Mothers' Anticipation and Prevention of Unintentional Injury to Young Children in the Home

Investigated anticipation and prevention of children's unintentionalinjuries in the home. 150 mothers of 1-, 2-, and 3-year-oldchildren kept weekly diaries of anticipated injuries and unanticipatedinjuries/near injuries to their child. Mothers anticipated between57 and 67% of all injury events, a majority when the child wasin the same room as the injury-causing agent prior to interactingwith it. Few anticipated injuries led to injury. In these casesno significant differences were found depending on child's ageand sex. In contrast, mothers of younger children most frequentlyreported preventing injury by physically restricting or movingthe child away and by changing the environment, whereas mothersof older children more frequently engaged in teaching.     

Progesterone modulates m TOR in the hippocampus of mice after traumatic brain injury

the mechanistic target of rapamycin(m tor) is an intracellular protein kinase that functions as an energy and nutrient sensor in the cellular microenvironment of neurons. modulation of m tor is vital when nutrient and energy sources become limited. hypoxia, traumatic brain injury, cellular energy states, and growth factors all regulate the phosphorylation and total levels of m tor in cells. alterations in the microenvironment induce transduction of signals to downstream proteins by m tor allowing for cells to make the necessary adjustments to counteract stressors and survive. progesterone, a hydrophobic steroid hormone, has been shown in studies of non-neural tissue to be a suppressor of m tor and modulator of m tor phosphorylation. our study tested the effects of progesterone on m tor expression following traumatic brain injury. c57 bl/6 mice were treated with progesterone(8 mg/kg) at 1(intraperitoneal), 6(subcutaneous), 24(subcutaneous), and 48(subcutaneous) hours post closed skull traumatic brain injury. the hippocampus was then harvested 72 hours post injury and prepared for western blot analysis. we found that progesterone significantly decreased total m tor levels in all groups compared to sham treated with vehicle. this was further confirmed by immunostaining showing decreased cytoplasmic m tor levels compared to sham. our study shows progesterone is a significant modulator of m tor levels in the hippocampus of mice following traumatic brain injury.     

Accurate detection of stent-graft migration in a pulsatile aortic model using Roentgen stereophotogrammetric analysis.

PURPOSE: To evaluate the feasibility and accuracy of Roentgen stereophotogrammetric analysis (RSA) versus computed tomography (CT) for detecting stent-graft migration in an in vitro pulsatile circulation model and to study the feasibility of a nitinol endovascular clip (NEC) as an aortic wall reference marker for RSA. METHODS: An aortic model with stent-graft was constructed and connected to an artificial circulation with a physiological flow and pressure profile. Tantalum markers and NECs were used as aortic reference markers for RSA analysis. Stent-graft migrations were measured during pulsatile circulation with RSA and CT. CT images acquired with 64 x 0.5-mm beam collimation were analyzed with Vitrea postprocessing software using a standard clinical protocol and central lumen line reconstruction. RSA in the model with the circulation switched off was used as the reference standard to determine stent-graft migration. The measurement errors of RSA and CT were determined during pulsatile circulation. RESULTS: The mean measurement error +/- standard deviation (maximum) of RSA during pulsatile circulation using the tantalum markers was -0.5+/-0.16 (0.7) mm. Using the NEC, the mean (maximum) measurement error was -0.4+/-0.25 (1.1) mm. The mean (maximum) measurement error of CT was -1.1+/-1.17 (2.8) mm. CONCLUSION: RSA is an accurate and feasible tool to measure stent-graft migration in a pulsatile environment. Migration measurement with RSA was more accurate than CT in this experimental setup. The nitinol clip tested in this study is potentially feasible as an aortic reference marker in patients after endovascular repair.     

Kinematics of the distal tibiofibular syndesmosis

In 11 healthy volunteers, the normal kinematics of the tibiofibular syndesmosis of the ankle during weight bearing and external rotation stress were compared to a nonweight-bearing neutral position by radiostereometry. We found very small rotations and displacements in this “normal” group, which indicated that the fibula is closely attached to the tibia, thereby preventing larger movements at the level of the ankle. We found no common kinematic pattern during weight bearing in the neutral position.

Application of a 7.5 Nm external rotation moment on the foot caused external rotation of the fibula between 2 and 5 degrees, medial translation between 0 and 2.5 mm and posterior displacement between 1.0 and 3.1 mm. These data can be used as normal reference values for studies of patients with suspected syndesmotic injuries.     

Kinematics before and after reconstruction of the anterior syndesmosis of the ankle: A prospective radiostereometric and clinical study in 5 patients

Background We have previously shown that patients with instability of the anterior syndesmosis benefit from an anatomical reconstruction. It is not known whether this is because of restored kinematics.

Methods In a prospective study of 5 patients, we assessed clinical findings and tibiofibular kinematics, evaluated by radiostereometry, before and after reconstruction of a chronic syndesmotic injury.

Results We found no statistically significant differences in tibiofibular kinematics before and after reconstruction. The kinematics of the fibula relative to the tibia during external rotation stress differed from that known in asymptomatic volunteers, but the differences were not typical enough to differentiate between patients and healthy subjects. Clinical examination and ankle scores, however, showed that all patients benefited from reconstruction of the anterior syndesmosis.

Interpretation Radiostereometry is not an adequate technique to diagnose chronic syndesmotic instability or to demonstrate restoration of the kinematics of the ankle as a cause of the beneficial effect of anatomical reconstruction of the syndesmosis.     

Kinematics of the distal tibiofibular syndesmosis: radiostereometry in 11 normal ankles

In 11 healthy volunteers, the normal kinematics of the tibiofibular syndesmosis of the ankle during weight bearing and external rotation stress were compared to a nonweight-bearing neutral position by radiostereometry. We found very small rotations and displacements in this "normal" group, which indicated that the fibula is closely attached to the tibia, thereby preventing larger movements at the level of the ankle. We found no common kinematic pattern during weight bearing in the neutral position. Application of a 75 Nm external rotation moment on the foot caused external rotation of the fibula between 2 and 5 degrees, medial translation between 0 and 2.5 mm and posterior displacement between 1.0 and 3.1 mm. These data can be used as normal reference values for studies of patients with suspected syndesmotic injuries.     

External rotation stress imaging in syndesmotic injuries of the ankle: comparison of lateral radiography and radiostereometry in a cadaveric model

We compared the value of 7.5 Nm external rotation stress in diagnosing tibiofibular syndesmotic injuries of the ankle on lateral radiographs with radiostereometric analysis (RSA) in 10 cadaveric legs. After sectioning 2 ligaments, RSA showed an increase in posterior translation and external rotation of the fibula. This increase in posterior translation was smaller than the posterior displacement of the fibula on the lateral radiograph, and RSA showed mainly an increase in external rotation of the fibula that can not be measured on conventional radiographs. We conclude that instability of the syndesmosis in cadaveric ankles can be detected with 7.5 Nm external rotation stress RSA, but that external rotation stress lateral radiography is unreliable.