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Measuring the effect of multiple eye fixations on memory for visual attributes.

Because of limited peripheral vision, many visual tasks depend on multiple eye fixations. Good performance in such tasks demonstrates that some memory must survive from one fixation to the next. One factor that must influence performance is the degree to which multiple eye fixations interfere with the critical memories. In the present study, the amount of interference was measured by comparing visual discriminations based on multiple fixations to visual discriminations based on a single fixation. The procedure resembled partial report, but used a discrimination measure. In the prototype study, two lines were presented, followed by a single line and a cue. The cue pointed toward one of the positions of the first two lines. Observers were required to judge if the single line in the second display was longer or shorter than the cued line of the first display. These judgments were used to estimate a length threshold. The critical manipulation was to instruct observers either to maintain fixation between the lines of the first display or to fixate each line in sequence. The results showed an advantage for multiple fixations despite the intervening eye movements. In fact, thresholds for the multiple-fixation condition were nearly as good as those in a control condition where the lines were foveally viewed without eye movements. Thus, eye movements had little or no interfering effect in this task. Additional studies generalized the procedure and the stimuli. In conclusion, information about a variety of size and shape attributes was remembered with essentially no interference across eye fixations.

Adult↗

Strategic control over saccadic eye movements: studies of the fixation offset effect.

We studied the strategic (presumably cortical) control of ocular fixation in experiments that measured the fixation offset effect (FOE) while manipulating readiness to make reflexive or voluntary eye movements. The visual grasp reflex, which generates reflexive saccades to peripheral visual signals, reflects an opponent process in the superior colliculus (SC) between fixation cells at the rostral pole, whose activity helps maintain ocular position and increases when a stimulus is present at fixation, and movement cells, which generate saccades and are inhibited by rostral fixation neurons. Voluntary eye movements are controlled by movement and fixation cells in the frontal eye field (FEF). The FOE--a decrease in saccade latency when the fixation stimulus is extinguished--has been shown to reflect activity in the collicular eye movement circuitry and also to have an activity correlate in the FEF. Our manipulation of preparatory set to make reflexive or voluntary eye movements showed that when reflexive saccades were frequent and voluntary saccades were infrequent, the FOE was attenuated only for reflexive saccades. When voluntary saccades were frequent and reflexive saccades were infrequent, the FOE was attenuated only for voluntary saccades. We conclude that cortical processes related to task strategy are able to decrease fixation neuron activity even in the presence of a fixation stimulus, resulting in a smaller FOE. The dissociation in the effects of a fixation stimulus on reflexive and voluntary saccade latencies under the same strategic set suggests that the FOEs for these two types of eye movements may reflect a change in cellular activity in different neural structures, perhaps in the SC for reflexive saccades and in the FEF for voluntary saccades.

Adult↗

Structure of rat kidneys following microwave accelerated fixation.

In contrast to fixation of tissue in externally heated fixative, microwave-irradiation can generate uniform internal heat, which is of utmost importance for successful fixation of biological tissue. To evaluate the effectiveness of microwave-accelerated chemical fixation, we compared the structure of rat kidney fixed by a conventional method and a microwave-accelerated method, by scanning and transmission electron microscopy. Following perfusion, rat kidney pieces 1-2 mm in size were irradiated in Karnovsky's fixative in a domestic Amana microwave oven, till the temperature of the fixative reached 45-50 degrees C. For conventional fixation, tissue pieces were fixed overnight at room temperature in the same fixative. Both types of samples were processed further for electron microscopy using identical protocols. The microwave fixed samples showed excellent preservation of structure comparable to the samples fixed by the conventional method. Glomeruli and the renal tubules showed normal morphology with no cellular swelling. The cytoplasm and nuclear matrix of the epithelial cells was uniformly dense. Other fixation sensitive organelles like mitochondria and Golgi apparatus showed superior preservation with continuous membranes. These results demonstrate that microwave accelerated chemical fixation results in excellent preservation of tissue structure, reduces processing time significantly and is therefore a practical alternative to conventional protocols.

Animals↗

Load tolerance, security, and failure modes of fixation devices for synthetic knee ligaments.

One weak link in synthetic ligament reconstruction of the knee is the fixation device-ligament-bone interface. In this study, a laboratory model using bovine calf bone was designed to evaluate six different fixation devices combined with either an unlooped ligament in different configurations or a looped ligament. Results are expressed in terms of maximum load to failure, elongation at the site of fixation, stiffness of fixation prior to failure, and mode of failure. When failure of the test model occurred, it was always at the ligament--fixation device interface, the fixation device--bone interface, or a combination of the two. Elongation was recorded in all modes of fixation. The most secure fixation was obtained with a cortical screw and a looped ligament, the strength and predictability being mainly dependent on bone quality. The least secure and least predictable fixation was obtained with a prototype called bucket wedge. A barbed ligament staple and an unlooped ligament also had low predictability and considerably less strength than the screw fixation but showed less sensitivity to alterations in bone quality.

Animals↗

Safety and image artifact of external fixators and magnetic resonance imaging.

External fixators commonly used in orthopaedic trauma and reconstruction may pose a potential safety hazard to patients exposed to magnetic resonance imaging. This interaction with the scanner depends on fixator composition, magnetism, and geometry. Image artifact produced by devices during scanning may diminish the diagnostic quality of the image. A mail survey of 91 radiologists' and 167 radiological technologists' current practices identified an absence of consensus regarding protocols for scanning patients who had external fixators in place. Eighteen external fixators were tested. Force was measured during exposure to the magnetic field at 30 cm from the magnetic resonance imaging portal, at the portal, and 30 cm inside the portal. The recordings ranged from 0 to 2.2 kg. Three fixators did not generate measurable forces and therefore are considered safe for the magnetic resonance imaging based on previously published safety standards. Ten devices did not produce measurable forces until placed at the portal, indicating that these fixators may be considered safe, providing the scanned area is distant to the fixator. To investigate image artifact, the fixators were placed on a phantom model and scanned. There was substantial variation among the fixators and image quality produced, depending on fixator composition and geometry.

Artifacts↗

Experimental studies addressing rigid fixation in craniofacial surgery.

This article has reviewed several experimental studies that address certain aspects of the use of rigid fixation in clinical craniofacial surgery. The effect of rigid fixation on growth was studied in an infant Rhesus monkey model. It showed that osteotomy and fixation resulted in subtle changes in skull shape and that the severity of the deformity was related to the complexity of the fixation employed. Deformities were seen with wire fixation alone, however. A study using a rabbit model showed that the revascularization and resorption of onlay bone grafts immobilized with a microscrew occurred primarily in the cancellous portion of the graft. This led Chen et al to speculate that the volume of cranial bone grafts persists better than with iliac crest grafts, because they contain relatively less cancellous bone and more cortical bone, which is slower to revascularize and resorb. Fiala et al studied the artifacts seen in CT and MR scans associated with plate and screw fixation devices. They showed that, compared with stainless steel and vitallium, titanium resulted in less "starburst" and "black hole" artifact in CT and MR images, respectively. Amarante et al compared butyl-2-cyanoacrylate adhesive fixation with fixation by plates and screws of osteotomized bone segments in a minipig model. They found it to be as effective as plates and screws for bone fixation in this model. In the future, this material, together with resorbable plates and screws, may provide a means of fixation of the craniofacial skeleton and can be anticipated to receive further experimental and clinical study.

Animals↗

Dual-energy X-ray absorptiometry of canine femurs with and without fracture fixation devices.

The effect of 5 fracture fixation methods on bone mineral density (BMD) measurement of femurs, using dual-energy X-ray absorptiometry (DXA) was determined in a canine model. Six regions of interest were measured, including the entire femur, the diaphysis of the femur, and small regions centered over the middiaphysis of the bone (lateral middiaphyseal cortex, medial middiaphyseal cortex, middiaphyseal medullary canal, and total middiaphysis). Eight unpaired femurs were collected and scanned by use of DXA before (5 separate scans/femur) and after (5 separate scans/femur) fixation by use of 1 of 5 fixation methods. These fixation methods included: intramedullary (IM) nail; IM nail and cerclage wires; IM nail and external skeletal fixation; locked IM nail; and a dynamic compression plate (DCP). All implants were made of stainless steel. The IM nail fixation devices caused significant decreases in the DXA measurement of BMD in the small regions of interest, compared with femurs without fixation devices (mean decrease, 37.3%; P < 0.05). The locked nail caused similar, but larger, decreases in the DXA measurement of BMD, compared with the IM nail fixation methods (P < 0.05). Plate fixation caused a small, but significant (P < 0.05), decrease (2.8%) in the DXA measurement of BMD in the large regions of interest, but when all regions were averaged, it did not cause significant change in this measurement, compared with femurs without fixation devices.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

Differences in acetylcholine but not choline in brain tissue fixed by freeze fixation or microwave heating.

Among the many rapidly metabolized compounds in the brain, acetylcholine is one of the most challenging to sample effectively due to its rapid synthesis, degradation and sequestration. To ascertain problems that invalidate sampling procedures two methods of tissue fixation, microwave heat inactivation and freeze fixation, were used for obtaining mice and rat brain samples, respectively. The data show that acetylcholine levels obtained by microwave fixation were much higher than those obtained by freeze fixation. Choline levels were not affected by the fixation method used. Microwave fixation results in more accurate assessment of acetylcholine levels than the freeze fixation method, even though the tissue fixation time was less than 1 s in both methods, because tissue integrity is maintained in the microwave fixation, but not during freeze fixation.

Acetylcholine↗

Delayed posterior internal fixation of unstable pelvic fractures.

Fifteen patients with unstable pelvic fractures were treated with immediate anterior external fixation followed by delayed posterior fixation, including five sacroiliac lag screws, six transiliac rods, and four iliac plates. Initial anterior external fixation aided in resuscitation of hemodynamically unstable patients and allowed early mobilization. Delayed posterior internal fixation avoided infection and hemorrhage but failed to achieve anatomic reduction of disrupted sacroiliac joints and sacral fractures. Followup examination confirmed maintenance of fixation and fracture healing but pain and persistent neurologic deficits were common findings. Lumbosacral nerve plexus injuries occurred in patients with fractures through the sacral foramina. Fixation of these fractures with sacroiliac screws and transiliac rods caused overcompression and the resulting foraminal encroachment may be a factor in the lack of neurologic recovery. In this study, delayed posterior internal fixation was not associated with perioperative morbidity and achieved better reductions than those obtained with external fixation alone. Delaying the fixation, however, increased the difficulty of obtaining anatomic reduction of certain posterior arch disruptions.

Adolescent↗

Pinless external fixation. Indications and preliminary results in tibial shaft fractures.

A major drawback of conventional fixator systems is the penetration of the fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and the outer environment. The new AO pinless fixator bypasses this disadvantage by clamping its trocar points onto the outer cortex without penetrating it. Thus, exposure and consequent contamination of the medullary cavity does not occur. The clinical use of this easily manageable fixator with no drilling requirement is for tibial fractures in which the general and local conditions are poor or the infrastructure of the clinic is inadequate for primary internal stabilization or both. All options for a later conversion to internal fixation remain open. For highly unstable tibial shaft fractures, the pinless fixator can be applied as an additional, minimally invasive, external, locked system to increase the stability of intramedullary nail fixation. The pinless external fixator can be combined favorably with the standard AO tubular system and is a valuable addition to the existing fixator systems.

Adolescent↗

Microwave irradiation as a form of fixation for light and electron microscopy.

Microwave irradiation was used to fix a wide range of surgical and autopsy specimens as well as tissue from freshly killed rats. Although there appeared to be varying optimum temperatures of fixation for different tissues, from a practical standpoint, the heating to 58 degrees C of tissues submerged in normal saline resulted in fixation of a quality comparable with that produced by conventional fixation to 10 per cent formalin. Microwave irradiation applied to tissues which had up to 1 h prior immersion in 10 per cent formalin also produced excellent preservation of cytomorphology, the time required for microwave fixation being no more than 150 s. This form of rapid heat fixation had no deleterious effects on special stains, sectioned as well as control fixed blocks and produced less shrinkage artefact than conventional formalin fixation. Immunocytochemical staining for more stable cytoplasmic antigens revealed no significant difference between microwave fixation compared with formalin fixation. The more labile membrane associated antigens of lymphocytes, however, were not preserved by either method of fixation. Microwave fixation was also found to be applicable to electron microscopy. Tissue samples immersed in 2.5 per cent glutaraldehyde and fixed in 90 s by irradiation to 50 degrees C showed excellent preservation of ultrastructural morphology.

Animals↗

Lysozyme antigenicity and tissue fixation.

The preservation of lysozyme (LZM) antigenicity was studied in paraffin embedded tissue blocks. The reactivity for LZM varied with the type of tissue studied, the fixative used, the osmolarity and pH of the fixative, fixation time and temperature, and the method of dehydration. In both rat and human tissues aqueous fixatives were superior to nonaqueous fixatives in retaining LZM antigenicity. Brief fixation in fixatives of low osmolarity enhanced LZM staining in the parenchymatous tissues but diminished staining in human cartilage; prolonged fixation in fixatives of high osmolarity gave opposite results. Least affected by fixation was the LZM antigenicity in the serous cells of the glands of the respiratory tract. These cells also stained most intensely for LZM of all autopsy material studied.

Animals↗

[The development and biomechanical testing of a femoral press fit fixation for hamstring tendons].

PURPOSE: The purpose of this study was to investigate press fit femoral fixation of hamstring tendons and to compare the mechanical properties with press fit patellar tendon bone (PTB) fixation. METHODS: The PTB and hamstring tendons of 30 human cadavers (age: 55.8+/-18.0 years) were used as grafts. An outside-in press fit fixation with a knot in the semitendinosus and gracilis graft (SG-K) and an inside-out (SG-BI) and an outside-in fixation (SG-BO) with the tendons looped over a bone block were compared with a bone-patellar tendon (PT) press fit fixation in 30 bovine femora. The angle between the direction of force and bone tunnel was 60 degrees. The constructs underwent 20 cycles of loading between 60 and 260 N. Constructs were loaded until failure at a speed of 1 mm/sec. Graft fixation was analyzed in terms of maximum load to failure, stiffness and elongation during cyclic stretching. A video analysis of length changes was investigated. RESULTS: There was a significant difference in the maximum load to failure. The SG-BI fixation was inferior to the other three techniques (Mann-WhitneyU-test, P<0.01). There was no difference in stiffness between the techniques. Length changes of PT-fixation from the first to the fifth loading cycle were significantly smaller compared with all other groups (0.73+/-0.58 mm). There was no significant difference between the groups from the 15th to the 20th cycle of cyclic loading. CONCLUSIONS: Press fit fixation of hamstring grafts is technically challenging. However, pull-out forces for SG-O and SG-K were equivalent to BPT-graft fixation. Adequate preconditioning for all hamstring tendon press fit techniques is crucial.

Anterior Cruciate Ligament↗

Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction.

Press-fit fixation of patellar tendon bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary to achieve fixation. Up till the present point, there is no biomechanical data available for the tibial press-fit fixation of the hamstring tendons. Hamstring tendons of 21 human cadavers (age: 41.9 +/- 13.1 years) were used. A press-fit fixation with looped semitendinosus and gracilis tendons secured by a tape (T) over a bone bridge, or by a baseball-stitched suture (S), was compared with degradable interference screw fixation (I) in 21 porcine tibiae. The constructs were cyclically strained and subsequently loaded to failure. The maximum load to failure, stiffness, and elongation during cyclical loading were measured. The maximum load to failure was highest for the T-fixation at 970 +/- 83 N, followed by the I-fixation with 544 +/- 109 N, and the S-fixation with 402 +/- 78 N (P < 0.03). Stiffness of the constructs averaged 78 +/- 13 N/mm for T, 108 +/- 18 N/mm for S, and 162 +/- 27 N/mm for I (P < 0.03). Elongation during initial cyclical loading was 2.0 +/- 0.6 mm for T, 3.3 +/- 1.1 mm for S, and 1.4 +/- 0.5 mm for I (S inferior to I and T, P<0.05). Elongation between the 20th and 1,500th loading cycle was lower for T (2.2 +/- 0.7 mm) compared with I (4.1 +/- 2.7 mm) and S (4.8 +/- 0.7 mm; P < 0.001). The T-fixation technique exhibited a significantly higher failure load than the S-, and I- techniques. All techniques exhibited larger elongation during initial cyclical loading than is reported in the literature for grafts with bone blocks. Only one technique (T) showed satisfactory elongation behavior during long-term cyclic loading. Interference screw fixation demonstrated significantly higher stiffness. Only one of the investigated techniques (T) seemed to exhibit adequate mechanical properties necessary for early aggressive rehabilitation programs.

Adolescent↗

Increased bone turnover as reflected by biochemical markers in patients with potentially unstable fixation of the tibial component.

INTRODUCTION: Whether biochemical markers of bone metabolism can be used in assessing the conditions of implant fixation is unknown. In this study, the serum levels of three bone markers were measured prospectively in patients undergoing total knee arthroplasty (TKA) to determine if patients with different fixation conditions of the tibial component showed any differences in the levels of the markers. MATERIALS AND METHODS: The fixation of the tibial component in 40 knees (40 patients, 14 male and 26 female, average age 71 years) was assessed by radiostereometric analysis (RSA), and based upon the pattern of migration, implants with stable fixation ( n=25) and potentially unstable fixation ( n=15) were identified. Serum levels of carboxyterminal propeptide of type I procollagen (PICP), osteocalcin (OC) and cross-linked carboxyterminal telopeptide of type I collagen (ICTP) were assessed and compared between the two fixation groups. Blood samples were obtained preoperatively (baseline) and repeated postoperatively at 1 week, 3, 6, 12, and 24 months. RESULTS: The baseline levels of the markers were statistically the same ( p>0.05) between the two fixation groups. Postoperatively, ICTP levels in the unstable group were significantly higher than in the stable group from 6 to 24 months ( p=0.02). Levels of OC in the unstable group were higher at 12 and 24 months compared with the stable group, reaching statistical significance only at 12 months ( p=0.03). No difference in the levels of PICP was found between the two groups. CONCLUSION: The findings indicate a more active bone turnover probably at the bone-cement/implant interface in knees with potentially unstable fixation. It reveals the potential value for biochemical markers in monitoring implant fixation and aseptic loosening and suggests a possibility for improving implant fixation by drugs which inhibit osteolysis.

Aged↗

Primary stability of hamstring graft fixation with biodegradable suspension versus interference screws.

PURPOSE: During the early postoperative period, the stability of the fixation of a hamstring graft to the bone tunnel is the primary factor in limiting rehabilitation. The aim of this study was to evaluate if the initial fixation strength of a new suspension screw is comparable to that of the biodegradable interference screw fixation technique in the hamstring reconstruction of the anterior cruciate ligament (ACL). TYPE OF STUDY: Experimental laboratory study. METHODS: We evaluated the initial fixation strength of a biodegradable poly-L-lactide/tri-calcium phosphate (PLLA/TCP) screw that suspended the graft in the bone tunnel and compared it with the strength of an interference screw for fixation of hamstring grafts in ACL reconstruction using bovine knees. Single-cycle and cyclic loading tests were performed using a materials testing machine. RESULTS: The suspension screw provided a significantly higher yield load and ultimate failure load than the interference screw. There was no significant difference in the stiffness of both techniques. The typical failure mode for the suspension screw was fracture of the screw and for the interference screw it was slippage of the graft past the screw. In cyclic testing, both methods of fixation ran out to 1,000 cycles up to 250 N with a mean displacement of 2.6 mm (range, 1.8 to 3.3 mm) for the suspension screw and 4.1 mm (range, 2.3 to 6.0 mm) for the interference screw. Only the grafts fixed with the suspension screw survived a protocol with 1,000 cycles up to 400 N. CONCLUSIONS: Our biomechanical data suggest that hamstring graft fixation using a biodegradable PLLA/TCP suspension screw provides an alternative to interference screw fixation. CLINICAL RELEVANCE: Hamstring graft fixation using a suspension screw provides a reasonable alternative to interference screw fixation.

Absorbable Implants↗

Relationship of proximal fixation to postoperative renal dysfunction in patients with normal serum creatinine concentration.

OBJECTIVES: This study was performed to determine whether there is deterioration in renal function during follow-up in patients who have undergone endovascular aneurysm repair (EVAR), as recommended by the device manufacturers; to determine whether suprarenal fixation correlates with impairment of renal function; and to explore the potential implication of life-long surveillance of renal function with contrast-enhanced computed tomography. METHODS: One hundred forty-six consecutive patients underwent EVAR at our institution. Data from 113 of these patients who were free from preoperative renal insufficiency or postoperative renal disease were analyzed. Fifty-three patients received infrarenal (IR) fixation devices, and 60 patients received suprarenal (SR) fixation devices. All SR fixation devices were placed under investigational device exemption protocols. The average follow-up was 688 days. Sixty-five consecutive patients who had undergone open repair of an abdominal aortic aneurysm (AAA) served as the control group. RESULTS: Preoperative creatinine concentration, intraoperative blood loss, contrast volume, and number of contrast-enhanced procedures were not significantly different between the IR and SR groups. Two renal artery occlusions (1 SR, 1 IR; P=NS) were identified, and 8 renal infarcts (5 SR, 3 IR; P=NS). There was an increase in mean creatinine concentration in the open AAA, IR, and SR fixation groups at each time point in the analysis. Mean elevation in creatinine concentration at 12, 24, and 36 months was 0.10, 0.10, and 0.04 mg/dL, respectively, for open AAA repair; 0.20, 0.21, and 0.28 mg/dL for IR fixation; and 0.15, 0.21, and 0.12 mg/dL for SR fixation. At life table analysis, renal impairment at 36 months was seen in 36% +/- 9% of patients in the IR group, 25% +/- % of patients in the SR group, and 19% +/- 6% of patients in the open AAA group (P=.04 for IR fixation vs open AAA repair). CONCLUSIONS: A decrease in kidney function is seen after EVAR, regardless of fixation level, that is independent of renal disease and renal arterial occlusion. In patients with normal renal function the site of proximal fixation does not affect postoperative creatinine concentration. The decrease in renal function is likely related to the repetitive administration of contrast agent.

Aged↗

Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery.

Between 1940 and 1975, 86 patients with malrotation of the intestine leading to intestinal obstruction or volvulus were treated at the University Children's Hospital of Zürich. All case histories and radiograms have been examined and a questionnaire has been sent to all surviving patients. Forty-four of them were reexamined personally 3 to 37 yr later. The study was undertaken to find out whether at the time of correction of intestinal malrotation simultaneous additional fixation of the mesentery had any value. Six of the 86 patients were successfully treated nonoperatively and 3 died before surgery of other severe malformations. Of the remaining 77 children who underwent surgery, additional fixation was done in 28 of the earlier cases, but not done in 49 of the later cases. The percentage of early survivors was 85.7% in the group with intestinal fixation and 83.7% in the group without fixation. The number of reoperations was slightly lower in the group without fixation (10.4%) when compared to the group with fixation (16.6%). 25% of the children with intestinal fixation and 21% of the children without fixation had occasionally slight abdominal symptoms at a later time. These results demonstrate that intestinal fixation neither increased the number of early survivors nor reduced the number of reoperations, nor the percentage of children with abdominal complaints. It was therefore concluded that additional fixation after correction of intestinal malrotations was of no benefit and unnecessary.

Adolescent↗