Full Immobilization Research Articles

Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry.

Standards for immobilizing potentially spine-injured patients in the prehospital environment are evolving. Current guidelines call for more research into treatment practices. Available research into spinal immobilization (SI) reveals a number of limitations. There are currently few techniques for measuring head and neck motion that address identified limitations and can be adapted to clinically relevant scenarios. This study investigates one possible method. Study participants were fitted with miniaturized accelerometers to record head motion. Participants were exposed to three levels of restraint: none, cervical-collar only, and full immobilization. In each condition, participants were instructed to move in single planes, with multiple iterations at each of four levels of effort. Participants were also instructed to move continuously in multiple planes, with iterations at each of three levels of simulated patient movement. Peak and average displacement and acceleration were calculated for each immobilization condition and level of effort. Comparisons were made with video-based measurement. Participant characteristics also were tracked. Acceleration and displacement of the head increased with effort and decreased with more restraint. In some conditions, participants generated measurable acceleration with minimal displacement. Continuous, multi-dimensional motions produced greater displacement and acceleration than single-plane motions under similar conditions. Study results suggest a number of findings: acceleration complements displacement as a measure of motion in potentially spine-injured patients; participant effort has an effect on outcome measures; and continuous, multi-dimensional motion can produce results that differ from single-plane motions. Miniaturized accelerometers are a promising technology for future research to investigate these findings in realistic, clinically relevant scenarios.

Primary implant stability in augmented sinuslift-sites after completed bone regeneration: a randomized controlled clinical study comparing four subantrally inserted biomaterials.

Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.

Evaluation of etorphine reversed by diprenorphine for the immobilisation of free-ranging Atlantic walrus (&lt;i&gt;Odobenus rosmarus rosmarus&lt;/i&gt; L.)

To date no problem-free method exists for the immobilisation of free‑ranging walruses (Odobenus rosmarus). In the period 1989-2001, 69 immobilisations with etorphine HCl were performed by remote darting of 41 individual free-ranging adult Atlantic walruses (O. r. rosmarus), with body masses 633 ‑ 1883 kg, as a rerequisite for the attachment of radio tracking and dive recording instruments, and for studies of metabolism. Ten individuals were immobilised several times. We present data on these 69 immobilisations and evaluate the method. Full immobilisation was achieved in 58 cases (84 %). The animals were insufficiently restrained in 6 cases (9 %) and 5 animals died (7 %) following the immobilisation. The animals were fully immobilised and approachable after 5 min (n = 38, range = 1.9 ‑ 12.4 min, SD = 2.2) with a dose of etorphine of 6.1 μg/kg (range 2.4 ‑ 12.6 μg /kg, SD = 2.4). Induction time was negatively correlated with the dosage of etorphine. Etorphine-induced apnoea lasted 13.7 min (n = 36, range 17.0 ‑ 26.7 min, SD = 5.1) and was reversed by multiple doses of the antagonist diprenorphine HCl. The first dose of antagonist of 12.2 mg (n = 39, range 6.0 ‑ 21.0 mg, SD = 3.5) was administered 8.4 min (n = 38, range 4.7 ‑ 18.0 min, SD = 2.8) after injection of the agonist. The total dose of diprenorphine per animal ranged between 7.7 and 41.7 μg/kg (n = 31, mean = 17.2 μg/kg, SD = 7.5). For some animals blood pH values were measured following the apnoea and reached low levels (min pH 6.8). For animals that were immobilised several times there were no indications of changed sensitivity to etorphine as reflected in unchanged induction times. Mortalities could neither be related to the doses of agonist and antagonist, nor to the times of administration of the drugs. From this (n = 69) and other (n = 103) studies involving etorphine immobilisation of walruses (both Atlantic and Pacific) the overall success rate is 83 % (8 % casualty rate). We conclude that the combination etorphine‑ diprenorphine is suitable for both single and multiple immobilisations of walruses provided that (a) a casualty rate of 7-8% is acceptable (b) the antagonist diprenorphine is administered fast and well into a tissue with good blood irrigation, and (c) the animal is promptly intubated endotracheally to facilitate the restoration of breathing after drug-induced apnoea.

Multifunctional Homopolymer Vesicles for Facile Immobilization of Gold Nanoparticles and Effective Water Remediation

Homopolymers have been considered as a nonideal building block for creating well-defined nanostructures due to their fuzzy boundary between hydrophobic and hydrophilic moieties. However, this unique fuzzy boundary may provide some opportunities for fabricating functional nanomaterials. Presented in this paper is a pH-responsive multifunctional homopolymer vesicle based on poly[2-hydroxy-3-(naphthalen-1-ylamino)propyl methacrylate] (PHNA). This vesicle is confirmed to be an excellent supporter for gold nanoparticles (AuNPs) to facilitate the reduction reaction of 4-nitrophenol (4-NP). The pH-responsive vesicle membrane favors the effective embedding and full immobilization of AuNPs because it is kinetically frozen under neutral and basic environments, preventing AuNPs from aggregation. Meanwhile, there is a synergistic effect between the AuNPs and the supporter (PHNA vesicle). Due to the π-π interaction between the naphthalene pendants in every repeat unit of PHNA and the extra aromatic compounds, a substrate-rich (high concentration of 4-NP) microenvironment can be created around AuNPs, which can dramatically accelerate the AuNPs-catalyzed reactions. In addition, we proposed a method for more accurately determining the membrane thickness of rigid polymer vesicles from TEM images based on "stack-up" vesicles, which may overturn the measuring method commonly used by far. Moreover, proof-of-concept studies showed that those homopolymer vesicles may be used as a powerful adsorbent for effective water remediation to remove trace carcinogenic organic pollutants such as polycyclic aromatic hydrocarbons to below parts per billion (ppb) level at a very fast rate based on the π-π interaction between the naphthalene pendants in PHNA vesicle and polycyclic aromatic hydrocarbons. Overall, this multifunctional homopolymer vesicle provides an alternative insight on preparing effective recyclable AuNPs-decorated nanoreactor and powerful water remediation adsorbent.

Noisy continuous time random walks

Experimental studies of the diffusion of biomolecules within biological cells are routinely confronted with multiple sources of stochasticity, whose identification renders the detailed data analysis of single molecule trajectories quite intricate. Here, we consider subdiffusive continuous time random walks that represent a seminal model for the anomalous diffusion of tracer particles in complex environments. This motion is characterized by multiple trapping events with infinite mean sojourn time. In real physical situations, however, instead of the full immobilization predicted by the continuous time random walk model, the motion of the tracer particle shows additional jiggling, for instance, due to thermal agitation of the environment. We here present and analyze in detail an extension of the continuous time random walk model. Superimposing the multiple trapping behavior with additive Gaussian noise of variable strength, we demonstrate that the resulting process exhibits a rich variety of apparent dynamic regimes. In particular, such noisy continuous time random walks may appear ergodic, while the bare continuous time random walk exhibits weak ergodicity breaking. Detailed knowledge of this behavior will be useful for the truthful physical analysis of experimentally observed subdiffusion.

Maximum PTV Dose Predicts for Radiation Pneumonitis Following Lung Stereotactic Body Radiation Therapy

Materials/Methods: Patients were treated with SBRT for medically inoperable non-small cell lung cancer or metastatic lung lesions at Mayo Clinic from January 11, 2008 to January 12, 2010. Treatment planning was performed with full body immobilization, 4-dimensional CT-based planning and daily cone-beam CT for image guidance. Tissue heterogeneity corrections were used in all cases. Dosimetric data was collected prospectively on all patients. Follow-up care consisted of CT imaging and clinical exam every 3 months. The incidence of radiation pneumonitis (RP) was evaluated and graded according to CTCAE v3.0. The impact of demographic and dosimetric variables on the risk of RP . grade 2 was estimated using Cox proportional hazards regression modeling.

Mobility characterization for autonomous mobile robots using machine learning

This paper presents a supervised learning approach to improving the autonomous mobility of wheeled robots through sensing the robot's interaction with terrain `underfoot.' Mobility characterization is cast as a hierarchical task, in which pre-immobilization detection is achieved using support vector machines in time to prevent full immobilization, and if a pre-immobilization condition is detected, the associated terrain feature affecting mobility is identified using a Hidden Markov model. These methods are implemented using a hierarchical, layered control scheme developed for the Yeti robot, a 73-kg, four-wheeled robot designed to perform autonomous medium-range missions in polar terrain. The methodology is motivated by the difficultly of visually recognizing terrain features that impact mobility in low contrast terrain. The efficacy of the approach is evaluated using data from a suite of proprioceptive sensors. Real-time implementation shows that Yeti can consistently detect pre-immobilization conditions, stop in time to avoid unrecoverable immobilization, identify the terrain feature presenting the mobility challenge, and execute an escape sequence to retreat from the condition.

Open and subcutaneous recent tibialis anterior tendon ruptures: Does postoperative immobilization method influence outcome?

We report on seven traumatic lesions of the tibialis anterior tendon (one subcutaneous rupture and six open tears) in seven injured patients of mean age 45 years [17-79] all managed by direct suture and immobilization either using a cast boot (four cases) or a lower leg external fixator (three cases). After a mean follow-up of 31 months (6-50), external fixation achieved favourable clinical results with no specific complication. External fixation improves the conditions for suture efficiency, provides full immobilization and facilitates wound care in patients at a high risk of developing cutaneous complications. In accordance with data published in the literature, immobilization by means of a windowed cast boot achieved satisfactory results in patients with no risk factors. This method compatible with early mobilization avoids placement of a posterior splint which could induce slackening and weakening of tendon repair. Retrospective study (Level IV).

What Governs Protein Adsorption and Immobilization at a Charged Solid Surface?

The adsorption of hen egg white lysozyme at a model charged surface is studied using fully atomistic molecular dynamics simulations. The simulations are performed over a 90 ns time scale which is sufficient to observe rotational and translational steps in the adsorption process. Electrostatics is found to play a key role in guiding the protein to the favorable binding orientation with the N,C-terminal face against the substrate. However, full immobilization appears to only occur through the strong interaction of Arg128 with the surface, facilitated by the protein’s flexibility at the terminal face. Simulated mutation at this residue confirms its crucial role. This work demonstrates that electrostatics alone might not be sufficient to guide the development of material systems that exploit protein adsorption and immobilization.

Do all fractures need full immobilisation?

As I was about to start my morning general practice clinic, the receptionist told me of a patient who was coming in with an injury and handed me a faxed...

A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization.

Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined. Based on ICD-9 codes, all patients admitted to the trauma center diagnosed with spinal fractures with or without spinal damage were identified. The sensitivity of the combination of five clinical criteria (reduced awareness, evidence of intoxication, neurological deficit, pain of the spine on palpation, (significant) distracting injury) and an age criterion (65 years or older at time of accident) was determined. If one or more criteria were positive, standard full immobilization would be indicated. The other patients would not have been immobilized. A total of 238 blunt trauma victims primarily admitted to the trauma center were included for this study. Median age of the included patients was 39 years (range 5-98), with 32.8% female. A total of 236 had at least one positive criterion (sensitivity 99.2%). The two missed patients were male, 40 and 41 years old. Radiology showed a small fissure in the arch of C2, and a transverse process fracture of L3, respectively. Both patients were discharged the next day without complications or medical interventions. In this retrospective study, a selective protocol based on clinical criteria instead of trauma mechanism showed 99.2% sensitivity for spinal fractures with or without spinal cord damage. Based on this study and the current controversy surrounding spinal immobilization, a prospective study should be considered to evaluate the five clinical criteria and one age criterion in the prehospital setting.

Development of steady state adsorption distribution over interface of a bubble rising in solutions of n-alkanols (C 5, C 8) and n-alkyltrimethylammonium bromides (C 8, C 12, C 16)

Initial accelerations, local and terminal velocities, dimensions and shape variations of the bubbles rising in n-pentanol, n-octanol, n-octyltrimethylammonium (OTAB), n-dodecyltrimethylammonium (DDTAB) and n-cetyltrimethylammonium (CTAB) bromides solutions were determined. Single bubbles were formed at the capillary orifice in a so controlled way that the time of the bubble surface rapid expansion size was always 1.6 ±0.2 s (adsorption time). Motion of the rising bubbles was monitored and recorded using the CCD camera coupled to the JVC professional video recorder and Motic Images Plus 2.0 digital recording system. Stroboscopic illumination of frequency 100 and 200 Hz was applied. It was found that initial bubble acceleration was decreasing with solution concentration from ca. 930 in distilled water to 500 cm/s 2 in 0.005 mol/dm 3 n-pentanol solution. Profiles of the local velocity variations with distance from the capillary depended on concentration of the solutions studied. Generally, two types of the velocity profiles were observed. At low concentrations a maximum value of velocity was achieved after initial acceleration, next bubble decelerated prior a plateau value of the terminal velocity was attained. Heights and widths of the maximum were diminishing with increasing solution concentration. There was no maximum in distilled water and high concentrations of the solutions. The bubbles terminal velocity was 34.7 ± 0.3 cm/s in distilled water and decreased to ca. 15 cm/s at high concentration of the solution. Magnitudes of the adsorption coverage at surface of the detaching bubble were calculated and the minimum degrees of adsorption coverage's needed for full immobilization of the bubble interface were determined. It was also evaluated that the time needed for development of dynamic steady state structure of the adsorption layer over surface of the rising bubbles was varying from ca. 0.1 up to over 1 s, depending on the solution concentration.

Effects of Partial Neuromuscular Blockade on Facial Nerve Monitorization in Otologic Surgery

Objective—Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery.Material and Methods—Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action.Results—All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10±0.08 and 0.11±0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%.Conclusion—This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.

Spinal Injuries

The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further...

Arrêt cardiocirculatoire chez l’enfant traumatisé : une cause rare, la luxation atlanto-occipitale

We report the case of a trauma child who developed a cardiac arrest due to atlanto-occipital luxation of the cervical spine. The occurrence of a rapidly reversible cardiac arrest in a trauma patient should alert physicians about cervical trauma. Adequate resuscitation of these patients require endotracheal intubation with concomitant full immobilisation of the cervical spine, plasma expansion to prevent arterial hypotension and immobilisation of the cervical spine during transport. Thorough application of these resuscitation techniques should increase the survival rate on admission to trauma centres of paediatric patients presenting with such a severe condition. Nevertheless, atlanto-occipital luxation is a major cause of paediatric cervical trauma mortality and our patient did not survive this condition.

Effect of Surfactants on the Immobilization of 4-(2-Pyridylazo)resorcinol on Silochroms

The effect of cationic surfactants (cetyltrimethylammonium bromide, cetylpyridinium bromide, and tetrabutylammonium perchlorate) and a nonionic surfactant (OP-7) on the conditions of the immobilization of 4-(2-pyridylazo)resorcinol (PAR) on three types of silica gel (Silochrom S-120 (200–350 μm), Silochrom S-120 (315–500 μm), and Silochrom S-80 (200–350 μm)) was studied. It was found that OP-7 does not affect the adsorption of surfactants. The effect of cationic surfactants increases in the order tetrabutylammonium perchlorate < cetyltrimethylammonium bromide < cetylpyridinium bromide. The adsorption activity of silica gels increases in the order Silochrom S-120 (315–500 μm) < Silochrom S-80 (200–350 μm) < Silochrom S-120 (200–350 μm). Cetylpyridinium bromide provides full immobilization of PAR on silica gel Silochrom S-120 (200–350 μm) in the pH range 2–9.

Chemical restraint of Weddell seals (Leptonychotes weddellii) with a combination of tiletamine and zolazepam.

A 1:1 combination by weight of tiletamine hydrochloride and zolazepam hydrochloride was administered to 30 adult Weddell seals (Leptonychotes weddellii) in doses varying from 100 to 300 mg. Full immobilization was achieved in 16 seals, moderate sedation in seven and light sedation in seven. Three animals died; two were fully immobilized and one was moderately sedated prior to death. The drug combination was considered satisfactory, although its usefulness was limited by the lack of chemical antagonists when complications were encountered in immobilized animals.

Immobilization of polar bears (Ursus maritimus) with Telazol in the Canadian Arctic.

In 1986, 213 polar bears (Ursus maritimus) were immobilized with Telazol on the sea ice of the eastern Beaufort Sea during April and May, and 106 along the western coast of Hudson Bay near Churchill, Manitoba (Canada) in September. No animals died from handling. The efficacy of this drug at different seasons and the physiological responses of the immobilized bears were compared. A single injection of 8 to 9 mg of Telazol per kg of body weight gave a rapid full immobilization with satisfactory analgesia, and faster recovery than other drugs for which there is no antagonist. The reactions of the bears could be reliably and easily interpreted from a safe distance before the animal was approached. There was a wide range of tolerance to high dosages and bears appeared able to thermoregulate while immobilized. The mortality rate due to handling was lower than with any other drug used to date.

Resorbable suture support for ventricular aneurysmectomy

The edge of tissue left after ventricular aneurysmectomy requires very careful placement and tying of the sutures. The use of Teflon felt as a support appears to redistribute the pressure and thus prevent the sutures from cutting through the vulnerable tissue. In many cases, Teflon felt reinforcement is preferred to direct unsupported closure because of perioperative of immediately postoperative bleeding complications. However, the unavoidable full immobilization of the sutured area, the possible risk of foreign body infection, and the extensive adhesions and calcification in the long term compelled us to search for a better alternative, combining the convenience of both methods and limiting the risks. PDS (polydioxine) resorbable pledgets and strips, provided by Ethicon GmbH, were used as a suture support during the past 2 years for closure of 29 ventricular aneurysmectomies and four ischemic ventricular septal defects, all except one in combination with coronary bypass grafting. The PDS material was easy and efficient to apply and caused no complications during and after the operation. In one case, we had the opportunity to review the supported scar during a second operation for new coronary grafts after 18 months. The formerly feared "linear scar petrification," usual after use of Teflon felt, was absent. The scar was free from difficult adhesions. Our initial experience suggests the further extensive use of this resorbable material as a support for various sutures at risk.

Elective postoperative I.P.P.V. for extensive head and neck skin grafting.

Patients with extensive skin-grafting of the head and neck are managed for the first 24-48 hours postoperatively in the Intensive Care Unit with muscle paralysis, controlled ventilation, timed parenteral analgesia and sedation. The aims are to provide full immobilization of the graft and to allow pressure dressings without embarrassment to the airway. The regime is suggested as an added indication for intensive care therapy.