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PubMed1996

Human head-neck biomechanics under axial tension.

A significant majority of cervical spine biomechanics studies has applied the external loading in the form of compressive force vectors. In contrast, there is a paucity of data on the tensile loading of the neck structure. These data are important as the human neck not only resists compression but also has to withstand distraction due to factors such as the anatomical characteristics and loading asymmetry. Furthermore, evidence exists implicating tensile stresses to be a mechanism of cervical spinal cord injury. Recent advancements in vehicular restraint systems such as air bags may induce tension to the neck in adverse circumstances. Consequently, this study was designed to develop experimental methodologies to determine the biomechanics of the human cervical spinal structures under distractive forces. A part-to-whole approach was used in the study. Four experimental models from 15 unembalmed human cadavers were used to demonstrate the feasibility of the methodology. Structures included isolated cervical spinal cords, intervertebral disc units, skull to T3 preparations, and intact unembalmed human cadavers. Axial tensile forces were applied, and the failure load and distraction were recorded. Stiffness and energy absorbing characteristics were computed. Maximum forces for the spinal cord specimens were the lowest (278 N +/- 90). The forces increased for the intervertebral disc (569 N +/- 54). skull to T3 (1555 N +/- 459), and intact human cadaver (3373 N +/- 464) preparations, indicating the load-carrying capacities when additional components are included to the experimental model. The experimental methodologies outlined in the present study provide a basis for further investigation into the mechanism of injury and the clinical applicability of biomechanical parameters.

Adult↗
PubMed2001

A cross-validation of the biphasic poroviscoelastic model of articular cartilage in unconfined compression, indentation, and confined compression.

The biphasic poroviscoelastic (BPVE) model was curve fit to the simultaneous relaxation of reaction force and lateral displacement exhibited by articular cartilage in unconfined compression (n=18). Model predictions were also made for the relaxation observed in reaction force during indentation with a porous plane-ended metal indenter (n=4), indentation with a nonporous plane ended metal indenter (n=4), and during confined compression (n=4). Each prediction was made using material parameters resulting from curve fits of the unconfined compression response of the same tissue. The BPVE model was able to account for both the reaction force and the lateral displacement during unconfined compression very well. Furthermore, model predictions for both indentation and confined compression also followed the experimental data well. These results provide substantial evidence for the efficacy of the biphasic poroviscoelastic model for articular cartilage, as no successful cross-validation of a model simulation has been demonstrated using other mathematical models.

Animals↗
PubMedDate not supplied

The degree of neointimal formation after stent placement in atherosclerotic rabbit iliac arteries is dependent on the underlying plaque.

The purpose of this study was to determine the effects of stent placement on the underlying arterial morphology and the relations of stent-vessel wall interactions with subsequent neointimal formation in an atherosclerotic artery. Seven New Zealand White rabbits with experimentally induced atherosclerosis underwent balloon angioplasty (n = 7) and stent placement after balloon angioplasty (n = 7) in the iliac arteries. Histologic analysis of the treated arteries was performed at 28 days to assess device interactions with the artery and the pattern of the neointimal response. The area within the external elastic lamina of the stented vessels was 66% greater than the arteries with balloon angioplasty alone (p = 0.001) which contributed to a significantly greater late lumen area (3.33 +/- 0.51 mm2 versus 1.33 +/- 0.20 mm2, p = 0.0028). Neointimal thickness was measured at 220 stent wire sites from 21 sections of stented arteries of which 139 (63%) had underlying plaque and 81 (37%) were adjacent to normal media. Rupture of the internal elastic lamina (IEL) occurred at only 9 (11%) of the 81 stent wire sites over normal media. The mean neointimal thickness was 0.16 +/- 0.01 mm lor all stent wire sites. The neointimal thickness was greater at the stent wire sites with underlying plaque (0.23 +/- 0.01 min) than at the stent wire sites adjacent to normal media (0.08 +/- 0.01 mm) or at sites with rupture of the internal elastic lamina (0.16 +/- 0.02 mm, p = 0.0001). The degree of neointimal formation within the stents strongly correlated with the area of the underlying atherosclerotic plaque (r = 0.76, p = 0.0007) and the extent of plaque or medial compression by the struts (r = 0.90, p = 0.006). The present study characterizes stent interactions in a model commonly employed to evaluate novel therapies for the prevention of restenosis. The neointimal response was influenced by the local arterial morphology and correlated with the extent of plaque or medial compression by the stent. These data may be useful for future studies in this model and understanding the mechanism of in-stent restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1987

Light and electron microscopic evaluation of hydrogen ion-induced brain necrosis.

Excessive accumulation of hydrogen ions in the brain may play a pivotal role in initiating the necrosis seen in infarction and following hyperglycemic augmentation of ischemic brain damage. To examine possible mechanisms involved in hydrogen ion-induced necrosis, sequential structural changes in rat brain were examined following intracortical injection of sodium lactate solution (pH 4.5), as compared with injections at pH 7.3. Following pH 7.3 injection, neuronal swelling developed between 1 and 6 h, but only a needle track wound surrounded by a thin rim of necrotic neurons and vacuolated neuropil was present 24 h after injection. In contrast, pH 4.5 injection produced neuronal necrosis as soon as 1 h after injection, followed by necrosis of astrocytes and intravascular thrombi at 3 and 6 h. Alterations common to both groups included vascular permeability to horseradish peroxidase, dilation of extracellular spaces, astrocyte swelling, capillary compression, and vascular stasis. These data suggest that neurons, astrocytes, and endothelia can be directly damaged by increased acid in the interstitial space. Lethal injury initially appeared to affect neurons, while subsequent astrocyte necrosis and vascular occlusion may damage tissue by secondary ischemia.

Animals↗
PubMed2003

Correlation between optic disc atrophy and aetiology: anterior ischaemic optic neuropathy vs optic neuritis.

BACKGROUND: The morphologic features of swollen disc in the acute stage of optic neuritis and anterior ischaemic optic neuropathy (AION) have been extensively investigated in contrast to the morphologic features of optic disc atrophy after these events. OBJECTIVE: : A prospective study to evaluate the morphologic features of optic disc atrophy 6 months or more after optic neuritis and nonarteritic AION. PATIENTS AND METHODS: A total of 35 optic discs after nonarteritic AION (n=27) and 24 after optic neuritis (n=19) in otherwise healthy subjects have been evaluated by direct fundoscopic examination with a +90 diopters lens and optic disc photography. The average age of patients at the onset of AION was 57.8 years (range: 38-80) and at the onset of optic neuritis was 32.6 (range: 19-46). The female:male ratio was 18 : 17 in the former and 15 : 9 in the latter. The evaluated parameters included: degree of rim pallor (0 to +3), location of rim pallor, height of rim above the retina, depth and width of cup, peripapillary retinal artery to vein (A : V) ratio, and peripapillary pigment epithelial atrophy. A comparison was made also with 17 age-matched normal discs of 17 patients. Statistical significance was calculated with chi(2) and Fisher's exact test. RESULTS: Most of the discs after AION were paler (+2: 70%, +3: 26%) than after optic neuritis (normal colour: 8%, +1: 58%, P< or =0.007). Rim segmental involvement after AION was usually either superior 'altitudinal' (53%) or inferior 'altitudinal' (29%), whereas after optic neuritis, it was usually either temporal-central (papillomacular) (42%) or diffuse temporal (42%, P<0.0001). Discs had lower A : V ratio (1 : 3, 40%) after AION compared with optic neuritis (1 : 3, 8%) (P=0.007). There were no significant differences between the two groups in height of the rim, cupping, and peripapillary atrophy. CONCLUSIONS: : A combination of the degree of rim pallor, location of rim pallor, and A : V ratio may be of value in assessing the aetiology of optic disc atrophy when no previous clinical data are available and a compressive lesion has been ruled out.

Acute Disease↗
PubMed1981

The effect of word list and talker variation on word recognition scores using time-altered speech.

Time-altered versions of the Auditec recordings of CID W-22 and Northwestern Auditory Test No. 6 (NU-6) were compared at five time-compressed ratios (0%, 30%, 40%, 50%, and 60%) on twenty-eight normal-hearing listeners. NU-6 scores were consistently poorer than the W-22's, with significant differences observed at the 30% and 60% time-compressed conditions. The NU-6 data in this investigation were also compared with previously reported normative data, which used a different recorded version of NU-6. The scores from this study were found to be markedly poorer. Clinical implications are discussed.

Adolescent↗
PubMed2006

The RIONI study rationale and design: validation of the first stored electrograms transmitted via home monitoring in patients with implantable defibrillators.

Appropriate and inappropriate therapies of implantable cardioverter defibrillators (ICDs) have a major impact on morbidity and quality of life in ICD recipients. The recently introduced home monitoring of ICD devices is a promising new technique which remotely offers information about the status of the system. Stored intracardiac electrograms (IEGMs), which are essential for correct classification of appropriate and inappropriate ICD discharges, have until now not been available with ICD home monitoring on a day-by-day basis because of limitations of transferable data. We demonstrate the first compressed IEGMs daily transferable via home monitoring (IEGM-online). Validation of these electrograms will be performed in the Reliability of IEGM-Online Interpretation (RIONI) study. A total of 210 episodes of stored IEGMs will be collected by at least 12 European centres. The primary endpoint of this study is to investigate whether the IEGM-online based evaluation of the appropriateness of the ICDs therapeutic decision following episode detection is equivalent to the evaluation based on the complete ICD episode Holter extracted from the IEGM stored. The evaluation is independently done by an expert board of three experienced ICD investigators. The equivalence of the two methods is accepted if the evaluations yield a different conclusion for <10% of all evaluated IEGMs. The conclusion of the study is expected at the beginning of 2007. If RIONI successfully validates IEGMs transmitted via home monitoring, a strong basis for the use of this promising technique will be established.

Death, Sudden, Cardiac↗
PubMed1998

Digital echocardiography.

Continued improvement in the computer price-to-performance ratio and the adoption of international standards have enhanced the feasibility of completely digital echocardiographic laboratories that were initially described more than a decade ago. Digital archival has distinct advantages over analog recording, including improved laboratory efficiency, capability of side-by-side comparison of current and historical studies, streamlined image storage, and enhanced interinstitution image transfer. Studies have demonstrated that clinical and electronic image compression allows efficient storage of data, without affecting diagnostic accuracy. Finally, digital echocardiography has important telemedicine applications.

Echocardiography↗
PubMed2004

Surgical timing in orbital fracture treatment: experience with 108 consecutive cases.

Orbital fractures can lead to esthetic deformities and functional impairments, and adequate surgical timing is considered important in obtaining good results from surgery. By means of chart review, a retrospective analysis was carried out in 108 consecutive cases of pure orbital fractures to investigate the differences in surgical timing and the correlations with patient age and clinical and radiographic findings. In this analysis, surgical timing of pure orbital fractures was strongly related to the combination of parameters such as anatomical location of the fracture, eventual exposure of the fracture, cerebrospinal fluid (CSF) leakage or penetrating wounds, age of patients, eventual functional impairments or muscle entrapment, and serious conditions of compression or ischemia. As the data confirmed, an urgent approach was considered indispensable in severe orbital apex fractures and in orbital fractures with CSF leakage, penetrating objects, or exposure. Early surgery was necessary within 3 days in children with diplopia (type IIIb) and mainly within 7 days in adults with double vision (type IIIa). Delayed surgery, within 12 days in all cases, was performed orbital wall fractures with no impairments (type II) or in orbital rim fractures (type I). Data from this retrospective analysis confirm the need for an aggressive approach to all orbital fractures. In our experience, surgery was performed within 12 days and most orbital fractures were treated during the first week after trauma, which is earlier than previously reported.

Adolescent↗
PubMedDate not supplied

PC-based multiparameter full-color display for tissue segmentation in MRI of adnexal masses.

OBJECTIVE: Our purpose was to apply full-color composite generation methods to multiparameter MRI to assess the ability of the technique to quantitatively segment clinically important anatomic and pathologic tissues. MATERIALS AND METHODS: With use of a personal computer with a 386 microprocessor and full-color (24 bit) graphics display capabilities, custom and commercially available image-processing softwares were applied to spatially aligned multiparameter SE MR image sets obtained from six patients undergoing diagnostic work-up for suspected adnexal or pelvic masses to generate intensity-based color composites. To quantitatively assess the ability of this technique to differentially segment anatomically and pathologically confirmed tissue types into unique color regions within the full-color spectrum, color image analysis was performed on the multiparameter color composites within each patient case, and the results were compared using 95% confidence intervals. RESULTS: Based on the results of pathologic correlation and color image analysis, the generation of full-color composites represents a feasible technique for compressing the diverse tissue contrast data present in multiparameter MR images of adnexal masses. CONCLUSION: With this technique, it is possible to generate composites that simultaneously display uniquely color-coded anatomic and pathologic tissue information within the context of partially natural-appearing images.

Adnexal Diseases↗
PubMed1999

Hearing preservation in microvascular decompression for trigeminal neuralgia.

OBJECTIVE/HYPOTHESIS: Sensorineural hearing loss is a disturbing complication of microvascular decompression (MVD) for trigeminal neuralgia with an incidence of 1% to 23.8%. Cerebellar retraction with increasing I-V interpeak latency (IPL) during intraoperative brainstem auditory evoked potentials (BAEP) has been identified as the chief cause of acoustic injury. This study was designed to eliminate cerebellar retraction by a modification of the standard suboccipital craniectomy. STUDY DESIGN: Nine consecutive patients undergoing surgery for trigeminal neuralgia were prospectively selected for this study between 1994 and 1995. METHODS: Preoperative and postoperative audiograms were obtained. Preoperative and intraoperative BAEPs were performed. The surgical modification describes initiating a partial mastoidectomy to enhance early recognition and delineation of the sigmoid and transverse sinuses crucial to maximizing the lateral extent of the craniectomy. The additional exposure gained by this technique allows for improved visualization of the brainstem without cerebellar retraction. RESULTS: All patients were relieved of neuralgic pain. Postoperative IPL values were not significantly different from preoperative values (4.9+/-0.6 vs. 4.7+/-0.3 ms). Maintaining IPL of less than 1.5 ms is considered critical for preventing injury to the auditory nerve. In this study the average increase in postoperative IPL was 0.25 ms for the ipsilateral ear and 0.1 ms for the contralateral ear. CONCLUSIONS: The authors offer a surgical modification of the standard suboccipital craniectomy and furnish intraoperative neurophysiologic data to demonstrate how cerebellar compression can be eliminated and hearing preserved in MVD for trigeminal neuralgia.

Adult↗
PubMed1998

Effect of the pedicle and posterior arch on vertebral body strength predictions in finite element modeling.

STUDY DESIGN: A finite element study to predict the contribution of the pedicles and the posterior arch to vertebral body strength. OBJECTIVE: To determine the effect of the pedicle and posterior arch on strain distributions occurring within the vertebral body under axial compressive loading. SUMMARY OF BACKGROUND DATA: Posterior vertebral body fracture can arise from high-impact or normal loading in bones compromised by osteoporosis or neoplasm and can result in spinal canal encroachment. Anatomically, the pedicles and posterior arch have a potential role as a structural buttress to the posterior vertebral body wall. However, most finite element models used to investigate vertebral body strength have neglected these structures. METHODS: Three 3-dimensional finite element models were developed of L1, incorporating anatomic curvature, with varying degrees of posterior element inclusion (no pedicle, pedicle, and pedicle and posterior arch). Three cases were analyzed with each model: 25% dehydrated disc, normal healthy disc, and uniform pressure loading. Outcome variables were the maximum von Mises strains and the displacement of the posterior wall into the spinal canal. RESULTS: Inclusion of the posterior arch resulted in substantial decreases in maximum strain and posterior wall displacement under all loading configurations using transversely isotropic trabecular bone properties. No changes in maximum strains or displacements were recorded in the pedicle model, compared with that observed in the no-pedicle baseline case. CONCLUSIONS: The pedicle functions as a structural buttress, providing support to the posterior wall of the vertebral body when constrained through the posterior arch. To yield more accurate vertebral body strength predictions from finite element modeling, the posterior arch should be included.

Biomechanical Phenomena↗
PubMedDate not supplied

Adaptive extraction of time-varying isosurfaces.

We present an algorithm for adaptively extracting and rendering isosurfaces from compressed time-varying volume data sets. Tetrahedral meshes defined by longest edge bisection are used to create a multiresolution representation of the volume in the spatial domain that is adapted over time to approximate the time-varying volume. The reextraction of the isosurface at each time step is accelerated with the vertex programming capabilities of modern graphics hardware. A data layout scheme which follows the access pattern indicated by mesh refinement is used to access the volume in a spatially and temporally coherent manner. This data layout scheme allows our algorithm to be used for out-of-core visualization.

Journal Article↗
PubMedDate not supplied

High-resolution fluorodeoxyglucose positron emission tomography with compression ("positron emission mammography") is highly accurate in depicting primary breast cancer.

We sought to prospectively assess the diagnostic performance of a high-resolution positron emission tomography (PET) scanner using mild breast compression (positron emission mammography [PEM]). Data were collected on concomitant medical conditions to assess potential confounding factors. At four centers, 94 consecutive women with known breast cancer or suspicious breast lesions received 18F-fluorodeoxyglucose (FDG) intravenously, followed by PEM scans. Readers were provided clinical histories and x-ray mammograms (when available). After excluding inevaluable cases and two cases of lymphoma, PEM readings were correlated with histopathology for 92 lesions in 77 women: 77 index lesions (42 malignant), 3 ipsilateral lesions (3 malignant), and 12 contralateral lesions (3 malignant). Of 48 cancers, 16 (33%) were clinically evident; 11 (23%) were ductal carcinoma in situ (DCIS), and 37 (77%) were invasive (30 ductal, 4 lobular, and 3 mixed; median size 21 mm). PEM depicted 10 of 11 (91%) DCIS and 33 of 37 (89%) invasive cancers. PEM was positive in 1 of 2 T1a tumors, 4 of 6 T1b tumors, 7 of 7 T1c tumors, and 4 of 4 cases where tumor size was not available (e.g., no surgical follow-up). PEM sensitivity for detecting cancer was 90%, specificity 86%, positive predictive value (PPV) 88%, negative predictive value (NPV) 88%, accuracy 88%, and area under the receiver-operating characteristic curve (Az) 0.918. In three patients, cancer foci were identified only on PEM, significantly changing patient management. Excluding eight diabetic subjects and eight subjects whose lesions were characterized as clearly benign with conventional imaging, PEM sensitivity was 91%, specificity 93%, PPV 95%, NPV 88%, accuracy 92%, and Az 0.949 when interpreted with mammographic and clinical findings. FDG PEM has high diagnostic accuracy for breast lesions, including DCIS.

Adult↗
PubMedDate not supplied

Possible reasons for the variability of human responses to IAC-CPR.

OBJECTIVE: To propose reasons for the variability of the hemodynamic responses and survival data observed when interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is performed on humans in cardiac arrest. METHODS: Critical content review of all studies performed in the United States examining IAC-CPR in humans and of selected animal studies addressing hemodynamic mechanisms of CPR. Articles in the English language dealing with human IAC-CPR studies from 1970-1993 were retrieved using the MEDLINE database of the National Library of Medicine. RESULTS: IAC-CPR does not consistently improve coronary perfusion pressure (CPP) over standard CPR in humans and is capable of decreasing as well as increasing CPP. This variability does not seem dependent on the manner in which abdominal compressions are performed. Because of the limited response to standard CPR, significant increases in return of spontaneous circulation would be expected with IAC-CPR if a large percentage of patients were to have favorable increases in CPP. However, other patients may be adversely affected by decreases in CPP during IAC-CPR, with unsuccessful resuscitation of those individuals. Return of spontaneous circulation also may be enhanced using IAC-CPR due to other factors reflected in the initial arrest rhythm and in arrest-population demographics. CONCLUSION: IAC-CPR should not be recommended for routine use until the mechanism of its beneficial effects is known and until those patients who are likely to benefit from the technique can be better identified.

Abdomen↗
PubMed1986

The shape of the nonlinearity generating the combination tone 2f1-f2.

If the level behavior of the cubic difference tone is explained by a static nonlinear characteristic, the correspondence between this characteristic and certain components and quantities of the basilar membrane must be clarified. This is attempted here for a nonlinearity compatible with the idea of an active undamping feedback mechanism saturating at high levels. The relation between asymptotic behavior of the nonlinearity and the measured CDT level dependence is established. Agreement with psychoacoustic data requires a very "softly" compressing characteristic; linear or logarithmic asymptotes are ruled out. The psychoacoustically known level dependence is well reproduced for small primary-frequency differences by cancellation experiments with a digitally simulated basilar-membrane model.

Auditory Perception↗
PubMed1989

Models of the additivity of masking.

Three models of masking additivity are reviewed, which are referred to as the high-compression model [M. J. Penner, J. Acoust. Soc. Am. 67, 608-616 (1980); M. J. Penner and R. M. Shiffrin, J. Acoust. Soc. Am. 67, 617-627 (1980)], the power-law model [R. A. Lutfi, J. Acoust. Soc. Am. 73, 262-267 (1983); 80, 422-428 (1986)], and the modified power-law model with compressed internal noise [Humes et al., J. Acoust. Soc. Am. 83, 188-202 (1988)]. While the high-compression model was derived from data for two or more nonsimultaneous maskers and the power-law model was derived from data for two or more simultaneous maskers, the modified power-law model can be applied to both cases. The modified power-law model assumes that the threshold in quiet is equivalent to a masked threshold resulting from an internal noise that is continually present. Additional assumptions concern the interaction of two maskers prior to the addition of the masking effects. Most of the data on the additivity of masking are well described by the modified power-law model, regardless of the nature of the maskers. Thus the model provides a good description of data for combined simultaneous maskers and combined nonsimultaneous maskers, a task heretofore requiring the use of at least two separate and independently developed models.

Auditory Threshold↗
PubMed1997

Melting of (Mg,Fe)2SiO4 at the Core-Mantle Boundary of the Earth

The lower mantle of the Earth is believed to be largely composed of (Mg,Fe)O (magnesiowustite) and (Mg,Fe)SiO3 (perovskite). Radiative temperatures of single-crystal olivine [(Mg0.9,Fe0.1)2SiO4] decreased abruptly from 7040 +/- 315 to 4300 +/- 270 kelvin upon shock compression above 80 gigapascals. The data indicate that an upper bound to the solidus of the magnesiowustite and perovskite assemblage at 4300 +/- 270 kelvin is 130 +/- 3 gigapascals. These conditions correspond to those for partial melting at the base of the mantle, as has been suggested occurs within the ultralow-velocity zone beneath the central Pacific.

Journal Article↗