commercial whitewater rafting.

OBJECTIVE: To describe injuries sustained by participants in commercial whitewater rafting. DESIGN: Analysis of injury reports submitted by commercial outfitters to the West Virginia Division of Natural Resources. PARTICIPANTS: Customers of commercial rafting outfitters who sustained injuries in the 1995-1997 whitewater seasons on the New, Gauley, Cheat, and Shenandoah Rivers and for whom injury reports were submitted as required by the West Virginia Legislative Rules. RESULTS: A total of 200 rafting injuries were reported from 1995 through 1997, with a resulting overall injury incidence rate of 0.263 per 1,000 rafters. Incidence rates ranged from 0. 145 per 1,000 on the Shenandoah to 0.381 per 1,000 on the Gauley River. The average age of injured persons was 33.14 years, 53.3% were male, and 59.8% had previous rafting experience. The body part most frequently injured was the face (33.3%), including the eye (12.1%), mouth (6.6%), other facial parts (5.1%), nose (4.5%), and teeth (4.0%), followed by the knee (15.3%), arm/wrist/hand (11.6%), other parts of the leg, hip, or foot (10.5%), ankle (7.4%), torso (6.8%), shoulder (6.3%), and head/neck (5.3%). Predominant injury types included lacerations (32.5%), sprains/strains (23.2%), fractures (14.9%), contusions/bruises (9.8%), dislocations (8.2%), and two deaths. On-site administration of first aid included bandages (29%), ice (26.9%), splinting/immobilization (17.7%), antiseptic (11.3%), direct pressure (4.2%), elevation (2.1%), cardiopulmonary resuscitation (1%), and treatment for shock (0.4%). No first aid was administered for 4.6% of injuries. Most injuries occurred in the raft (51.3%) as a result of collisions among passengers, being struck by a paddle or other equipment, or entanglement of extremities in parts of the raft; 40.3% of injuries occurred in the water after falling from the raft. Types of injuries were independent of where they occurred, but differences were found in injured body parts by location of occurrence. Injuries occurring in the raft more commonly were to the face, and injuries occurring in the water involved the extremities and face. Injuries requiring evacuation to an outfitter's base camp or to a medical facility occurred at a higher rate among persons without previous rafting experience. Gender differences were not found for types of reported injuries, but body part injured did vary by gender. Female boaters more frequently sustained facial injuries, whereas male boaters more frequently sustained injuries to the limbs and torso. CONCLUSION: Overall injury rates were low, but verification limitations render a determination of unreported injuries difficult. Because most injuries occur in the raft while running rapids, involve injuries to the face, and result from contact among passengers or paddling equipment, preventive measures such as attaching face protection to paddling helmets, carrying fewer passengers per raft, or portaging dangerous rapids are suggested. More research is needed to verify injury rates and severity, and to document related medical costs.

Adult↗
PubMed1996

Wearing an abdominal belt increases diastolic blood pressure.

The purpose of this study was to determine the effect of wearing an abdominal belt on blood pressure (systolic and diastolic) and heart rate during a variety of tasks. The belt was typical of the elastic type with suspenders and Velcro tabs for cinching the belt snug. The tasks performed included sitting at rest, sitting with the torso inclined forward at 45 degrees, standing with the torso inclined forward at 45 degrees (with and without holding an 11-kg weight), a trunk axial rotation task, and squat lifting. Blood pressure was monitored noninvasively with a FINAPRES blood pressure monitor. Twenty healthy men performed each task with and without the abdominal belt. Although no significant increases in mean systolic blood pressure or heart rate were found, there was a significant increase in diastolic blood pressure in all conditions. All people considering wearing an abdominal belt should also consider the risks and liability associated with the additional cardiovascular load, particularly heart attack and stroke.

Adult↗
PubMed2003

Comparison of three lumbar orthoses using motion assessment during task performance.

STUDY DESIGN: Four conditions (three orthoses, one no orthosis), full cross-over, randomized order, 12 subjects tested 3 months after a lumbar surgical arthrodesis. OBJECTIVES: To assess whole torso and lumbar motions and comfort for each orthoses condition during performance of activities of daily living. SUMMARY OF BACKGROUND DATA: Previous noninvasive studies measured whole torso (not just lumbar) movement. Recent development of a low profile, flexible, strain-gauged device ("Lordosimeter") facilitated this study. MATERIALS AND METHODS: The Lordosimeter was taped to the skin along the midline of the lumbosacral region. Orthoses studied were Boston anterior opening, Aspen lumbosacral, and Cybertech. Specified activities of daily living were performed for each orthosis condition. Subject effort during the flexion/extension task was assessed by surface electromyography (EMG). Comfort was assessed by visual analog scale. RESULTS: There were no significant differences in EMG between orthoses. For lumbar flexion, trunk flexion, total lumbar motion, and total trunk motion, the mean values for Aspen and Boston (but not Cybertech) were significantly smaller than for no orthosis for most of the tasks and there were no significant differences between Aspen and Boston. The total lumbar motion allowed by each orthosis (averaged across tasks and relative to the no orthosis condition) was 81% for Aspen, 79% for Boston, and 97% for Cybertech. The comfort rating averaged across tasks was 2.24 for Aspen, 4.12 for Boston, and 3.92 for Cybertech (0 = very comfortable, 10 = very uncomfortable). Aspen was significantly more comfortable than Boston or Cybertech. Boston and Cybertech did not differ significantly. CONCLUSIONS: The Lordosimeter is useful for measuring lumbar motion during orthosis wear. The Aspen and the Boston orthoses provided significant flexion-extension motion restriction compared with no orthosis, but for almost all of the motion measures did not differ from each other. The Cybertech did not differ significantly from the no orthosis condition. The Aspen orthosis was rated significantly more comfortable than the Boston or the Cybertech.

Activities of Daily Living↗
PubMed2005

The role of the sternum, costosternal articulations, intervertebral disc, and facets in thoracic sagittal plane biomechanics: a comparison of three different sequences of surgical release.

STUDY DESIGN: Eighteen human torsos were used in three experiments (A, B, and C) to determine the changes in sagittal motion due to three different sequences of three surgical releases. OBJECTIVES: To investigate the relative effects of releasing the intervertebral disc, the costosternal joint, the sternum, and the facet joints on sagittal thoracic motion and the consequences of altering the sequence of the releases. SUMMARY OF BACKGROUND DATA: The biomechanics of the thoracic spine are different from the cervical and lumbar spine particularly due to the ribs and sternum, which contribute to stability and control motion. The role of the sternum and costosternal articulation in the biomechanics of thoracic sagittal motion has not been well studied. The effects of releasing each of these structures, whether alone or with discectomy and/or facetectomy, is potentially relevant in the surgical correction of thoracic deformities, such as severe kyphosis, and in the biomechanics of thoracic fracture. METHODS: In Experiment A, the release sequence was back to front: total facetectomy (T4-T8), then radical discectomy (T4-T8), then costosternal release, then sternal osteotomy. In Experiment B, the release sequence was front to back: sternal osteotomy, then costosternal release, then radical discectomy, and finally total facetectomy. In Experiment C, the release sequence was: radical discectomy, then sternal osteotomy, then costosternal release, then total facetectomy. The different sequences allowed separate analysis of each component and the synergistic patterns. In each of the three experiments, the torso was flexed then extended each time by an applied force (25 N) before and after each release. The extent of flexion and the extent of extension were measured each time and compared with the intact condition, after each release. RESULTS: The results obtained for sternal osteotomy were combined with the results obtained for costosternal release to give "sternal release." Radical discectomy provided the greatest increase (P < 0.05) in range of motion (ROM) compared with the other two single releases, no matter what the sequence. For paired release combinations, the radical discectomy and sternal release (as in Experiments B and C) provided a significant (P < 0.05) increase in total sagittal ROM compared with the combination of radical discectomy and total facetectomy (Experiment A). In Experiment A, sternal release accounted for 42% of the total sagittal ROM compared with only 26% related to the total facetectomy (Experiment B). In general, all of the releases allowed more extension than flexion. CONCLUSIONS: Sagittal plane motion in the thoracic spine is influenced by all three structures tested in this experiment. Overall, the radical discectomy provides the greatest increase in total ROM and in extension compared with the other two releases. The second most influential release is the combination of sternal osteotomy plus costosternal release (i.e., sternal release), particularly in extension (correction of kyphosis). When two releases are done in sequence, radical discectomy plus sternal release provides the greatest increase in total ROM and in extension. Overall, total facetectomy is the least effective release. These data have relevance for surgical strategies in the correction of thoracic kyphosis or lordosis and suggest a potential role for sternal osteotomy and costosternal release in severe and rigid upper thoracic kyphosis.

Aged↗
PubMed2004

Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury.

OBJECTIVE: This study determines whether acid-base data obtained in the emergency department correlate with outcome from major vascular injury. DESIGN: Observational, retrospective record review of trauma patients requiring vascular repair (torso or extremity, January 1988 to December 1997). Data included age, Injury Severity Score, injury mechanism, survival, laboratory profiling, calculated anion gap, strong ion difference, and strong ion gap. Patients were divided into survivors and nonsurvivors with comparison by Student's t-test; significance was assumed for p < or = .05. Multivariate logistic regression was used for further analysis of univariate predictors of mortality, and receiver operator characteristic curves were generated for mortality from each variable. SETTING: Urban level I trauma facility. PATIENTS: Trauma patients requiring vascular repair of torso or extremity injury. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Both nonsurvivors (n = 64) and survivors (n = 218) were similar with respect to age (31 +/- 9 vs. 31.5 +/- 10.5, p = 0.15) and injury mechanics (81% penetrating in survivors vs. 83% penetrating in nonsurvivors, p = .71). Non-survivor Injury Severity Score exceeded that of survivors (27.5 +/- 7.8 vs. 12.4 +/- 9.4, p < .001). Nonsurvivor pH (7.06 +/- 0.15 vs. 7.34 +/- 0.08, p < .001) and apparent strong ion difference (31.38 +/- 4.39 vs. 37.53 +/- 3.86, p < .001) were significantly lower, whereas nonsurvivor standard base excess (-17.9 +/- 5.1 vs. -2.9 +/- 4.4 mEq/L, p < .001), lactate (11.1 +/- 3.6 vs. 3.6 +/- 1.5 mmol/L, p < .001), anion gap (28.2 +/- 4.1 vs. 15.6 +/- 3.1, p < .001), and strong ion gap (10.8 +/- 3.2 vs. 2.4 +/- 1.8, p < .001) were higher. All but one nonsurvivor had initial emergency department pH < or = 7.26, standard base excess < or = -7.3 mEq/L, lactate > or = 5 mmol/L, and strong ion gap > or = 5 mEq/L. All of the acid-base descriptors were strongly associated with outcome, but the strong ion gap discriminated most strongly with an area under the receiver operator characteristic of 0.991 (95% confidence interval, 0.972-0.998). CONCLUSIONS: The initial emergency department acid-base variables of pH, base deficit, lactate, anion gap, apparent strong ion difference, and strong ion gap discriminate survivors from non-survivors of major vascular injury. The strong ion gap is most strongly predictive of mortality following major vascular trauma.

Acid-Base Equilibrium↗
PubMed2007

Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation.

BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: NIRS-derived muscle StO2 measurements perform similarly to BD in identifying poor perfusion and predicting the development of MODS or death after severe torso trauma, yet have the additional advantages of being continuous and noninvasive.

Adolescent↗
PubMed1982

Representation and recognition of the movements of shapes.

The problems posed by the representation and recognition of the movements of 3-D shapes are analysed. A representation is proposed for the movements of shapes that lie within the scope of the Marr & Nishihara (1978) 3-D model representation of static shapes. The basic problem is how to segment a stream of movement into pieces, each of which can be described separately. The representation proposed here is based upon segmenting a movement at moments when a component axis, e.g. an arm, starts to move relative to its local coordinate frame (here the torso). For example, walking is divided into a segment of the stationary states between each swing of the arms and legs, and the actual motions between the stationary points (relative to the torso, not the ground). This representation is called the state-motion-state (SMS) moving shape representation, and several examples of its application are given.

Form Perception↗
PubMed1994

A temperature-sensitive MEK mutation demonstrates the conservation of the signaling pathways activated by receptor tyrosine kinases.

MEK, a dual specificity threonine/tyrosine kinase, has been postulated to be a convergent point for signaling from receptor protein tyrosine kinases (RTKs) and G-protein-coupled receptors. In contrast to yeast and mammalian cells where several MEKs have been isolated, only one Drosophila MEK (D-Mek) has been characterized to date. Previous studies have shown that D-Mek acts in the Torso RTK signaling pathway. To demonstrate that D-Mek also operates downstream of other RTKs, we generated a temperature-sensitive allele of D-mek (D-mekts) by site-directed mutagenesis based on the amino acid change of a yeast cdc2ts mutation. Using D-mekts, we show that in addition to its role in Torso signaling, D-Mek operates in the Sevenless and in the Drosophila epidermal growth factor RTK pathways. Because loss-of-function mutations in D-mek and the upstream receptors give rise to similar phenotypes, it suggests that D-mek is the only MEK activated by Drosophila RTKs. In addition, we demonstrate that different RTK pathways respond differently to alteration in D-Mek activity.

Alleles↗
PubMed1994

Elucidation of the role of breathless, a Drosophila FGF receptor homolog, in tracheal cell migration.

DFGF-R1 (breathless), a Drosophila FGF receptor homolog, is required for the migration of tracheal cells and the posterior midline glial cells during embryonic development. To define the role of this receptor in cell migration, we have monitored the biological effects of a deregulated receptor containing the extracellular and transmembrane regions of the torso dominant allele and the cytoplasmic domain of DFGF-R1. Ubiquitous expression of the chimeric receptor at the time of tracheal cell migration did not disrupt migration in wild-type embryos. However, induction of the chimeric receptor corrected the tracheal defects of breathless (btl) mutant embryos, allowing the tracheal cells to migrate along their normal tracts. This result indicates that the normal activity of DFGF-R1 in promoting cell migration does not require spatially restricted cues. Late inductions of the chimeric construct, after the normal initiation of tracheal migration, allowed the definition of a broad time window during which the external signals guiding migration persist and the tracheal cells retain the capacity to respond to these cues. Rescue of tracheal migration in btl mutant embryos by the chimeric construct provides a sensitive biological assay for the activity of other Drosophila receptor tyrosine kinases (RTKs). Deregulated receptors containing the cytoplasmic domains of DFGF-R2, DER, torso, and sevenless were all able to partially rescue the migration defects. Consistent with the notion that these RTKs share a common signaling pathway, constructs containing the activated downstream elements Dras1 and Draf were also able to rescue tracheal migration, demonstrating that these two proteins are key players in the DFGF-R1 signaling pathway.

Animals↗
PubMed1994

A finite element model for radiofrequency ablation of the myocardium.

A finite element model was developed to simulate the temperature distributions produced by radiofrequency catheter ablation. This model incorporated blood, myocardium and torso tissues. The Laplace equation was solved to determine the steady-state electric field. The heat generation in the tissues was then computed from the power density distribution and the bioheat equation was solved to determine the time-varying temperature distribution, taking into account the convective energy exchange at the blood-myocardium and torso-air interfaces. This model was used to predict the lesion depth and to evaluate the effects of electrode location, changes of the electrical and thermal conductivities, and the electrode radius on the thermally induced damage to the myocardium. Temperature distributions induced by radiofrequency ablation were found to be: i) not very sensitive to the reference electrode location, ii) more sensitive to electrical conductivity changes than to thermal conductivity changes, and iii) larger electrodes allow a current distribution at higher level of power with reducing the chance of impedance rise.

Arrhythmias, Cardiac↗
PubMed1997

Electrical defibrillation optimization: an automated, iterative parallel finite-element approach.

To date, optimization of electrode systems for electrical defibrillation has been limited to hand-selected electrode configurations. In this paper we present an automated approach which combines detailed, three-dimensional (3-D) finite-element torso models with optimization techniques to provide a flexible analysis and design tool for electrical defibrillation optimization. Specifically, a parallel direct search (PDS) optimization technique is used with a representative objective function to find an electrode configuration which corresponds to the satisfaction of a postulated defibrillation criterion with a minimum amount of power and a low possibility of myocardium damage. For adequate representation of the thoracic inhomogeneities, 3-D finite-element torso models are used in the objective function computations. The CPU-intensive finite-element calculations required for the objective function evaluation have been implemented on a message-passing parallel computer in order to complete the optimization calculations in a timely manner. To illustrate the optimization procedure, it has been applied to a representative electrode configuration for transmyocardial defibrillation, namely the subcutaneous patch-right ventricular catheter (SP-RVC) system. Sensitivity of the optimal solutions to various tissue conductivities has been studied. Results for the optimization of defibrillation systems are presented which demonstrate the feasibility of the approach.

Algorithms↗