Spatial and temporal dynamics of HDACs class IIa following mild traumatic brain injury in adult rats.

The fundamental role of epigenetic regulatory mechanisms involved in neuroplasticity and adaptive responses to traumatic brain injury (TBI) is gaining increased recognition. TBI-induced neurodegeneration is associated with several changes in the expression-activity of various epigenetic regulatory enzymes, including histone deacetylases (HDACs). In this study, PET/CT with 6-([18F]trifluoroacetamido)-1- hexanoicanilide ([18F]TFAHA) to image spatial and temporal dynamics of HDACs class IIa expression-activity in brains of adult rats subjected to a weight drop model of diffuse, non-penetrating, mild traumatic brain injury (mTBI). The mTBI model was validated by histopathological and immunohistochemical analyses of brain tissue sections for localization and magnitude of expression of heat-shock protein-70 kDa (HSP70), amyloid precursor protein (APP), cannabinoid receptor-2 (CB2), ionized calcium-binding adapter protein-1 (IBA1), histone deacetylase-4 and -5 (HDAC4 and HDAC5). In comparison to baseline, the expression-activities of HDAC4 and HDAC5 were downregulated in the hippocampus, nucleus accumbens, peri-3rd ventricular part of the thalamus, and substantia nigra at 1-3 days post mTBI, and remained low at 7-8 days post mTBI. Reduced levels of HDAC4 and HDAC5 expression observed in neurons of these brain regions post mTBI were associated with the reduced nuclear and neuropil levels of HDAC4 and HDAC5 with the shift to perinuclear localization of these enzymes. These results support the rationale for the development of therapeutic strategies to upregulate expression-activity of HDACs class IIa post-TBI. PET/CT (MRI) with [18F]TFAHA can facilitate the development and clinical translation of unique therapeutic approaches to upregulate the expression and activity of HDACs class IIa enzymes in the brain after TBI.

Whole Body PMHS Response in Injurious Experimental Accelerative Loading Events.

Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative loading intended to reproduce seat and floor velocity histories occurring in under-body blast (UBB) events (e.g.,. References 10, 11, 21 These previous studies employed loading conditions that only rarely produced injuries to the foot/ankle and pelvis, which are body regions of interest for injury assessment in staged UBB testing using anthropomorphic test devices. To investigate more injurious whole-body conditions, three series of tests were conducted with PMHS that were equipped with military personal protective equipment and seated in an upright posture. These tests used higher velocity and shorter duration floor and seat inputs than were previously used with the goal of producing pelvis and foot/ankle fractures. A total of nine PMHS that were approximately midsize in stature and mass were equally allocated across three loading conditions, including a 15.5 m/s, 2.5 ms time-to-peak (TTP) floor velocity pulse with a 10 m/s, 7.5 ms TTP seat pulse; a 13 m/s, 2.5 ms TTP floor pulse with a 9.0 m/s, 5 ms TTP seat pulse; and a 10 m/s, 2.5 ms TTP floor pulse with a 6.5 m/s, 7.5 ms TTP seat pulse. In the first two conditions, the seat was padded with a ~ 120-mm-thick foam cushion to elongate the pulse experienced by the PMHS. Of the nine PMHS tests, five resulted in pelvic ring fractures, five resulted in a total of eight foot/ankle fractures (i.e., two unilateral and three bilateral fractures), and one produced a femur fracture. Test results were used to develop corridors describing the variability in kinematics and in forces applied to the feet, forces applied to the pelvis and buttocks in rigid seat tests, and in forces applied to the seat foam in padded seat tests. These corridors and the body-region specific injury/no-injury response data can be used to assess the performance and predictive capability of anthropomorphic test devices and computational models used as human surrogates in simulated UBB testing.

Dynamic Response of the Thoracolumbar and Sacral Spine to Simulated Underbody Blast Loading in Whole Body Post Mortem Human Subject Tests.

Fourteen simulated underbody blast impact sled tests were performed using a horizontal deceleration sled with the aim of evaluating the dynamic response of the spine in under various conditions. Conditions were characterized by input (peak velocity and time-to-peak velocity for the seat and floor), seat type (rigid or padded) and the presence of personnel protective equipment (PPE). A 50% (T12) and 30% (T8) reduction in the thoracic spine response for the specimens outfitted with PPE was observed. Longer duration seat pulses (55 ms) resulted in a 68-78% reduction in the magnitude of spine responses and a reduction in the injuries at the pelvis, thoracic and lumbar regions when compared to shorter seat pulses (10 ms). The trend analysis for the peak Z (caudal to cranial) acceleration measured along the spine showed a quadratic fit (p < 0.05), rejecting the hypothesis that the magnitude of the acceleration would decrease linearly as the load traveled caudal to cranial through the spine during an Underbody Blast (UBB) event. A UBB event occurs when an explosion beneath a vehicle propels the vehicle and its occupants vertically. Further analysis revealed a relationship (p < 0.01) between peak sacrum acceleration and peak spine accelerations measured at all levels. This study provides an initial analysis of the relationship between input conditions and spine response in a simulated underbody blast environment.

Optimization of Underbody Blast Energy-Attenuating Seat Mechanisms Using Modified MADYMO Human Body Models.

Though energy attenuating (EA) seats for air and spacecraft applications have existed for decades, they have not yet been fully characterized for their energy attenuation capability or resulting effect on occupant protection in vertical underbody blast. EA seats utilize stroking mechanisms to absorb energy and reduce the vertical forces imparted on the occupant's pelvis and lower spine. Using dynamic rigid-body modeling, a virtual tool to determine optimal force and deflection limits was developed to reduce pelvis and lower spine injuries in underbody blast events using a generic seat model. The tool consists of a mathematical dynamic model (MADYMO)-modified human body model (HBM), basic EA seat model, and an optimizing sequence using modefrontier software. This optimizing tool may be shared with EA seat manufacturers and applied to military seat development efforts for EA mechanisms for a given occupant and designated blast severity. To optimally tune the EA seat response, the MADYMO human body model was first updated to improve its fidelity in kinematic response data for high rate vertical accelerative loading relative to experimental data from laboratory simulated underbody blast tests using postmortem human surrogates (PMHS). Subsequently, using available injury criteria for underbody blast, the optimization tool demonstrated the ability to identify successful EA mechanism critical design value configurations to reduce forces and accelerations in the pelvis and lower spine HBM to presumed noninjurious levels. This tool could be tailored by varying input pulses, force and deflection limits, and occupant size to evaluate EA mechanism designs.

Mechanisms and timing of injury to the thoracic, lumbar and sacral spine in simulated underbody blast PMHS impact tests.

During an underbody blast (UBB) event, mounted occupants are exposed to high rate loading of the spine via the pelvis. The objective of this study was to simulate UBB loading conditions and examine mechanisms of injury in the thoracic, lumbar and sacral spine. Fourteen instrumented, whole-body, postmortem human subject (PMHS) experiments were performed using the WSU-decelerative horizontal sled system. The specimens were positioned supine on a decelerative sled, which then impacted an energy absorbing system mounted to a concrete barrier. Variables included the peak velocity and time-to-peak velocity for seat and floor, and the presence or absence of personal protective equipment (PPE) and seat padding. Post-test CT scans and autopsies were performed to identify the presence and severity of injuries. Acceleration and angular rate data collected at vertebra T1, T5, T8, T12, and S1 were used to assess injury timing and mechanisms. Additionally, joint time-frequency analysis (JTFA) of the spinal Z acceleration of the sacrum and vertebrae was developed with the aim of verifying spinal fracture timing. Injuries observed in the spine were attributed to axial compression applied through the pelvis, together with flexion moment due to the offset in the center of gravity of the torso, and are consistent with UBB-induced combat injuries reported in the literature. The injury timing estimation techniques discussed in this study provide a time interval when the fractures are predicted to have occurred. Furthermore, this approach serves as an alternative to the estimation methods using acoustic sensors, force and acceleration traces, and strain gauges.

Investigate the Variations of the Head and Brain Response in a Rodent Head Impact Acceleration Model by Finite Element Modeling.

Diffuse axonal injury (DAI) is a severe form of traumatic brain injury and often induced by blunt trauma. The closed head impact acceleration (IA) model is the most widely used rodent DAI model. However, this model results in large variations of injury severity. Recently, the impact device/system was modified to improve the consistency of the impact energy, but variations of the head kinematics and subsequent brain injuries were still observed. This study was aimed to utilize a Finite Element (FE) model of a rat head/body and simulation to investigate the potential biomechanical factors influencing the impact energy transfer to the head. A detailed FE rat head model containing detailed skull and brain anatomy was developed based on the MRI, microCT and atlas data. The model consists of over 722,000 elements, of which 310,000 are in the brain. The white matter structures consisting of highly aligned axonal fibers were simulated with transversely isotropic material. The rat body was modeled to provide a realistic boundary at the spine-medulla junction. Rodent experiments including dynamic cortical deformation, brain-skull displacement, and IA kinematics were simulated to validate the FE model. The model was then applied to simulate the rat IA experiments. Parametric studies were conducted to investigate the effect of the helmet inclination angles (0°-5°) and skull stiffness (varied 20%) on the resulting head kinematics and maximum principal strain in the brain. The inclination angle of the helmet at 5° could vary head linear acceleration by 8-31%. The change in head rotational velocity was inversely related to the change in linear acceleration. Varying skull stiffness resulted in changes in head linear acceleration by 3% but with no effect on rotational velocity. The brain strain in the corpus callosum was only affected by head rotation while the strain in the brainstem was influenced by the combined head kinematics, local skull deformation, and head-neck position. Validated FE models of rat impact head injury can assist in exploring various biomechanical factors influencing the head impact response and internal brain response. Identification of these variables may help explain the variability of injury severity observed among experiments and across different labs.

Response Ratio Development for Lateral Pendulum Impact with Porcine Thorax and Abdomen Surrogate Equivalents.

There has been recent progress over the past 10 years in research comparing 6-year-old thoracic and abdominal response of pediatric volunteers, pediatric post mortem human subjects (PMHS), animal surrogates, and 6-year-old ATDs. Although progress has been made to guide scaling laws of adult to pediatric thorax and abdomen data for use in ATD design and development of finite element models, further effort is needed, particularly with respect to lateral impacts. The objective of the current study was to use the impact response data of age equivalent swine from Yaek et al. (2018) to assess the validity of scaling laws used to develop lateral impact response corridors from adult porcine surrogate equivalents (PSE) to the 3-year-old, 6-year-old, and 10-year-old for the thorax and abdominal body regions. Lateral impact response corridors were created from 50th adult male PSE pendulum lateral impact T1, T14, and L6 accelerations and pendulum impact force time histories for the thorax and abdomen testing performed. The ISO 9790 scaling technique using length, mass, and elastic modulus scale factor formulas were used in conjunction with measured swine parameters to calculate scale factors for the PSE. In addition to calculation of pertinent test scale factors, response ratios for the pendulum impact tests were calculated. The scaling factors and response ratios determined for the porcine surrogates were compared to the already established ISO human lateral pendulum impact response ratios to determine whether a consistent pattern over the age levels described for the two sets of data (human and swine) exists. The actual lateral impact pendulum data, for both thoracic and abdominal regions, increases in magnitude and time duration from the 3-year-old PSE up to the 50th male PSE. This increase in magnitude and time duration is comparable to the human response corridors developed based on an impulse-momentum analysis and the elastic bending modulus derived from human skull bone. This pattern in the human impact response corridors was observed in the response ratio values and the swine response data. Based on the current study's findings, when utilizing the elastic modulus of human skull bone presented previously in research, thoracic and abdominal lateral pendulum impact response of PSE follows the general scaling laws, based on the impulse-momentum spring-mass model. The thoracic and abdominal lateral pendulum force impact response of PSE also follows the human scaled impact response corridors for lateral pendulum impact testing presented in previous research. The overall findings of the current study confirm, through actual swine testing of appropriate weight porcine surrogates, that scaling laws are applicable from the midsized-male adult down to the 3-year-old age level using human skull elastic modulus values established in previous research.

Side Impact Assessment and Comparison of Appropriate Size and Age Equivalent Porcine Surrogates to Scaled Human Side Impact Response Biofidelity Corridors.

Analysis and validation of current scaling relationships and existing response corridors using animal surrogate test data is valuable, and may lead to the development of new or improved scaling relationships. For this reason, lateral pendulum impact testing of appropriate size cadaveric porcine surrogates of human 3-year-old, 6-year-old, 10-year-old, and 50th percentile male age equivalence, were performed at the thorax and abdomen body regions to compare swine test data to already established human lateral impact response corridors scaled from the 50th percentile human adult male to the pediatric level to establish viability of current scaling laws. Appropriate Porcine Surrogate Equivalents PSE for the human 3-year-old, 6-year-old, 10-year-old, and 50th percentile male, based on whole body mass, were established. A series of lateral impact thorax and abdomen pendulum testing was performed based on previously established scaled lateral impact assessment test protocols. The PSE thorax and abdominal impact response data were assessed against previously established scaled human thorax lateral impact response corridors and scaled abdominal oblique impact response corridors for the 3-year-old, 6-year-old, 10-year-old, and 50th percentile human male based on lateral pendulum impact testing. The overall findings of the current study confirm that lateral impact force response of the thorax and abdomen of appropriate weight porcine surrogates established for human-equivalent-age 3-year-old, 6-year-old, 10-year-old, and 50th adult male are consistent with the previously established human scaled lateral impact response corridors). Porcine surrogate biomechanics testing can prove to be a powerful research means to further characterize and understand injury and response in lateral impact.

Mechanical strain to maxillary incisors during direct laryngoscopy.

BACKGROUND: While most Direct laryngoscopy leads to dental injury in 25-39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP). METHODS: A mannequin head designed to teach and test intubation was instrumented with eight single axis strain gauges placed on the four maxillary incisors: four on the facial or front surface of the incisors and four on the lingual or back, near the insertion of the incisor in the gums to measure bending strain as well as compression. Anesthesiology faculty, residents, and certified registered nurse anesthetists intubated with Macintosh and Miller blades with and without APP. Using strain-time curves, the maximum strain, strain rate, and strain time integral were calculated. RESULTS: Across the 92 subjects, strain varied 8-12 fold between the 25th and 75th percentiles for all four techniques, but little by experience, while strain rate and strain integral varied 6-13 fold and 15-26 fold, respectively, for the same percentiles. Intubators who had high strain values with one blade tended to have high strains with the other blade with and without the APP (all pairwise correlation rho = 0.42-0.63). CONCLUSIONS: Strain varies widely by intubator and that the use of the APP reduces strain rate which may decrease the risk of or the severity of dental injury.

Neuronal Injury and Glial Changes Are Hallmarks of Open Field Blast Exposure in Swine Frontal Lobe.

With the rapid increase in the number of blast induced traumatic brain injuries and associated neuropsychological consequences in veterans returning from the operations in Iraq and Afghanistan, the need to better understand the neuropathological sequelae following exposure to an open field blast exposure is still critical. Although a large body of experimental studies have attempted to address these pathological changes using shock tube models of blast injury, studies directed at understanding changes in a gyrencephalic brain exposed to a true open field blast are limited and thus forms the focus of this study. Anesthetized, male Yucatan swine were subjected to forward facing medium blast overpressure (peak side on overpressure 224-332 kPa; n = 7) or high blast overpressure (peak side on overpressure 350-403 kPa; n = 5) by detonating 3.6 kg of composition-4 charge. Sham animals (n = 5) were subjected to all the conditions without blast exposure. After a 3-day survival period, the brain was harvested and sections from the frontal lobes were processed for histological assessment of neuronal injury and glial reactivity changes. Significant neuronal injury in the form of beta amyloid precursor protein immunoreactive zones in the gray and white matter was observed in the frontal lobe sections from both the blast exposure groups. A significant increase in the number of astrocytes and microglia was also observed in the blast exposed sections compared to sham sections. We postulate that the observed acute injury changes may progress to chronic periods after blast and may contribute to short and long-term neuronal degeneration and glial mediated inflammation.

Quantitative electroencephalography in a swine model of blast-induced brain injury.

OBJECTIVE: Electroencephalography (EEG) was used to examine brain activity abnormalities earlier after blast exposure using a swine model to develop a qEEG data analysis protocol. METHODS: Anaesthetized swine were exposed to 420-450 Kpa blast overpressure and survived for 3 days after blast. EEG recordings were performed at 15 minutes before the blast and 15 minutes, 30 minutes, 2 hours and 1, 2 and 3 days post-blast using surface recording electrodes and a Biopac 4-channel data acquisition system. Off-line quantitative EEG (qEEG) data analysis was performed to determine qEEG changes. RESULTS: Blast induced qEEG changes earlier after blast exposure, including a decrease of mean amplitude (MAMP), an increase of delta band power, a decrease of alpha band root mean square (RMS) and a decrease of 90% spectral edge frequency (SEF90). CONCLUSIONS: This study demonstrated that qEEG is sensitive for cerebral injury. The changes of qEEG earlier after the blast indicate the potential of utilization of multiple parameters of qEEG for diagnosis of blast-induced brain injury. Early detection of blast induced brain injury will allow early screening and assessment of brain abnormalities in soldiers to enable timely therapeutic intervention.

Correlation of mechanical impact responses and biomarker levels: A new model for biomarker evaluation in TBI.

A modified Marmarou impact acceleration model was used to help screen biomarkers to assess brain injury severity. Anesthetized male Sprague-Dawley rats were subjected to a closed head injury from 1.25, 1.75 and 2.25 m drop heights. Linear and angular responses of the head were measured in vivo. 24h after impact, cerebrospinal fluid (CSF) and serum were collected. CSF and serum levels of phosphorylated neurofilament heavy (pNF-H), glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), and amyloid beta (Aß) 1-42 were assessed by enzyme-linked immunosorbent assay (ELISA). Compared to controls, significantly higher CSF and serum pNF-H levels were observed in all impact groups, except between 1.25 m and control in serum. Furthermore, CSF and serum pNF-H levels were significantly different between the impact groups. For GFAP, both CSF and serum levels were significantly higher at 2.25 m compared to 1.75 m, 1.25 m and controls. There was no significant difference in CSF and serum GFAP levels between 1.75 m and 1.25 m, although both groups were significantly higher than control. TBI rats also showed significantly higher levels of IL-6 versus control in both CSF and serum, but no significant difference was observed between each impact group. Levels of Aß were not significantly different between groups. Pearson's correlation analysis showed pNF-H and GFAP levels in CSF and serum had positive correlation with power (rate of impact energy), followed by average linear acceleration and surface righting (p<0.01), which were good predictors for traumatic axonal injury according to histologic assessment in our previous study, suggesting that they are directly related to the injury mechanism. The model used in this study showed a unique ability in elucidating the relationship between biomarker levels and severity of the mechanical trauma to the brain.

Traumatic Brain Injury by a Closed Head Injury Device Induces Cerebral Blood Flow Changes and Microhemorrhages.

OBJECTIVES: Traumatic brain injury is a poly-pathology characterized by changes in the cerebral blood flow, inflammation, diffuse axonal, cellular, and vascular injuries. However, studies related to understanding the temporal changes in the cerebral blood flow following traumatic brain injury extending to sub-acute periods are limited. In addition, knowledge related to microhemorrhages, such as their detection, localization, and temporal progression, is important in the evaluation of traumatic brain injury. MATERIALS AND METHODS: Cerebral blood flow changes and microhemorrhages in male Sprague Dawley rats at 4 h, 24 h, 3 days, and 7 days were assessed following a closed head injury induced by the Marmarou impact acceleration device (2 m height, 450 g brass weight). Cerebral blood flow was measured by arterial spin labeling. Microhemorrhages were assessed by susceptibility-weighted imaging and Prussian blue histology. RESULTS: Traumatic brain injury rats showed reduced regional and global cerebral blood flow at 4 h and 7 days post-injury. Injured rats showed hemorrhagic lesions in the cortex, corpus callosum, hippocampus, and brainstem in susceptibility-weighted imaging. Injured rats also showed Prussian blue reaction products in both the white and gray matter regions up to 7 days after the injury. These lesions were observed in various areas of the cortex, corpus callosum, hippocampus, thalamus, and midbrain. CONCLUSIONS: These results suggest that changes in cerebral blood flow and hemorrhagic lesions can persist for sub-acute periods after the initial traumatic insult in an animal model. In addition, microhemorrhages otherwise not seen by susceptibility-weighted imaging are present in diverse regions of the brain. The combination of altered cerebral blood flow and microhemorrhages can potentially be a source of secondary injury changes following traumatic brain injury and may need to be taken into consideration in the long-term care of these cases.

Acute and subacute effects of the ultrasonic blade and electrosurgery on nerve physiology.

Ultrasonic blades have been shown to cause less acute electrophysiological damage when applied near nerves than monopolar electrosurgery (ES). This study was performed to determine whether the acute nerve damage observed for ES, as well as the relative lack of damage observed for ultrasonic dissection, extends through a subacute timeframe. Muscle incisions were made in rat with the Harmonic(®) Blade (HB) and ES at a distance of 2 mm from the sciatic nerve. Sham surgery was also performed which consisted of similar exposure of the sciatic nerve without use of an energized device. Electrophysiological function was assessed acutely over a 3-h period, and subacutely after a 7-day survival, by monitoring the sciatic nerve compound action potential (CAP), conduction velocity (CV), von Frey hair (VFH) stimulation force, leukocyte infiltration, and impaired axonal transport via ß-amyloid precursor protein (ß-APP) immunocytochemistry. During the acute period, ES produced significantly lower CAP and CV, and higher levels of leukocytes and ß-APP than sham, whereas the ultrasonic blade was not significantly different from sham, and had significantly lower VFH force than ES. After the subacute survival, ES continued to display significantly lower CAP and CV, and higher levels of leukocytes and ß-APP than sham, whereas ultrasonic blade had higher CAP and CV than sham, and lower VFH than ES. This study confirms that incisions made with an ultrasonic blade cause less acute nerve damage than monopolar ES, and are comparable to sham surgery at a distance of 2 mm from the sciatic nerve. The negative effects of electrosurgery extend through at least a 7-day survival period, whereas subacute recovery after application of the ultrasonic blade was comparable to that of sham surgery. For surgical procedures in the vicinity of vital nerves, use of the ultrasonic blade represents a lower risk than ES for both acute and subacute neural trauma.

Blast overpressure induced axonal injury changes in rat brainstem and spinal cord.

INTRODUCTION: Blast induced neurotrauma has been the signature wound in returning soldiers from the ongoing wars in Iraq and Afghanistan. Of importance is understanding the pathomechansim(s) of blast overpressure (OP) induced axonal injury. Although several recent animal models of blast injury indicate the neuronal and axonal injury in various brain regions, animal studies related to axonal injury in the white matter (WM) tracts of cervical spinal cord are limited. OBJECTIVE: The purpose of this study was to assess the extent of axonal injury in WM tracts of cervical spinal cord in male Sprague Dawley rats subjected to a single insult of blast OP. MATERIALS AND METHODS: Sagittal brainstem sections and horizontal cervical spinal cord sections from blast and sham animals were stained by neurofilament light (NF-L) chain and beta amyloid precursor protein immunocytochemistry and observed for axonal injury changes. RESULTS: Observations from this preliminary study demonstrate axonal injury changes in the form of prominent swellings, retraction bulbs, and putative signs of membrane disruptions in the brainstem and cervical spinal cord WM tracts of rats subjected to blast OP. CONCLUSIONS: Prominent axonal injury changes following the blast OP exposure in brainstem and cervical spinal WM tracts underscores the need for careful evaluation of blast induced injury changes and associated symptoms. NF-L immunocytochemistry can be considered as an additional tool to assess the blast OP induced axonal injury.

Evaluation of sciatic nerve function after ultrasonic and electrocautery muscle dissection: an electromyographic study.

BACKGROUND: Minimally invasive surgery has been developed with various innovative surgical tools. Ultrasonic (US) blades have been introduced as an alternative to conventional electrocautery (EC) monopolar device. The purpose of the present study was to evaluate the effects of surgical devices used for muscle dissection close to peripheral nerves on motor nerve function using electromyographic (EMG) recordings. MATERIALS AND METHODS: A total of 24 rats were used in this study. The rats were assigned to the following three groups: Control (n = 8), EC (n = 8), and US (n = 8). A stimulus electrode was placed under the sciatic nerve at a sciatic notch. A pair of recording electrodes was implanted into the midbelly regions of the gastrocnemius muscle. To evoke compound muscle action potentials (CMAPs), 3-V stimuli with 0.3-ms duration were applied to the sciatic nerve at a frequency of 1 Hz. After the recording of the baseline, a monopolar surgical device (EC or US) was applied to cut the muscle 10 mm in length and 2 mm away on both sides of the sciatic nerve. Amplitude and latency of the evoked CMAPs were measured. CMAPs were monitored until 3 hours after the device application. RESULTS: The EC device caused a marked drop in the amplitude of CMAP with no recovery at the end of the experiment. In the US group, the amplitude of CMAP was stable and constant CMAP over 3 hours, similar to the control group could be measured. In all three groups, the latency of CMAP showed no significant changes through the experiment. CONCLUSION: The study showed that the EC device resulted in injury to several motor units in the sciatic nerve. The US device may be a safe tool for muscle dissection around peripheral nerves.

Alerting thresholds for the prevention of intraoperative awareness with explicit recall: a secondary analysis of the Michigan Awareness Control Study.

BACKGROUND: Intraoperative awareness with explicit recall is a potentially devastating complication of surgery that has been attributed to low anaesthetic concentrations in the vast majority of cases. Past studies have proposed the determination of an adequate dose for general anaesthetics that could be used to alert providers of potentially insufficient anaesthesia. However, there have been no systematic analyses of appropriate thresholds to develop population-based alerting algorithms for preventing intraoperative awareness. OBJECTIVE: To identify a threshold for intraoperative alerting that could be applied for the prevention of awareness with explicit recall. DESIGN: Secondary analysis of a randomised controlled trial (Michigan Awareness Control Study). SETTING: Three hospitals at a tertiary care centre in the USA. PATIENTS: Unselected patients presenting for surgery under general anaesthesia. INTERVENTIONS: Alerts based on end-tidal anaesthetic concentration or bispectral index values. MAIN OUTCOME MEASURES: Using case and outcomes data from the primary study, end-tidal anaesthetic concentration and bispectral index values were analysed using Youden's index and c-statistics derived from a receiver operating characteristic curve to determine a specific alerting threshold for the prevention of awareness. RESULTS: No single population-based threshold that maximises sensitivity and specificity could be identified for the prevention of intraoperative awareness, using either anaesthetic concentration or bispectral index values. The c-statistic for anaesthetic concentration was 0.431 ±â€Š0.046, and 0.491 ±â€Š0.056 for bispectral index values. CONCLUSION: We could not derive a single population-based alerting threshold for the prevention of intraoperative awareness using either anaesthetic concentration or bispectral index values. These data indicate a need to move towards individualised alerting strategies in the prevention of intraoperative awareness. TRIAL REGISTRATION: Primary trial registration (Michigan Awareness Control Study) ClinicalTrials.gov identifier: NCT00689091.

An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement.

BACKGROUND: Percutaneous stabilization using three-dimensional (3D) navigation system is a promising treatment for pelvic and acetabular fractures. However, there are still some controversies regarding the use of 3D navigation to treat pelvic and acetabular fractures. The purpose of this study was to compare the Iso-C(3D) fluoroscopic navigation, standard fluoroscopy, and two-dimensional (2D) fluoroscopic navigation in placing percutaneous lag screws in pelvic specimens to better understand the merits of 3D navigation techniques. METHODS: Fifty-four instrumentation procedures were performed in this study using six cadaveric pelvic specimens. Three groups were designated for different procedures and tests: group I, standard fluoroscopy; group II, 2D fluoroscopic navigation; and group III, Iso-C(3D) fluoroscopic navigation. Nine screws were placed in each pelvis, including four screws placed bilaterally through the ilium into S1 and S2 vertebrae, four screws placed bilaterally through anterior and posterior columns of acetabulum, and one screw placed through the pubic symphysis. 3D fluoroscopic techniques were evaluated to determine the accuracy of screw position, instrumentation time, and fluoroscopic time. The data were statistically analyzed using SPSS 13.0. RESULTS: The malposition rate was 38.89%, 22.22%, and 0% in standard fluoroscopy, 2D fluoroscopic navigation, and Iso-C(3D) fluoroscopic navigation groups, respectively. There was no significant difference between standard fluoroscopy and 2D fluoroscopic navigation. Compared with Iso-C(3D) fluoroscopic navigation, there were significant differences (analysis of variance [ANOVA], P < 0.05). The mean instrumentation operating time using Iso-C(3D) fluoroscopic navigation technique was 15.4 ± 4.5 min. There were significant differences compared with standard fluoroscopy (31.5 ± 6.2 min) and 2D fluoroscopic navigation (26.3 ± 7.5 min; ANOVA, post hoc Scheffe, P < 0.01). The mean fluoroscopic time of Iso-C(3D) fluoroscopic navigation was 66 ± 4.8 min. Compared with standard fluoroscopy (132.8 ± 7.3 min) and 2D fluoroscopic navigation (47.7 ± 5.6 min), there were significant differences (ANOVA, post hoc least significant difference, P < 0.01). CONCLUSIONS: In the present study, we compared Iso-C(3D) fluoroscopic navigation, 2D fluoroscopic navigation, and standard fluoroscopy. Iso-C(3D) fluoroscopic navigation showed a higher accuracy rate in positioning and a shorter instrumentation operating time. The fluoroscopic time was longer in Iso-C(3D) fluoroscopic navigation than that in standard fluoroscopy, indicating that radiation exposure can be moderately reduced in Iso-C(3D) fluoroscopic navigation operation, although the fluoroscopic time was the shortest in 2D fluoroscopic navigation.

Magnetic resonance imaging-based relationships between neck muscle cross-sectional area and neck circumference for adults and children.

BACKGROUND: Computer models and human surrogates used to study the forces and motion of the human neck under various loading conditions are based solely on adult data. Pediatric computer models and dummy surrogates used to improve the safety of children could be improved with the inclusion of previously unavailable pediatric muscle data. METHODS: Measurements of neck circumference and neck muscle cross-sectional area (CSA) were taken from ten 50th percentile adult male and ten 10-year old male volunteer subjects. Muscle cross-sectional areas were calculated from magnetic resonance images of axial cross-sections of the neck. RESULTS: Neck muscle cross-sectional area was calculated for six muscles/muscle groups. A power-law regression analysis was used to describe the relationship between neck circumference and neck muscle cross-sectional area. CONCLUSIONS: The cross-sectional area and the power-law functions determined by the data in this study provide a means of calculating muscle cross-sectional area for young children, where such data are currently unavailable. This will provide an opportunity to develop more representative pediatric neck models.