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Effects of compression on the loss of newly synthesized proteoglycans and proteins from cartilage explants.

The effects of mechanical compression of calf cartilage explants on the catabolism and loss into the medium of proteoglycans and proteins radiolabeled with [35S]sulfate and [3H]proline were examined. A single 2- or 12-h compression of 3-mm diameter cartilage disks from a thickness of 1.25 to 0.50 mm, or slow cyclic compression (2 h on/2 h off) from 1.25 mm to 1.00, 0.75, or 0.50 mm for 24 h led to transient alterations and/or sustained increases in loss of radiolabeled macromolecules. The effects of imposing or removing loads were consistent with several compression-induced physical mediators including fluid flow, diffusion, and matrix disruption. Cyclic compression induced convective fluid flow and enhanced the loss of 35S- and 3H-labeled macromolecules from tissue into medium. In contrast, prolonged static compression induced matrix consolidation and appeared to hinder the diffusional transport and loss of 35S- and 3H-labeled macromolecules. Since high amplitude cyclic compression led to a sustained increase in the rate of loss of 3H- and 35S-labeled macromolecules that was accompanied by an increase in the rate of loss of [3H]hydroxyproline residues and an increase in tissue hydration, such compression may have caused disruption of the collagen meshwork. The 35S-labeled proteoglycans lost during such cyclic compression were of smaller average size than those from controls, but contained a similarly low proportion (approximately 15%) that could form aggregates with excess hyaluronate and link protein. The size distribution and aggregability of the remaining tissue proteoglycans and 35S-labeled proteoglycans were not markedly affected. The loss of tissue proteoglycan paralleled the loss of 35S-labeled macromolecules. This study provides a framework for elucidating the biophysical mechanisms involved in the redistribution, catabolism, and loss of macromolecules during cartilage compression.

Animals↗

Interfragmentary compression across a simulated scaphoid fracture--analysis of 3 screws.

PURPOSE: To measure the interfragmentary compression generated across a simulated fracture in cadaveric scaphoids by 3 different headless compression screws. METHODS: A transverse osteotomy was made through the waist of each scaphoid and a load cell to measure compression was interposed between the fragments, which were then fixed internally retrograde with either an Acutrak Standard (n = 10), Acutrak Mini (n = 12), or Bold (n = 10) screw. The surgeon was blinded to the measured compression, which was recorded during screw insertion and for the following 5 minutes. As a measure of scaphoid bone quality the modulus of elasticity of the trabecular bone of each specimen was then calculated from uniaxial compression tests. RESULTS: The mean interfragmentary compression generated by the Acutrak Standard screw was significantly greater and more consistent than the Bold screw or the Acutrak Mini screw. The compression achieved by the Acutrak Standard screw was also more consistent than that obtained by either the Bold or the Acutrak Mini screws as reflected by the lower standard deviation. The mean modulus of elasticity of the scaphoid trabecular bone was similar for each screw group. CONCLUSIONS: The interfragmentary compression generated by the Acutrak Standard screw was significantly greater and more consistent than that generated by either the Bold or Acutrak Mini screws. The compression generated by the Acutrak Standard and Mini screws was significantly better sustained over time than that generated by the Bold screw; however, these differences were small and may not be clinically important. The optimal compression required to promote scaphoid fracture union remains unknown and clinical trials are needed to further evaluate the outcome from using these devices.

Adult↗

Iliac vein compression in an asymptomatic patient population.

OBJECTIVE: May-Thurner syndrome is a well-recognized anatomic variant that is associated with the development of symptomatic acute venous thrombosis of the left iliac vein. However, the natural frequency of compression of the left iliac vein and its clinical significance in asymptomatic disease has not been established. Therefore the purpose of this descriptive anatomic study was to determine the incidence of left common iliac vein compression in an asymptomatic population. METHODS: A retrospective analysis of medical records and helical abdominal computed tomography scans was conducted in 50 consecutive patients evaluated in the emergency department because of abdominal pain. Medical records were reviewed for symptoms and risk factors for deep venous thrombosis, and data were collected and reported according to the Joint Society Reporting Standards for acute lower extremity venous thrombosis. All computed tomography was performed with intravenous contrast medium, and 2-mm to 5-mm axial images were obtained. The minor diameter of the common iliac arteries and veins was measured. The technique of transverse image measurement was validated with multiplanar reconstructions and orthogonal diameter measurements in a subset of subjects. Statistical analysis was performed with the Student t test or Spearman rank correlation. RESULTS: Mean age of subjects without symptoms was 40 years (range, 19-85 years), and 60% (n = 30) were female patients. The mean acute lower extremity venous thrombosis risk factor score was 1.16 +/- 0.23 (range, 0-6; maximum possible score, 28). It was surprising that 24% (n = 12) of patients had greater than 50% compression and 66% (n = 33) had greater than 25% compression. Mean compression of the left common iliac vein was 35.5% (range, -5.6%-74.8%). The structure most often compressing the left common iliac vein against the vertebral body was the right common iliac artery (84%). There was no strong correlation between patient age or common iliac artery size and compression of the left common iliac vein. However, women had greater mean compression of the left common iliac vein (women, 41.2% +/- 3.1%; men, 27.0% +/- 3.0%; P =.003). CONCLUSION: Hemodynamically significant left common iliac vein compression is a frequent anatomic variant in asymptomatic individuals. Therefore compression of the left iliac vein may represent a normal anatomic pattern that has thus far been thought of as a pathologic condition.

Adult↗

Iliac compression syndrome and recanalization of femoropopliteal and iliac venous thrombosis: a prospective study with magnetic resonance venography.

OBJECTIVES: Poor iliac vein recanalization has been associated with compression of the left common iliac vein by the right common iliac artery (RCIA/LCIV compression); however, this finding has been difficult to confirm. In a baseline study, RCIA/LCIV compression was detected with magnetic resonance imaging in patients with deep venous thrombosis. We compared recanalization of left femoropopliteal and iliac thrombosis with and without RCIA/LCIV compression. METHODS: This was a prospective blinded study carried out in a 1355-bed university hospital. Thirty-one patients were recruited from consecutive cohorts of patients with iliofemoral and femoropopliteal DVT who underwent direct thrombus magnetic resonance imaging, venous enhanced peak arterial magnetic resonance venography, and magnetic resonance arteriography as part of the baseline study relating RCIA/LCIV compression to extent of thrombosis. Magnetic resonance venography was performed 6 weeks, 6 months, and 1 year after diagnosis of deep venous thrombosis. Femoropopliteal and iliac venous segments that were occluded at diagnosis were classified as occluded, partially occluded, or patent on follow-up scans. RESULTS: At 6-week follow-up, recanalization of all segments was incomplete. At both 6-month and 1-year follow-up, recanalization of left iliac segments associated with RCIA/LCIV compression was poorer compared with recanalization of left iliac segments not associated with compression (6 of 6 occluded vs 1 of 6 occluded and 1 of 6 partially occluded at 6 months, P =.015; 6 of 6 occluded vs 5 of 5 patent at 1 year, P = .002). This was due to complete failure of recanalization of left common iliac veins associated with RCIA/LCIV compression in 6 of 6 cases. All other iliac and femoropopliteal segments including left external iliac veins associated with RCIA/LCIV compression had high rates of recanalization at both 6 months and 1 year. CONCLUSION: RCIA/LCIV compression is associated with persistent occlusion of the left common iliac vein. The recanalization rate for all other femoropopliteal and iliac segments was high.

Constriction, Pathologic↗

Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses.

BACKGROUND: The majority of proximal deep venous thromboses (DVTs) are thought to have propagated as a contiguous column from the calf veins. However, several authors have proposed that ileofemoral DVT commonly originates in the left common iliac vein (LCIV) at a site of compression by the overlying right common iliac artery (RCIA/LCIV compression). This mechanism could explain both the left-sided predominance of ileofemoral DVT and the finding that ileofemoral DVT frequently occurs either in the absence of calf vein thrombosis (isolated ileofemoral DVT) or is not contiguous with calf vein thrombosis (noncontiguous ileofemoral DVT). This mechanism remains unconfirmed. OBJECTIVES: The purpose of this study was to detect RCIA/LCIV compression using multimodal magnetic resonance imaging in thrombosed and patent iliac veins, to determine whether RCIA/LCIV compression occurs more frequently in cases of left ileofemoral DVT than other types of DVT, and to determine if RCIA/LCIV compression is specifically associated with left isolated and noncontiguous ileofemoral DVT. PATIENTS AND METHODS: This prospective study conducted at the 1355-bed University Hospital included 18 patients with ileofemoral DVT, 23 with femoropopliteal DVT, 15 with isolated calf DVT recruited consecutively, and 28 control patients in whom DVT had been excluded. Interventions included magnetic resonance direct thrombus imaging (MRDTI), venous enhanced peak arterial magnetic resonance venography (VESPA) and magnetic resonance arteriography (MRA) within 48 hours of routine conventional venography (CV). RCIA/LCIV compression of patent LCIVs was assessed using VESPA and MRA; RCIA/LCIV compression of thrombosed LCIVs was assessed using MRDTI and MRA. The extent of calf and popliteal thrombosis was detected using CV; the extent of femoral and iliac thrombosis was detected using VESPA and MRDTI. RESULTS: RCIA/LCIV compression was more commonly detected in cases of left ileofemoral DVT (9/16 cases) than in cases of left femoropopliteal DVT (1/11 cases; P = .018), right femoropopliteal DVT (2/12 cases; P = .054), left isolated calf DVT (1/9 cases; P = .037), right isolated calf DVT (0/6 cases; P = .046) and control patients (4/28 cases; P = .006). RCIA/LCIV compression was more commonly detected in cases of left isolated ileofemoral DVT (6/6 cases; P = .005), and cases of left noncontiguous ileofemoral DVT (2/2 cases; P = .067) than in cases in which thrombosis was contiguous from the calf to the iliac veins (1/8 cases). CONCLUSION: RCIA/LCIV compression was strongly associated with left ileofemoral DVT and was specifically associated with cases that involve independent ileofemoral thrombosis.

Adult↗

Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution.

OBJECTIVE: To discover design principles underlying the optimal waveforms for external chest and abdominal compression and decompression during cardiac arrest and cardiopulmonary resuscitation (CPR). METHOD: A 14-compartment mathematical model of the human cardiopulmonary system is used to test successive generations of randomly mutated external compression waveforms during cardiac arrest and resuscitation. Mutated waveforms that produced superior mean perfusion pressure became parents for the next generation. Selection was based upon either systemic perfusion pressure (SPP = thoracic aortic minus right atrial pressure) or upon coronary perfusion pressure (CPP = thoracic aortic pressure minus myocardial wall pressure). After simulations of 64,414 individual CPR episodes, 40 highly evolved waveforms were characterized in terms of frequency, duty cycle, and phase. A simple, practical compression technique was then designed by combining evolved features with a constant rate of 80 min(-1) and duty cycle of 50%. RESULTS: All ultimate surviving waveforms included reciprocal compression and decompression of the chest and the abdomen to the maximum allowable extent. The evolved waveforms produced 1.5-3 times the mean perfusion pressure of standard CPR and greater perfusion pressure than other forms of modified CPR reported heretofore, including active compression-decompression (ACD)+ITV and interposed abdominal compression (IAC)-CPR. When SPP was maximized by evolution, the chest compression/abdominal decompression phase was near 70% of cycle time. When CPP was maximized, the abdominal compression/chest decompression phase was near 30% of cycle time. Near-maximal SPP/CPP of 60/21 mmHg (forward flow 3.8 L/min) occurred at a compromise compression frequency of 80 min(-1) and duty cycle for chest compression of 50%. CONCLUSIONS: Optimized waveforms for thoraco-abdominal compression and decompression include previously discovered features of active decompression and interposed abdominal compression. These waveforms can be used by manual (Lifestick-like) and mechanical (vest-like) devices to achieve short periods of near normal blood perfusion non-invasively during cardiac arrest.

Abdomen↗

Restoring geometric and loading alignment of the thoracic spine with a vertebral compression fracture: effects of balloon (bone tamp) inflation and spinal extension.

BACKGROUND CONTEXT: In patients with osteoporosis, changes in spinal alignment after a vertebral compression fracture (VCF) are believed to increase the risk of fracture of the adjacent vertebrae. The alterations in spinal biomechanics as a result of osteoporotic VCF and the effects of deformity correction on the loads in the adjacent vertebral bodies are not fully understood. PURPOSE: To measure 1) the effect of thoracic VCFs on kyphosis (geometric alignment) and the shift of the physiologic compressive load path (loading alignment), 2) the effect of fracture reduction by balloon (bone tamp) inflation in restoring normal geometric and loading alignment and 3) the effect of spinal extension alone on fracture reduction and restoration of normal geometric and loading alignment. STUDY DESIGN/SETTING: A biomechanical study using six fresh human thoracic specimens, each consisting of three adjacent vertebrae with all soft tissues and bony structures intact. METHODS: In order to reliably create fracture, cancellous bone in the middle vertebral body was disrupted by inflation of bone tamps. After removal of the bone tamps, the specimen was compressed using bilateral loading cables until a fracture was observed with anterior vertebral body height loss of >/=25%. Fracture reduction was performed under a compressive preload of 250 N first under the application of extension moments, and then using inflatable bone tamps. The vertebral body heights, kyphotic deformity of the fractured vertebra and adjacent segments and location of compressive load (cable) path in the fractured and adjacent vertebral bodies were measured on video-fluoroscopic images. RESULTS: The VCF caused anterior wall height loss of 37+/-15%, middle-height loss of 34+/-16%, segmental kyphosis increase of 14+/-7.0 degrees and vertebral kyphosis increase of 13+/-5.5 degrees (p<.05). The compressive load path shifted anteriorly by about 20% of anteroposterior end plate width in the fractured and adjacent vertebrae (p=.008). Bone tamp inflation restored the anterior wall height to 91+/-8.9%, middle-height to 91+/-14% and segmental kyphosis to within 5.6+/-5.9 degrees of prefracture values. The compressive load path returned posteriorly relative to the postfracture location in all three vertebrae (p=.004): the load path remained anterior to the prefracture location by about 9% to 11% of the anteroposterior end plate width. With application of extension moment (6.3+/-2.2 Nm) until segmental kyphosis and compressive load path were fully restored, anterior vertebral body heights were improved to 85+/-8.6% of prefracture values. However, the middle vertebral body height was not restored and vertebral kyphotic deformity remained significantly larger than the prefracture values (p<.05). CONCLUSIONS: The anterior shift of the compressive load path in vertebral bodies adjacent to VCF can induce additional flexion moments on these vertebrae. This eccentric loading may contribute to the increased risk of new fractures in osteoporotic vertebrae adjacent to an uncorrected VCF deformity. Bone tamp inflation under a physiologic preload significantly reduced the VCF deformity (anterior and middle vertebral body heights, segmental and vertebral kyphosis) and returned the compressive load path posteriorly, approaching the prefracture alignment. Application of extension moments also was effective in restoring the prefracture geometric and loading alignment of adjacent segments, but the middle height of the fractured vertebra and vertebral kyphotic deformity were not restored with spinal extension alone.

Aged↗

Apparent size of an object remains uncompressed during presaccadic compression of visual space.

It is well known that compression of visual space occurs near the saccade goal when visual stimuli are briefly flashed at various locations on a visual reference just before a saccade. We investigated how presaccadic compression of visual space affected the apparent size of an object. In the first experiment, subjects were instructed to report the apparent number of multiple bars briefly presented around the time of saccade onset. The reported number of four bars began to decline at the 50 ms mark before a saccade and reached a minimum near the saccade onset. This confirms that the compression of visual space occurs just before saccades. In the second experiment, subjects judged the apparent width of a rectangle (a single element) or four bars (four elements) presented just before saccades. The apparent width of the four-bar stimulus was compressed just before saccades, but that of the rectangle stimulus was not compressed. Experiment 3 shows that the width compression of the four-bar stimulus is consistent with the width change predicted by compression of position. These findings indicate that the shape of a single object is not distorted at the saccade goal during presaccadic compression of visual space. In addition, experiment 4 indicates that the apparent width of a flashed stimulus just before saccades depends on the processing of global shape. This extends the definition of a visual object during presaccadic compression of visual space to not only a solid element but also a constellation of multiple elements. Furthermore, the results from these experiments suggest that presaccadic compression of visual space does not prevent object recognition underlying an attentional mechanism in generating saccadic eye movements.

Adult↗

Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min.

Guidelines for the performance of cardiopulmonary resuscitation (CPR) have been revised recently and now advocate that chest compressions are performed without interruption for 3 min in patients during asystole and pulseless electrical activity. The aim of the present study was to determine if rescuer fatigue occurs during 3 min of chest compressions and if so, the effects on the rate and quality of compressions. Forty subjects competent in basic life support (BLS) were studied. They performed continuous chest compressions on a Laerdal Skillmeter Resusci-Anne manikin for two consecutive periods of 3 min separated by 30 s. The total number of compressions attempted was well maintained at approximately 100 min(-1) throughout the period of study. However, the number of satisfactory chest compressions performed decreased progressively during resuscitation (P < 0.001) as follows: first min, 82 min(-1); second, 68 min(-1); third, 52 min(-1); fourth, 70 min(-1); fifth, 44 min(-1); sixth, 27 min(-1). We observed significant correlations between the number of satisfactory compressions performed and both height and weight of the rescuer. Female subjects achieved significantly fewer satisfactory compressions compared with males (P = 0.03). Seven subjects (five female, two male) were unable to complete the second 3-min period because of exhaustion. We conclude that rescuer fatigue adversely affects the quality of chest compressions when performed without interruption over a 3-min period and that this effect may be greater in females due to their smaller stature. Consideration should be given to rotating the rescuer performing chest compressions after 1 min intervals.

Adult↗

Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model.

OBJECTIVE: To compare the two-finger versus the two-thumb method of chest compression on an infant model. METHOD STUDY: an unblinded, prospective, cross-over experimental study. SETTING: the metropolitan area of a city with a population of greater than 260,000. PARTICIPANTS: pediatric medical personnel and emergency workers. Anyone unable to complete the study was excluded. INTERVENTIONS: participants performed chest compressions on an infant mannikin for 2 min. PARTICIPANTS were randomized to use the two-finger method or the two-thumb method for the first minute. The investigators recorded the skillguide readings of green (correct), green and orange (too deep), red (wrong placement), or no light (too shallow). Sixty or more correct compressions were judged to be adequate. RESULTS: Two hundred and nine participants completed the study. PARTICIPANTS included: 66 nurses, 45 EMTs, 38 physicians, 27 paramedics, 14 nurse's assistants/emergency department technicians, 10 firefighters, five respiratory therapists, and four students. Seventy-one percent (149/209) of participants failed to give adequate compressions by either method. Only 40 participants performed adequate compressions using the two-thumb method (95% confidence interval. 14-25%). Thirty-eight participants gave adequate compressions using the two-finger method (95% confidence interval, 13-24%). No statistically significant difference existed between the two groups (P = 0.877; the McNemar test). A statistically significant difference was found in the number of shallow compressions for each method. Forty participants (19.1%) had more than 40 compressions that were too shallow versus 15 (7.2%) using the two-thumb method (P < 0.005). CONCLUSIONS: Medical personnel often fail to give adequate compressions. The two-thumb method was as adequate as the two-finger method. Overall, more compressions were measured as shallow with the two-finger method.

Adult↗

The spray drying of acetazolamide as method to modify crystal properties and to improve compression behaviour.

Acetazolamide shows a very poor compression ability and tablets must usually be produced through a wet granulation process. However, the possibility to obtain pure acetazolamide for direct compression could be interesting for industrial application. With the scope to obtain a material for direct compression, three different crystallisation methods were chosen, with respect to acetazolamide solvent solubility. (a) Acetazolamide was dissolved in an ammonia solution and then spray dried. It was possible to characterise the spherical particles as a mixture of two polymorphic forms, I and II by Powder X-ray diffraction study. (b) Pure form I was obtained by slowly cooling to room temperature a boiling water solution. (c) Pure form II, the marketed form, was obtained by neutralisation of an ammonia solution. Their compression behaviour was investigated firstly by a rotary press. Whilst pure polymorphic forms I and II could not be compressed, the spray dried particles showed very good compression properties. In fact, tablets were obtained only by spray dried particles, which show very good properties under compression and the absence of capping tendency. On the other hand, it was impossible to obtain tablets from polymorphic forms I and II, whatever compression pressures were used. In order to explain their densification mechanism, a single-punch tablet machine, equipped for the measurement of the upper punch displacement in the die, was used. From calculated Heckel's parameters, it was demonstrated that the spray dried material shows a greater particle rearrangement in the initial stage of compression due to its spherical habit and minor wrinkledness of particle surface. The crystalline structure due to the presence of polymorphic forms I and II concur to lowering the intrinsic elasticity of the material. This fact avoids the risk of the rupturing the interpaticulate bonds, which are formed during the compression, concurring to the consolidation of the tablet.

Acetazolamide↗

Breast compression and radiation dose in two different mammographic oblique projections: 45 and 60 degrees.

INTRODUCTION: Standard mammography includes two views, craniocaudal and medio-lateral oblique. Depending on patient's body constitution, central beam angle in mediolateral oblique projection may vary, with 45 degrees being suitable for the majority of patients in routine daily practice. With continuous improvement in X-ray technology and radiographers' training, the risk of radiation induced cancerogenesis is considerably reduced and acceptable when compared to benefit. However, the risk still exists, being cumulative and directly related to absorbed glandular dose. There is no minimal dose of radiation which is absolutely harmless, and every effort to reduce the dose is welcome. In this retrospective study two different angles (45 vs. 60 degrees) of mediolateral oblique view were compared according to radiation dose and efficacy of breast compression. PATIENTS AND METHODS: In 52 women, additional 60 degrees oblique films were done after craniocaudal and mediolateral oblique 45 degrees-films, with the same kVp and positioning technique. Breast thickness, time-current products (mA s) and absorbed doses were compared between 45 degrees- and 60 degrees-films. Subgroups of women with large, small, prominent and pendulous breasts were analyzed separately, following the same methodology as for the whole group. RESULTS: mA s were 11.5% lower and compression 7% better with an angle of 60 degrees than with 45 degrees. In the subgroup of women with small breasts, mA s values were 13% lower and compression 9% better with 60 degrees than with 45 degrees, while in the subgroup with large breasts, mA s were 9% lower and compression 5% better. In the subgroup of patients with pendulous breasts, mA s values were 12% lower and compression 10% better with 60 degrees than with 45 degrees, while in the subgroup with prominent breasts, mA s values were 4% lower and compression 3% better. Absorbed glandular dose was estimated to be approximately 20% lower when an oblique mammogram was done with 60 degrees instead of 45 degrees. The compression with 15 kp was well tolerated by the majority of patients. DISCUSSION AND CONCLUSION: Mammograms of excellent quality should be done with as low a radiation dose as possible. Adequate breast compression is fundamental in mammography due to immobilization of the breast, shortening of the exposure times, reduction of motion and geometric blur and prevention of overpenetration by means of equalizing breast thickness. As the absorbed glandular dose cannot be accurately measured, it is convenient to estimate the dose approximately, on the basis of its linear proportionality with exposure dose. With constant technical properties of X-ray machines, exposure dose is determined only by mA s. Hence, the absorbed glandular dose in our study was influenced only by changes of mA s and breast thickness. As the absorbed dose reduction is proportional to the product of the reduction of mA s and thickness, we estimated that absorbed dose was 7-22% lower if 60 degrees is applied instead of 45 degrees. Breast compression and mA s were more favourable in women with pendulous breasts, possibly because of elongation of the glandular disc in the lateroascending direction, with its longer axis directed more perpendicularly. Fibroglandular tissue in the 60 degrees-view is thus projected onto a larger film area, with less effect of superimposition. In conclusion, because of lower mA s values and better compression, which finally result in a 25% lower absorbed dose, we recommend the oblique view be done with an angle of 60 degrees, especially for small and pendulous breasts.

Adult↗

Effects of rhythmic muscle compression on arterial blood pressure at rest and during dynamic exercise in humans.

This study was designed to examine the hypothesis that a rhythmic mechanical compression of muscles would affect systemic blood pressure regulation at rest and during dynamic exercise in humans. We measured the changes in mean arterial pressure (MAP) occurring (a) at rest with pulsed (350 ms pulses at 50 pulses min(-1)) or static compression (50 and 100 mmHg) of leg muscles with or without upper thigh occlusion, and (b) during 12-min supine bicycle exercise (75 W, 50 r.p.m.) with or without pulsed compression (50, 100, 150 mmHg) of the legs in synchrony with the thigh extensor muscle contraction. At rest with thigh occlusion, MAP increased by 4-8 mmHg during static leg compression, and by 5-9 mmHg during pulsed leg compression. This suggests that at rest pulsed leg compression elicits a reflex pressor response of similar magnitude to that evoked by static compression. During dynamic exercise without leg compression, MAP (having risen initially) gradually declined, but imposition of graded pulsed leg compression prevented this decline, the MAP values being significantly higher than those recorded without pulsed leg compression by 7-10 mmHg. These results suggest that the rhythmic increase in intramuscular pressure that occurs during dynamic exercise evokes a pressor response in humans.

Adult↗

Is digital image compression acceptable within diabetic retinopathy screening?

AIMS: The National Screening Committee (NSC), whilst recommending the use of digital mydriatic retinal photography for diabetic retinopathy screening, has not yet accepted the use of digitally compressed images for grading. By greatly reducing the file size, however, compression of images is invaluable for storage and for its rapid transmission across computer networks. We undertook a study to compare the different levels of JPEG compression with the original bit-mapped image to determine whether there was any loss of clinical detail following compression. METHODS: Three hundred and thirty images were analysed in this study. These images had been captured from 66 eyes consecutively photographed in a diabetic retinopathy screening programme, using a Sony DXC-950 P 3CCD colour video camera mounted on a Canon CR6-45NMf fundus camera. Single 45 degrees macula-centred images were taken from each eye. The images were compressed using the JPEG algorithm within Adobe Photoshop (version 4.0) and then displayed with a Sony Trinitron colour monitor. Four different levels of compression were used, JPEG-1, JPEG-2, JPEG-3, JPEG-4, and an objective analysis was undertaken using 'lesion counts'. The compressed images were assessed separately and blindly and the results compared with their original BMP images. RESULTS: Eight BMP images could not be evaluated (five right eye and three left eye). A total of 290 images were therefore used in the final evaluation. All the JPEG-1 images with file sizes between 16 and 24 kb were found to be 'pixelated', while the JPEG-4 images (66-107 kb) appeared similar to the original BMP (1.3 Mb) images. Both JPEG-2 and JPEG-3 images had significantly lower counted lesions than the BMP images. CONCLUSIONS: From our findings we can conclude that only some degree of image compression (compression ratios of 1 : 20 to 1 : 12) with file sizes of 66-107 kb is permissible using JPEG format, whereas the images obtained after higher compression ratios may not be suitable for diabetic retinopathy screening.

Adult↗

[Axial compressive strength of thoraco-lumbar vertebrae--an experimental biomechanical study].

PURPOSE: This study analyzed the correlation between the compressive strength of human thoracolumbar vertebrae, bone density and endplate area (measured by SE-QCT). METHOD: The compressive strength of 110 human vertebral specimens (D11-L5) was measured. In order to determine standard values for human vertebral specimens from each level and different female and male age groups were examined. Before biomechanical testing the specimens were examined using SE-QCT with 1.5 and 10 mm slice thickness. Three different slice locations (mid-vertebral and adjacent to both endplates) and 6 regions of interest (ROI) were chosen to assess BMD. The area of the vertebral endplates was measured by CT. RESULTS: Highest correlations between BMD and compressive strength were found for the 10 mm thick midvertebral slices with a small ellipsoid ROI. Cancellous and cortical bone contributed to the compressive strength to the same amount. Compressive strength and endplate area increased in the cranio-caudal direction, bone density was constant throughout thoracolumbar spine. Bone density and compressive strength depended on age and sex. Compressive strength of human thoracolumbar vertebrae increased with bone density as well as the size of the endplates. CONCLUSIONS: Using bone density and endplate area (SE-QCT) of human thoracolumbar vertebrae (D11-L5) a prediction of compressive strength is possible with an error of estimation of 1.17 kN and a correlation factor of 0.85. The prediction of the compressive strength allows an estimation of the risk of vertebral fracture, i.e. in patients with osteoporosis or in individuals with intensive physical activities. The standard values of the human thoracolumbar vertebrae together with biomechanical examinations of vertebral metastases can be used to estimate the compressive strength of osteolytic and osteoplastic spinal metastases.

Adult↗

A clinical comparison of pneumatic compression devices: the basis for selection.

PURPOSE: The five pneumatic compression devices (PCDs) that are marketed provide mechanical protection from deep venous thrombosis (DVT). They differ with respect to patterns of compression and the length of the sleeve. Evidence linking differences to clinical outcomes is lacking. Our purpose was twofold: to evaluate each of the marketed PCDs with respect to effectiveness, compliance, and patient and nursing satisfaction and to determine whether there is a clinical basis for the selection of one device over another. METHODS: Each of the marketed devices was used exclusively for a 4-week period. Patients participated in an evaluation including venous duplex ultrasound scan, DVT risk assessment, and device evaluation. Vascular laboratory records were used to document DVT. Compliance was measured by meters installed on all pumps. A ranking matrix was stratified by compression pattern: rapid graduated sequential compression, graduated compression, and intermittent compression, and each device was rated by patients and nurses. RESULTS: The PCDs were used in 1350 cases with a DVT rate of 3.5% ranging from 2% to 9.8% depending on the method of compression. Patients with DVT were older (58 vs 54 years), had better compliance (67% vs 50%), and had more compression days (11 vs 7.2). When thigh-length sleeves were used, a greater proportion of DVT occurred in the proximal segments (71%) as compared with the number of proximal DVT when the calf-length devices were used (52%; P =.21). Devices W, X, and Y had comparable rates of DVT, which were lower than those for V and Z. Compression device W, [correction] with calf and thigh sleeves, achieved the best overall ranking largely because of high scores for patient and nurse satisfaction. CONCLUSION: Our data appear at odds with commonly held beliefs. We were unable to show a difference in DVT incidence based on the length of the device or the method of compression. Randomized studies are needed to confirm our findings and evaluate hypotheses derived from this study.

Bandages↗

Mechanical conditions of rebound of the intracranial pressure after a period of cerebral compression.

Brain compression of precisely defined degree and duration was produced by means of expansion of a supratentorial epidural balloon in anaesthetized and mechanically ventilated dogs. After deflation of the balloon there was a rebound of the intracranial pressure (ICP) to values in the range 30-89 mm Hg when critical thresholds of time and compression had been exceeded during the period of compression. A time versus cerebral perfusion pressure (CPP) graph indicated a CPP threshold of about 50 mm Hg and time threshold of about 6 min. Within these limits the critical CPP varied as a function of time. The ICP rebound had an approximately exponential time course with an initial rapid rise levelling off towards a final plateau in about 30 min. The final value was dependent on the time of compression but independent of the CPP. A transtentorial pressure gradient was induced during the compression phase and reestablished after the decompression when a rebound of ICP developed. Hydrostatic compression by means of infusion of fluid into the subarachnoid space was followed by a rebound of ICP in only 2/21 of the experiments in spite of time and CPP parameters which crossed the critical thresholds defined in the balloon compression experiments. These results support the hypothesis that the rebound phenomenon is related to an ischaemic mechanism. The difference in incidence of rebound in balloon compression and hydrostatic compression can probably be accounted for by a greater depth of ischaemia in the former case because of a direct compressive effect on the vascular bed by the balloon.

Animals↗

The effect of presentation level and compression characteristics on sentence recognition in modulated noise.

The effect of fast-acting compression on speech recognition in fully modulated (FUM) noise in listeners with normal and impaired hearing was investigated in two experiments We wanted to determine the relationships between the benefit from compression and some audiological factors. Furthermore, the sensitivity to changes in compression parameters was also evaluated. The results showed that two-thirds of the listeners performed worse with fast-acting compression than with linear processing. Normal-hearing listeners showed the most benefit from compression. A significant relationship was found between benefit from compression and speech-to-noise ratio at threshold (SNRT) in slightly modulated (SM) noise. Pure-tone threshold was found to be a weak predictor of benefit from compression. No relationship was found between benefit from compression and the release of masking for the FUM noise. The variability in the results across different compression parameters was related to SNRT in SM noise. The results suggest an inverse relationship between benefit from compression and the severity of the suprathreshold hearing loss

Adult↗