Predictive performance of Shock Index for postpartum hemorrhage during cesarean delivery

BACKGROUND

The Shock Index (SI), defined as heart rate divided by systolic blood pressure, is reportedly an early surrogate indicator for postpartum hemorrhage (PPH). However, most previous studies have used clinical data of women who delivered vaginally. Therefore, we aimed to evaluate the SI pattern during cesarean delivery and determine its usefulness in detecting PPH.

METHODS

This was a single-center retrospective study using the clinical data of women (n = 331) who underwent cesarean delivery under spinal anesthesia at term between 2018 and 2021. We assessed the SI pattern stratified by total blood loss and evaluated the predictive performance of each vital sign in detecting PPH (total blood loss ≥1000 mL) based on the area under the receiver operating characteristic curve (AUROC).

RESULTS

At 10-15 min after delivery, the mean SI peaked between 0.84 and 0.90 and then decreased to a level between 0.72 and 0.77, which was similar to that upon entering the operating room. Among 331 women, 91 (27.5%) were diagnosed with PPH. There was no correlation between SI and total blood loss (rs = 0.02). The SI had low ability to detect PPH (AUROC 0.54, 95% confidence interval 0.47 to 0.61), which was similar to other vital signs (AUROCs 0.53-0.56).

CONCLUSION

We determined the pattern of SI during cesarean delivery. We found no correlation between SI and total blood loss. Unlike in vaginal delivery, the prognostic accuracy of SI for PPH detection in cesarean delivery was low.

The prevalence and impact of chronic neuropathic pain on daily and social life: A nationwide study in a Japanese population

BACKGROUND

This study marks the first epidemiological evaluation of the prevalence and burden of chronic neuropathic pain (NeP) in an Asian population. The objective of this nationwide cross-sectional study was to identify the characteristics of individuals with NeP, detect the NeP features that affect their quality of life (QOL), and demonstrate the negative effects of NeP on social and daily living as well as comorbidities including depression, anxiety and sleep disorders.

METHODS

We mailed a cross-sectional, population-based epidemiological survey to a random nationwide sample of 10,000 Japanese adults over 20 years old.

RESULTS

The response rate was 54.4% (2445 men, 2992 women; mean age, 53.4 years). Prevalence of chronic pain was 16.6%, and prevalence of NeP was 3.2% as detected by the PainDETECT. Participants with NeP showed significantly lower quality of life according to scores on the EuroQol-5 Dimensions scale (p < 0.001), higher levels of psychological distress on the Kessler 6-item psychological distress scale (p < 0.001), poorer sleep quality (p < 0.001), and more workdays lost (p < 0.001) than did participants without NeP. Linear regression modelling showed that widespread pain, thermal hyperalgesia and pressure-induced pain had strong associations with lower QOL, with regression coefficients of -0.046 (p < 0.001), -0.038 (p < 0.001), and -0.040 (p < 0.001), respectively.

CONCLUSIONS

This study is the first to report the prevalence of NeP in an Asian population using a validated questionnaire. This study provides compelling evidence that chronic NeP is more strongly associated with poorer QOL, mental health and social well-being than CP without a neuropathic component.

SIGNIFICANCE

This population-based nationwide epidemiological study revealed the prevalence, characteristics, and negative effects of chronic pain with neuropathic components in Asian society. The prevalence of neuropathic pain was 3.2% with PainDETECT.

Maternal molecular hydrogen treatment attenuates lipopolysaccharide-induced rat fetal lung injury

Maternal inflammation is associated with spontaneous preterm birth and respiratory impairment among premature infants. Recently, molecular hydrogen (H2) has been reported to have a suppressive effect on oxidative stress and inflammation. The aim of this study was to evaluate the effects of H2 on fetal lung injury caused by maternal inflammation. Cell viability and the production of interleukin-6 (IL-6) and reactive oxygen species (ROS) were examined by treatment with lipopolysaccharide (LPS) contained in ordinal or H2-rich medium (HM) using a human lung epithelial cell line, A549. Pregnant Sprague Dawley rats were divided into three groups: Control, LPS, and HW + LPS groups. Rats were injected with phosphate-buffered saline (Control) or LPS intraperitoneally (LPS) on gestational day 19 and provided H2 water (HW) ad libitum for 24 h before LPS injection (HW + LPS). Fetal lung samples were collected on day 20, and the levels of apoptosis, oxidative damage, IL-6, and vascular endothelial growth factor (VEGF) were evaluated using immunohistochemistry. The number of apoptotic cells, and levels of ROS and IL-6 were significantly increased by LPS treatment, and repressed following cultured with HM in A549 cells. In the rat models, the population positive for cleaved caspase-3, 8-hydroxy-2'-deoxyguanosine, IL-6, and VEGF was significantly increased in the LPS group compared with that observed in the Control group and significantly decreased in the HW + LPS group. In this study, LPS administration induced apoptosis and oxidative damage in fetal lung cells that was ameliorated by maternal H2 intake. Antenatal H2 administration may decrease the pulmonary mobility associated with inflammation in premature infants.

The microRNA-23a has limited roles in bone formation and homeostasis in vivo

Recent studies have demonstrated that some microRNAs (miRNAs) inhibit bone formation by inhibiting the translation of specific genes. Several in vitro studies have suggested that miR-23a inhibits osteogenic differentiation by suppressing the translation of Runx2, a transcription factor essential for osteoblastogenesis, and of Satb2, a member of the special AT-rich binding protein family. In the present study, we used a gain-of-function approach to determine the roles of miR-23a in bone formation and homeostasis in vivo. The miR-23a transgenic (Tg) mice grew normally and their body size and weight were similar to those of wild-type (WT) littermates. Bone structure and morphology were similar in Tg and WT mice. Furthermore, the numbers of osteoblasts and osteoclasts, as well as their activities in bone were similar between Tg and WT mice. Our results indicate that miR-23 has limited roles in bone formation and maintenance in vivo in mice.

Repeated intra-articular injections of acidic saline produce long-lasting joint pain and widespread hyperalgesia

BACKGROUND

Synovial fluid in inflamed joint shows a drop in pH, which activates proton-gated ion channels in nociceptors. No studies have ever tried to develop and characterize acid-induced joint pain.

METHODS

Rats were injected intra-articularly with pH 4.0 acidic saline twice, 5 days apart. Pain-related behaviour tests including weight-bearing asymmetry, paw withdrawal threshold and knee compression threshold were conducted. To clarify the roles of proton-gated ion channels, rats were injected intra-articularly with selective antagonists for ASIC1a, ASIC3 and TRPV1 on day 5 (before the second injection) or on day 14. Underlying peripheral and central pain mechanisms were evaluated using joint histology, interleukin-1β concentrations in the synovium, single-fibre recording of the knee afferent and expression of phosphorylated cyclic adenosine monophosphate-responsive element-binding protein (p-CREB) in the spinal dorsal horn.

RESULTS

Repeated injections of acidic saline induced weight-bearing asymmetry, decrease in paw withdrawal threshold and knee compression threshold bilaterally, which lasted until day 28. Early administration of ASIC3 antagonist reduced the bilateral and long-lasting hyperalgesia. Neither articular degeneration nor synovial inflammation was observed. C-fibre of the knee afferent was activated by acidic saline, which was attenuated by pre-injection of ASIC3 antagonist. p-CREB expression was transiently up-regulated bilaterally on day 6, but not on day 14.

CONCLUSION

We developed and characterized a model of acid-induced long-lasting bilateral joint pain. Peripheral ASIC3 and spinal p-CREB played important roles for the development of hyperalgesia. This animal model gives insights into the mechanisms of joint pain, which is helpful in developing better pain treatments.

The use of sonication treatment to decellularize aortic tissues for preparation of bioscaffolds

A novel decellularization method using sonication treatment is described. Sonication treatment is the combination of physical and chemical agents. These methods will disrupt cell membrane and release cell contents to external environments. The cell removal was facilitated by subsequent rinsing of sodium dodecyl sulfate detergents. Sonication treatment is used in the preparation of complete decellularized bioscaffolds. The aim of this study is to confirm the usefulness of sonication treatment for preparation of biological scaffolds. In this study, samples of aortic tissues are decellularized by sonication treatment at frequency of 170 kHz in 0.1% and 2% sodium dodecyl sulfate detergents for 10-h treatment time. The relation between decellularization and sonication parameters such as dissolved oxygen concentration, conductivity, and pH is investigated. Histological analysis and biomechanical testing is performed to evaluate cell removal efficiency as well as changes in biomechanical properties. Minimal inflammation response elicit by bioscaffolds is confirmed by xenogeneic implantation and immunohistochemistry. Sonication treatment is able to produce complete decellularized tissue suggesting that these treatments could be applied widely as one of the decellularization method.

Preparation of decellularized meniscal scaffolds using sonication treatment for tissue engineering

Scaffolds play a key role in the process of regeneration and morphogenesis of tissue or organ. We have developed a novel sonication decellularization system to prepare decellularized bio-scaffolds in a short treatment time. The aim of the study is to investigate sonication decellularization condition that completely decellularize meniscus can be changed as well as to maintain the biomechanical parameters of scaffolds. The meniscus samples were decellularized using sonication treatment. The treated samples were evaluated histologically by EVG for cell removal, picrosirius red for content of collagen type I and III, and safranin-O/fast green staining for content of glycosaminoglycan, and SEM for observation of scaffold surface. Indentation apparatus was used to analyze the unconfined deformation under load of native and decellularized menisci. The load parameters which are stiffness, compression and residual force were not significantly different compare with native and sonicated scaffolds. However, the content of extracellular matrix and its fiber alignment changed significantly due to sonication treatment as observed by SEM and safranin-O/fast green staining, respectively. The removal of immunogenic cell components by sonication decellularization as well as maintain its biomechanical strength of decellularized scaffolds, so that it has potential to use as an implant material for tissue engineering of menisci.

Development of heat hyperalgesia and changes of TRPV1 and NGF expression in rat dorsal root ganglion following joint immobilization

The aim of this study was to examine whether threshold to heat stimuli, and expression of transient receptor potential vanilloid1 (TRPV1) and nerve growth factor (NGF) in dorsal root ganglion (DRG) altered under conditions of long-term limb immobilization. A plastic cast was wrapped around the right limb from the forearm to the forepaw to keep wrist joint at 90° of flexion for 5 weeks. Heat hyperalgesia was tested using the plantar test at 6 h after removing cast. The rats were perfused transcardially with 4 % paraformaldehyde and DRGs were excised at 24 h after removing cast. For size distributions of the TRPV1-IR and NGF-IR neuronal profile, the DRG area measurements over 1000 DRG neurons per animal were measured in each side, on both the immobilized (ipsilateral) and contralateral sides. Ipsilateral withdrawal latency was significantly shorter than contralateral sides. Ipsilateral percentage of immunoreactive neurons in the total DRG neurons was significantly higher than contralateral sides in TRPV1-IR and NGF-IR. Long-term casting induced heat hyperalgesia, and up-regulation and phenotypic change of TRPV1-IR and NGF-IR in DRGs on the immobilized side. These DRG alterations may involve heat hyperalgesia after long-term limb immobilization.

Two-week cast immobilization induced chronic widespread hyperalgesia in rats

It has been postulated that physical immobilization is an essential factor in developing chronic pain after trauma or surgery in an extremity. However, the mechanisms of sustained immobilization-induced chronic pain remain poorly understood. The present study, therefore, aimed to develop a rat model for chronic post-cast pain (CPCP) and to clarify the mechanism(s) underlying CPCP. To investigate the effects of cast immobilization on pain behaviours in rats, one hindlimb was immobilized for 2 weeks with a cast and remobilization was conducted for 10 weeks. Cast immobilization induced muscle atrophy and inflammatory changes in the immobilized hindlimb that began 2 h after cast removal and continued for 1 week. Spontaneous pain-related behaviours (licking and reduction in weight bearing) in the immobilized hindlimb were observed for 2 weeks, and widespread mechanical hyperalgesia in bilateral calves, hindpaws and tail all continued for 5-10 weeks after cast removal. A sciatic nerve block with lidocaine 24 h after cast removal transitorily abolished bilateral mechanical hyperalgesia in CPCP rats, suggesting that sensory inputs originating in the immobilized hindlimb contribute to the mechanism of both ipsilateral and contralateral hyperalgesia. Intraperitoneal injection of the free radical scavengers 4-hydroxy-2,2,6,6-tetramethylpiperydine-1-oxy1 or N-acetylcysteine 24 h after cast removal clearly inhibited mechanical hyperalgesia in bilateral calves and hindpaws in CPCP rats. These results suggest that cast immobilization induces ischaemia/reperfusion injury in the hindlimb and consequent production of oxygen free radicals, which may be involved in the mechanism of widespread hyperalgesia in CPCP rats.

Increased heart rate variability correlation between mother and child immediately pre-operation

BACKGROUND

Maternal distress would correlate with the children's mental status, thereby influencing the activity of the autonomic nervous system (ANS) of the children and mothers. We hypothesized that pre-anesthetic maternal ANS activity, when approaching close to their children's operation time, would correlate with children's ANS activity, and that the values of heart rate variability (HRV) would correlate.

METHODS

We calculated maternal and children's HRVs and analyzed the relationship between the two. A total of 24 pairs of mother and child were analyzed. Maternal and children's HRVs were recorded from the night before the child's surgery to the arrival to the operation room.

RESULTS

The ratios of low-frequency components (LF) to high-frequency components (HF) (LF/HF ratio) of children's and maternal HRVs obtained during the immediate pre-operative period (06:00-08:00 hours) showed a significantly, positive correlation, but no correlation was found for the LF/HF ratios obtained during the pre-operative night.

CONCLUSION

The LF/HF ratios of HRV immediately before surgery in children and mothers showed a significant positive correlation.

Epidural puncture can be confirmed by the Queckenstedt-test procedure in patients with cervical spinal canal stenosis

BACKGROUND

The loss-of-resistance test is the most popular method for identifying the epidural space, but it cannot confirm epidural puncture. Therefore, we developed a new method to confirm epidural puncture by assessing indirect changes in epidural pressure using the Queckenstedt-test procedure, which increases subarachnoid pressure by compressing the internal jugular veins. Because this new method depends on the dynamics of cerebrospinal fluid, blockade of cerebrospinal fluid flow, as with severe spinal stenosis, is predicted to reduce changes in epidural pressure. Thus, in this study, we examined the effect of spinal stenosis on the Queckenstedt-test procedure.

METHODS

Epidural puncture using the loss-of-resistance test was utilized to insert an electrode in patients undergoing cervical spine surgery. Epidural pressure was monitored during bilateral compression of the internal jugular veins to confirm epidural puncture. The insertion of the electrode into the epidural space was confirmed by observation of muscle twitch evoked by electric stimulation.

RESULTS

In 60 patients, epidural puncture was performed with the loss-of-resistance test; a second trial was required in 13 patients. Increased epidural pressure was observed in 57/73 trials. When increased epidural pressure was observed, epidural puncture was always successful. The sensitivity and specificity of this method was 92.0% and 100%, respectively. The positive and negative predictive values were 100% and 66.7%, respectively.

CONCLUSION

An increase in epidural pressure during bilateral compression of the internal jugular veins could offer a reliable method for confirming epidural puncture in combination with the loss-of-resistance test, even if patients have potential spinal canal narrowing.

Induction and emergence behavior of children undergoing general anesthesia correlates with maternal salivary amylase activity before the anesthesia

BACKGROUND

The parents of the children who undergo surgery experience stress during the pre-anesthetic period. Such stress influences the mental status of their children, thereby inducing their pre-anesthetic anxiety and problematic behavior at emergence. Recently, measurement of salivary biomarkers was evaluated as stress biomarkers. Especially, alpha-amylase is utilized as an excellent index for psychological stress. In the present study, we tested whether salivary amylase activity of mothers before the surgery of their children correlates with the peri-operative children's behaviors.

METHODS

A total of 22 pairs of mothers and children were analyzed. Maternal salivary amylase activity was evaluated at the entrance of the operation room. The children underwent minor plastic surgery under general anesthesia, and induction and emergence behaviors were assessed.

RESULTS

The higher the maternal salivary amylase activity, the severer the children's induction anxiety (r(s)=-0.667, n=22, P<0.0001), and the higher the maternal amylase activity, the severer the children's emergence agitation (r(s)=0.705, n=22, P<0.0001).

CONCLUSION

Induction and emergence behaviors of children undergoing general anesthesia significantly correlated with their respective maternal salivary amylase activity during the pre-anesthetic period.

Fabrication of microstructures in photosensitive biodegradable polymers for tissue engineering applications

Combining the MEMS technology and biology requirements for tissue engineering, the fabrication processes of microstructured chambers and microchannels made in biodegradable photosensitive polymers are presented. The fabrication processes, based on softlithography are very fast and flexible. Various single and multistepwise microstructures could be achieved using the biodegradable polymers. Microstructures down to 50microm, which are suitable for liver reconstructs, could be fabricated. As the pCLLA acrylate photosensitive polymer has interesting property for implantable bioreactors, that is, its softness, we examined the ability of various mammalian cells to grow and spread on it. With Hep G2 cells, human umbilical blood vessel endothelial cells (HUVEC), 3T3-L1 mouse fibroblasts, static cultures could be successfully performed on single stepwise microstructures. Then, by using this photosensitive biodegradable polymer, a microstructure with simple fluidic channels is fabricated and a perfusion experiment could be carried out. Both cell cultures and perfusion experiments suggested the possibility to use the present photosensitive polymer as microfluidic supports for biodegradable bioreactors for implantation applications.

Development of cone and plate-type rheometer for quantitative analysis of endothelial cell detachment by shear stress

We developed an apparatus, which has a structure based on a cone and plate-type rheometer, to facilitate quantitative analysis of the detachment process of endothelial cells (EC) from diverse materials including 3-dimensional scaffolds such as plate, membrane and porous-shaped materials. As an artificial vascular model, a material inoculated with EC to a polycarbonate membrane coated with laminin was prepared. In consequence, reduced cell number, medium volume, and material size was enough to evaluate cell detachment from various materials by shear stress in our system. When shear stress was loaded to a material with EC, the ratio retained of initially inoculated cells decreased with time. Increase of magnitude of shear stress also decreased the ratio. We conclude that our apparatus could analyze quantitatively detachment of EC with ease for screenings to find materials that enhance adhesive force of EC. To produce artificial blood vessels with small diameter, our apparatus could become a useful instrument.

Paradoxical enhancement of spinal-cord-evoked potentials rostral and caudal to the site of progressive cord compression in the cat

STUDY DESIGN

Analysis of the sequential waveform changes of the spinal-cord-evoked potentials (SCEPs) associated with progressive cord compression in the cat.

OBJECTIVES

To document the phenomenon of paradoxical enhancement of SCEPs despite conduction abnormalities and to evaluate its possible significance.

SETTING

Kochi Medical School, Kochi, Japan.

METHODS

SCEPs were recorded simultaneously at four serial intervertebral levels, from T6-7 to T9-10 caudal to, and at three serial levels from T2-3 to T4-5 rostral to the compression site at T5-6 following epidural stimulation at L6 in 14 cats.

RESULTS

Caudal to the compression site, the area of negative peak significantly increased toward maximal values of 277+/-36 (mean+/-SE), 151+/-9 and 110+/-4% as compared to the baseline precompression values (100%) at T6-7, T7-8, and T8-9, respectively. Rostral to the compression site, the area of negative peak significantly increased before subsequent deterioration and reached 105+/-2, 106+/-2, and 104+/-2% at T4-5, T3-4, and T2-3, respectively. The onset of negative peak enhancement, recorded either caudal or rostral to the compression site, showed a close temporal correlation (r>0.8, P&<0.001) with that of the prolongation in latency of SCEPs at T2-3.

CONCLUSIONS

A progressive focal conduction block induced by compression of the spinal cord can paradoxically enhance the ascending SCEPs both caudally and, though less consistently, rostrally, representing a warning of the impending risk of paraplegia.

Motor evoked potentials elicited from erector spinae muscles in patients with thoracic myelopathy

STUDY DESIGN

A prospective study was conducted to test the utility of the motor evoked potentials (MEPs) from the erector spinae muscles as a measure to estimate the motor level of thoracic compression myelopathies in 13 consecutive patients.

OBJECTIVE

To confirm whether this test is a useful addition to the neurological examination in non-invasively localizing the level responsible for the main functional change in mild to moderate thoracic myelopathy.

SETTING

Department of Orthopaedic Surgery, Kochi Medical School, Kochi, Japan.

METHODS

This electrophysiological study consisted of transcranial magnetic stimulation (TMS) of the brain and surface recording of MEPs from voluntarily contracted erector spinae muscles with the patient in the prone position. The recordings were obtained unilaterally from the same side as the lower-limb affected at 12 serial interspinous levels from T5-6 to L4-5. The results were compared to the MEP data from normal subjects and to neurological and MRI findings.

RESULTS

Multisegmental MEP studies demonstrated a focal conduction block in one patient, a single site of conduction delay in seven, and normal conduction in five. The conduction block was characterized by an abrupt reduction in amplitude of the MEPs. Examination of the sites conduction delay showed that the latency difference between the two adjacent levels was longer than the corresponding normal upper limit by 1.00+/-0.40 ms (range, 0.62-1.61 ms). The site of conduction abnormalities approximated to the compressive lesion site shown by MRI. All five patients with false-negative MEP findings had the lesion site at or caudal to the T10-11 vertebral level.

CONCLUSION

This method has the advantage of instantaneously testing multisegments of the thoracic spinal cord. The technique is of particular value in estimating the motor level of the lesions rostral to T10-11 vertebral level, which can not be achieved by clinical examinations or MEP recordings from the lower limb.

Age related shift in the primary sites of involvement in cervical spondylotic myelopathy from lower to upper levels

Ascending axonal volleys were analysed after epidural stimulation at multiple sites along the cervical cord to localise the site of the lesion precisely in cervical spondylotic myelopathy. The intraoperative recordings uncovered a single site of focal conduction block in 129 of 136 affected patients who underwent surgical intervention because of evidence of multilevel compression obtained by magnetic resonance imaging. Statistical analyses showed a shift of abnormalities from lower to upper cervical levels with advancing age (p < 0.0001). In particular, 92% of the oldest group (aged over 70 years) had localised dysfunction at C3-4 or C4-5, while 68% of patients aged under 60 years had lesions at C5-6 or C6-7.

Formation of human fibroblast aggregates (spheroids) by rotational culture

In the current study, we attempted to form aggregates of fibroblasts by rotationally shaking, declining fibroblast-material interactions, and augmenting cell-cell interactions. In addition, to promote cell-cell interactions, the medium was supplemented with insulin, dexamethasone, and basic fibroblast growth. Under such improved culture conditions, normal neonatal human dermal fibroblasts formed spheroidal aggregates within 1 day of rotation on a rotational shaker. The aggregates that formed had irregular shapes and were composed from only several cells after 12 h. However, they became nearly spheroidal after 24 h of shaking. The aggregates were approximately 240 microm in diameter. After 36 h of shaking, their shape became more rounded and their surfaces became smoother. No evidence of necrosis in the center of the aggregates was observed, although a small number of dead cells was scattered throughout the aggregates. After 24-36 h, aggregates of normal human fibroblasts were collected and reinoculated onto a scaffold composed of polyglycolic acid. which is used commercially as a scaffold for artificial skin, coated with collagen. The aggregates were successfully trapped to the mesh of polyglycolic acid and became attached within 24 h. Therefore, the aggregates could provide an alternative method for seeding fibroblasts to scaffold for an artificial skin, such as a mesh of polyglycolic acid.

In vitro organization of biohybrid rat liver tissue incorporating growth factor- and hormone-releasing biodegradable polymer microcapsules

To enhance the liver-specific functions of rat hepatocyte aggregates without the addition of exogenous growth factors, polylactic acid-polyglycolic acid (PLGA)/gelatin microcapsules that release insulin, dexamethasone, epidermal growth factors, and glucagon were prepared and incorporated into the hepatocyte aggregates in suspension culture. Precoating the capsules with fibronectin enhanced the incorporation of the microcapsules into the hepatocyte aggregates. In a growth factor- and hormone-free culture medium, these microcapsule-containing aggregates showed a sustained cell number and an ammonium detoxification capacity compared with two types of control culture. One was the culture of microcapsule-free aggregates with albumin-containing control capsules and the other was the culture of capsule-free aggregates that were supplied with the same factors and hormones from the culture medium at concentration levels expected from the release kinetics of the microcapsules. Our new methodology demonstrates that the performance and duration of bioartificial liver systems can be enhanced due to a more efficient maintenance of cell number by using such growth factor- and hormone-releasing microcapsules.

Poly(DL-lactic-co-glycolic acid) sponge hybridized with collagen microsponges and deposited apatite particulates

A novel three-dimensional porous scaffold has been developed for bone tissue engineering by hybridizing synthetic poly(DL-lactic-co-glycolic acid) (PLGA), naturally derived collagen, and inorganic apatite. First, a porous PLGA sponge was prepared. Then, collagen microsponges were formed in the pores of the PLGA sponge. Finally, apatite particulates were deposited on the surfaces of the collagen microsponges in the pores of PLGA sponge. The PLGA-collagen sponge served as a template for apatite deposition, and the deposition was accomplished by alternate immersion of PLGA-collagen sponge in CaCl(2) and Na(2)HPO(4) aqueous solutions and centrifugation. The deposited particulates were small and scarce after one cycle of alternate immersion. Their number and size increased with the number of alternate immersion cycles. The surfaces of collagen microsponges were completely covered with apatite after three cycles of alternate immersion. The porosity of the hybrid sponge decreased gradually as the number of alternate immersion increased. Energy-dispersive spectroscopy analysis and X-ray diffraction spectra showed that the calcium-to-phosphorus molar ratio of the deposited particulates and the level of crystallinity increased with the number of alternate immersion cycles, and became almost the same as that of hydroxyapatite after four cycles of alternate immersion. The deposition process was controllable. Use of the PLGA sponge as a mechanical skeleton facilitated formation of the PLGA-collagen-apatite hybrid sponge into desired shapes and collagen microsponges facilitated the uniform deposition of apatite particulates throughout the sponge. The PLGA-collagen-apatite hybrid sponge would serve as a useful three-dimensional porous scaffold for bone tissue engineering.

Preparation of poly(L-lactic acid) and poly(DL-lactic-co-glycolic acid) foams by use of ice microparticulates

Biodegradable foams of poly(L-lactic acid) (PLLA) and poly(DL-lactic-co-glycolic acid) (PLGA) for tissue engineering were fabricated by a porogen-leaching technique using ice microparticulates as the porogen material. PLLA or PLGA solution in chloroform was mixed with ice microparticulates. The mixtures were frozen by being placed in molds in liquid nitrogen and freeze-dried to form the foams. Scanning electron microscopic observation of the PLLA and PLGA foams showed that evenly distributed and interconnected pore structures were formed in these foams. The porosity and surface area of the foams increased with an increase in the weight fraction of the ice microparticulates, while the median pore size remained unchanged. The pore structures of the foams could be manipulated by controlling processing variables such as the size and weight fraction of the ice microparticulates and polymer concentration.

Changes in dorsal horn neuronal responses in an experimental wrist contracture model

Joint contracture, a major complication after casting, usually makes the therapeutic outcome worse by causing a limited range of motion and related pain. We developed rat models of wrist contracture with fracture of the radius (group A) and wrist contracture without fracture (group B), and investigated whether contracture and fracture changed the characteristics of cervical dorsal horn neuronal responses and the behavior of the animals. After 4 weeks of immobilization, both groups showed wrist contracture and disuse tendencies in the treated forelimb. In an electrophysiological study, the responses of 403 cervical dorsal horn neurons to mechanical stimuli were examined. In normal (control) animals, the neurons had the following distribution: 63% were low-threshold (LT); 15% were high-threshold (HT); and 22% were wide-dynamic-range (WDR). In group A, the distribution of the neurons changed to 51% LT, 16% HT, and 33% WDR. Similar changes were observed for group B. Responses during wrist movement were also examined. Forty-one percent of cells in the control group were responsive to the movements, whereas the number of neurons responding to motion stimulus in both groups A and B was increased, to 77%. The changed population of WDR and LT neurons responding to wrist movement suggests that the characteristics of dorsal horn neurons may undergo plastic changes after contracture.

Sequential changes of orthodromic sensory nerve action potentials induced by experimental compression of the median nerve at the wrist

OBJECTIVE

We studied sequential waveform changes associated with a progressive conduction block to elucidate the relative vulnerability of slow versus fast conducting fibers to a focal compression.

METHODS

In 12 healthy men, orthodromic compound sensory nerve action potentials (SNAPs) of the median nerve were recorded unipolarly at 4 sites over the forearm during a 30 min period of constant, localized compression of the nerve at the wrist.

RESULTS

Initial findings at the compression site consisted of nearly immediate reduction in size of the negative component accompanied by progressive enlargement of the initial-positive component. Recording at 2 cm proximal to the compression and at the elbow showed no change in onset latency initially, indicating at least partial preservation of the fast conducting fibers. Amplitude also remained unchanged for about 20 min, presumably because loss of negative and positive peaks compensated each other until conduction block began to involve a greater number of the fast conducting fibers.

CONCLUSIONS

The analysis of waveform changes and their time course suggests that a focal compression initially affects the slow conducting small diameter fibers. Partial conduction block gives rise to complex waveform changes depending on recording sites. A reduction in one polarity of constituent nerve fiber action potentials may enhance the other polarity of the SNAP.

Effect of shear stress on platelet adhesion to expanded polytetrafluoroethylene, a silicone sheet, and an endothelial cell monolayer

We visualized in real-time platelets adhering to the surface of three representative biomaterials, by using an apparatus consisting of a modified cone and plate rheometer combined with an upright epifluorescence microscope under two shear flows (0.1 and 5.0 dyne/cm2). The materials were expanded polytetrafluoroethylene (ePTFE), silicone sheet, and a monolayer of bovine endothelial cells (ECs) formed on glass, all of which are opaque materials used for artificial blood vessels and medical devices. According to quantitative analysis, the monolayer of ECs formed on glass had better blood compatibility than did either the ePTFE or the silicone sheet under shear flow conditions. Under a shear flow condition of 0.1 dyne/cm2, platelet adhesion was silicone sheet > ePTFE. In contrast, under a shear flow condition of 5.0 dyne/cm2, ePTFE > silicone sheet. These results indicate that the intensity of shear stress could modify the order of hemocompatibility of the materials. Therefore, direct observation of platelet adhesion under shear flow conditions is indispensable for testing and screening biomaterials and for providing a precise quantitative evaluation of platelet adhesion.

A biodegradable hybrid sponge nested with collagen microsponges

A biodegradable hybrid sponge of poly(DL-lactic-co-glycolic acid) (PLGA) and collagen was fabricated by forming microsponges of collagen in the pores of PLGA sponge. Observation of the PLGA-collagen hybrid sponge by scanning electron microscopy (SEM) showed that microsponges of collagen with interconnected pore structures were formed in the pores of PLGA sponge. The hybrid structure further was confirmed by scanning electron microscopy-electron probe microanalysis (SEM-EPMA), and elemental nitrogen was detected in the microsponges of collagen and on the pore surfaces of PLGA, but not in cross-sections of PLGA regions. The formation of collagen microsponges was dependent on collagen concentration, the effective range of which was from 0.1 to 1.5 (w/v) %. The mechanical strength of the hybrid sponge was higher than that of either PLGA or collagen sponges, in both dry and wet states. The wettability with water was improved by hybridization with collagen, which facilitated cell seeding in the hybrid sponge. Mouse fibroblast L929 cells attached well and spread on the surfaces of the microsponges of collagen in the hybrid sponge. The distribution of cells was spatially uniform throughout the hybrid sponge. Use of the PLGA sponge as a skeleton facilitated formation of the hybrid sponge into desired shapes with high mechanical strength while collagen microsponges contributed good cell interaction and hydrophilicity.

Intraoperative electroneurography in the assessment of the level of operation for cervical spondylotic myelopathy in the elderly

We treated 31 patients aged 65 years or more with cervical spondylotic myelopathy by microsurgical decompression and fusion at a single most appropriate level, in spite of MRI evidence of compression at several levels. Spinal cord potentials evoked at operation localised the level responsible for the principal lesion at C3-4 in 18 patients, C4-5 in 11 and at C5-6 in two. Despite the frequent coexistence of other age-related conditions, impairing ability to walk, the average Nurick grade improved from 3.5 before operation to 2.2 at a mean follow-up of 48 months. There was also good recovery of finger dexterity and sensitivity.

Operation at a single optimal level, as opposed to several, has the advantage of minimising complications, of particular importance in this age group.

Intraoperative electroneurography in the assessment of the level of operation for cervical spondylotic myelopathy in the elderly

We treated 31 patients aged 65 years or more with cervical spondylotic myelopathy by microsurgical decompression and fusion at a single most appropriate level, in spite of MRI evidence of compression at several levels. Spinal cord potentials evoked at operation localised the level responsible for the principal lesion at C3-4 in 18 patients, C4-5 in 11 and at C5-6 in two. Despite the frequent coexistence of other age-related conditions, impairing ability to walk, the average Nurick grade improved from 3.5 before operation to 2.2 at a mean follow-up of 48 months. There was also good recovery of finger dexterity and sensitivity. Operation at a single optimal level, as opposed to several, has the advantage of minimising complications, of particular importance in this age group.

Evaluation of cytotoxicity of UHMWPE wear debris

We established a novel method to investigate the phagocytosis of ultra high molecular weight polyethylene using primary macrophage cells by an inverted cell culture method. Abundant wear debris derived from implant materials are generated in aseptic loosening and are deposited in periprosthetic tissues in which they are phagocytized by mono- and multi-nucleated macrophage like cells. Ultra-high-molecular-weight-polyethylene wear debris generated from different sources namely, from laboratory test wear machine, in vivo methods and from knee and hip simulator were mainly used in this investigation. The cytotoxicity index of the different UHMWPE particles obtained from various sources were compared with that of the PE beads and the control without particles by Alamar Blue and Neutral Red assays. The results showed that the cytotoxicity index was significantly lower for the wear debris from the in vivo experiments than that for other particles. SEM analysis were also done to understand the morphology of the wear debris and polyethylene beads and to confirm the phagocytosis process. The mean diameter of the wear debris obtained from the in vivo experiments as estimated from the imaging analysis of the SEM photographs was found to be the least. The inverted cell culture method may be regarded as one of the good methods to study the phagocytosis of UHMWPE by macrophage cells.

Contralateral thalamic perfusion in patients with reflex sympathetic dystrophy syndrome

Iodine-123-labelled iodoamphetamine single-photon emission computed tomography of patients with reflex sympathetic dystrophy syndrome showed substantial variation in thalamic perfusion of the side contralateral to the painful limb. The variations are related to time from the onset of symptoms, which suggests that the thalamus undergoes adaptive changes in the course of this neurological disorder.

Real time observation of platelet adhesion to opaque biomaterial surfaces under shear flow conditions

We developed a new system which enables direct observation of platelet adhesion on opaque biomaterials under shear flow conditions, by combining a thin quartz cone which produces laminar shear flows, with an upright epifluorescence microscope which visualizes stained platelets through the rotating cone. This is the first report on the observation of platelets adhered to opaque biomaterials in real time under shear flow conditions. The direct observation of platelet adhesion to expanded polytetrafluoroethylene (ePTFE) as an opaque biomaterial revealed that the kinetics of platelet adhesion to ePTFE depended greatly on shear stresses, showing that the shear stress of 5.0 dyne/cm2 induced higher adhesiveness of platelets to ePTFE than that of either 0.1 or 15 dyne/cm2. The observation also showed a difference in platelet adhesiveness among ePTFEs with different fibril lengths--0, 3.2, 18, and 35 microm--indicating that ePTFEs with shorter fibril length had lower adhesiveness of platelets under a shear stress of 5.0 dyne/cm2. It is indispensable for analyzing the phenomena of platelet adhesion to opaque biomaterials to observe in real-time rolling, adhesion, and detachment of platelets under shear stresses without disturbing shear flow conditions. The results showed that the mechanical and optical design of the system could serve this purpose.

Effects of hyperbaric oxygen on procollagen messenger RNA levels and collagen synthesis in the healing of rat tendon laceration

In the present study, we examined the effect of intermittent exposure to hyperbaric oxygen (HBO) on experimentally induced tendon laceration in the right hind limb of 56 male Wistar rats. We compared animals treated by HBO (2 atmospheres absolute [ATA] 100% O(2) x 60 min x once per day) with control animals (without HBO) at 3, 7, 14, and 28 days after wound creation. Histology, and pro-alpha1 (I) mRNA by Northern hybridization, pro-alpha1 (III) mRNA, transforming growth factor-beta1 (TGF-beta1) mRNA by RT-PCR were studied. Our results indicate the use of HBO influences the pro-a1 (I) mRNA expression. The level of pro-alpha1 (I) mRNA was especially increased at 7 14 days after laceration by HBO. These results suggest that intermittent oxygen exposure may play a significant role in collagen synthesis and be beneficial for producing the extracellular matrices in tissue engineering.

Peripheral administration of an N-methyl-D-aspartate receptor antagonist (MK-801) changes dorsal horn neuronal responses in rats

Due to the discovery of peripheral N-methyl-D-aspartate (NMDA) receptors, the effects of peripherally administrated MK-801, a non-competitive NMDA receptor antagonist, and phosphate buffered saline were tested by using the response changes of wide-dynamic range cells in the lumbar enlargement of the spinal cord in Sprague-Dawley rats. MK-801 (1 microM, 50 microl) administered directly into the subcutaneous tissue of the receptive field (n = 7), produces a reversible reduction of responses to noxious and innocuous stimuli by a peripheral action. There was no change in the responses to cutaneous stimuli following injection of phosphate buffered saline (n = 7) or following administration of MK-801 into the contralateral foot (n = 7). The present study suggests that MK-801 produces a local anesthetic like effect in the peripheral tissue.