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Increasing strain and strain rate strengthen transient stiffness but weaken the response to subsequent compression for articular cartilage in unconfined compression.

Strain amplitude and strain rate dependent nonlinear behavior and load-induced mechanical property alterations of full-thickness bovine articular cartilage attached to bone were investigated in unconfined compression. A sequence of test compressions of finite deformation (ranging from 0.9% to 34.5% nominal strain) was performed at strain rates ranging from approximately 0.053%/s to 5.8%/s. Peak and equilibrium loads were analyzed to determine strain amplitude and strain rate dependence of linear versus nonlinear responses. The test protocol was designed to reveal changes in mechanical properties due to these finite deformations by interspersing small-amplitude witness ramps of approximately 1.1% deformation and approximately 0.44%/s strain rate between the test ramps ("witness" meaning to assess any mechanical property changes). We found that peak loads displayed high nonlinearity, stiffening with both increasing compression amplitude and more so with increasing strain rate. The response to witness ramps suggested that mechanical weakening occurred when compression amplitude reached 1.9-2.9% strain and beyond, and that weakening was much more significant at higher strain rate. These findings delineate regimes of linear versus nonlinear behavior of cartilage, and indicate the types of loads which can cause mechanical property alterations. Biological implications of this study are that strain amplitude and strain rate dependent stiffening may be essential to bear physiological loads and to protect cells and matrix from mechanical damage. Structural changes reflected by mechanical weakening at small compression could also initiate remodeling or disease processes.

Animals↗

Highly compressible paracetamol - II. Compression properties.

Paracetamol particles crystallized in the presence of polyvinylpyrrolidone (PVP) exhibited an obvious improvement in their compression properties compared to untreated paracetamol. Paracetamol particles crystallized in the presence of 0.5% w/v PVP 10000 or PVP 50000 produced tablets with improved crushing strength with no tendency to cap even at high compression speeds. The very low values of strain rate sensitivity (SRS) and the lack of reduction in crushing strength with increasing compression speed for these particles, were indicative of a high degree of fragmentation during compression. The results of elastic recoveries and elastic energies of tablets were indicative of much less elastic behaviour of these particles than untreated paracetamol. The low elastic energy/plastic energy (EE/PE) ratio for paracetamol crystallized in the presence of PVP indicated that, contrary to untreated paracetamol, a minor portion of compression energy was utilized as elastic energy.

Acetaminophen↗

Percutaneous translumbar spinal cord compression injury in dogs from an angioplasty balloon: MR and histopathologic changes with balloon sizes and compression times.

BACKGROUND AND PURPOSE: Our previous model of spinal cord injury (SCI) included six dogs undergoing 30-minute compression with a balloon in the subarachnoid space. We determined whether various balloon sizes and compression times creates a gradation of injuries. METHODS: In 17 dogs (including our original six), angioplasty balloons 2, 4, or 7 mm in diameter (2 cm long) were inflated at T6 for 30, 120, or 240 minutes. T1- and T2-weighted, gadolinium-enhanced, and short-tau inversion recovery (STIR) MR images were obtained at 1.5 T. Spinal canal occlusion (SCO) was measured as balloon area-spinal cord area. Hematoxylin-eosin and beta amyloid precursor protein staining were performed to demonstrate hemorrhage and axonal injury, respectively. Injuries were scored as mild, moderate, or severe. Trends were assessed with one-way analysis of variance. RESULTS: SCO was 12.5-20% for 2-mm balloons, 28-56% for 4 mm, and 62-82% for 7 mm. No abnormalities were seen with SCO <30%. T1- and T2-weighted images had the poorest diagnostic performance; STIR images were best for predicting hemorrhage and axonal injury. Hemorrhage was demonstrated more frequently than was axonal injury. SCO (P < .0001) and hemorrhage (P = .002) significantly increased with balloon size. Longer inflation times tended to increase injuries for a given size, but differences were not significant. CONCLUSION: Compression injuries depended on the level of SCO. The compression times tested had less effect than the degree of compression. The value of 1.5-T MR imaging varied with the sequence and improved with contrast enhancement. STIR images showed SCIs not otherwise detected.

Angioplasty, Balloon↗

Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression.

Edema formation in spinal nerve roots of the pig cauda equina was studied following experimental compression at various pressure levels, durations, and rates of onset, using a fluorescence microscopic technique. The time-pressure thresholds for the occurrence of edema in the nerve roots were: following rapid onset of compression (0.05-0.1 seconds), 2 minutes at both 50 mm Hg and 200 mm Hg, and following slow onset of compression (the pressure was slowly increased during 15-20 seconds), 2 hours at 50 mm Hg and 2 minutes at 200 mm Hg. Generally, the edema formation was more pronounced after rapid than after slow onset of compression. The data in this study also indicate that intraneural edema might be more easily formed in nerve roots than in peripheral nerves after compression injury.

Animals↗

Randomized clinical trial of compression plus surgery versus compression alone in chronic venous ulceration (ESCHAR study)--haemodynamic and anatomical changes.

BACKGROUND: The aim of this study was to evaluate the anatomical and haemodynamic effects of superficial venous surgery and compression on legs with chronic venous ulceration. METHODS: Legs with open or recently healed ulceration and saphenous reflux were treated with multilayer compression bandaging or superficial venous surgery plus compression as part of a clinical trial. Venous duplex imaging was performed before treatment and at 1 year. Legs were stratified before surgery as having no deep reflux, segmental deep reflux or total deep reflux. Venous refill times (VRTs) were calculated before treatment and at 1 year using photoplethysmography, with and without a narrow below-knee cuff inflated to 80 mmHg. RESULTS: Of 214 legs investigated, 112 were treated with compression and 102 with compression plus surgery. Saphenous surgery abolished deep reflux in ten of 22 legs with segmental deep reflux and three of 17 with total deep reflux. Overall median (range) VRT increased from 10 (3-48) to 15 (4-48) s 1 year after surgery (P < 0.001). Preoperative change in VRT on application of a below-knee tourniquet correlated with actual change in VRT following surgery. CONCLUSION: Superficial venous surgery resulted in a significant haemodynamic benefit for legs with venous ulceration despite co-existent deep reflux; residual saphenous reflux was common.

Aged↗

Dynamic unconfined compression of articular cartilage under a cyclic compressive load.

To study the effect of dynamic mechanical force on cartilage metabolism, many investigators have applied a cyclic compressive load to cartilage disc explants in vitro. The most frequently used in vitro testing protocol has been the cyclic unconfined compression of articular cartilage in a bath of culture medium. Cyclic compression has been achieved by applying either a prescribed cyclic displacement or a prescribed cyclic force on a loading platen placed on the top surface of a cylindrical cartilage disc. It was found that the separation of the loading platen from the tissue surface was likely when a prescribed cyclic displacement was applied at a high frequency. The purpose of the present study was to simulate mathematically the dynamic behavior of a cylindrical cartilage disc subjected to cyclic unconfined compression under a dynamic force boundary condition protocol, and to provide a parametric analysis of mechanical deformations within the extracellular matrix. The frequency-dependent dynamic characteristics of dilatation, hydrostatic pressure and interstitial fluid velocity were analyzed over a wide range of loading frequencies without the separation of the loading platen. The result predicted that a cyclic compressive force created an oscillating positive-negative hydrostatic pressure together with a forced circulation of interstitial fluid within the tissue matrix. It was also found that the load partitioning mechanism between the solid and fluid phases was a function of loading frequency. At a relatively high loading frequency, a localized dynamic zone was developed near the peripheral free surface of the cartilage disc, where a large dynamic pressure gradient exists, causing vigorous interstitial fluid flow.

Biomechanical Phenomena↗

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↗

Relationship of blood pressure and flow during CPR to chest compression amplitude: evidence for an effective compression threshold.

This study was conducted to investigate the importance of the depth of chest compression in producing effective cardiopulmonary resuscitation (CPR) in animals, as indicated by cardiac output and mean arterial blood pressure. Cardiac output was measured by a modified indicator dilution technique in 8 anesthetized dogs, 6 to 12 kg body weight, during repeated 2-minute episodes of electrically induced ventricular fibrillation and CPR provided by a mechanical chest compressor and ventilator (Thumper). Chest compression exceeding a threshold value (xo) between 1.5 and 3.0 cm was required in each animal to produce measurable cardiac output. In particular, cardiac output (CO) was linearly related to chest compression depth (x) by an expression of the form CO = a(x-xo) for x greater than xo. The mean value of xo was 2.3 cm. A similar threshold for measurable blood pressure was observed in 7 of the 8 dogs, with a mean value of 1.8 cm. For chest compression of 2.5 cm or greater, relatively modest increases in chest compression depth caused relatively large changes in cardiac output.

Animals↗

Manual compression repair of post-catheterization femoral pseudoaneurysms: an alternative to ultrasound guided compression repair?

BACKGROUND: It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative. METHODS: After ultrasound diagnosis of a pseudoaneurysm, direct manual compression was applied to the lesion until the characteristic clinical signs disappeared or for a maximum of 1 hour. Then a compression bandage was applied for 24 hours. If the pseudoaneurysm persisted, MCR was repeated up to a maximum of three times. RESULTS: Of 96 consecutive patients with pseudoaneurysms, ten patients were referred to primary surgery; one patient refused any therapy. The remaining 85 patients (89%) were treated by MCR. MCR was successful in 74 patients (87%). Of these, 74% were cured at the first attempt, while 16% resp. 10% required 2 resp. 3 compression manoeuvers for definite cure. The success rate tended to be somewhat lower in patients on anticoagulants (78%) than in those on aspirin (91%) or those without any antithrombotic medication (89%) (p = 0.14). No major complications were observed. Of the 11 patients in whom MCR was unsuccessful, five patients underwent surgical repair; in four patients the pseudoaneurysms thrombosed spontaneously within 1-3 months and 2 pseudoaneurysms persist without complications. CONCLUSIONS: Our results with MCR are comparable to those published for UGCR. Since MCR requires less technical equipment and seems to be less painful for the patient, a prospective comparison of both methods appears warranted.

Adult↗

Efficacy of interposed abdominal compression-cardiopulmonary resuscitation (CPR), active compression and decompression-CPR and Lifestick CPR: basic physiology in a spreadsheet model.

This study was undertaken to understand and predict results of experimental cardiopulmonary resuscitation (CPR) techniques involving compression and decompression of either the chest or the abdomen. Simple mathematical models of the adult human circulation were used. Assumptions of the models are limited to normal human anatomy and physiology, the definition of compliance (volume change/pressure change), and Ohm's law (flow = pressure/resistance). Interposed abdominal compression-CPR, active compression and decompression of the chest, and Lifestick CPR, which combines interposed abdominal compression and active compression and decompression, produce, respectively, 1.9-, 1.2-, and 2.4-fold greater blood flow than standard CPR and systemic perfusion pressures of 45, 30, and 58 mm Hg, respectively. These positive effects are explained by improved pump priming and are consequences of fundamental principles of cardiovascular physiology.

Abdomen↗

[Studies of the properties of tablets made from directly compressible starch and its mixtures with directly compressible lactose].

The paper studies the strength and disintegration time of compacts made from directly compressible Starch 1500 and its mixtures with directly compressible lactose Pharmatosa DCL 15 in different relative proportions in dependence on the added lubricant magnesium stearate and the model active ingredient ascorbic acid. The dry binders under study differ in their mechanisms of compression and thus in their sensitivity to the addition of the lubricant, which is manifested in decreased strengths of the compacts as well as the mechanism of disintegration of the compacts. The mixtures of substances under study were in the relative representations of 1:3, 1:1 and 3:1. The employed concentration of the lubricant magnesium stearate was 0.4%, that of ascorbic acid, 50%. The study has confirmed and quantitatively evaluated the sensitivity of directly compressible starch to the addition of magnesium stearate. A higher share of directly compressible lactose in the mixture decreased the sensitivity of tableting material to the addition of the lubricant and shortened disintegration time. The presence of stearate did not negatively influence disintegration time, with an exception of the mixture of Starch 1500 and Pharmatosa DCL 15 1:3. An addition of the model active ingredient ascorbic acid decreased the strength of the compacts and shortened the disintegration time in all tableting materials tested.

Lactose↗

Immediate hemodynamic effect of the additional use of the SCD EXPRESS Compression System in patients with venous ulcers treated with the four-layer compression bandaging system.

OBJECTIVES: To test the hypothesis that the SCD EXPRESS intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity. DESIGN: Twenty limbs of 18 patients with venous leg ulcers were studied, median age 76 years. The Total Volume Flow (TVF) and the Peak Systolic Velocity (PSV) were recorded in the popliteal vein using duplex ultrasonography. Measurements were made (i) without bandage, (ii) with four layer bandage and (iii) following the application of the SCD Compression System on top of a four-layer bandage for at least 15 minutes. RESULTS: The median VCSS was 17 (range, 12-22) while the median VSDS for reflux was 4.5 (range, 1-7.5). The median TVF was 71 mL/min (inter-quartile range 57-101) without bandage, 112 (IQR 89-148) with four-layer bandage and 291 (IQR 241-392) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). The median PSV was 8.4 cm/sec (IQR 6.8-14) without bandage, 13 (9.0-19) with four-layer bandage and 27 (21-31) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). Both TVF and PSV increased slightly with the addition of the four-layer bandage. However, with the addition of the SCD System these parameters increased three fold. CONCLUSIONS: The SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. The combination of four-layer compression with the SCD System on healing venous ulcers needs to be tested by a clinical effectiveness study.

Aged↗

Correlation between spinal cord compression and abnormal patterns of median nerve somatosensory evoked potentials in compressive cervical myelopathy: comparison of surface and epidurally recorded responses.

To investigate the correlation between the level of spinal cord lesion and the abnormal pattern of median nerve somatosensory evoked potentials (SSEPs), evoked spinal cord potentials (ESCPs) were also recorded from the posterior epidural space intraoperatively in 18 patients with compressive cervical myelopathy. Levels of symptomatic spinal cord compression were determined by ESCP findings. Spinal N13 potential of the SSEPs was recorded from the surface of the posterior neck with anterior neck reference. Brainstem P14 and cortical N20 potential were recorded from the parietal scalp contralateral to the stimulated side. Spinal N13, P14, and N20 potentials were all normal when the ESCPs were abnormal at localized segmental region (C4-5 or C5-6 level alone). Spinal N13 potential was significantly attenuated in all of patients with abnormal ESCP findings at widespread segmental area of the median nerve territory. In four of these seven patients, brainstem P14 potential was also prolonged or diminished, but three patients showed normal P14 and N20 potentials. Isolated P14 abnormality with normal spinal N13 potential was characteristic in patients with abnormal ESCP at the C3-4 lesion. Although sensitivity of abnormal ESCP was higher than that of the SSEPs, abnormal patterns of spinal N13, P14 and N20 potentials following median nerve stimulation were useful in detecting not only the pathology (posterior horn and/or posterior column) but also symptomatic spinal compression level in compressive cervical myelopathy.

Adult↗

Influence of Avicel PH-301 on the compressibility of alpha-methyldopa and phenobarbitone in direct compression.

The aim of this work was to investigate the compressibility behavior of alpha-methyldopa and phenobarbitone using a Korsch EK0 instrumented eccentric tablet machine, with force-time and force-displacement curves constructed and applied to calculate different compressional values to study the compressional behavior. The results of this work revealed a difference in compressibility behavior between the two drugs during the compressional process. alpha-Methyldopa gave an abnormal compressional curve with high friction in the pre- and postcompressional phases. A residual force could be seen on the lower punch. Furthermore, capping and sticking were observed visually during tablet pressing, indicating poor compressibility behavior. In the case of phenobarbitone, no friction was observed in the precompressional phase, but there was higher friction in the postcompressional phase, especially in the ejection phase. The compressibility of the drugs was improved by the addition of Avicel PH-301 and magnesium stearate.

Anticonvulsants↗

Magnetic stimulation as a diagnostic tool in cervical nerve root compression and compression-induced neuropathy.

Magnetic stimulation of motor cortex and cervical spinal cord was used to assess motor impairment in patients with either cervical nerve root compression or myelopathy. Evoked potentials were recorded from biceps brachii and abductor pollicis brevis. Our interest centered on whether the paresis resulting from root compression is accompanied by an increased latency of magnetically evoked muscle potentials and whether latency is increased in cases of cervical root compression or myelopathy in which no paresis occurs. Latency increase does appear to be a moderately good indicator of disturbed nerve conduction. In particular, prolonged latencies in cases of "subclinical" paresis could be used as an important diagnostic tool for the early detection of motor deficits in cervical compression radiculopathy and myelopathy.

Electrodiagnosis↗

The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model.

OBJECTIVE: The purpose of this cadaveric study was to compare the mechanical behavior of a locked compression plate, which uses threaded screw heads to create a fixed angle construct, with a dynamic compression plate construct in a cadaver radius model. DESIGN: Mechanical study with cyclic testing and high-speed optical motion analysis. SETTING: Biomechanics laboratory at an academic institution. PATIENTS/PARTICIPANTS: Eighteen pairs of fresh-frozen human cadaver radii were divided into 3 groups of 6 to be tested as a group in each of the following force applications: anteroposterior (AP) bending, mediolateral bending, or torsion. INTERVENTION: Each bone was osteotomized leaving a 5-mm fracture gap and then fixed with a plate. For each pair, 1 radius received a standard plate (limited-contact dynamic compression plates; LC-DCP), the contralateral radius was fixed with a locking compression plate (LCP), and specimens underwent cyclic loading. Normalized stiffness, average energy absorbed, and Newton-cycles to failure were calculated. In addition, a 3-dimensional, high-speed, infrared motion analysis system was used to evaluate motion at the fracture site. MAIN OUTCOME MEASUREMENTS: Construct stiffness, fracture site motion, cycles to failure, and energy absorption. Repeated measures ANOVA were used to detect differences between groups with time. RESULTS: In the torsion group, LCP specimens failed at 60% greater Newton-cycles than the LC-DCP (1473 vs. 918; P < 0.05). In the AP group, the LC-DCP absorbed significantly greater energy during 10,000 cycles compared with the LCP group (P < 0.05). The 2 constructs demonstrated different biomechanical behavior with time. As cycling progressed in the LC-DCP specimens under torsion testing, stiffness (measured at the actuator at the bone ends) did not change significantly; however, fracture motion (measured at the fracture surfaces) decreased significantly (P = 0.04). The LCP specimens did not display similar behavior. CONCLUSIONS: Our findings indicated that LCP constructs may demonstrate subtle mechanical superiority compared with the LC-DCP. The LCP specimens had less energy absorption in the AP group and survived longer in the torsion group. Discordance of motion between measurement regions was observed only in the LC-DCP torsion group, and may have been caused by plate-bone slippage or bone-screw subcatastrophic failure. However, many other compared parameters were found to be similar, and the clinical significance of the few differences found between constructs mandates further investigation.

Biomechanical Phenomena↗

The asymmetry of transient response in compression versus release for cartilage in unconfined compression.

Observations in compression tests of articular cartilage have revealed unequal load increments for compression and release of the same amplitude applied to a disk with an identical previously imposed compression (in equilibrium). The mechanism of this asymmetric transient response is investigated here using a nonlinear fibril-reinforced model. It is found that the asymmetry is predominantly produced by the fibril stiffening with its tensile strain. In addition, allowing the hydraulic permeability to decrease significantly with compressive dilatation of cartilage increases the transient fibril strain, resulting in a stronger asymmetry. Large deformation also enhances the asymmetry as a consequence of stronger fibril stiffening.

Biomechanical Phenomena↗

An overview of digital compression of medical images: can we use lossy image compression in radiology?

The increasing volume of data generated by new imaging modalities such as multislice computed tomography scanners and magnetic resonance imaging justifies the use of lossy compression techniques to decrease the cost of storage and improve the efficiency of transmission over networks for teleradiology or for access to electronic patient records. We summarize here the most commonly used compression techniques and compare their main features. Having conducted an extensive literature review, we present a range of average compression ratios for different modalities and body parts. This article lays the groundwork for further evaluation with standardized statistical methods to ultimately elaborate acceptable compression guidelines.

Algorithms↗