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Zhang H, Yang Z. Research on dynamic comfort maintenance by measuring lower limb edema and seat pressure during simulated seated sleep in flight. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:72-83. [PMID: 37401853 DOI: 10.1080/10803548.2023.2232635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Objectives. Seated sleep during flight can bring significant discomfort to passengers. The objective of this research was to study passengers' dynamic comfort maintenance strategies in lower limb postural shifting during seated sleep in flight. Methods. Studies on seated sleep postures and sitting comfort were conducted. First, 40 participants were recruited to the observational research for collecting typical leg postures during seated sleep. Then, an experiment was conducted with the participants simulating seated sleep in the aircraft seat. The changes in lower limb edema and seat pressure in different postures were measured with a bioelectrical impedance device, near-infrared spectroscopy device and pressure mapping device. Results. Six postures were selected through the observational research. The experiment showed that tissues of the thighs and buttocks suffer alternate higher compression by shifting between the six postures. Lower limb edema is higher when the shanks are forward, while the tissue under the ischial tuberosity suffers higher compression when the shanks are neutral. Conclusion. Six motivations for passengers to shift each sitting posture to achieve dynamic comfort were summarized, which helps obtain alternating rest in different body parts. The suggestion of a leg position adjustment system was also proposed.
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Affiliation(s)
- Huizhong Zhang
- School of Mechanical Engineering, Northwestern Polytechnical University, China
| | - Zhi Yang
- Department of Science and Technology, Beijing Institute of Fashion Technology, China
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Kim DG, Park ES, Nam SM, Cha HG, Choi CY. Volumetric Evaluation of Dead Space in Ischial Pressure Injuries Using Magnetic Resonance Imaging: A Case Series. Adv Skin Wound Care 2021; 34:668-673. [PMID: 34807898 DOI: 10.1097/01.asw.0000797960.52759.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish a preoperative evaluation procedure by measuring the volume of dead space using MRI in patients with ischial pressure injuries. METHODS Patients with spinal cord injury and ischial pressure injuries who underwent treatment between August 2016 and November 2019 were included in the study. Preoperative MRI scan was conducted on all patients. The volume estimation and three-dimensional (3D) reconstruction were performed based on MRI data using a 3D Slicer. Based on the resulting volume, a muscle flap that could fit the dead space was selected. Surgery was performed with the selected muscle flap, and a fasciocutaneous flap was added, if necessary. RESULTS A total of eight patients with ischial pressure injuries were included in the study. The mean patient age was 59.0 ± 11.0 years. The mean body mass index was 26.62 ± 3.89 kg/m2. The mean volume of dead space was 104.75 ± 81.05 cm3. The gracilis muscle was the most selected muscle flap and was used in four patients. In five of eight cases, a fasciocutaneous flap was used as well. The mean follow-up period was 16 months, and by that point, none of the patients evinced complications that required surgery. CONCLUSIONS To the authors' knowledge, this is the first report on volumetric evaluation of dead space in ischial pressure injuries. The authors believe that the 3D reconstruction process would enable adequate dead space obliteration in ischial pressure injuries. The authors propose that preoperative MRI scans in patients with ischial pressure injury should become an essential part of the process.
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Affiliation(s)
- Dong Gyu Kim
- In the Department of Plastic and Reconstructive Surgery at the Soonchunhyang University Bucheon Hospital in Bucheon, Republic of Korea, Dong Gyu Kim, MD, is Resident; Eun Soo Park, MD, PhD, is Professor and Chief of the Medical Department; Seung Min Nam, MD, PhD, and Chang Yong Choi, MD, PhD are Associate Professors; and Han Gyu Cha, MD, is Assistant Professor. Acknowledgments : This work was supported by the Soonchunhyang University Research Fund. The authors have disclosed no other financial relationships related to this article. Submitted October 16, 2020; accepted in revised form January 26, 2021
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Nelissen JL, Sinkus R, Nicolay K, Nederveen AJ, Oomens CW, Strijkers GJ. Magnetic resonance elastography of skeletal muscle deep tissue injury. NMR IN BIOMEDICINE 2019; 32:e4087. [PMID: 30897280 PMCID: PMC6593838 DOI: 10.1002/nbm.4087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 05/31/2023]
Abstract
The current state-of-the-art diagnosis method for deep tissue injury in muscle, a subcategory of pressure ulcers, is palpation. It is recognized that deep tissue injury is frequently preceded by altered biomechanical properties. A quantitative understanding of the changes in biomechanical properties preceding and during deep tissue injury development is therefore highly desired. In this paper we quantified the spatial-temporal changes in mechanical properties upon damage development and recovery in a rat model of deep tissue injury. Deep tissue injury was induced in nine rats by two hours of sustained deformation of the tibialis anterior muscle. Magnetic resonance elastography (MRE), T2 -weighted, and T2 -mapping measurements were performed before, directly after indentation, and at several timepoints during a 14-day follow-up. The results revealed a local hotspot of elevated shear modulus (from 3.30 ± 0.14 kPa before to 4.22 ± 0.90 kPa after) near the center of deformation at Day 0, whereas the T2 was elevated in a larger area. During recovery there was a clear difference in the time course of the shear modulus and T2 . Whereas T2 showed a gradual normalization towards baseline, the shear modulus dropped below baseline from Day 3 up to Day 10 (from 3.29 ± 0.07 kPa before to 2.68 ± 0.23 kPa at Day 10, P < 0.001), followed by a normalization at Day 14. In conclusion, we found an initial increase in shear modulus directly after two hours of damage-inducing deformation, which was followed by decreased shear modulus from Day 3 up to Day 10, and subsequent normalization. The lower shear modulus originates from the moderate to severe degeneration of the muscle. MRE stiffness values were affected in a smaller area as compared with T2 . Since T2 elevation is related to edema, distributing along the muscle fibers proximally and distally from the injury, we suggest that MRE is more specific than T2 for localization of the actual damaged area.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King's College LondonLondonUK
| | - Klaas Nicolay
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Cees W.J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical EngineeringEindhoven University of TechnologyThe Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
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Myoglobin and troponin concentrations are increased in early stage deep tissue injury. J Mech Behav Biomed Mater 2019; 92:50-57. [DOI: 10.1016/j.jmbbm.2018.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 12/27/2022]
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Traa WA, van Turnhout MC, Nelissen JL, Strijkers GJ, Bader DL, Oomens CWJ. There is an individual tolerance to mechanical loading in compression induced deep tissue injury. Clin Biomech (Bristol, Avon) 2019; 63:153-160. [PMID: 30897463 DOI: 10.1016/j.clinbiomech.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. The objective of this study was to compare mechanical loading conditions to the associated damage in 3D. METHODS An indentation test was performed on the tibialis anterior muscle of rats (n = 39). Changes in the form of oedema and structural damage were monitored with MRI in an extensive region. The internal deformations were evaluated using MRI based 3D finite element models. FINDINGS Damage propagates away from the loaded region. The 3D analysis indicates that there is a subject specific tolerance to compression induced deep tissue injury. INTERPRETATION Individual tolerance is an important factor when considering the mechanical loading conditions which induce damage.
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Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Mark C van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jules L Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Traa WA, van Turnhout MC, Moerman KM, Nelissen JL, Nederveen AJ, Strijkers GJ, Bader DL, Oomens CWJ. MRI based 3D finite element modelling to investigate deep tissue injury. Comput Methods Biomech Biomed Engin 2018; 21:760-769. [DOI: 10.1080/10255842.2018.1517868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Willeke A. Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mark C. van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kevin M. Moerman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jules L. Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan L. Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Cees W. J. Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Neumann W, Bichert A, Fleischhauer J, Stern A, Figuli R, Wilhelm M, Schad LR, Zöllner FG. A novel 3D printed mechanical actuator using centrifugal force for magnetic resonance elastography: Initial results in an anthropomorphic prostate phantom. PLoS One 2018; 13:e0205442. [PMID: 30296308 PMCID: PMC6175527 DOI: 10.1371/journal.pone.0205442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 12/12/2022] Open
Abstract
This work demonstrates a new method for the generation of mechanical shear wave during magnetic resonance elastography (MRE) that creates greater forces at higher vibrational frequencies as opposed to conventionally used pneumatic transducers. We developed an MR-compatible pneumatic turbine with an eccentric mass that creates a sinusoidal centrifugal force. The turbine was assessed with respect to its technical parameters and evaluated for MRE on a custom-made anthropomorphic prostate phantom. The silicone-based tissue-mimicking materials of the phantom were selected with regard to their complex shear moduli examined by rheometric testing. The tissue-mimicking materials closely matched human soft tissue elasticity values with a complex shear modulus ranging from 3.21 kPa to 7.29 kPa. We acquired MRE images on this phantom at 3 T with actuation frequencies of 50, 60 Hz, 70 Hz, and 80 Hz. The turbine generated vibrational wave amplitudes sufficiently large to entirely penetrate the phantoms during the feasibility study. Increased wave length in the stiffer inclusions compared to softer background material were detected. Our initial results suggest that silicone-based phantoms are useful for the evaluation of elasticities during MRE. Furthermore, our turbine seems suitable for the mechanical assessment of soft tissue during MRE.
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Affiliation(s)
- Wiebke Neumann
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Bichert
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jonas Fleischhauer
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Antonia Stern
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roxana Figuli
- Institute for Chemical Technology and Polymer Chemistry of Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Manfred Wilhelm
- Institute for Chemical Technology and Polymer Chemistry of Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lothar R. Schad
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G. Zöllner
- Department of Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Nelissen JL, Traa WA, de Boer HH, de Graaf L, Mazzoli V, Savci-Heijink CD, Nicolay K, Froeling M, Bader DL, Nederveen AJ, Oomens CWJ, Strijkers GJ. An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury. J Appl Physiol (1985) 2018; 124:1580-1596. [DOI: 10.1152/japplphysiol.00891.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T2, T2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T2 corresponded with edema, muscle cell damage, and inflammation. T2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue’s microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans H. de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Mazzoli
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Orthopedic Research Laboratory, Radboud UMC, Nijmegen, The Netherlands
| | | | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan L. Bader
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Nelissen JL, de Graaf L, Traa WA, Schreurs TJL, Moerman KM, Nederveen AJ, Sinkus R, Oomens CWJ, Nicolay K, Strijkers GJ. A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats. PLoS One 2017; 12:e0169864. [PMID: 28076414 PMCID: PMC5226723 DOI: 10.1371/journal.pone.0169864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/23/2016] [Indexed: 02/01/2023] Open
Abstract
Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tom J. L. Schreurs
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin M. Moerman
- Center for Extreme Bionics, Media lab, MIT, Cambridge, MA, United States of America
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King’s College London, London, United Kingdom
| | - Cees W. J. Oomens
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Mohammadkhah M, Murphy P, Simms CK. The in vitro passive elastic response of chicken pectoralis muscle to applied tensile and compressive deformation. J Mech Behav Biomed Mater 2016; 62:468-480. [DOI: 10.1016/j.jmbbm.2016.05.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
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Jagannathan NS, Tucker-Kellogg L. Membrane permeability during pressure ulcer formation: A computational model of dynamic competition between cytoskeletal damage and repair. J Biomech 2015; 49:1311-1320. [PMID: 26772800 DOI: 10.1016/j.jbiomech.2015.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Pressure ulcers are debilitating wounds that arise frequently in people who have lost mobility. Mechanical stress, oxidative stress and ischemia-reperfusion injury are potential sources of damage during pressure ulcer formation, but cross-talk between these sources has rarely been investigated. In vitro experiments with mechanically-induced cell damage previously demonstrated that non-lethal amounts of static cell deformation could induce myoblast membrane permeabilization. Permeabilization, in turn, has the potential to induce oxidative stress via leakage of calcium, myoglobin or alarmins. In this work, we constructed a hypothetical causal network of cellular-scale effects resulting from deformation and permeabilization, and we investigated the theoretical sensitivity of cell death toward various parameters and pathways of the model. Simulations showed that the survival/death outcome was particularly sensitive to the speed of membrane repair. The outcome was also sensitive to whether oxidative stress could decrease the speed of membrane repair. Finally, using the assumption that apoptosis and necrosis would have opposite effects on membrane leakage in dying cells, we showed that promoting apoptosis might under certain conditions have the paradoxical effect of decreasing, rather than increasing, total cell death. Our work illustrates that apoptosis may have hidden benefits at preventing spatial spread of death. More broadly, our work shows the importance of membrane repair dynamics and highlights the need for experiments to measure the effects of ischemia, apoptosis induction, and other co-occurring sources of cell stress toward the speed of membrane repair.
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Affiliation(s)
- N Suhas Jagannathan
- Centre for Computational Biology, and Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore
| | - Lisa Tucker-Kellogg
- Centre for Computational Biology, and Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore; Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore; BioSystems and Micromechanics (BioSyM) Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore.
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Oomens CWJ, Bader DL, Loerakker S, Baaijens F. Pressure Induced Deep Tissue Injury Explained. Ann Biomed Eng 2014; 43:297-305. [DOI: 10.1007/s10439-014-1202-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
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Loerakker S, Bader DL, Baaijens FP, Oomens CW. Which factors influence the ability of a computational model to predict thein vivodeformation behaviour of skeletal muscle? Comput Methods Biomech Biomed Engin 2013; 16:338-45. [DOI: 10.1080/10255842.2011.621423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Traditional Japanese formula kigikenchuto accelerates healing of pressure-loading skin ulcer in rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:592791. [PMID: 21660308 PMCID: PMC3108106 DOI: 10.1155/2011/592791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/02/2011] [Accepted: 03/13/2011] [Indexed: 12/20/2022]
Abstract
We evaluated the effect of kigikenchuto (KKT), a traditional Japanese formula, in a modified rat pressure-loading skin ulcer model. Rats were divided into three groups, KKT extract orally administered (250 or 500 mg/kg/day for 35 days) and control. KKT shortened the duration until healing. Immunohistochemically, KKT increased CD-31-positive vessels in early phase and increased α-smooth muscle actin-(α-SMA-) positive fibroblastic cells in early phase and decreased them in late phase of wound healing. By Western blotting, KKT showed the potential to decrease inflammatory cytokines (MCP-1, IL-1β, and TNF-α) in early phase, decrease vascular endothelial growth factor in early phase and increase it in late phase, and modulate the expression of extracellular protein matrix (α-SMA, TGF-β1, bFGF, collagen III, and collagen I). These results suggested the possibility that KKT accelerates pressure ulcer healing through decreases of inflammatory cytokines, increase of angiogenesis, and induction of extracellular matrix remodeling.
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Hedayatpour N, Falla D, Arendt-Nielsen L, Farina D. Effect of delayed-onset muscle soreness on muscle recovery after a fatiguing isometric contraction. Scand J Med Sci Sports 2010; 20:145-53. [PMID: 19000101 DOI: 10.1111/j.1600-0838.2008.00866.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An increase to above-baseline levels of electromyography (EMG) mean power spectral frequency (MPF) has been observed previously during muscle recovery following fatiguing contractions and has been explained by membrane hyperpolarization due to increased activation of the Na+-K+ pump. It is hypothesized that this membrane mechanism is impaired by muscle fiber damage following eccentric exercise. Thus, the aim of the study was to investigate surface EMG signal characteristics during recovery from fatigue after eccentric exercise. Ten healthy subjects performed sustained isometric knee extensions at 40% of the maximal torque (MVC) until task failure before, immediately after and 24 and 48 h after eccentric exercise. Bipolar surface EMG signals were recorded from six locations over the quadriceps during the sustained isometric contraction and during 3-s long contractions at 40% MVC separated by 1-min intervals for 15 min (recovery). Before the eccentric exercise, MPF of EMG signals increased to values above baseline during recovery from the fatiguing isometric contraction (P<0.001), whereas immediately after and 24 and 48 h after the eccentric task, MPF was lower than baseline during the entire recovery period (P<0.01). In conclusion, delayed-onset muscle soreness abolished the supranormal increase in EMG MPF following recovery from fatigue.
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Affiliation(s)
- N Hedayatpour
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
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Temporal effects of mechanical loading on deformation-induced damage in skeletal muscle tissue. Ann Biomed Eng 2010; 38:2577-87. [PMID: 20232152 PMCID: PMC2900588 DOI: 10.1007/s10439-010-0002-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 03/04/2010] [Indexed: 11/06/2022]
Abstract
Mechanical loading of soft tissues covering bony prominences can cause skeletal muscle damage, ultimately resulting in a severe pressure ulcer termed deep tissue injury. Recently, by means of an experimental-numerical approach, it was shown that local tissue deformations cause tissue damage once a deformation threshold is exceeded. In the present study, the effects of load exposure time and intermittent load relief on the development of deformation-induced muscle damage were investigated. The data showed that a 2 h loading period caused more damage than 10 min loading. Intermittent load reliefs of 2 min during a 2 h loading period had minimal effect on the evolution of skeletal muscle damage. In addition, a local deformation threshold for damage was found, which was similar for each of the loading regimes applied in this study. For short loading periods, these results imply that local tissue deformations determine whether muscle damage will develop and the exposure time influences the amount of tissue damage. Temporary load reliefs were inefficient in reducing deformation-induced damage, but may still influence the development of ischemia-induced damage during longer loading periods.
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Reenalda J, Jannink M, Nederhand M, IJzerman M. Clinical Use of Interface Pressure to Predict Pressure Ulcer Development: A Systematic Review. Assist Technol 2009; 21:76-85. [DOI: 10.1080/10400430903050437] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Ceelen K, Stekelenburg A, Loerakker S, Strijkers G, Bader D, Nicolay K, Baaijens F, Oomens C. Compression-induced damage and internal tissue strains are related. J Biomech 2008; 41:3399-404. [DOI: 10.1016/j.jbiomech.2008.09.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 08/03/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
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Ceelen KK, Stekelenburg A, Mulders JLJ, Strijkers GJ, Baaijens FPT, Nicolay K, Oomens CWJ. Validation of a Numerical Model of Skeletal Muscle Compression With MR Tagging: A Contribution to Pressure Ulcer Research. J Biomech Eng 2008; 130:061015. [DOI: 10.1115/1.2987877] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sustained tissue compression can lead to pressure ulcers, which can either start superficially or within deeper tissue layers. The latter type includes deep tissue injury, starting in skeletal muscle underneath an intact skin. Since the underlying damage mechanisms are poorly understood, prevention and early detection are difficult. Recent in vitro studies and in vivo animal studies have suggested that tissue deformation per se can lead to damage. In order to conclusively couple damage to deformation, experiments are required in which internal tissue deformation and damage are both known. Magnetic resonance (MR) tagging and T2-weighted MR imaging can be used to measure tissue deformation and damage, respectively, but they cannot be combined in a protocol for measuring damage after prolonged loading. Therefore, a dedicated finite element model was developed to calculate strains in damage experiments. In the present study, this model, which describes the compression of rat skeletal muscles, was validated with MR tagging. Displacements from both the tagging experiments and the model were interpolated on a grid and subsequently processed to obtain maximum shear strains. A correlation analysis revealed a linear correlation between experimental and numerical strains. It was further found that the accuracy of the numerical prediction decreased for increasing strains, but the positive predictive value remained reasonable. It was concluded that the model was suitable for calculating strains in skeletal muscle tissues in which damage is measured due to compression.
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Affiliation(s)
- K. K. Ceelen
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - A. Stekelenburg
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - J. L. J. Mulders
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - G. J. Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - F. P. T. Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - K. Nicolay
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - C. W. J. Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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21
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Hashimoto M, Kurose T, Kawamata S. Comparison between a weight compression and a magnet compression for experimental pressure ulcers in the rat. Histological studies and effects of anesthesia. ACTA ACUST UNITED AC 2008; 71:303-16. [DOI: 10.1679/aohc.71.303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Masakazu Hashimoto
- Department of Anatomy and Histology, Graduate School of Health Sciences, Hiroshima University
| | - Tomoyuki Kurose
- Department of Anatomy and Histology, Graduate School of Health Sciences, Hiroshima University
| | - Seiichi Kawamata
- Department of Anatomy and Histology, Graduate School of Health Sciences, Hiroshima University
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22
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Ceelen KK, Oomens CWJ, Baaijens FPT. Microstructural analysis of deformation-induced hypoxic damage in skeletal muscle. Biomech Model Mechanobiol 2007; 7:277-84. [PMID: 17710456 PMCID: PMC2798056 DOI: 10.1007/s10237-007-0097-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 04/29/2007] [Indexed: 12/01/2022]
Abstract
Deep pressure ulcers are caused by sustained mechanical loading and involve skeletal muscle tissue injury. The exact underlying mechanisms are unclear, and the prevalence is high. Our hypothesis is that the aetiology is dominated by cellular deformation (Bouten et al. in Ann Biomed Eng 29:153–63, 2001; Breuls et al. in Ann Biomed Eng 31:1357–364, 2003; Stekelenburg et al. in J App Physiol 100(6):1946–954, 2006) and deformation-induced ischaemia. The experimental observation that mechanical compression induced a pattern of interspersed healthy and dead cells in skeletal muscle (Stekelenburg et al. in J App Physiol 100(6):1946–954, 2006) strongly suggests to take into account the muscle microstructure in studying damage development. The present paper describes a computational model for deformation-induced hypoxic damage in skeletal muscle tissue. Dead cells stop consuming oxygen and are assumed to decrease in stiffness due to loss of structure. The questions addressed are if these two consequences of cell death influence the development of cell injury in the remaining cells. The results show that weakening of dead cells indeed affects the damage accumulation in other cells. Further, the fact that cells stop consuming oxygen after they have died, delays cell death of other cells.
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Affiliation(s)
- K K Ceelen
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands.
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23
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Solis LR, Hallihan DP, Uwiera RRE, Thompson RB, Pehowich ED, Mushahwar VK. Prevention of pressure-induced deep tissue injury using intermittent electrical stimulation. J Appl Physiol (1985) 2007; 102:1992-2001. [PMID: 17272408 DOI: 10.1152/japplphysiol.01092.2006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pressure ulcers develop due to morphological and biochemical changes triggered by the combined effects of mechanical deformation, ischemia, and reperfusion that occur during extended periods of immobility. The goal of this study was to test the effectiveness of a novel electrical stimulation technique in the prevention of deep tissue injury (DTI). We propose that contractions elicited by intermittent electrical stimulation (IES) in muscles subjected to constant pressure would induce periodic relief in internal pressure; additionally, each contraction would also restore blood flow to the tissue. The application of constant pressure to the quadriceps muscles of rats generated a DTI that affected 60 ± 15% of the compressed muscle as assessed by magnetic resonance imaging. In contrast, in the groups of rats that received IES at 10- and 5-min intervals, DTI of the muscle was limited to 16 ± 16 and 25 ± 13%, respectively. Injury to the muscle was corroborated by histology. In an experiment with a human volunteer, compression of the buttocks reduced the oxygenation level of the muscles by ∼4%; after IES, oxygenation levels increased by ∼6% beyond baseline. Concurrently, the surface pressure profiles of the loaded muscles were redistributed and the high-pressure points were reduced during each IES-induced contraction. The results of this study indicate that IES significantly reduces the amount of DTI by increasing the oxygen available to the tissue and by modifying the pressure profiles of the loaded muscles. This presents a promising technique for the prevention of pressure ulcers in immobilized and/or insensate individuals.
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Affiliation(s)
- Leandro R Solis
- Dept. of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2S2
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Stekelenburg A, Oomens CWJ, Strijkers GJ, de Graaf L, Bader DL, Nicolay K. A new MR-compatible loading device to study in vivo muscle damage development in rats due to compressive loading. Med Eng Phys 2006; 28:331-8. [PMID: 16118060 DOI: 10.1016/j.medengphy.2005.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 06/09/2005] [Accepted: 07/08/2005] [Indexed: 10/25/2022]
Abstract
To study the aetiology of pressure ulcers an MR-compatible loading device was developed. Magnetic resonance imaging provides the possibility of non-invasive evaluation of muscle tissue after compressive loading. Pressure was applied to the tibialis anterior region of rats by means of an indenter. The developed MR-compatible loading device allowed high quality consecutive MR measurements for up to 6h. Tissue was evaluated both during and after loading. Two loading protocols were used; a large indentation of 4.5mm (mean pressure 150 kPa) was applied for 2h and a small indentation of 2.9 mm (mean pressure 50 kPa) was applied for 4h. T2-weighted MR images after the large indentation showed an immediate increase in signal intensity, associated with damage, following load removal. After 20 h the signal intensity remained higher in the affected regions. Afterwards the tissue was perfusion fixated for histological examination. Histological evaluation revealed an inflammatory response and severe muscle necrosis. No signal increase was observed after small indentation. With this new set-up, the different factors that may play a role in the onset of muscle damage can be studied, what we believe will lead to a better understanding of the contributing factors to pressure ulcer development.
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Affiliation(s)
- A Stekelenburg
- Department of Materials Technology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
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Linder-Ganz E, Engelberg S, Scheinowitz M, Gefen A. Pressure–time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics. J Biomech 2006; 39:2725-32. [PMID: 16199045 DOI: 10.1016/j.jbiomech.2005.08.010] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 08/17/2005] [Indexed: 11/15/2022]
Abstract
Deep pressure sores (DPS) are associated with inadequate soft tissue perfusion and excessive tissue deformation over critical time durations, as well as with ischemia-reperfusion cycles and deficiency of the lymphatic system. Muscle tissue shows the lowest tolerance to pressure injuries, compared with more superficial tissues. In this communication, we present new histopathology data for muscle tissue of albino (Sprague-Dawley) rats exposed to pressures for 15 or 30 min. These data are superimposed with an extensive literature review of all previous histopathology reported for albino rat skeletal muscles subjected to pressure. The pooled data enabled a new mathematical characterization of the pressure-time threshold for cell death in striated muscle of rats, in the form of a sigmoid pressure-time relation, which extends the previous pressure-time relation to the shorter exposure periods. We found that for pressure exposures shorter than 1 h, the magnitude of pressure is the important factor for causing cell death and the exposure time has little or no effect: even relatively short exposures (15 min - 1 h) to pressures greater than 32 kPa (240 mmHg) cause cell death in rat muscle tissue. For exposures of 2 h or over, again the magnitude of pressure is the important factor for causing cell death: pressures greater than 9 kPa (67 mmHg) applied for over 2 h consistently cause muscle cell death. For the intermediate exposures (between 1 and 2 h), the magnitude of cell-death-causing pressure strongly depends on the time of exposure, i.e., critical pressure levels drop from 32 to 9 kPa. The present sigmoidal pressure-time cell death threshold is useful for design of studies in albino rat models of DPS, and may also be helpful in numerical simulations of DPS development, where there is often a need to extrapolate from tissue pressures to biological damage.
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Affiliation(s)
- Eran Linder-Ganz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
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