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Sample records for brachial ejection time

  1. Relationship between ankle brachial index and ejection fraction in elderly Egyptians with ischemic heart disease.

    PubMed

    Amer, Moatasem S; Tawfik, Heba M; Abd Elmotteleb, Ayman M; Maamoun, Manar M A

    2015-04-01

    There is a high prevalence of combined peripheral and coronary artery disease, with increasing morbidity and decline in cardiac function. The aim of the present study was to find an association between ankle brachial index, a non-invasive measure of peripheral artery disease, and ejection fraction in elderly patients with severe coronary artery disease. A case-control study recruiting 200 elderly male and female ischemic patients in Ain Shams University hospitals was carried out. All participants had significant coronary artery disease lesions in coronary angiography carried out before the study. Cases and controls were divided according to ankle brachial index, with further subdivision of each group according to age. Measurements include: ankle brachial index using Bistos handheld vascular Doppler (BT 200V,8 MHz), electrocardiography and echocardiography showing left ventricular ejection fraction. Coronary artery disease severity was estimated using the number of diseased vessels. The mean age of our study group was 67 years. Although our participants had mild to moderate peripheral artery disease, ejection fraction statistically decreased with decreasing ankle brachial index, being the lowest in participants aged > 70 years (46.84 ± 9.82 years) and the highest in controls aged >70 years (53.02 ± 5.53 years; P = 0.009). Ejection fraction was positively correlated with ankle brachial index (P = 0.011, 0.006) for cases and controls, respectively. Ankle brachial index can correlate with ejection fraction in elderly ischemic Egyptians with more severe coronary artery disease. © 2014 Japan Geriatrics Society.

  2. Coronal Mass Ejections travel time

    NASA Astrophysics Data System (ADS)

    Braga, Carlos Roberto; Souza de Mendonça, Rafael Rodrigues; Dal Lago, Alisson; Echer, Ezequiel

    2017-10-01

    Coronal mass ejections (CMEs) are the main source of intense geomagnetic storms when they are earthward directed. Studying their travel time is a key-point to understand when the disturbance will be observed at Earth. In this work, we study the CME that originated the interplanetary disturbance observed on 2013/10/02. According to the observations, the CME that caused the interplanetary disturbance was ejected on 2013/09/29. We obtained the CME speed and estimate of the time of arrival at the Lagrangian Point L1 using the concept of expansion speed. We found that observed and estimated times of arrival of the shock differ between 2 and 23 hours depending on method used to estimate the radial speed.

  3. Automated analysis of brachial ultrasound time series

    NASA Astrophysics Data System (ADS)

    Liang, Weidong; Browning, Roger L.; Lauer, Ronald M.; Sonka, Milan

    1998-07-01

    Atherosclerosis begins in childhood with the accumulation of lipid in the intima of arteries to form fatty streaks, advances through adult life when occlusive vascular disease may result in coronary heart disease, stroke and peripheral vascular disease. Non-invasive B-mode ultrasound has been found useful in studying risk factors in the symptom-free population. Large amount of data is acquired from continuous imaging of the vessels in a large study population. A high quality brachial vessel diameter measurement method is necessary such that accurate diameters can be measured consistently in all frames in a sequence, across different observers. Though human expert has the advantage over automated computer methods in recognizing noise during diameter measurement, manual measurement suffers from inter- and intra-observer variability. It is also time-consuming. An automated measurement method is presented in this paper which utilizes quality assurance approaches to adapt to specific image features, to recognize and minimize the noise effect. Experimental results showed the method's potential for clinical usage in the epidemiological studies.

  4. Birth brachial plexus palsy: a race against time.

    PubMed

    Patra, Sambeet; Narayana Kurup, Jayakrishnan K; Acharya, Ashwath M; Bhat, Anil K

    2016-07-11

    A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps. The problem of birth brachial plexus palsy is proving to be a global health burden both in developed countries and in developing countries such as India. The lack of awareness among the general public and primary healthcare providers and inadequate orthopaedic and neurosurgeons trained to treat the condition have worsened the prognosis. This case lays stress on the delayed complications in birth brachial palsy and its effective management. 2016 BMJ Publishing Group Ltd.

  5. Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus.

    PubMed

    Birch, R

    2015-07-01

    While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well evidence from experimental work and clinical outcomes.In this article Professor Birch argues for early exploration of the brachial plexus as the optimum both to delineate the pathology and undertake reconstructive surgery. © The Author(s) 2014.

  6. Waiting Time Distribution of Emissions in Complex Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Méndez Berhondo, Adolfo L.; Rodríguez Taboada, Ramón E.; Larralde, Liliana Alfonso

    2006-04-01

    The waiting time distribution of emissions in Coronal Mass Ejections (CMEs) with several emissions is examined. We define the waiting time as the time interval between the commencement of an emission and the commencement of the next emission considered as parts of a unique CME. The distribution seems to follow a power-law. Two classes of CMEs several emissions are considered: “close” and “separate” depending on angular distance between emissions.

  7. Waiting time distribution of emissions in complex coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Méndez Berhondo, A. L.; Rodríguez Taboada, R. E.; Larralde, L. Alfonso

    The waiting time distribution of emissions in Coronal Mass Ejections (CMEs) with several emissions is examined. We define the waiting time (?) as the time interval between the commencement of an emission and the commencement of the next emission considered as parts of a unique CME. The distribution seems to follow a power-law.Two classes of CMEs several emissions are considered: “close” and “separate” depending on angular distance between emissions.

  8. Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus.

    PubMed

    Hems, T E J

    2015-07-01

    While it is widely accepted that cases of traumatic injury to the brachial plexus benefit from early surgical exploration and repair, with results deteriorating with long delays, policies vary regarding the exact timing of intervention. This is one of a pair of review articles considering the clinical issues, investigations, and surgical factors relating to management of injuries to the supraclavicular brachial plexus, as well as evidence from experimental work and clinical outcomes.In this article Mr Hems outlines when waiting may be advantageous, allowing for further investigation to help clarify the extent of the injury and thus the best surgical options. © The Author(s) 2014.

  9. Bilateral transit time assessment of upper and lower limbs as a surrogate ankle brachial index marker.

    PubMed

    Foo, Jong Yong Abdiel

    2008-01-01

    Ankle brachial index is useful in monitoring the pathogenesis of peripheral arterial occlusive diseases. Sphygmomanometer is the standard instrument widely used but frequent prolonged monitoring can be less comfortable for patients. Pulse transit time is known to be inversely correlated with blood pressure and a ratio-based pulse transit time measurement has been proposed as a surrogate ankle brachial index marker. In this study, 17 normotensive adults (9 men; aged 25.4 +/- 3.9 years) were recruited. Two postural change test activities were performed to induce changes in the stiffness of the arterial wall of the moved periphery. Results showed that only readings from the limbs that adopted a new posture registered significant blood pressure and pulse transit time changes (P < .05). Furthermore, there was significant correlation between the ankle brachial index and pulse transit time ratio measure for both test activities (R(2) > or = 0.704). The findings herein suggest that pulse transit time ratio is a surrogate and accommodating ankle brachial index marker.

  10. Detection of systolic ejection click using time growing neural network.

    PubMed

    Gharehbaghi, Arash; Dutoit, Thierry; Ask, Per; Sörnmo, Leif

    2014-04-01

    In this paper, we present a novel neural network for classification of short-duration heart sounds: the time growing neural network (TGNN). The input to the network is the spectral power in adjacent frequency bands as computed in time windows of growing length. Children with heart systolic ejection click (SEC) and normal children are the two groups subjected to analysis. The performance of the TGNN is compared to that of a time delay neural network (TDNN) and a multi-layer perceptron (MLP), using training and test datasets of similar sizes with a total of 614 normal and abnormal cardiac cycles. From the test dataset, the classification rate/sensitivity is found to be 97.0%/98.1% for the TGNN, 85.1%/76.4% for the TDNN, and 92.7%/85.7% for the MLP. The results show that the TGNN performs better than do TDNN and MLP when frequency band power is used as classifier input. The performance of TGNN is also found to exhibit better immunity to noise.

  11. Ejection time by ear densitogram and its derivative - Clinical and physiologic applications.

    NASA Technical Reports Server (NTRS)

    Quarry-Pigott, V.; Chirife, R.; Spodick, D. H.

    1973-01-01

    Ear densitographic ejection times (EDET) and first derivative ear densitogram ejection times (dEDET) were studied to determine whether their reliability and validity justify their substitution for ejection times derived from the far less stable carotid pulse tracing. Inter- and intra-subject comparisons were made on thirty individuals under a wide variety of disease and challenge states. Statistical analysis of the data - which had been obtained through a blinded procedure - showed an overall correlation (r) of .98 for carotid vs EDET and .99 for carotid vs dEDET. The t-test demonstrated no significant differences among ejection times derived from the three methods. Moreover, the close tracking at rest and during challenges of ejection times derived from these curves with those from the carotid indicate that either method may be substituted for standard carotid curves without sacrificing reliability or validity of the measure.

  12. Space-time evolution of ejected plasma for the triggering of gas switch

    NASA Astrophysics Data System (ADS)

    Liu, Shanhong; Liu, Xuandong; Shen, Xi; Feng, Lei; Tie, Weihao; Zhang, Qiaogen

    2016-06-01

    Ejected plasma has been widely applied to the discharge process of gas spark switches as a trigger technology, and the development process of ejected plasma has a direct and important effect on the discharge characteristics of gas switches. In this paper, both the injection characteristics and space-time evolution of ejected plasma for the triggering of gas spark switch with different stored energies, pulse polarities, and pressures are studied. The discharge characteristics and breakdown process of a gas switch ignited by ejected plasma under different working coefficients are also discussed briefly. The results show that stored energy has significant influence on the characteristics of ejected plasma. With the increase of stored energy, the propulsion mode of ejected plasma in the axial direction transforms from "plasmoid" to "plasma flow," and the distribution of the ejected plasma goes through "cloud," "core-cloud," and "branch" in sequence. The velocity of ejected plasma under negative pulse polarity is obviously higher than that under positive pulse polarity, especially at the very beginning time. The radial dimensions of ejected plasma under two kinds of pulse polarities follow the similar varying pattern over time, which increase first and then decrease, assuming an inverted "U"-shaped curve. With the increase of pressure, the velocity of ejected plasma significantly decreases and the "branch" channels droop earlier. Applying the ejected plasma to the triggering of a gas switch, the switch can be triggered reliably in a much wide working coefficient range of 10%-90%. With the increase of working coefficient, the breakdown process of the switch translates from slow working mode to fast working mode, and the delay time reduces from tens of μs to hundreds of ns.

  13. Space-time evolution of ejected plasma for the triggering of gas switch

    SciTech Connect

    Liu, Shanhong Liu, Xuandong; Shen, Xi; Feng, Lei; Zhang, Qiaogen; Tie, Weihao

    2016-06-15

    Ejected plasma has been widely applied to the discharge process of gas spark switches as a trigger technology, and the development process of ejected plasma has a direct and important effect on the discharge characteristics of gas switches. In this paper, both the injection characteristics and space-time evolution of ejected plasma for the triggering of gas spark switch with different stored energies, pulse polarities, and pressures are studied. The discharge characteristics and breakdown process of a gas switch ignited by ejected plasma under different working coefficients are also discussed briefly. The results show that stored energy has significant influence on the characteristics of ejected plasma. With the increase of stored energy, the propulsion mode of ejected plasma in the axial direction transforms from “plasmoid” to “plasma flow,” and the distribution of the ejected plasma goes through “cloud,” “core-cloud,” and “branch” in sequence. The velocity of ejected plasma under negative pulse polarity is obviously higher than that under positive pulse polarity, especially at the very beginning time. The radial dimensions of ejected plasma under two kinds of pulse polarities follow the similar varying pattern over time, which increase first and then decrease, assuming an inverted “U”-shaped curve. With the increase of pressure, the velocity of ejected plasma significantly decreases and the “branch” channels droop earlier. Applying the ejected plasma to the triggering of a gas switch, the switch can be triggered reliably in a much wide working coefficient range of 10%–90%. With the increase of working coefficient, the breakdown process of the switch translates from slow working mode to fast working mode, and the delay time reduces from tens of μs to hundreds of ns.

  14. Radionuclide analysis of ejection time, peak ejection rate, and time to peak ejection rate: response to supine bicycle exercise in normal subjects and in patients with coronary heart disease

    SciTech Connect

    Slutsky, R.A.; Mancini, G.B.; Gerber, K.H.; Carey, P.H.; Ashburn, W.L.; Higgins, C.B.

    1983-05-01

    Using equilibrium radionuclide angiography, we evaluated the ejection time (ET), peak ejection rate (PER), and time to peak ejection rate (TTp) at test and during supine bicycle exercise in 39 subjects, divided into three groups: group 1 . 13 normal subjects; group 2 . 10 patients with a previous infarction (MI); and group 3 . 16 patients with coronary disease without a previous MI. Normal subjects had greater ejection fractions and PERs than the other two groups at rest or peak exercise (p less than 0.05). PER was no more useful than ejection fraction in identifying cardiac dysfunction at either rest or exercise. The time of its occurrence varied with the group studied, and was slightly but significantly later in systole in groups 2 and 3 when compared to normals (p less than 0.05), though substantial overlap between groups occurred. During exercise, absolute ET shortened in all groups, but actually increased as a function of the R-R interval. The time to peak ejection rate (normalized for the R-R interval) was greater in the noninfarct group (group 3) patients (p less than 0.05) when compared to the group 1 or group 2 individuals at peak exercise. In conclusion, equilibrium radionuclide angiography is a useful technique for the quantification and characterization of events during systole, and is capable of providing information on the timing of events during ejection. Tardokinesis, or the delay of ventricular ejection, is not seen in the response of global indices of left ventricular function to exercise stress. While global early systolic indexes may not detect regional dyssynchrony, their timing during stress may occasionally aid in discerning the presence of cardiac dysfunction.

  15. Brachial plexus

    MedlinePlus

    The brachial plexus is a group of nerves that run from the lower neck through the upper shoulder area. ... Damage to the brachial plexus nerves can cause muscle and sensation problems that are often associated with pain in the same area. Symptoms ...

  16. THE NATURE OF HYPERVELOCITY STARS AND THE TIME BETWEEN THEIR FORMATION AND EJECTION

    SciTech Connect

    Brown, Warren R.; Geller, Margaret J.; Kenyon, Scott J.; Cohen, Judith G. E-mail: mgeller@cfa.harvard.edu E-mail: jlc@astro.caltech.edu

    2012-07-20

    We obtain Keck HIRES spectroscopy of HVS5, one of the fastest unbound stars in the Milky Way halo. We show that HVS5 is a 3.62 {+-} 0.11 M{sub Sun} main-sequence B star at a distance of 50 {+-} 5 kpc. The difference between its age and its flight time from the Galactic center is 105 {+-} 18 (stat) {+-}30 (sys) Myr; flight times from locations elsewhere in the Galactic disk are similar. This 10{sup 8} yr 'arrival time' between formation and ejection is difficult to reconcile with any ejection scenario involving massive stars that live for only 10{sup 7} yr. For comparison, we derive arrival times of 10{sup 7} yr for two unbound runaway B stars, consistent with their disk origin where ejection results from a supernova in a binary system or dynamical interactions between massive stars in a dense star cluster. For HVS5, ejection during the first 10{sup 7} yr of its lifetime is ruled out at the 3{sigma} level. Together with the 10{sup 8} yr arrival times inferred for three other well-studied hypervelocity stars (HVSs), these results are consistent with a Galactic center origin for the HVSs. If the HVSs were indeed ejected by the central black hole, then the Galactic center was forming stars {approx_equal}200 Myr ago, and the progenitors of the HVSs took {approx_equal}100 Myr to enter the black hole's loss cone.

  17. Brachial plexopathy

    PubMed Central

    Khadilkar, Satish V.; Khade, Snehaldatta S.

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise. PMID:23661957

  18. Time and reliability issues associated with automatic vs. manual measurements of Ankle to Brachial pressure Index (ABI) following heavy load exercise.

    PubMed

    Congnard, Florian; Bruneau, Antoine; Abraham, Pierre; Colas-Ribas, Christophe; Picquet, Jean; Noury-Desvaux, Benedicte

    2015-11-01

    Ankle to brachial index after heavy load exercise is the most accurate way of diagnosing minor arterial lesions in athletes, such as endofibrosis. The reliability and practical aspects of ankle to brachial index measurements after heavy-load exercise have not been studied. The purpose of this study was to analyze the interest of oscillometric automatic vs. manual Doppler measurements, for the calculation of ankle to brachial index, after heavy-load exercise in athletes. Prospective single-center study. Fifteen healthy trained athletes performed an incremental test twice. Ankle to brachial index measurements were performed at Rest, as soon as possible after exercise (Rec-0), and then started at the 3rd minute of recovery (Rec-3), by two operators using each one of the two ankle to brachial index measurement methods. Mean times for automatic vs. manual ankle to brachial availability were 99 ± 18 s vs. 113 ± 25 s (p = 0.005) and 44 ± 25 s vs. 53 ± 12 s (p = 0.001) respectively at Rec-0 and Rec-3. Ankle to brachial index values from the two methods were highly correlated (r = 0.89). Mean absolute differences of automatic vs. manual ankle to brachial values from test-retest were 0.04 ± 0.05 vs. 0.08 ± 0.08 (p > 0.05) and 0.07 ± 0.05 vs. 0.09 ± 0.10 (p > 0.05) at Rest and Rec-0. Automatic method allows obtaining faster and simultaneously post-exercise ankle to brachial index measurement compare to the manual Doppler. This time issue does not result in a significant change in absolute ankle to brachial index values, nor in the absolute differences of these in test-retest. Nevertheless, the test-retest variability of post-exercise ankle to brachial index results seems smaller with the automatic than the manual method. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  19. Ankle-Brachial Index Testing at the Time of Stress Testing in Patients Without Known Atherosclerosis.

    PubMed

    Narula, Amar; Benenstein, Ricardo J; Duan, Daisy; Zagha, David; Li, Lilun; Choy-Shan, Alana; Konigsberg, Matthew W; Lau, Ginger; Phillips, Lawrence M; Saric, Muhamed; Vreeland, Lisa; Reynolds, Harmony R

    2016-01-01

    Individuals referred for stress testing to identify coronary artery disease may have nonobstructive atherosclerosis, which is not detected by stress tests. Identification of increased risk despite a negative stress test could inform prevention efforts. Abnormal ankle-brachial index (ABI) is associated with increased cardiovascular risk. Routine ABI testing in the stress laboratory will identify unrecognized peripheral arterial disease in some patients. Participants referred for stress testing without known history of atherosclerotic disease underwent ABI testing (n = 451). Ankle-brachial index was assessed via simultaneous arm and leg pressure using standard measurement, automated blood-pressure cuffs at rest. Ankle-brachial index was measured after exercise in 296 patients and 30 healthy controls. Abnormal postexercise ABI was defined as a >20% drop in ABI or fall in ankle pressure by >30 mm Hg. Overall, 2.0% of participants had resting ABI ≤0.90, 3.1% had ABI ≥1.40, and 5.5% had borderline ABI. No patient with abnormal or borderline ABI had an abnormal stress test. Participants who met peripheral arterial disease screening criteria (age ≥65 or 50-64 with diabetes or smoking) tended toward greater frequency of low ABI (2.9% vs 1.0%; P = 0.06) and were more likely to have borderline ABI (0.91 to 0.99; 7.8% vs 2.9%; P = 0.006). Postexercise ABI was abnormal in 29.4% of patients and 30.0% of controls (P not significant). Ankle-brachial index screening at rest just before stress testing detected low ABI in 2.0% of participants, all of whom had negative stress tests. © 2015 Wiley Periodicals, Inc.

  20. Left ventricular ejection time, not heart rate, is an independent correlate of aortic pulse wave velocity.

    PubMed

    Salvi, Paolo; Palombo, Carlo; Salvi, Giovanni Matteo; Labat, Carlos; Parati, Gianfranco; Benetos, Athanase

    2013-12-01

    Several studies showed a positive association between heart rate and pulse wave velocity, a sensitive marker of arterial stiffness. However, no study involving a large population has specifically addressed the dependence of pulse wave velocity on different components of the cardiac cycle. The aim of this study was to explore in subjects of different age the link between pulse wave velocity with heart period (the reciprocal of heart rate) and the temporal components of the cardiac cycle such as left ventricular ejection time and diastolic time. Carotid-femoral pulse wave velocity was assessed in 3,020 untreated subjects (1,107 men). Heart period, left ventricular ejection time, diastolic time, and early-systolic dP/dt were determined by carotid pulse wave analysis with high-fidelity applanation tonometry. An inverse association was found between pulse wave velocity and left ventricular ejection time at all ages (<25 years, r(2) = 0.043; 25-44 years, r(2) = 0.103; 45-64 years, r(2) = 0.079; 65-84 years, r(2) = 0.044; ≥ 85 years, r(2) = 0.022; P < 0.0001 for all). A significant (P < 0.0001) negative but always weaker correlation between pulse wave velocity and heart period was also found, with the exception of the youngest subjects (P = 0.20). A significant positive correlation was also found between pulse wave velocity and dP/dt (P < 0.0001). With multiple stepwise regression analysis, left ventricular ejection time and dP/dt remained the only determinant of pulse wave velocity at all ages, whereas the contribution of heart period no longer became significant. Our data demonstrate that pulse wave velocity is more closely related to left ventricular systolic function than to heart period. This may have methodological and pathophysiological implications.

  1. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study.

    PubMed

    Crofts, J F; Lenguerrand, E; Bentham, G L; Tawfik, S; Claireaux, H A; Odd, D; Fox, R; Draycott, T J

    2016-01-01

    To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme. Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12). Southmead Hospital, Bristol, UK, with approximately 6000 births per annum. Infants and their mothers who experienced shoulder dystocia. A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000. Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval). Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P < 0.001) pre-training, and 92% (241/262, P < 0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P < 0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training. There are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12 months in 562 cases of shoulder dystocia. © 2015 Royal College of Obstetricians and Gynaecologists.

  2. Heart rate-left ventricular ejection time relations - Variations during postural change and cardiovascular challenges

    NASA Technical Reports Server (NTRS)

    Lance, V. Q.; Spodick, D. H.

    1976-01-01

    Experiments were conducted on healthy human subjects to determine HR-LVET (Heart Rate-Left Ventricular Ejection Time) regression relations in different postures, including tilt, and during isometric exercise. The subjects were tested in the resting state in supine and sitting positions, during isometric handgrip in supine and sitting positions and during 70 deg headup tilt. The recordings included a bipolar electrocardiogram and a right external carotid pulse curve. Comparison of the HR-LVET relation for the conditions under analysis revealed differences among the respective regression equations, which can be explained by the well-established differences in stroke volume and ejection rate among these states. These differences appear to account for the fact that under conditions in which stroke volume variations should be the major determinant, slopes will be similar but intercepts will vary. Since substantial differences among intercepts are observed, caution should be exercised whenever the intercept factor is used to predict LVET for HR.

  3. Heart rate-left ventricular ejection time relations - Variations during postural change and cardiovascular challenges

    NASA Technical Reports Server (NTRS)

    Lance, V. Q.; Spodick, D. H.

    1976-01-01

    Experiments were conducted on healthy human subjects to determine HR-LVET (Heart Rate-Left Ventricular Ejection Time) regression relations in different postures, including tilt, and during isometric exercise. The subjects were tested in the resting state in supine and sitting positions, during isometric handgrip in supine and sitting positions and during 70 deg headup tilt. The recordings included a bipolar electrocardiogram and a right external carotid pulse curve. Comparison of the HR-LVET relation for the conditions under analysis revealed differences among the respective regression equations, which can be explained by the well-established differences in stroke volume and ejection rate among these states. These differences appear to account for the fact that under conditions in which stroke volume variations should be the major determinant, slopes will be similar but intercepts will vary. Since substantial differences among intercepts are observed, caution should be exercised whenever the intercept factor is used to predict LVET for HR.

  4. Brachial neuritis.

    PubMed

    Dillin, L; Hoaglund, F T; Scheck, M

    1985-07-01

    Brachial neuritis is an unusual syndrome of unknown etiology that can be confused with other causes of pain or weakness, or both, of the shoulder and arm. It is important to distinguish this disorder because of its dramatic symptoms and relatively good prognosis. Sharp pain, usually in the elbow or shoulder, marks the onset of brachial neuritis, but is relatively short-lived. Weakness generally occurs as the pain is subsiding and most frequently involves the deltoid, spinati, serratus anterior, biceps, and triceps. Paresthesias, atrophy, and sensory loss are inconstant features. Electromyographic findings of fibrillation potentials and positive waves characteristically are found in a pattern indicating combined nerve-root and peripheral nerve involvement. Electromyography more frequently than clinical examination shows that the lesion is bilateral, and also is of both diagnostic and prognostic value. Other laboratory studies serve only to exclude other causes of shoulder pain. The clinical course is variable, but in 90 per cent of patients complete recovery occurs within three years. Recurrences are uncommon.

  5. Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

    PubMed Central

    Smith, Shane P.; Secomb, Timothy W.; Hong, Brian D.; Moulton, Michael J.

    2016-01-01

    Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects. Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded. Results. Peak longitudinal and circumferential strain was globally reduced in patients (p < 0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p < 0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p < 0.001). Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains. PMID:27042673

  6. User-guided automated segmentation of time-series ultrasound images for measuring vasoreactivity of the brachial artery induced by flow mediation

    NASA Astrophysics Data System (ADS)

    Sehgal, Chandra M.; Kao, Yen H.; Cary, Ted W.; Arger, Peter H.; Mohler, Emile R.

    2005-04-01

    Endothelial dysfunction in response to vasoactive stimuli is closely associated with diseases such as atherosclerosis, hypertension and congestive heart failure. The current method of using ultrasound to image the brachial artery along the longitudinal axis is insensitive for measuring the small vasodilatation that occurs in response to flow mediation. The goal of this study is to overcome this limitation by using cross-sectional imaging of the brachial artery in conjunction with the User-Guided Automated Boundary Detection (UGABD) algorithm for extracting arterial boundaries. High-resolution ultrasound imaging was performed on rigid plastic tubing, on elastic rubber tubing phantoms with steady and pulsatile flow, and on the brachial artery of a healthy volunteer undergoing reactive hyperemia. The area of cross section of time-series images was analyzed by UGABD by propagating the boundary from one frame to the next. The UGABD results were compared by linear correlation with those obtained by manual tracing. UGABD measured the cross-sectional area of the phantom tubing to within 5% of the true area. The algorithm correctly detected pulsatile vasomotion in phantoms and in the brachial artery. A comparison of area measurements made using UGABD with those made by manual tracings yielded a correlation of 0.9 and 0.8 for phantoms and arteries, respectively. The peak vasodilatation due to reactive hyperemia was two orders of magnitude greater in pixel count than that measured by longitudinal imaging. Cross-sectional imaging is more sensitive than longitudinal imaging for measuring flow-mediated dilatation of brachial artery, and thus may be more suitable for evaluating endothelial dysfunction.

  7. Lower trunk of brachial plexus injury in the neonate rat: effects of timing repair.

    PubMed

    Lauretti, Liverana; Pallini, Roberto; Romani, Rossana; Di Rocco, Federico; Ciampini, Alessandro; Gangitano, Carlo; Del Fa, Aurora; Fernandez, Eduardo

    2009-06-01

    After lesion of a peripheral nerve in neonatal mammals, motoneurons undergo a cell death. We wanted to ascertain if early surgery could influence such post-axotomy motoneuronal death and improve the functional outcome. In this study, we investigated the functional and anatomical results after immediate and delayed repair of the lower trunk of brachial plexus (BP) sectioned at birth in rats. In neonate rats, the lower trunk of the left BP was cut. This nerve trunk was repaired either immediately [immediately-reconstructed group of rats (IR), or 30 days after, tardy reconstructed group of rats (TR)]; in the third group of animals, the nerve was not repaired (noreconstructed group of rats, NoR). In each group of animals, functional studies were performed at 90 days of age using the grooming test and the walking tracks analysis. Histologic studies of the C7-T1 spinal cord and lower trunk of BP were performed at 30 and 90 days of age; the numbers of motoneuron and axon were counted. Functional recovery was related to the difference in motoneuron number between the injured and the uninjured sides of the spinal cord of the operated animals. On the one side, only in the rats in which the inferior trunk was immediately repaired, the difference in motoneuron number between the two sides of the spinal cord was not statistically significant; these animals showed a good axonal regeneration and function recovery. On the other side, in the rats in which the inferior trunk was left unrepaired or tardy repaired, the decrease in motoneuron number in the injured side compared with the uninjured side of the spinal cord was statistically significant; these animals showed no axonal regeneration and no function recovery. The results cited above suggest that an important role in restoration of good neurological function after section of the lower trunk of BP in neonate rats is played by early nerve repair. Good neurological function was related more to a quite numerical balance of

  8. To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

    PubMed Central

    Ahuja, V; Thapa, D; Gombar, S; Dhiman, D

    2016-01-01

    Background: Unintentional intraneural injection under ultrasound guidance (USG) with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB) have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30): SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30): SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events. PMID:27375378

  9. WAITING TIMES OF QUASI-HOMOLOGOUS CORONAL MASS EJECTIONS FROM SUPER ACTIVE REGIONS

    SciTech Connect

    Wang Yuming; Liu Lijuan; Shen Chenglong; Liu Rui; Ye Pinzhong; Wang, S.

    2013-02-01

    Why and how do some active regions (ARs) frequently produce coronal mass ejections (CMEs)? These are key questions for deepening our understanding of the mechanisms and processes of energy accumulation and sudden release in ARs and for improving our space weather prediction capability. Although some case studies have been performed, these questions are still far from fully answered. These issues are now being addressed statistically through an investigation of the waiting times of quasi-homologous CMEs from super ARs in solar cycle 23. It is found that the waiting times of quasi-homologous CMEs have a two-component distribution with a separation at about 18 hr. The first component is a Gaussian-like distribution with a peak at about 7 hr, which indicates a tight physical connection between these quasi-homologous CMEs. The likelihood of two or more occurrences of CMEs faster than 1200 km s{sup -1} from the same AR within 18 hr is about 20%. Furthermore, the correlation analysis among CME waiting times, CME speeds, and CME occurrence rates reveals that these quantities are independent of each other, suggesting that the perturbation by preceding CMEs rather than free energy input is the direct cause of quasi-homologous CMEs. The peak waiting time of 7 hr probably characterizes the timescale of the growth of the instabilities triggered by preceding CMEs. This study uncovers some clues from a statistical perspective for us to understand quasi-homologous CMEs as well as CME-rich ARs.

  10. Brachial Plexus Injuries

    MedlinePlus

    ... to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves. Symptoms ... sensation in the arm or hand Brachial plexus injuries can occur as a result of shoulder trauma, ...

  11. Brachial plexus (image)

    MedlinePlus

    The brachial plexus is a group of nerves that originate from the neck region and branch off to give ... movement in the upper limb. Injuries to the brachial plexus are common and can be debilitating. If ...

  12. Toward an Accurate Prediction of the Arrival Time of Geomagnetic-Effective Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Shi, T.; Wang, Y.; Wan, L.; Cheng, X.; Ding, M.; Zhang, J.

    2015-12-01

    Accurately predicting the arrival of coronal mass ejections (CMEs) to the Earth based on remote images is of critical significance for the study of space weather. Here we make a statistical study of 21 Earth-directed CMEs, specifically exploring the relationship between CME initial speeds and transit times. The initial speed of a CME is obtained by fitting the CME with the Graduated Cylindrical Shell model and is thus free of projection effects. We then use the drag force model to fit results of the transit time versus the initial speed. By adopting different drag regimes, i.e., the viscous, aerodynamics, and hybrid regimes, we get similar results, with a least mean estimation error of the hybrid model of 12.9 hr. CMEs with a propagation angle (the angle between the propagation direction and the Sun-Earth line) larger than their half-angular widths arrive at the Earth with an angular deviation caused by factors other than the radial solar wind drag. The drag force model cannot be reliably applied to such events. If we exclude these events in the sample, the prediction accuracy can be improved, i.e., the estimation error reduces to 6.8 hr. This work suggests that it is viable to predict the arrival time of CMEs to the Earth based on the initial parameters with fairly good accuracy. Thus, it provides a method of forecasting space weather 1-5 days following the occurrence of CMEs.

  13. Flow-mediated dilatation, using time course data, shows maturation of the brachial artery from young children to mid-adolescents.

    PubMed

    Kontos, Anna; Pamula, Yvonne; Martin, James; Gent, Roger; Lushington, Kurt; Baumert, Mathias; Willoughby, Scott; Richardson, Malcolm; Couper, Jennifer; Kennedy, Declan

    2015-03-01

    Flow-mediated dilatation (FMD) is a tool widely used to measure arterial responsiveness to sheer stress. However, there is scant literature to show how the peripheral arterial response changes as the vascular system matures. One reason for this is that the feasibility of measuring FMD in younger children has not been established. The aim of the present study was to assess brachial artery function at rest and during the FMD response after 4 min ischaemia of the forearm in children aged 6-15 years. Time to reach maximum FMD (FMDmax ) was found to be correlated with age (r = 0.4, P < 0.05), resting brachial artery diameter (r = 0.4, P < 0.05), height (r = 0.4, P < 0.05), body mass index (BMI; r = 0.45, P < 0.05), body surface area (r = 0.44, P < 0.05) and resting blood flow (r = 0.37, P < 0.05). However, there was no correlation between the traditional FMD response at 60 s or FMD maximal dilation and age, resting brachial artery diameter, height, weight, BMI, body surface area and resting blood flow. In conclusion, the time taken to reach the maximal dilation response is related to age, brachial artery luminal diameter and body habitus, but not the traditional measure of FMD response at 60 s or the maximal dilatation percentage. © 2014 Wiley Publishing Asia Pty Ltd.

  14. Detection of Coronal Mass Ejections Using Multiple Features and Space-Time Continuity

    NASA Astrophysics Data System (ADS)

    Zhang, Ling; Yin, Jian-qin; Lin, Jia-ben; Feng, Zhi-quan; Zhou, Jin

    2017-07-01

    Coronal Mass Ejections (CMEs) release tremendous amounts of energy in the solar system, which has an impact on satellites, power facilities and wireless transmission. To effectively detect a CME in Large Angle Spectrometric Coronagraph (LASCO) C2 images, we propose a novel algorithm to locate the suspected CME regions, using the Extreme Learning Machine (ELM) method and taking into account the features of the grayscale and the texture. Furthermore, space-time continuity is used in the detection algorithm to exclude the false CME regions. The algorithm includes three steps: i) define the feature vector which contains textural and grayscale features of a running difference image; ii) design the detection algorithm based on the ELM method according to the feature vector; iii) improve the detection accuracy rate by using the decision rule of the space-time continuum. Experimental results show the efficiency and the superiority of the proposed algorithm in the detection of CMEs compared with other traditional methods. In addition, our algorithm is insensitive to most noise.

  15. Estimating Travel Times of Coronal Mass Ejections to 1 AU Using Multi-spacecraft Coronagraph Data

    NASA Astrophysics Data System (ADS)

    Kilpua, E. K. J.; Mierla, M.; Rodriguez, L.; Zhukov, A. N.; Srivastava, N.; West, M. J.

    2012-08-01

    We study the relationship between the speeds of coronal mass ejections (CMEs) obtained close to the Sun and in the interplanetary medium during the low solar-activity period from 2008 to 2010. We use a multi-spacecraft forward-modeling technique to fit a flux-rope-like model to white-light coronagraph images from the STEREO and SOHO spacecraft to estimate the geometrical configuration, propagation in three-dimensions (3D), and the radial speeds of the observed CMEs. The 3D speeds obtained in this way are used in existing CME travel-time prediction models. The results are compared to the actual CME transit times from the Sun to STEREO, ACE, and Wind spacecraft as well as to the transit times calculated using projected CME speeds. CME 3D speeds give slightly better predictions than projected CME speeds, but a large scatter is observed between the predicted and observed travel times, even when 3D speeds are used. We estimate the possible sources of errors and find a weak tendency for large interplanetary CMEs (ICMEs) with high magnetic fields to arrive faster than predicted and small, low-magnetic-field ICMEs to arrive later than predicted. The observed CME transit times from the Sun to 1 AU show a particularly good correlation with the upstream solar-wind speed. Similar trends have not been observed in previous studies using data sets near solar maximum. We suggest that near solar minimum a relatively narrow range of CME initial speeds, sizes, and magnetic-field magnitudes led to a situation where aerodynamic drag between CMEs and ambient solar wind was the primary cause of variations in CME arrival times from the Sun to 1 AU.

  16. Real-time Ensemble Forecasting of Coronal Mass Ejections using the WSA-ENLIL+Cone Model

    NASA Astrophysics Data System (ADS)

    Mays, M. L.; Taktakishvili, A.; Pulkkinen, A. A.; MacNeice, P. J.; Rastaetter, L.; Kuznetsova, M. M.; Odstrcil, D.

    2013-12-01

    Ensemble forecasting of coronal mass ejections (CMEs) provides significant information in that it provides an estimation of the spread or uncertainty in CME arrival time predictions due to uncertainties in determining CME input parameters. Ensemble modeling of CME propagation in the heliosphere is performed by forecasters at the Space Weather Research Center (SWRC) using the WSA-ENLIL cone model available at the Community Coordinated Modeling Center (CCMC). SWRC is an in-house research-based operations team at the CCMC which provides interplanetary space weather forecasting for NASA's robotic missions and performs real-time model validation. A distribution of n (routinely n=48) CME input parameters are generated using the CCMC Stereo CME Analysis Tool (StereoCAT) which employs geometrical triangulation techniques. These input parameters are used to perform n different simulations yielding an ensemble of solar wind parameters at various locations of interest (satellites or planets), including a probability distribution of CME shock arrival times (for hits), and geomagnetic storm strength (for Earth-directed hits). Ensemble simulations have been performed experimentally in real-time at the CCMC since January 2013. We present the results of ensemble simulations for a total of 15 CME events, 10 of which were performed in real-time. The observed CME arrival was within the range of ensemble arrival time predictions for 5 out of the 12 ensemble runs containing hits. The average arrival time prediction was computed for each of the twelve ensembles predicting hits and using the actual arrival time an average absolute error of 8.20 hours was found for all twelve ensembles, which is comparable to current forecasting errors. Some considerations for the accuracy of ensemble CME arrival time predictions include the importance of the initial distribution of CME input parameters, particularly the mean and spread. When the observed arrivals are not within the predicted range, this

  17. [Perinatal brachial plexus palsy].

    PubMed

    Macko, Jozef

    2010-08-01

    Upper limbs palsy as a result of affliction of plexus brachialis nervous bunch is disorder, whose frequency moves among 0.42-5.1 / 1000 liveborn children. Delivery mechanism itself certain weighty, no however only cause rising paralysis. Some way paralysis rise already intrauterinne, some way then at surgical childbirth per sectionem caeseream. Brachial plexus palsy isn't benign disorder. If isn't this disorder in time diagnosed and accordingly treated, child threatens late aftermath, especially significant limitation of limbs movement with functional consequencies.

  18. [Obstetric brachial palsy, a historical review].

    PubMed

    Collado-Vazquez, S; Jimenez-Antona, C; Carrillo, J M

    2012-11-16

    Lesions of the peripheral nerves have been known since ancient times, but there are few references to the treatments that were used in the past. AIM. To analyse obstetric brachial palsy and its treatments throughout history. There are a number of different references to the peripheral nerves and their lesions, although little is known about the treatments that were applied in the past. William Smellie first reported obstetric brachial palsy in 1764 and the term was coined by Duchenne de Boulogne in 1872. In 1877, Erb analysed four cases of obstetric brachial palsy and conducted studies on the excitation of the brachial plexus with electric currents. In 1885, Klumpke described palsy of the lower roots of the brachial plexus. In the late 19th century pathophysiology studies were carried out and at the beginning of the 20th century the first surgical interventions were performed. Today, microsurgery techniques, protocols on how to proceed, and rehabilitation treatment of this lesion are all available and offer good outcomes. Since the first clinical description of obstetric brachial palsy by Smellie and the reports of the different types of brachial palsy by Duchenne, Erb and Klumpke, many pathophysiological studies have been conducted. Notable developments have been made in conservative and surgical treatments, with very favourable recoveries being observed in children with obstetric brachial palsy.

  19. Near Real-Time Photometric Data Processing for the Solar Mass Ejection Imager (SMEI)

    NASA Astrophysics Data System (ADS)

    Hick, P. P.; Buffington, A.; Jackson, B. V.

    2004-12-01

    The Solar Mass Ejection Imager (SMEI) records a photometric white-light response of the interplanetary medium from Earth over most of the sky in near real time. In the first two years of operation the instrument has recorded the inner heliospheric response to several hundred CMEs, including the May 28, 2003 and the October 28, 2003 halo CMEs. In this preliminary work we present the techniques required to process the SMEI data from the time the raw CCD images become available to their final assembly in photometrically accurate maps of the sky brightness relative to a long-term time base. Processing of the SMEI data includes integration of new data into the SMEI data base; a conditioning program that removes from the raw CCD images an electronic offset ("pedestal") and a temperature-dependent dark current pattern; an "indexing" program that places these CCD images onto a high-resolution sidereal grid using known spacecraft pointing information. At this "indexing" stage further conditioning removes the bulk of the the effects of high-energy-particle hits ("cosmic rays"), space debris inside the field of view, and pixels with a sudden state change ("flipper pixels"). Once the high-resolution grid is produced, it is reformatted to a lower-resolution set of sidereal maps of sky brightness. From these sidereal maps we remove bright stars, background stars, and a zodiacal cloud model (their brightnesses are retained as additional data products). The final maps can be represented in any convenient sky coordinate system. Common formats are Sun-centered Hammer-Aitoff or "fisheye" maps. Time series at selected locations on these maps are extracted and processed further to remove aurorae, variable stars and other unwanted signals. These time series (with a long-term base removed) are used in 3D tomographic reconstructions. The data processing is distributed over multiple PCs running Linux, and, runs as much as possible automatically using recurring batch jobs ('cronjobs'). The

  20. [Brachial plexus sleep palsy].

    PubMed

    Fourcade, G; Taieb, G; Renard, D; Labauge, P; Pradal-Prat, D

    2011-01-01

    Brachial plexus is rarely involved in "Saturday night palsy". A young man was admitted for numbness and weakness of his right upper limb after awaking from sleep. Neurophysiological studies, consistent with brachial plexopathy, revealed presence of proximal conduction blocks. Patient presented spontaneous clinical and neurophysiological improvement. Diagnosis of compressive brachial plexopathy needs to eliminate other causes of neuropathy with conduction block. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  1. Severe Brachial Plexus Injuries in American Football.

    PubMed

    Daly, Charles A; Payne, S Houston; Seiler, John G

    2016-11-01

    This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.].

  2. Ankle-brachial index predicts change over time in functional status in the San Diego Population Study.

    PubMed

    Wassel, Christina L; Allison, Matthew A; Ix, Joachim H; Rifkin, Dena E; Forbang, Nketi I; Denenberg, Julie O; Criqui, Michael H

    2016-09-01

    Peripheral artery disease (PAD) affects millions of people, both in the U.S. and worldwide. Even when asymptomatic, PAD and the ankle-brachial index (ABI), the major clinical diagnostic criterion for PAD, are associated with decreased functional status and quality of life, as well as mobility impairment. Whether the ABI or change in the ABI predicts decline in functional status over time has not been previously assessed in a population-based setting. Participants were 812 non-Hispanic white, African American, Hispanic, and Asian men and women from the San Diego Population Study (SDPS) who attended a baseline examination (1994-1998), and follow-up clinic examination approximately 11 years later. The Medical Outcomes Study 36-Item Short Form (SF-36) was obtained at both the baseline and follow-up examinations, and the summary performance score (SPS) at the follow-up examination. Associations of the baseline ABI and clinically relevant change in the ABI (<-0.15 vs ≥-0.15) with change in SF-36 scores over time were assessed using growth curve models, a type of mixed model that accounts for within participant correlation of measurements over time, and using linear regression for SPS. Models were adjusted for baseline age, sex, race/ethnicity, body mass index, ever smoking, physical activity, hypertension, diabetes, and dyslipidemia. Mean ± standard deviation (SD) for the baseline ABI was 1.11 ± 0.10, and 50.8 ± 9.0 for the baseline Physical Component Score (PCS), 50.1 ± 9.5 for the baseline Mental Component Score (MCS), and 11.2 ± 1.9 for the SPS at the follow-up examination. In fully adjusted models, each SD lower of the baseline ABI was significantly associated with an average decrease over time of 0.6 (95% confidence interval [CI], -1.1 to -0.1; P = .02) units on SF-36 PCS. Each SD lower of the baseline ABI was also significantly associated with an average decrease over time of 1.2 units (95% CI, -2.3 to -0.2; P = .02) on the SF-36 physical

  3. Ankle Brachial Index (ABI) Predicts Change over Time in Functional Status in the San Diego Population Study (SDPS)

    PubMed Central

    Wassel, Christina L.; Allison, Matthew A.; Ix, Joachim H.; Rifkin, Dena E.; Forbang, Nketi I.; Denenberg, Julie O.; Criqui, Michael H.

    2016-01-01

    Background Peripheral artery disease (PAD) affects millions of people, both in the US and world-wide. Even when asymptomatic, PAD and the ankle brachial index (ABI), the major clinical diagnostic criterion for PAD, are associated with decreased functional status and quality of life, as well as mobility impairment. Whether the ABI or change in the ABI predicts decline in functional status over time has not been previously assessed in a population-based setting. Methods Participants were 812 non-Hispanic white, African-American, Hispanic and Asian men and women from the San Diego Population Study (SDPS) who attended a baseline exam (1994–98), and follow up clinic exam approximately 11 years later. The Medical Outcomes Study 36-item short form (SF-36) was obtained at both the baseline and follow-up exams, and the summary performance score (SPS) at the follow up exam. Associations of the baseline ABI and clinically relevant change in the ABI (<−0.15 vs ≥−0.15) with change in SF-36 scores over time were assessed using growth curve models, a type of mixed model which accounts for within participant correlation of measurements over time, and using linear regression for SPS. Models were adjusted for baseline age, sex, race/ethnicity, body mass index, ever smoking, physical activity, hypertension, diabetes, and dyslipidemia. Results Mean±SD for the baseline ABI was 1.11±0.10, and 50.8±9.0 for the baseline PCS, 50.1±9.5 for the baseline MCS, and 11.2±1.9 for the SPS at the follow-up exam. In fully adjusted models, each SD lower of the baseline ABI was significantly associated with an average decrease over time of 0.6 (95% CI (−1.1, −0.1), p=0.02) units on SF-36 PCS. Each SD lower of the baseline ABI was also significantly associated with an average decrease over time of 1.2 units ((−2.3, −0.2), p=0.02) on the SF-36 physical functioning subscale, and a decrease of 1.3 units ((−2.3, −0.3), p=0.01) on the SF-36 energy/vitality subscale in fully adjusted

  4. Brachial plexus injuries and dysfunctions.

    PubMed

    Steinberg, H S

    1988-05-01

    The brachial plexus and its associated structures demonstrate a propensity for certain disease processes not common to other areas of the nervous system. Brachial plexus disease produces a gait disturbance that may mimic musculoskeletal disease. When evaluating a case with possible traumatic brachial plexus disease, one relies heavily on historical, physical, and neurologic information when differentiating musculoskeletal disorders, although both may sometimes be present simultaneously in the same limb. With inflammatory disease, electromyography is extremely helpful, although an empiric dietary change may help confirm a suspicion. Brachial plexus surgery requires careful planning and meticulous technique. Attempts to remove malignant schwannomas have not been as successful as one would hope (Table 2). To a large extent, these dogs are treated late in the course of their disease because they are often treated for extended periods of time for musculoskeletal disease first. Early diagnosis and prompt surgical intervention would help many of these dogs. New histopathologic techniques, electrodiagnostic equipment, and radiographic techniques are helping to define peripheral nerve disease in the companion animal. These techniques will help us categorize and treat these diseases with greater success in the future.

  5. Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury.

    PubMed

    Kachramanoglou, Carolina; Carlstedt, Thomas; Koltzenburg, Martin; Choi, David

    2017-07-01

    Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury. We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing. We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome. Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  6. Ejection of the Massive Hydrogen-rich Envelope Timed with the Collapse of the Stripped SN 2014C

    NASA Astrophysics Data System (ADS)

    Margutti, Raffaella; Kamble, A.; Milisavljevic, D.; Zapartas, E.; de Mink, S. E.; Drout, M.; Chornock, R.; Risaliti, G.; Zauderer, B. A.; Bietenholz, M.; Cantiello, M.; Chakraborti, S.; Chomiuk, L.; Fong, W.; Grefenstette, B.; Guidorzi, C.; Kirshner, R.; Parrent, J. T.; Patnaude, D.; Soderberg, A. M.; Gehrels, N. C.; Harrison, F.

    2017-02-01

    We present multi-wavelength observations of SN 2014C during the first 500 days. These observations represent the first solid detection of a young extragalactic stripped-envelope SN out to high-energy X-rays ∼40 keV. SN 2014C shows ordinary explosion parameters (Ek ∼ 1.8 × 1051 erg and Mej ∼ 1.7 M⊙). However, over an ∼1 year timescale, SN 2014C evolved from an ordinary hydrogen-poor supernova into a strongly interacting, hydrogen-rich supernova, violating the traditional classification scheme of type-I versus type-II SNe. Signatures of the SN shock interaction with a dense medium are observed across the spectrum, from radio to hard X-rays, and revealed the presence of a massive shell of ∼1 M⊙ of hydrogen-rich material at ∼6 × 1016 cm. The shell was ejected by the progenitor star in the decades to centuries before collapse. This result challenges current theories of massive star evolution, as it requires a physical mechanism responsible for the ejection of the deepest hydrogen layer of H-poor SN progenitors synchronized with the onset of stellar collapse. Theoretical investigations point at binary interactions and/or instabilities during the last nuclear burning stages as potential triggers of the highly time-dependent mass loss. We constrain these scenarios utilizing the sample of 183 SNe Ib/c with public radio observations. Our analysis identifies SN 2014C-like signatures in ∼10% of SNe. This fraction is reasonably consistent with the expectation from the theory of recent envelope ejection due to binary evolution if the ejected material can survive in the close environment for 103–104 years. Alternatively, nuclear burning instabilities extending to core C-burning might play a critical role.

  7. Ejection time-corrected systolic velocity improves accuracy in the evaluation of myocardial dysfunction: a study in piglets.

    PubMed

    Odland, Hans Henrik; Kro, Grete Anette Birkeland; Munkeby, Berit H; Edvardsen, Thor; Saugstad, Ola Didrik; Thaulow, Erik

    2010-10-01

    This study aimed to assess the effect of correcting for the impact of heart rate (HR) or ejection time (ET) on myocardial velocities in the long axis in piglets undergoing hypoxia. The ability to eject a higher volume at a fixed ET is a characteristic of contractility in the heart. Systolic velocity of the atrioventricular annulus displacement is directly related to volume changes of the ventricle. Both ET and systolic velocity may be measured in a single heartbeat. In 29 neonatal pigs, systolic velocity and ET were measured with tissue Doppler techniques in the mitral valve annulus, the tricuspid valve annulus, and the septum. All ejection time corrected velocities (S((ET)), mean ± SEM, cm/s) decreased significantly during hypoxia (S(mva(ET)) 15.5 ± 0.2 to 13.2 ± 0.3 (p < 0.001), S(septal(ET)) 9.9 ± 0.1 to 7.8 ± 0.2 (p < 0.001), S(tva(ET)) 12.1 ± 0.2 to 9.8 ± 0.3 (p < 0.001)). The magnitude of change from baseline to hypoxia was greater for ejection time corrected systolic velocities than for RR-interval corrected velocities (mean ± SEM, cm/s); ΔS(mva(ET)) 2.3 ± 2.0 vs. ΔS(mva(RR)) 1.6 ± 1.1 (p = 0.02), ΔS(septal(ET)) 2.1 ± 1.0 vs. ΔS(septal(RR)) 1.6 ± 1.0 (p < 0.01), ΔS(tva(ET)) 2.3 ± 1.1 vs. ΔS(tva(RR)) 1.8 ± 1.3 (p = 0.04). The receiver operator characteristic (ROC) showed superior performance of S((ET)) compared with uncorrected velocities. The decrease in S((ET)) during hypoxia was not influenced by important hemodynamic determinants. ET-corrected systolic velocity improves accuracy and decreases variability in the evaluation of systolic longitudinal function and contractility during global hypoxia in neonatal pigs compared with systolic velocity alone. It is robust toward hemodynamic changes. This novel method has the potential of becoming a useful tool in clinical practice.

  8. Determination of left ventricular volume, ejection fraction, and myocardial mass by real-time three-dimensional echocardiography

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Shiota, T.; Thomas, J. D.

    2000-01-01

    Reconstructed three-dimensional (3-D) echocardiography is an accurate and reproducible method of assessing left ventricular (LV) functions. However, it has limitations for clinical study due to the requirement of complex computer and echocardiographic analysis systems, electrocardiographic/respiratory gating, and prolonged imaging times. Real-time 3-D echocardiography has a major advantage of conveniently visualizing the entire cardiac anatomy in three dimensions and of potentially accurately quantifying LV volumes, ejection fractions, and myocardial mass in patients even in the presence of an LV aneurysm. Although the image quality of the current real-time 3-D echocardiographic methods is not optimal, its widespread clinical application is possible because of the convenient and fast image acquisition. We review real-time 3-D echocardiographic image acquisition and quantitative analysis for the evaluation of LV function and LV mass.

  9. Determination of left ventricular volume, ejection fraction, and myocardial mass by real-time three-dimensional echocardiography

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Shiota, T.; Thomas, J. D.

    2000-01-01

    Reconstructed three-dimensional (3-D) echocardiography is an accurate and reproducible method of assessing left ventricular (LV) functions. However, it has limitations for clinical study due to the requirement of complex computer and echocardiographic analysis systems, electrocardiographic/respiratory gating, and prolonged imaging times. Real-time 3-D echocardiography has a major advantage of conveniently visualizing the entire cardiac anatomy in three dimensions and of potentially accurately quantifying LV volumes, ejection fractions, and myocardial mass in patients even in the presence of an LV aneurysm. Although the image quality of the current real-time 3-D echocardiographic methods is not optimal, its widespread clinical application is possible because of the convenient and fast image acquisition. We review real-time 3-D echocardiographic image acquisition and quantitative analysis for the evaluation of LV function and LV mass.

  10. Ankle-Brachial Index

    MedlinePlus

    ... to getting your blood pressure taken in a routine visit to your doctor. You may feel some ... mayoclinic.org/tests-procedures/ankle-brachial-index/basics/definition/PRC-20014625 . Mayo Clinic Footer Legal Conditions and ...

  11. Recurrent brachial plexus neuropathy.

    PubMed

    Bradley, W G; Madrid, R; Thrush, D C; Campbell, M J

    1975-09-01

    The clinical, electrophysiological and pathological changes in 3 patients with recurrent attacks of non-traumatic brachial plexus neuropathy have been described. Two had recurrent attacks and a dominant family history of similar attacks, together with evidence of lesser degrees of nerve involvement outside the brachial plexus. In one patient the attacks were moderately painful, while in the other there was little or no pain. Only one showed undue slowing of motor nerve conduction during ischaemia, but in both cases the sural nerves had the changes of tomaculous neuropathy, with many sausage-shaped swellings of the myelin sheaths, and extensive segmental demyelination and remyelination. The third patient had two attacks of acute brachial plexus neuropathy which were both extremely painful. The clinical features were compatible with a diagnosis of neuralgic amuotrophy. In the second attack, there was vagus nerve involvement and the sural nerve showed evidence of healed extensive segmental demyelination. The various syndromes presenting with acute non-traumatic brachial plexus neuropathy are reviewed, and a tentative nonsological classification advanced. Most patients fall into the category of acute, painful paralysis with amyotrophy, with no family history and no evidence of lesions outside the brachial plexus. It is suggested that the term "neuralgic amyotrophy" be restricted to this group. Patients with features outside this clinical picture probably suffer from other disease entities presenting with brachial plexus neuropathy. The familial cases constitute one or more aetioliogical subgroups, differing from neuralgic amyotrophy in the frequency of recurrences, the relative freedom from pain in the attacks, the frequency of nerve lesions outside the brachial plexus, and of hypotelorism. Individual attacks of acute brachial plexus neuropathy, however, may be identical in patients with the different diseases, and further pathological and biochemical studies are

  12. Acoustic correlates of Georgian ejectives

    NASA Astrophysics Data System (ADS)

    Wysocki, Tamra M.

    2002-05-01

    In this paper we present results from acoustic analysis of Georgian ejectives. Georgian, a language of the Kartvelian (South Caucasian) family, has a three-way opposition for voiced, voiceless aspirated and ejective stops. There have not been many acoustic studies of ejectives; those studies that discuss ejectives, such as by Lindau [J. Phonetics 12, 147-155 (1984)], report cross-linguistic variation in timing between oral and glottal releases and the onset of a following vowel. In this paper we investigate acoustic correlates of Georgian ejectives and examine how these correlates are realized in two-member ejective clusters. Additionally, correlates of Georgian ejectives are compared to findings from previous studies and discussed in relation to cross-linguistic tendencies and variation. Data consist of field recordings of three native Georgian speakers producing single ejectives and ejective clusters in word-initial and word-medial (intervocalic) positions at a normal rate of speech. Acoustic analysis was completed using spectrograms and waveforms. Results indicate that, while there is variation within and among speakers, characteristics correlated with singleton Georgian ejectives include relative burst amplitude, noise quality following oral release, long, positive voice onset time, and a short period of creaky voice at the onset of a following vowel. Some of these characteristics differ from those of ejective clusters.

  13. Connecting speeds, directions and arrival times of 22 coronal mass ejections from the sun to 1 AU

    SciTech Connect

    Möstl, C.; Veronig, A. M.; Rollett, T.; Temmer, M.; Peinhart, V.; Amla, K.; Hall, J. R.; Liewer, P. C.; De Jong, E. M.; Colaninno, R. C.; Davies, J. A.; Harrison, R. A.; Lugaz, N.; Farrugia, C. J.; Galvin, A. B.; Liu, Y. D.; Luhmann, J. G.; Vršnak, B.

    2014-06-01

    Forecasting the in situ properties of coronal mass ejections (CMEs) from remote images is expected to strongly enhance predictions of space weather and is of general interest for studying the interaction of CMEs with planetary environments. We study the feasibility of using a single heliospheric imager (HI) instrument, imaging the solar wind density from the Sun to 1 AU, for connecting remote images to in situ observations of CMEs. We compare the predictions of speed and arrival time for 22 CMEs (in 2008-2012) to the corresponding interplanetary coronal mass ejection (ICME) parameters at in situ observatories (STEREO PLASTIC/IMPACT, Wind SWE/MFI). The list consists of front- and backsided, slow and fast CMEs (up to 2700 km s{sup –1}). We track the CMEs to 34.9 ± 7.1 deg elongation from the Sun with J maps constructed using the SATPLOT tool, resulting in prediction lead times of –26.4 ± 15.3 hr. The geometrical models we use assume different CME front shapes (fixed-Φ, harmonic mean, self-similar expansion) and constant CME speed and direction. We find no significant superiority in the predictive capability of any of the three methods. The absolute difference between predicted and observed ICME arrival times is 8.1 ± 6.3 hr (rms value of 10.9 hr). Speeds are consistent to within 284 ± 288 km s{sup –1}. Empirical corrections to the predictions enhance their performance for the arrival times to 6.1 ± 5.0 hr (rms value of 7.9 hr), and for the speeds to 53 ± 50 km s{sup –1}. These results are important for Solar Orbiter and a space weather mission positioned away from the Sun-Earth line.

  14. The product of resting heart rate times blood pressure is associated with high brachial-ankle pulse wave velocity.

    PubMed

    Wang, Anxin; Tao, Jie; Guo, Xiuhua; Liu, Xuemei; Luo, Yanxia; Liu, Xiurong; Huang, Zhe; Chen, Shuohua; Zhao, Xingquan; Jonas, Jost B; Wu, Shouling

    2014-01-01

    To investigate potential associations between resting heart rate, blood pressure and the product of both, and the brachial-ankle pulse wave velocity (baPWV) as a maker of arterial stiffness. The community-based "Asymptomatic Polyvascular Abnormalities in Community (APAC) Study" examined asymptomatic polyvascular abnormalities in a general Chinese population and included participants with an age of 40+ years without history of stroke and coronary heart disease. Arterial stiffness was defined as baPWV≥1400 cm/s. We measured and calculated the product of resting heart rate and systolic blood pressure (RHR-SBP) and the product of resting heart rate and mean arterial pressure (RHR-MAP). The study included 5153 participants with a mean age of 55.1 ± 11.8 years. Mean baPWV was 1586 ± 400 cm/s. Significant (P<0.0001) linear relationships were found between higher baPWV and higher resting heart rate or higher arterial blood pressure, with the highest baPWV observed in individuals from the highest quartiles of resting heart rate and blood pressure. After adjusting for confounding parameters such as age, sex, educational level, body mass index, fasting blood concentrations of glucose, blood lipids and high-sensitive C-reactive protein, smoking status and alcohol consumption, prevalence of arterial stiffness increased significantly (P<0.0001) with increasing RHR-SBP quartile (Odds Ratio (OR): 2.72;95%Confidence interval (CI):1.46,5.08) and increasing RHR-MAP (OR:2.10;95%CI:1.18,3.72). Similar results were obtained in multivariate linear regression analyses with baPWV as continuous variable. Higher baPWV as a marker of arterial stiffness was associated with a higher product of RHR-SBP and RHR-MAP in multivariate analysis. In addition to other vascular risk factors, higher resting heart rate in combination with higher blood pressure are risk factors for arterial stiffness.

  15. Change in Ankle-Brachial Index Over Time in a Screened Japanese Cohort - The Okinawa Peripheral Arterial Disease Study.

    PubMed

    Toma, Yuichiro; Ishida, Akio; Kinjo, Kozen; Ohya, Yusuke

    2016-08-25

    The temporal change in ankle-brachial index (ABI) in the general population, especially in those aged <40 years, remains unclear. ABIs of 23,673 individuals were measured in 1-day health checkups between 2003 and 2010. Among them, 1,117 participants aged 28-76 years (mean 53±9 years) whose ABI was measured at least twice within an interval of ≥4 years (mean: 4.9 years) were selected for this study. Baseline ABI was the lowest at age <40 years and increased with age. ABI significantly increased in participants aged <40 and 40-49 years, but not in participants aged 50-59 and ≥60 years. ABI increased in participants with borderline-low baseline ABI (0.9

  16. Material ejection

    NASA Technical Reports Server (NTRS)

    Webb, David F.; Forbes, Terry G.; Aurass, Henry; Chen, James; Martens, Piet; Rompolt, Bogdan; Rusin, Vojtech; Martin, Sara F.

    1994-01-01

    This paper reviews the major discussions and conclusions of the Flares 22 Workshop concerning the physical processes involved in mass ejecta events, with an emphasis on large-scale phenomena, especially Coronal Mass Ejections (CMEs). New insights have been gained from recent data obtained from the Solar Maximum Mission (SMM) and Yohkoh spacecraft and from several new ground-based radio and optical instruments, as well as from theoretical advances concerning the origins, driving mechanisms and long-term evolution of CMEs.

  17. Material ejection

    NASA Astrophysics Data System (ADS)

    Webb, David F.; Forbes, Terry G.; Aurass, Henry; Chen, James; Martens, Piet; Rompolt, Bogdan; Rusin, Vojtech; Martin, Sara F.

    1994-08-01

    This paper reviews the major discussions and conclusions of the Flares 22 Workshop concerning the physical processes involved in mass ejecta events, with an emphasis on large-scale phenomena, especially Coronal Mass Ejections (CMEs). New insights have been gained from recent data obtained from the Solar Maximum Mission (SMM) and Yohkoh spacecraft and from several new ground-based radio and optical instruments, as well as from theoretical advances concerning the origins, driving mechanisms and long-term evolution of CMEs.

  18. Material ejection

    NASA Technical Reports Server (NTRS)

    Webb, David F.; Forbes, Terry G.; Aurass, Henry; Chen, James; Martens, Piet; Rompolt, Bogdan; Rusin, Vojtech; Martin, Sara F.

    1994-01-01

    This paper reviews the major discussions and conclusions of the Flares 22 Workshop concerning the physical processes involved in mass ejecta events, with an emphasis on large-scale phenomena, especially Coronal Mass Ejections (CMEs). New insights have been gained from recent data obtained from the Solar Maximum Mission (SMM) and Yohkoh spacecraft and from several new ground-based radio and optical instruments, as well as from theoretical advances concerning the origins, driving mechanisms and long-term evolution of CMEs.

  19. Pulse volume recordings to identify falsely elevated ankle brachial index.

    PubMed

    Shirasu, Takuro; Hoshina, Katsuyuki; Akagi, Daisuke; Miyahara, Takuya; Yamamoto, Kota; Watanabe, Toshiaki

    2016-07-01

    Ankle brachial index can be falsely elevated in cases of medial arterial calcification, and its clinical use should be limited, especially in patients with diabetes. The aim of this study was to evaluate the potential role of pulse volume recording in detecting falsely elevated ankle brachial index. Two parameters of the pulse waveform were automatically calculated: upstroke time and percentage mean artery pressure. Pulse volume recordings were retrospectively evaluated in 171 consecutive patients (342 limbs); 73 (43%) had a diagnosis of diabetes. On multivariate analysis, diabetes (hazard ratio = 1.7), ankle brachial index ≤ 0.90 (hazard ratio = 4.4), upstroke time ≥ 180 ms (hazard ratio = 2.1), and percentage mean artery pressure ≥ 45% (hazard ratio = 2.8) were significantly related to toe brachial index < 0.60. Further analysis for falsely elevated ankle brachial index was performed in 196 limbs (146 patients) with ankle brachial index > 0.90. The difference between ankle brachial index and toe brachial index differentiated the limbs of diabetic patients, with percentage mean artery pressure ≥ 45%, from controls (0.45 ± 0.17 vs. 0.35 ± 0.16, p = 0.03); upstroke time was not found to be a discriminating factor. Although measurement of ankle brachial index remains the gold standard for diagnosing peripheral arterial disease, percentage mean artery pressure, automatically obtained in ankle brachial index measurement, may be useful to detect falsely elevated ankle brachial index, especially in patients with diabetes. © The Author(s) 2016.

  20. Improving an Empirical Prediction of the Transit Time of Coronal Mass Ejections from the Sun to the Earth

    NASA Astrophysics Data System (ADS)

    Biesecker, D. A.; Murtagh, W. J.; Zezula, D. J.; Arge, C. N.

    2005-05-01

    At the 2004 AAS/SPD meeting, we presented initial results of an attempt to predict (or forecast) the arrival of Earth-directed coronal mass ejections at Earth. Our initial work, following closely on that of Gopalswamy et al. (2000, 2001), incorporated knowledge of the solar wind conditions at the time of the CME and of the source location. This resulted in an improvement in forecast accuracy over Gopalswamy et al. by 25% (2.6 hours). At the time of presenting these results, we discussed potential improvements to the prediction algorithm. First, we proposed to complete a more sophisticated incorporation of solar wind data. The initial study used the solar wind speed measured at ACE at the time of the launch of the CME as a proxy for the solar wind speed encountered by the CME as it travels towards Earth. In this poster, we improve on this by incorporating the Wang-Sheeley-Arge solar wind speed model to model the actual solar wind encountered by the CME through its entire transit from the Sun to the Earth. Second, the initial study used Sudden Impulse (SI) times as the measure for CME arrival at Earth. While this is a useful measure to use to provide a meaningful forecast, it makes comparison with other transit time predictions more difficult. Therefore, in addition to predicting the time until the SI begins, we also show how well we can predict when the associated shock arrives at L1.

  1. Correlation Analyses Between the Characteristic Times of Gradual Solar Energetic Particle Events and the Properties of Associated Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Pan, Z. H.; Wang, C. B.; Wang, Yuming; Xue, X. H.

    2011-06-01

    It is generally believed that gradual solar energetic particles (SEPs) are accelerated by shocks associated with coronal mass ejections (CMEs). Using an ice-cream cone model, the radial speed and angular width of 95 CMEs associated with SEP events during 1998 - 2002 are calculated from SOHO/LASCO observations. Then, we investigate the relationships between the kinematic properties of these CMEs and the characteristic times of the intensity-time profile of their accompanied SEP events observed at 1 AU. These characteristic times of SEP are i) the onset time from the accompanying CME eruption at the Sun to the SEP arrival at 1 AU, ii) the rise time from the SEP onset to the time when the SEP intensity is one-half of peak intensity, and iii) the duration over which the SEP intensity is within a factor of two of the peak intensity. It is found that the onset time has neither significant correlation with the radial speed nor with the angular width of the accompanying CME. For events that are poorly connected to the Earth, the SEP rise time and duration have no significant correlation with the radial speed and angular width of the associated CMEs. However, for events that are magnetically well connected to the Earth, the SEP rise time and duration have significantly positive correlations with the radial speed and angular width of the associated CMEs. This indicates that a CME event with wider angular width and higher speed may more easily drive a strong and wide shock near to the Earth-connected interplanetary magnetic field lines, may trap and accelerate particles for a longer time, and may lead to longer rise time and duration of the ensuing SEP event.

  2. Modification over time of pulse wave velocity parallel to changes in aortic BP, as well as in 24-h ambulatory brachial BP.

    PubMed

    Oliveras, A; Segura, J; Suarez, C; García-Ortiz, L; Abad-Cardiel, M; Vigil, L; Gómez-Marcos, M A; Sans Atxer, L; Martell-Claros, N; Ruilope, L M; de la Sierra, A

    2016-03-01

    Arterial stiffness as assessed by carotid-femoral pulse wave velocity (cfPWV) is a marker of preclinical organ damage and a predictor of cardiovascular outcomes, independently of blood pressure (BP). However, limited evidence exists on the association between long-term variation (Δ) on aortic BP (aoBP) and ΔcfPWV. We aimed to evaluate the relationship of ΔBP with ΔcfPWV over time, as assessed by office and 24-h ambulatory peripheral BP, and aoBP. AoBP and cfPWV were evaluated in 209 hypertensive patients with either diabetes or metabolic syndrome by applanation tonometry (Sphygmocor) at baseline(b) and at 12 months of follow-up(fu). Peripheral BP was also determined by using validated oscillometric devices (office(o)-BP) and on an outpatient basis by using a validated (Spacelabs-90207) device (24-h ambulatory BP). ΔcfPWV over time was calculated as follows: ΔcfPWV=[(cfPWVfu-cfPWVb)/cfPWVb] × 100. ΔBP over time resulted from the same formula applied to BP values obtained with the three different measurement techniques. Correlations (Spearman 'Rho') between ΔBP and ΔcfPWV were calculated. Mean age was 62 years, 39% were female and 80% had type 2 diabetes. Baseline office brachial BP (mm Hg) was 143±20/82±12. Follow-up (12 months later) office brachial BP (mm Hg) was 136±20/79±12. ΔcfPWV correlated with ΔoSBP (Rho=0.212; P=0.002), Δ24-h SBP (Rho=0.254; P<0.001), Δdaytime SBP (Rho=0.232; P=0.001), Δnighttime SBP (Rho=0.320; P<0.001) and ΔaoSBP (Rho=0.320; P<0.001). A multiple linear regression analysis included the following independent variables: ΔoSBP, Δ24-h SBP, Δdaytime SBP, Δnighttime SBP and ΔaoSBP. ΔcfPWV was independently associated with Δ24-h SBP (β-coefficient=0.195; P=0.012) and ΔaoSBP (β-coefficient= 0.185; P=0.018). We conclude that changes in both 24-h SBP and aoSBP more accurately reflect changes in arterial stiffness than do office BP measurements.

  3. Real-Time Analysis of Global Waves Accompanying Coronal Mass Ejections

    DTIC Science & Technology

    2016-06-30

    observation, they were interpreted as either flows or shock waves produced by an erupting solar flare , they are strongly associated with Type II radio...active regions, solar flares , filaments and CMEs (for more details see Martens et al. 2012). This was mimicked for global coronal waves with the...run for a given solar eruption given a source point and start time, which are usually taken as the start time and location of the associated solar flare

  4. Real-time Analysis of Global Waves Accompanying Coronal Mass Ejections

    DTIC Science & Technology

    2016-09-01

    observation, they were interpreted as either flows or shock waves produced by an erupting solar flare , they are strongly associated with Type II radio...active regions, solar flares , filaments and CMEs (for more details see Martens et al. 2012). This was mimicked for global coronal waves with the...run for a given solar eruption given a source point and start time, which are usually taken as the start time and location of the associated solar flare

  5. Validation of Real-time Modeling of Coronal Mass Ejections Using the WSA-ENLIL+Cone Heliospheric Model

    NASA Astrophysics Data System (ADS)

    Romano, M.; Mays, M. L.; Taktakishvili, A.; MacNeice, P. J.; Zheng, Y.; Pulkkinen, A. A.; Kuznetsova, M. M.; Odstrcil, D.

    2013-12-01

    Modeling coronal mass ejections (CMEs) is of great interest to the space weather research and forecasting communities. We present recent validation work of real-time CME arrival time predictions at different satellites using the WSA-ENLIL+Cone three-dimensional MHD heliospheric model available at the Community Coordinated Modeling Center (CCMC) and performed by the Space Weather Research Center (SWRC). SWRC is an in-house research-based operations team at the CCMC which provides interplanetary space weather forecasting for NASA's robotic missions and performs real-time model validation. The quality of model operation is evaluated by comparing its output to a measurable parameter of interest such as the CME arrival time and geomagnetic storm strength. The Kp index is calculated from the relation given in Newell et al. (2007), using solar wind parameters predicted by the WSA-ENLIL+Cone model at Earth. The CME arrival time error is defined as the difference between the predicted arrival time and the observed in-situ CME shock arrival time at the ACE, STEREO A, or STEREO B spacecraft. This study includes all real-time WSA-ENLIL+Cone model simulations performed between June 2011-2013 (over 400 runs) at the CCMC/SWRC. We report hit, miss, false alarm, and correct rejection statistics for all three spacecraft. For hits we show the average absolute CME arrival time error, and the dependence of this error on CME input parameters such as speed, width, and direction. We also present the predicted geomagnetic storm strength (using the Kp index) error for Earth-directed CMEs.

  6. Predicting the Arrival Time of Coronal Mass Ejections with the Graduated Cylindrical Shell and Drag Force Model

    NASA Astrophysics Data System (ADS)

    Shi, Tong; Wang, Yikang; Wan, Linfeng; Cheng, Xin; Ding, Mingde; Zhang, Jie

    2015-06-01

    Accurately predicting the arrival of coronal mass ejections (CMEs) to the Earth based on remote images is of critical significance for the study of space weather. In this paper, we make a statistical study of 21 Earth-directed CMEs, specifically exploring the relationship between CME initial speeds and transit times. The initial speed of a CME is obtained by fitting the CME with the Graduated Cylindrical Shell model and is thus free of projection effects. We then use the drag force model to fit results of the transit time versus the initial speed. By adopting different drag regimes, i.e., the viscous, aerodynamics, and hybrid regimes, we get similar results, with a least mean estimation error of the hybrid model of 12.9 hr. CMEs with a propagation angle (the angle between the propagation direction and the Sun-Earth line) larger than their half-angular widths arrive at the Earth with an angular deviation caused by factors other than the radial solar wind drag. The drag force model cannot be reliably applied to such events. If we exclude these events in the sample, the prediction accuracy can be improved, i.e., the estimation error reduces to 6.8 hr. This work suggests that it is viable to predict the arrival time of CMEs to the Earth based on the initial parameters with fairly good accuracy. Thus, it provides a method of forecasting space weather 1-5 days following the occurrence of CMEs.

  7. [The relationship between physical activity in leasure time and the ankle-brachial index in a general Spanish population: The ARTPER study].

    PubMed

    Ruiz Comellas, Anna; Pera, Guillem; Baena Díez, José Miguel; Heras, Antonio; Alzamora Sas, Maria Teresa; Forés Raurell, Rosa; Torán Monserrat, Pere; Mundet Tudurí, Xavier

    2015-11-20

    High levels of daily physical activity have been shown to be linked to decreased functional impairment in peripheral artery disease (PAD) patients and positively related to the ankle brachial index (ABI) in subjects without PAD. The aim of this study was to examine the relationship between leisure time physical activity (LTPA) and the ABI in a general population. Baseline data from the ARTPER study cohort corresponding to 2,840 subjects>49 years from Barcelona were analyzed. The LTPA variable was obtained through the validated Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire. ABI<0.9 was taken to indicate PAD. Multivariate logistic regression analysis was performed to evaluate the independent association between LTPA and PAD. Subjects with more LTPA were younger, female, less smokers, and suffered fewer PAD. Total activity, measured in metabolic energy turnover (MET) and the LTPA hours, was significantly higher in subjects without PAD (P<.001). There was an inverse relationship between LTPA and the risk of suffering PAD (odds ratio 0.56, 95% confidence interval 0.38-0.81 for those who expended 2,700 METs or more in 14 days) adjusting for confounding factors. In our study, LTPA was positively related to the ABI, with those with PAD being the ones with less LTPA. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Obstetrical brachial plexus palsy.

    PubMed

    Romaña, M C; Rogier, A

    2013-01-01

    Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although most babies recover spontaneously in the first 3 months of life, a small number remains with poor recovery which requires surgical brachial plexus exploration. Surgical indications depend on the type of lesion (producing total or partial palsy) and particularly the nonrecovery of biceps function by the age of 3 months. In a global palsy, microsurgery will be mandatory and the strategy for restoration will focus first on hand reinnervation and secondarily on providing elbow flexion and shoulder stability. Further procedures may be necessary during growth in order to avoid fixed contractured deformities or to give or increase strength of important muscle functions like elbow flexion or wrist extension. The author reviews the history of obstetrical brachial plexus injury, epidemiology, and the specifics of descriptive and functional anatomy in babies and children. Clinical manifestations at birth are directly correlated with the anatomical lesion. Finally, operative procedures are considered, including strategies of reconstruction with nerve grafting in infants and secondary surgery to increase functional capacity at later ages. However, normal function is usually not recovered, particularly in total brachial plexus palsy.

  9. Ejection fractions and pressure-heart rate product to evaluate cardiac efficiency. Continuous, real-time diagnosis using blood pressure and heart rate.

    PubMed

    Kunig, H; Tassani-Prell, P; Engelmann, L

    2014-04-01

    Ejection fractions, derived from ventricular volumes, and double product, related to myocardial oxygen consumption, are important diagnostic parameters, as they describe the efficiency with which oxygen is consumed. Present technology often allows only intermittent determination of physiological status. This deficiency may be overcome if ejection fractions and myocardial oxygen consumption could be determined from continuous blood pressure and heart rate measurements. The purpose of this study is to determine the viability of pressure-derived ejection fractions and pressure-heart rate data in a diverse patient population and the use of ejection fractions to monitor patient safety. Volume ejection fractions, derived from ventricular volumes, EF(V), are defined by the ratio of the difference of end-diastolic volume, EDV, and end-systolic volume, ESV, to EDV. In analogy, pressure ejection fraction, EF(P), may be defined by the ratio of the difference of systolic arterial pressure, SBP, and diastolic arterial pressure, DBP, to SBP. The pressure-heart rate (heart rate: HR) is given by the product of systolic pressure and heart rate, SBP × HR. EF(P) and SBP × HR data were derived for all patients (n = 824) who were admitted in 2008 to the ICU of a university hospital at the specific time 30 min prior to leaving the ICU whether as survivors or non-survivors. The results are displayed in an efficiency/pressure-heart rate diagram. The efficiency/pressure-heart rate diagram reveals one subarea populated exclusively by survivors, another subarea populated statistically significant by non-survivors, and a third area shared by survivors and non-survivors. The efficiency/pressure-heart rate product relationship may be used as an outcome criterion to assess survival and to noninvasively monitor improvement or deterioration in real time to improve safety in patients with diverse dysfunctions.

  10. Wavelength and time-resolved imaging of material ejection in infrared matrix-assisted laser desorption.

    PubMed

    Fan, Xing; Murray, Kermit K

    2010-01-28

    The dynamics of glycerol ablation at atmospheric pressure was studied using fast photography. A mid-infrared optical parametric oscillator was used to irradiate a droplet of glycerol at normal incidence. The wavelength of the infrared source was tunable and was varied between 2.7 and 3.5 microm for the studies. After an adjustable delay, an excimer pumped dye laser was used to illuminate the expanding plume, and the 90 degrees scattered light was imaged with a high-speed CMOS camera. The time delay between the IR and UV lasers was varied up to 1 ms with a particular emphasis in the early stages of plume evolution below 1 micros. The threshold fluence for plume formation varied between 1000 and 6000 J/m(2), and the minimum fluence corresponded to the OH stretch absorption of glycerol near 3.0 microm, which also corresponded to the greatest scattered light signal and duration of material emission. The velocity of the expanding plume was measured and ranged from >300 m/s near the OH stretch absorption to <100 m/s near the 3.4 microm CH stretch. Plume modeling calculations suggest that material removal is driven by phase explosion in the stress confinement regime that is at a maximum near the wavelength of the OH stretch absorption.

  11. Determination of left ventricular ejection fraction by visual estimation during real-time two-dimensional echocardiography

    SciTech Connect

    Rich, S.; Sheikh, A.; Gallastegui, J.; Kondos, G.T.; Mason, T.; Lam, W.

    1982-09-01

    It has been shown that the measured reduction in the cross-sectional area of the left ventricle (LV), as viewed in the short axis, closely approximates its ejection fraction (EF). We assessed the reliability of using two-dimensional echocardiography (2DE) to visually estimate the EF during real-time viewing, without the need of digitizers, planimetry, or calculations. Twenty-five adult hospitalized patients with either suspected or known cardiac disease were evaluated prospectively. Each patient also had gated nuclear angiography during the same admission, and 14 had cardiac catheterization with left ventriculography. The EF was determined by 2DE using a visual estimate of the percent area reduction of the LV cavity in the short-axis view at the level of the papillary muscles. All 2 DE studies were read by two or more blinded reviewers, with a value for the EF to the nearest 2.5% determined by consensus. These values correlated closely to the values determined in all 25 patients with gated nuclear angiography (r . 0.927) and the 14 patients who had left ventriculography (r . 0.935). We believe that this method of visually estimating the LVEF will enable echocardiographers to easily use 2 DE for a reliable and instantaneous assessment of ventricular function, without the need of sophisticated analytical equipment.

  12. Perinatal brachial plexus palsy

    PubMed Central

    Andersen, John; Watt, Joe; Olson, Jaret; Van Aerde, John

    2006-01-01

    BACKGROUND Perinatal brachial plexus palsy (PBPP) is a flaccid paralysis of the arm at birth that affects different nerves of the brachial plexus supplied by C5 to T1 in 0.42 to 5.1 infants per 1000 live births. OBJECTIVES To identify antenatal factors associated with PBPP and possible preventive measures, and to review the natural history as compared with the outcome after primary or secondary surgical interventions. METHODS A literature search on randomized controlled trials, systematic reviews and meta-analyses on the prevention and treatment of PBPP was performed. EMBASE, Medline, CINAHL and the Cochrane Library were searched until June 2005. Key words for searches included ‘brachial plexus’, ‘brachial plexus neuropathy’, ‘brachial plexus injury’, ‘birth injury’ and ‘paralysis, obstetric’. RESULTS There were no prospective studies on the cause or prevention of PBPP. Whereas birth trauma is said to be the most common cause, there is some evidence that PBPP may occur before delivery. Shoulder dystocia and PBPP are largely unpredictable, although associations of PBPP with shoulder dystocia, infants who are large for gestational age, maternal diabetes and instrumental delivery have been reported. The various forms of PBPP, clinical findings and diagnostic measures are described. Recent evidence suggests that the natural history of PBPP is not all favourable, and residual deficits are estimated at 20% to 30%, in contrast with the previous optimistic view of full recovery in greater than 90% of affected children. There were no randomized controlled trials on nonoperative management. There was no conclusive evidence that primary surgical exploration of the brachial plexus supercedes conservative management for improved outcome. However, results from nonrandomized studies indicated that children with severe injuries do better with surgical repair. Secondary surgical reconstructions were inferior to primary intervention, but could still improve arm

  13. Ejection Fraction: What Does It Measure?

    MedlinePlus

    ... does the term "ejection fraction" mean? What does it measure? Answers from Rekha Mankad, M.D. Ejection fraction ... percentage of blood leaving your heart each time it contracts. During each heartbeat pumping cycle, the heart ...

  14. Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students.

    PubMed

    Hager, Shaun; Backus, Timothy Charles; Futterman, Bennett; Solounias, Nikos; Mihlbachler, Matthew C

    2014-05-01

    Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection.

  15. Traumatic Brachial Artery Injuries

    PubMed Central

    Ergunes, Kazim; Yilik, Levent; Ozsoyler, Ibrahim; Kestelli, Mert; Ozbek, Cengiz; Gurbuz, Ali

    2006-01-01

    We performed this retrospective study to analyze our strategies for managing and surgically treating brachial artery injuries. Fifty-seven patients with a total of 58 traumatic brachial artery injuries underwent surgery at our institution, from August 1996 through November 2004. Fifty-four patients were male and 3 were female (age range, 7 to 75 years; mean, 29.4 years). Forty-four of the patients had penetrating injuries (18 had stab wounds; 16, window glass injuries; and 10, industrial accidents), 10 had blunt trauma injuries (traffic accidents), and 3 had gunshot injuries. Fourteen patients (24.6%) had peripheral nerve injury. All patients underwent Doppler ultrasonographic examination. The repair of the 58 arterial injuries involved end-to-end anastomosis for 32 injuries (55.2%), reverse saphenous vein graft interpositional grafts for 18 (31%), and primary repair for 8 (13.8%). Venous continuity was achieved in 11 (84.6%) of 13 patients who had major venous injuries. Nine of the 57 patients (15.8%) required primary fasciotomy. Follow-up showed that 5 of the 14 patients with peripheral nerve injury had apparent disabilities due to nerve injury. One patient underwent amputation. There were no deaths. We believe that good results can be achieved in patients with brachial artery injuries by use of careful physical examination, Doppler ultrasonography, and restoration of viability with vascular repair and dbridement of nonviable tissues. Traumatic neurologic injury frequently leads to disability of the extremities. PMID:16572866

  16. Onset Time of 2% Lidocaine and 0.5% Bupivacaine Mixture versus 0.5% Bupivacaine Alone using Ultrasound and Double Nerve Stimulation for Infraclavicular Brachial Plexus Anesthesia in ESRD Patients Undergoing Arteriovenous Fistula Creation.

    PubMed

    Pongraweewan, Orawan; Inchua, Nipa; Kitsiripant, Chanatthee; Kongmuang, Benchawan; Tiwirach, Wannapa

    2016-05-01

    To reduce the onset of 0.5% bupivacaine by adding 2% lidocaine with 0.5% bupivacaine for ultrasound-guided and double stimulation technique at musculocutaneous and radial nerve for infraclavicular brachial plexus block. Prospective randomized double-blinded, controlled trial study. 90 patients undergoing creation of arteriovenous fistula under ultrasound-guided infraclavicular brachial plexus block were randomized into 2 groups. Gr B (46 patients) received 0.5% bupivacaine 30 mL and Gr BL (44 patients) received mixture of 0.5% bupivacaine 20 mL and 2% lidocaine 10 mL. The onset of sensory block were assessed by response to pinprick (grading: 0 = no sensation, 1 = hypoesthesia, and 2 = normal sensation). Rescue analgesia during the operation, duration of sensory and motor blockade were recorded. Surgeon and patient satisfactions are also evaluated using 6-point scale (0 = dissatisfied to 5 = very satisfied). There were no significant difference in the onset time of either group. Duration of sensory and motor block was not different. Surgeons' and patients' satisfaction were also not significantly different between the groups. Mixing 2% lidocaine with 0.5% bupivacaine to the final concentration of 0.67%for lidocaine and 0.33% for bupivacaine does not reduce the onset of ultrasound-guided infraclavicular brachial plexus block.

  17. An overlooked association of brachial plexus palsy: diaphragmatic paralysis.

    PubMed

    Karabiber, Hamza; Ozkan, K Ugur; Garipardic, Mesut; Parmaksiz, Gonul

    2004-01-01

    Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.

  18. [Obstetric brachial plexus injury].

    PubMed

    Pondaag, Willem; van Dijk, J Gert; Nelissen, Rob G H H; Malessy, Martijn J A

    2014-01-01

    Obstetric palsy is a birth injury that occurs when the brachial plexus is damaged by traction. In the majority of patients spontaneous recovery will occur; however, in case of incomplete spontaneous recovery early neurosurgical intervention may be indicated. We present 3 case reports in this article, as well as describing the strategy favoured in our clinic. We recommend referring patients who have incomplete spontaneous recovery at the age of 1 month. At that age a good prediction of prognosis can be made by combining neurological examination with needle electromyography (EMG) of the biceps muscle.

  19. Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Crooker, Nancy; Joselyn, Jo Ann; Feynman, Joan

    The early 1970's can be said to mark the beginning of The Enlightenment in the history of the Space Age, literally as well as by analogy to European history. Instruments blinded by Earth's atmosphere were lifted above and, for the first time, saw clearly and continuously the ethereal white light and sparkling x-rays from the solar corona. From these two bands of the light spectrum came images of coronal mass ejections and coronal holes, respectively. But whereas coronal holes were immediately identified as the source of high-speed solar wind streams, at first coronal mass ejections were greeted only by a sense of wonder. It took years of research to identify their signatures in the solar wind before the fastest ones could be identified with the well-known shock disturbances that cause the most violent space storms.

  20. Causes of neonatal brachial plexus palsy.

    PubMed

    Alfonso, Daniel T

    2011-01-01

    The causes of brachial plexus palsy in neonates should be classified according to their most salient associated feature. The causes of brachial plexus palsy are obstetrical brachial plexus palsy, familial congenital brachial plexus palsy, maternal uterine malformation, congenital varicella syndrome, osteomyelitis involving the proximal head of the humerus or cervical vertebral bodies, exostosis of the first rib, tumors and hemangioma in the region of the brachial plexus, and intrauterine maladaptation. Kaiser Wilhelm syndrome, neonatal brachial plexus palsy due to placental insufficiency, is probably not a cause of brachial plexus palsy. Obstetrical brachial plexus palsy, the most common alleged cause of neonatal brachial plexus palsy, occurs when the forces generated during labor stretch the brachial plexus beyond its resistance. The probability of obstetrical brachial plexus palsy is directly proportional to the magnitude, acceleration, and cosine of the angle formed by the direction of the vector of the stretching force and the axis of the most vulnerable brachial plexus bundle, and inversely proportional to the resistance of the must vulnerable brachial plexus bundle and of the shoulder girdle muscles, joints, and bones. Since in most nonsurgical cases neither the contribution of each of these factors to the production of the obstetrical brachial plexus palsy nor the proportion of traction and propulsion contributing to the stretch force is known, we concur with prior reports that the term of obstetrical brachial plexus palsy should be substituted by the more inclusive term of birth-related brachial plexus palsy.

  1. Treatment Options for Brachial Plexus Injuries

    PubMed Central

    Sakellariou, Vasileios I.; Badilas, Nikolaos K.; Stavropoulos, Nikolaos A.; Mazis, George; Kotoulas, Helias K.; Kyriakopoulos, Stamatios; Tagkalegkas, Ioannis; Sofianos, Ioannis P.

    2014-01-01

    The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed. PMID:24967125

  2. [Ankle brachial index measurement].

    PubMed

    Rucigaj, Tanja Planinsek

    2014-10-01

    Ultrasound examinations are noninvasive diagnostic methods which, along with appropriate history and clinical examination, provide basic information on the etiology and spread of the disease, as well as on treatment options required in patients with chronic venous insufficiency and arterial flow impairment. Doppler flow meter offers useful data on venous blood return, primarily in great veins, while both deep and superficial veins as well as arteries can be visualized and data on venous and arterial hemodynamics obtained by duplex ultrasonography. In addition, Doppler flow meter provides data on the peripheral arterial system action through ankle brachial index measurement, which will guide the choice of compression therapy when deciding on the treatment of peripheral arterial disease and mixed arteriovenous leg ulcers. However, diagnosis of arterial insufficiency requires additional examinations.

  3. Brachial plexus injury in newborns

    MedlinePlus

    ... the brachial plexus can be affected during a difficult delivery. Injury may be caused by: The infant's head and neck pulling toward the side as the shoulders pass through the birth canal Stretching of the infant's shoulders during a ...

  4. Acceleration time-to-ejection time ratio in fetal pulmonary artery predicts the development of neonatal respiratory distress syndrome: a prospective cohort study.

    PubMed

    Kim, Sun Min; Park, Joong Shin; Norwitz, Errol R; Hwang, Eun Ju; Kang, Hye Sim; Park, Chan-Wook; Jun, Jong Kwan

    2013-11-01

    This study investigates whether fetal pulmonary artery Doppler waveforms can predict the subsequent development of respiratory distress syndrome (RDS). A prospective cohort study was performed in women with impending preterm birth. Pulsatility index, resistance index, systolic-to-diastolic ratio, peak systolic velocity, and acceleration time-to-ejection time (At/Et) ratio were measured in the main pulmonary artery of fetus just before delivery. Neonates who developed RDS (n = 11) had significantly lower gestational age at birth than those without RDS (n = 31; median: 28.7 [range: 24.7 to 34.9] versus 32.9 [range: 25.7 to 36.0] weeks; p = 0.003); there was no difference in antenatal corticosteroid administration. Pulmonary artery At/Et ratio was significantly higher in fetuses that developed RDS compared with those that did not (median: 0.37 [range: 0.26 to 0.41] versus median: 0.30 [range: 0.21 to 0.44]; p = 0.008). RDS prediction score (=a hundredfold At/Et ratio) is significantly associated with the subsequent development of RDS after controlling for gestational age by logistic regression analysis (odds ratio = 1.31, 95% confidence interval 1.05 to 1.63, p = 0.017). An elevated At/Et ratio in the fetal pulmonary artery is independently associated with the development of RDS in preterm infants. These data suggest that fetal pulmonary artery Doppler velocimetry may provide a reliable noninvasive technique to evaluate fetal lung maturity, similar to the way in which middle cerebral artery Doppler has replaced amniocentesis for the assessment of fetal anemia. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Speeds and accelerations of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    St.cyr, O. Chris; Hundhausen, A. J.; Burkepile, J. T.

    1992-01-01

    More than 1300 coronal mass ejections have been detected in observations made by the coronagraph aboard SMM during 1980 and 1984-1989. The speed (projected onto the plane of the sky) for at least one morphoplogical feature in about half of these mass ejections could be measured. The average speed of all mass ejection features was about 350 km/s, but speeds range from a few 10s of km/s to more than 2000 km/s. There also appear to be significant variations between the speed distributions for different years. When a mass ejection feature appeared in three or more sequential images, its acceleration could also be calculated. But, because of the limited time a mass ejection remained in the SMM field of view, the ability to detect any given acceleration diminished with increasing mass ejection speed. In fact, the SMM observations do not reveal a discernable acceleration for most mass ejections. A modest yet credible acceleration was detected in 136 cases, while a deceleration was detected in only 7 cases. The LASCO coronagraph will have a more extensive field of view than the SMM instrument; hence, with these new SOHO (Solar and Heliospheric Observatory) observations, some of the challenging questions concerning mass ejection dynamics can be addressed. How far away from the Sun does the material in a mass ejection continue being accelerated? At what radial distance is the motion of the mass ejection dominated by deceleration as it interacts with the ambient interplanetary material?

  6. Characteristic Times of Gradual Solar Energetic Particle Events and Their Dependence on Associated Coronal Mass Ejection Properties

    DTIC Science & Technology

    2005-08-01

    2. REPORT TYPE 3. DATES COVERED (From - To) 01-08-2005 REPRINT 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Characteristic Times of Gradual Solar ...coronagraph on SOHO observed during 1998-2002 to statistically determine three characteristic times of gradual solar energetic particle (SEP) events as...functions of solar source longitude: (1) To, the time from associated CME launch to SEP onset at I AU, (2) TR, the rise time from SEO onset to the time when

  7. [Complications in brachial plexus surgery].

    PubMed

    Martínez, Fernando; Pinazzo, Samantha; Moragues, Rodrigo; Suarez, Elizabeth

    2015-01-01

    Although traumatic brachial plexus injuries are relatively rare in trauma patients, their effects on the functionality of the upper limb can be very disabling. The authors' objective was to assess the complications in a series of patients operated for brachial plexus injuries. This was a retrospective evaluation of patients operated on by the authors between August 2009 and March 2013. We performed 36 surgeries on 33 patients. The incidence of complications was 27.7%. Of these, only 1 (2.7%) was considered serious and associated with the procedure (iatrogenic injury of brachial artery). There was another serious complication (hypoxia in patients with airway injury) but it was not directly related to the surgical procedure. All other complications were considered minor (wound dehiscence, hematoma, infection). There was no mortality in our series. The complications in our series are similar to those reported in the literature. Serious complications (vascular, neural) are rare and represent less than 5% in all the different series. Given the rate of surgical complications and the poor functional perspective for a brachial plexus injury without surgery, we believe that surgery should be the treatment of choice. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  8. Tolerance of the Brachial Plexus to High-Dose Reirradiation.

    PubMed

    Chen, Allen M; Yoshizaki, Taeko; Velez, Maria A; Mikaeilian, Argin G; Hsu, Sophia; Cao, Minsong

    2017-05-01

    To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus-related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). The development of brachial plexus-related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Using the GPS to Improve Trajectory Position and Velocity Determination During Real-Time Ejection Seat Test and Evaluation

    DTIC Science & Technology

    2003-02-01

    fall testing or riding a roller coaster with the dual DIVEPACS could provide 73 more information on the DIVEPACS reacquisition time after loss of...20 GPS Receiver Tracking Loops .............................................................................................. 20 Differential GPS...19 Figure 9. Tracking Loops

  10. A Linear Relationship between Crystal Size and Fragment Binding Time Observed Crystallographically: Implications for Fragment Library Screening Using Acoustic Droplet Ejection

    PubMed Central

    Birone, Claire; Brown, Maria; Hernandez, Jesus; Neff, Sherry; Williams, Daniel; Allaire, Marc; Orville, Allen M.; Sweet, Robert M.; Soares, Alexei S.

    2014-01-01

    High throughput screening technologies such as acoustic droplet ejection (ADE) greatly increase the rate at which X-ray diffraction data can be acquired from crystals. One promising high throughput screening application of ADE is to rapidly combine protein crystals with fragment libraries. In this approach, each fragment soaks into a protein crystal either directly on data collection media or on a moving conveyor belt which then delivers the crystals to the X-ray beam. By simultaneously handling multiple crystals combined with fragment specimens, these techniques relax the automounter duty-cycle bottleneck that currently prevents optimal exploitation of third generation synchrotrons. Two factors limit the speed and scope of projects that are suitable for fragment screening using techniques such as ADE. Firstly, in applications where the high throughput screening apparatus is located inside the X-ray station (such as the conveyor belt system described above), the speed of data acquisition is limited by the time required for each fragment to soak into its protein crystal. Secondly, in applications where crystals are combined with fragments directly on data acquisition media (including both of the ADE methods described above), the maximum time that fragments have to soak into crystals is limited by evaporative dehydration of the protein crystals during the fragment soak. Here we demonstrate that both of these problems can be minimized by using small crystals, because the soak time required for a fragment hit to attain high occupancy depends approximately linearly on crystal size. PMID:24988328

  11. A linear relationship between crystal size and fragment binding time observed crystallographically: implications for fragment library screening using acoustic droplet ejection.

    PubMed

    Cole, Krystal; Roessler, Christian G; Mulé, Elizabeth A; Benson-Xu, Emma J; Mullen, Jeffrey D; Le, Benjamin A; Tieman, Alanna M; Birone, Claire; Brown, Maria; Hernandez, Jesus; Neff, Sherry; Williams, Daniel; Allaire, Marc; Orville, Allen M; Sweet, Robert M; Soares, Alexei S

    2014-01-01

    High throughput screening technologies such as acoustic droplet ejection (ADE) greatly increase the rate at which X-ray diffraction data can be acquired from crystals. One promising high throughput screening application of ADE is to rapidly combine protein crystals with fragment libraries. In this approach, each fragment soaks into a protein crystal either directly on data collection media or on a moving conveyor belt which then delivers the crystals to the X-ray beam. By simultaneously handling multiple crystals combined with fragment specimens, these techniques relax the automounter duty-cycle bottleneck that currently prevents optimal exploitation of third generation synchrotrons. Two factors limit the speed and scope of projects that are suitable for fragment screening using techniques such as ADE. Firstly, in applications where the high throughput screening apparatus is located inside the X-ray station (such as the conveyor belt system described above), the speed of data acquisition is limited by the time required for each fragment to soak into its protein crystal. Secondly, in applications where crystals are combined with fragments directly on data acquisition media (including both of the ADE methods described above), the maximum time that fragments have to soak into crystals is limited by evaporative dehydration of the protein crystals during the fragment soak. Here we demonstrate that both of these problems can be minimized by using small crystals, because the soak time required for a fragment hit to attain high occupancy depends approximately linearly on crystal size.

  12. The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: a randomized controlled study.

    PubMed

    Ip, Vivian H Y; Tsui, Ban C H

    2013-07-01

    Single-shot delivery of a supraclavicular brachial plexus block is effective for providing outpatient surgical anesthesia; however, patients generally must use oral analgesics to control pain shortly after discharge from the hospital. Catheterized delivery of supraclavicular blocks can be challenging to perform. We aimed to show that administering a second postoperative bolus of local anesthetic through a catheter placed by a catheter-over-needle assembly not only avoids time-consuming steps but also provides an extended analgesic effect compared with the traditional single-shot approach. Patients were randomized into two groups: one group received a single-shot supraclavicular block with 25-30 mL of local anesthetic (1.5% lidocaine and 0.125% bupivacaine mixture), while the other group received a supraclavicular block via a catheter-over-needle assembly with the same volume and concentration of local anesthetic as for the single-shot block, which was followed by a second bolus of analgesic solution (0.2 % ropivacaine 20 mL) administered postoperatively through the catheter before its removal. The duration between the initial bolus and onset of pain was measured as well as the duration of pain relief from the last bolus. Thirty patients were enrolled and randomized into the single-shot supraclavicular block group (n = 15) and the catheter-over-needle group (n = 15). One patient withdrew from the study, and five patients were lost to follow-up. We observed no significant difference between the two groups in time to perform the blocks. The mean (standard deviation [SD]) times were 3.1 (1.9) min and 4.4 (2.7) min for the top-up group and single-shot group, respectively (single-shot took 1.3 min longer than the catheter-over-needle group; 95% confidence interval [CI]: -0.65 to 3.25; P = 0.17). The mean (SD) duration of analgesia, measured from the beginning of the local anesthetic bolus to the onset of pain requiring rescue analgesia was 617.5 (288) min in the catheter

  13. Liquid metal drop ejection

    NASA Technical Reports Server (NTRS)

    Khuri-Yakub, B. T.

    1993-01-01

    The aim of this project was to demonstrate the possibility of ejecting liquid metals using drop on demand printing technology. The plan was to make transducers for operation in the 100 MHz frequency range and to use these transducers to demonstrate the ability to eject drops of liquid metals such as gallium. Two transducers were made by indium bonding piezoelectric lithium niobate to quartz buffer rods. The lithium niobate plates were thinned by mechanical polishing to a thickness of 37 microns for operation at 100 MHz. Hemispherical lenses were polished in the opposite ends of the buffer rods. The lenses, which focus the sound waves in the liquid metal, had an F-number equals 1. A mechanical housing was made to hold the transducers and to allow precise control over the liquid level above the lens. We started by demonstrating the ability to eject drops of water on demand. The drops of water had a diameter of 15 microns which corresponds to the wavelength of the sound wave in the water. A videotape of this ejection was made. We then used a mixture of Gallium and Indium (used to lower the melting temperature of the Gallium) to demonstrate the ejection of liquid metal drops. This proved to be difficult because of the oxide skin which forms on the surface of the liquid. In some instances, we were able to eject metal drops, however, this was not consistent and reproducible. An experiment was set up at NASA-Lewis to stabilize the process of drop on demand liquid metal ejection. The object was to place the transducer and liquid metal in a vacuum station so that no oxide would form on the surface. We were successful in demonstrating that liquid metals could be ejected on demand and that this technology could be used for making sheet metal in space.

  14. MRI of the Brachial Plexus: Modified Imaging Technique Leading to a Better Characterization of Its Anatomy and Pathology

    PubMed Central

    Torres, Carlos; Mailley, Kathleen; del Carpio O’Donovan, Raquel

    2013-01-01

    Summary Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of the brachial plexus due to its superior soft tissue resolution and multiplanar capabilities. The evaluation of the brachial plexus however represents a diagnostic challenge for the clinician and the radiologist. The imaging assessment of the brachial plexus, in particular, has been traditionally challenging due to the complexity of its anatomy, its distribution in space and due to technical factors. Herein, we describe a modified technique used in our institution for the evaluation of the brachial plexus which led to a substantial decrease in scanning time and to better visualization of all the segments of the brachial plexus from the roots to the branches, in only one or two images, facilitating therefore the understanding of the anatomy and the interpretation of the study. To our knowledge, we are the first group to describe this technique of imaging the brachial plexus. We illustrate the benefit of this modified technique with an example of a patient with a lesion in the proximal branches of the left brachial plexus that was clinically suspected but missed on conventional brachial plexus imaging for six consecutive years. In addition, we review the common and infrequent benign and malignant pathology that can affect the brachial plexus. PMID:24355190

  15. Crutch-induced bilateral brachial artery aneurysms.

    PubMed

    Konishi, Takanori; Ohki, Shin-ichi; Saito, Tsutomu; Misawa, Yoshio

    2009-12-01

    A 57-year-old man, who was a chronic axillary crutch user as a result of childhood poliomyelitis, was referred to our hospital because of a sudden onset of right forearm ischemia. The right forearm had no pulse, and three-dimensional computed tomography (3DCT) showed an aneurysm of the right brachial artery associated with arterial occlusion. The thrombosed aneurysm of the brachial artery was resected and the brachial artery was successfully revascularized by interposing a saphenous vein graft. Postoperative 3DCT revealed an asymptomatic left brachial artery aneurysm. His postoperative course was uneventful under warfarin anticoagulation therapy.

  16. ARRIVAL TIME CALCULATION FOR INTERPLANETARY CORONAL MASS EJECTIONS WITH CIRCULAR FRONTS AND APPLICATION TO STEREO OBSERVATIONS OF THE 2009 FEBRUARY 13 ERUPTION

    SciTech Connect

    Moestl, C.; Rollett, T.; Temmer, M.; Veronig, A. M.; Biernat, H. K.; Lugaz, N.; Farrugia, C. J.; Galvin, A. B.; Davies, J. A.; Harrison, R. A.; Crothers, S.; Luhmann, J. G.; Zhang, T. L.; Baumjohann, W.

    2011-11-01

    One of the goals of the NASA Solar TErestrial RElations Observatory (STEREO) mission is to study the feasibility of forecasting the direction, arrival time, and internal structure of solar coronal mass ejections (CMEs) from a vantage point outside the Sun-Earth line. Through a case study, we discuss the arrival time calculation of interplanetary CMEs (ICMEs) in the ecliptic plane using data from STEREO/SECCHI at large elongations from the Sun in combination with different geometric assumptions about the ICME front shape [fixed-{Phi} (FP): a point and harmonic mean (HM): a circle]. These forecasting techniques use single-spacecraft imaging data and are based on the assumption of constant velocity and direction. We show that for the slow (350 km s{sup -1}) ICME on 2009 February 13-18, observed at quadrature by the two STEREO spacecraft, the results for the arrival time given by the HM approximation are more accurate by 12 hr than those for FP in comparison to in situ observations of solar wind plasma and magnetic field parameters by STEREO/IMPACT/PLASTIC, and by 6 hr for the arrival time at Venus Express (MAG). We propose that the improvement is directly related to the ICME front shape being more accurately described by HM for an ICME with a low inclination of its symmetry axis to the ecliptic. In this case, the ICME has to be tracked to >30{sup 0} elongation to obtain arrival time errors < {+-} 5 hr. A newly derived formula for calculating arrival times with the HM method is also useful for a triangulation technique assuming the same geometry.

  17. Direct night-time ejection of particle-phase reduced biogenic sulfur compounds from the ocean to the atmosphere.

    PubMed

    Gaston, Cassandra J; Furutani, Hiroshi; Guazzotti, Sergio A; Coffee, Keith R; Jung, Jinyoung; Uematsu, Mitsuo; Prather, Kimberly A

    2015-04-21

    The influence of oceanic biological activity on sea spray aerosol composition, clouds, and climate remains poorly understood. The emission of organic material and gaseous dimethyl sulfide (DMS) from the ocean represents well-documented biogenic processes that influence particle chemistry in marine environments. However, the direct emission of particle-phase biogenic sulfur from the ocean remains largely unexplored. Here we present measurements of ocean-derived particles containing reduced sulfur, detected as elemental sulfur ions (e.g., (32)S(+), (64)S2(+)), in seven different marine environments using real-time, single particle mass spectrometry; these particles have not been detected outside of the marine environment. These reduced sulfur compounds were associated with primary marine particle types and wind speeds typically between 5 and 10 m/s suggesting that these particles themselves are a primary emission. In studies with measurements of seawater properties, chlorophyll-a and atmospheric DMS concentrations were typically elevated in these same locations suggesting a biogenic source for these sulfur-containing particles. Interestingly, these sulfur-containing particles only appeared at night, likely due to rapid photochemical destruction during the daytime, and comprised up to ∼67% of the aerosol number fraction, particularly in the supermicrometer size range. These sulfur-containing particles were detected along the California coast, across the Pacific Ocean, and in the southern Indian Ocean suggesting that these particles represent a globally significant biogenic contribution to the marine aerosol burden.

  18. High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy.

    PubMed

    Chang, Kate Wan-Chu; Yang, Lynda J-S; Driver, Lynn; Nelson, Virginia S

    2014-09-01

    An association of language impairment with neonatal brachial plexus palsy has not been reported in the literature. The current treatment paradigm for neonatal brachial plexus palsy focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with neonatal brachial plexus palsy and potential neonatal brachial plexus palsy-related factors involved. Twenty toddlers with neonatal brachial plexus palsy were consecutively recruited (12 males and eight females; mean age, 30 months). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. Neonatal brachial plexus palsy-related factors such as palsy side, treatment type, Narakas grade, muscle Medical Research Council score, and Raimondi hand score were reported. Student t test, chi-square test, or Fisher exact test were applied. Statistical significance level was established at P < 0.05. Of study participants, 30% had language delay, whereas the prevalence of language delay in the population with normal development in this age range was approximately 5-15%. We observed high language delay prevalence among toddlers with neonatal brachial plexus palsy. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Stereoscopic study of the kinematic evolution of a coronal mass ejection and its driven shock from the sun to the earth and the prediction of their arrival times

    SciTech Connect

    Hess, Phillip; Zhang, Jie

    2014-09-01

    We present a detailed study of the complete evolution of a coronal mass ejection (CME). We have tracked the evolution of both the ejecta and its shock, and further fit the evolution of the fronts to a simple but physics-based analytical model. This study focuses on the CME initiated on the Sun on 2012 July 12 and arriving at the Earth on 2012 July 14. Shock and ejecta fronts were observed by white light images, as well as in situ by the Advanced Composition Explorer satellite. We find that the propagation of the two fronts is not completely dependent upon one another, but can each be modeled in the heliosphere with a drag model that assumes the dominant force of affecting CME evolution to be the aerodynamic drag force of the ambient solar wind. Results indicate that the CME ejecta front undergoes a more rapid deceleration than the shock front within 50 R {sub ☉} and therefore the propagation of the two fronts is not completely coupled in the heliosphere. Using the graduated cylindrical shell model, as well as data from time-elongation stack plots and in situ signatures, we show that the drag model can accurately describe the behavior of each front, but is more effective with the ejecta. We also show that without the in situ data, based on measurements out to 80 R {sub ☉} combined with the general values for drag model parameters, the arrival of both the shock and ejecta can be predicted within four hours of arrival.

  20. Mass Spectra and Yields of Intact Charged Biomolecules Ejected by Massive Cluster Impact for Bioimaging in a Time-of-Flight Secondary Ion Microscope.

    PubMed

    Zhang, Jitao; Franzreb, Klaus; Aksyonov, Sergei A; Williams, Peter

    2015-11-03

    Impacts of massive, highly charged glycerol clusters (≳10(6) Da, ≳ ± 100 charges) have been used to eject intact charged molecules of peptides, lipids, and small proteins from pure solid samples, enabling imaging using these ion species in a time-of-flight secondary ion microscope with few-micrometer spatial resolution. Here, we report mass spectra and useful ion yields (ratio of intact charged molecules detected to molecules sputtered) for several molecular species-two peptides, bradykinin and angiotensin II; two lipids, phosphatidylcholine and sphingomyelin; Irganox 1010 (a detergent); insulin; and rhodamine B-and show that useful ion yields are high enough to enable bioimaging of peptides and lipids in biological samples with few-micrometer resolution and acceptable signals. For example, several hundred molecular ion counts should be detectable from a 3 × 3 μm(2) area of a pure lipid bilayer given appropriate instrumentation or tens of counts from a minor constituent of such a layer.

  1. Dose Constraints to Prevent Radiation-Induced Brachial Plexopathy in Patients Treated for Lung Cancer

    PubMed Central

    Amini, Arya; Yang, Jinzhong; Williamson, Ryan; McBurney, Michelle L.; Erasmus, Jeremy; Allen, Pamela K.; Karhade, Mandar; Komaki, Ritsuko; Liao, Zhongxing; Gomez, Daniel; Cox, James; Dong, Lei; Welsh, James

    2013-01-01

    Purpose As the recommended radiation dose for non-small cell lung cancer (NSCLC) increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum tolerated dose to the brachial plexus. Methods and Materials We identified 90 patients with NSCLC treated with definitive chemoradiation from March 2007 through September 2010 who had received>55 Gy to the brachial plexus. We used a multi-atlas segmentation method combined with deformable image registration to delineate the brachial plexuson the original planning CT scans and scoredplexopathy according to the Common Terminology Criteria for Adverse Events v4.03. Results The median radiation dose to the brachial plexus was 70 Gy (range 56-87.5 Gy, 1.5-2.5 Gy/fraction). At a median follow-up time of 14.0 months, 14 patients had had brachial plexopathy (16%) (8 [9%] grade 1 and 6 [7%] grade ≥2); median time to symptom onset was 6.5 months (range 1.4-37.4 months). On multivariate analysis, receipt of median brachial plexus dose >69 Gy(odds ratio [OR] 10.091, 95% confidence interval [CI] 1.512-67.331, P=0.005), maximum dose >75 Gy to 2 cm3 of the brachial plexus(OR 4.909, 95% CI 0.966-24.952, P=0.038), and the presence of plexopathy before irradiation(OR 4.722, 95% CI 1.267-17.606, P=0.021) were independent predictors of brachial plexopathy. Conclusions For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. We developed a computer-assisted image segmentation method which allowed us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. Our results could be used as a guideline in future prospective trialswithhigh dose radiation therapy for unresectable lung

  2. Dose Constraints to Prevent Radiation-Induced Brachial Plexopathy in Patients Treated for Lung Cancer

    SciTech Connect

    Amini, Arya; Yang Jinzhong; Williamson, Ryan; McBurney, Michelle L.; Erasmus, Jeremy; Allen, Pamela K.; Karhade, Mandar; Komaki, Ritsuko; Liao, Zhongxing; Gomez, Daniel; Cox, James; Dong, Lei; Welsh, James

    2012-03-01

    Purpose: As the recommended radiation dose for non-small-cell lung cancer (NSCLC) increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum dose tolerated by the brachial plexus. Methods and Materials: We identified 90 patients with NSCLC treated with definitive chemoradiation from March 2007 through September 2010, who had received >55 Gy to the brachial plexus. We used a multiatlas segmentation method combined with deformable image registration to delineate the brachial plexus on the original planning CT scans and scored plexopathy according to Common Terminology Criteria for Adverse Events version 4.03. Results: Median radiation dose to the brachial plexus was 70 Gy (range, 56-87.5 Gy; 1.5-2.5 Gy/fraction). At a median follow-up time of 14.0 months, 14 patients (16%) had brachial plexopathy (8 patients [9%] had Grade 1, and 6 patients [7%] had Grade {>=}2); median time to symptom onset was 6.5 months (range, 1.4-37.4 months). On multivariate analysis, receipt of a median brachial plexus dose of >69 Gy (odds ratio [OR] 10.091; 95% confidence interval [CI], 1.512-67.331; p = 0.005), a maximum dose of >75 Gy to 2 cm{sup 3} of the brachial plexus (OR, 4.909; 95% CI, 0.966-24.952; p = 0.038), and the presence of plexopathy before irradiation (OR, 4.722; 95% CI, 1.267-17.606; p = 0.021) were independent predictors of brachial plexopathy. Conclusions: For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. We developed a computer-assisted image segmentation method that allows us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. Our results could be used as a guideline in future prospective

  3. Dynamics of polymer ejection from capsid

    NASA Astrophysics Data System (ADS)

    Linna, R. P.; Moisio, J. E.; Suhonen, P. M.; Kaski, K.

    2014-05-01

    Polymer ejection from a capsid through a nanoscale pore is an important biological process with relevance to modern biotechnology. Here, we study generic capsid ejection using Langevin dynamics. We show that even when the ejection takes place within the drift-dominated region there is a very high probability for the ejection process not to be completed. Introducing a small aligning force at the pore entrance enhances ejection dramatically. Such a pore asymmetry is a candidate for a mechanism by which viral ejection is completed. By detailed high-resolution simulations we show that such capsid ejection is an out-of-equilibrium process that shares many common features with the much studied driven polymer translocation through a pore in a wall or a membrane. We find that the ejection times scale with polymer length, τ ˜Nα. We show that for the pore without the asymmetry the previous predictions corroborated by Monte Carlo simulations do not hold. For the pore with the asymmetry the scaling exponent varies with the initial monomer density (monomers per capsid volume) ρ inside the capsid. For very low densities ρ ≤0.002 the polymer is only weakly confined by the capsid, and we measure α =1.33, which is close to α =1.4 obtained for polymer translocation. At intermediate densities the scaling exponents α =1.25 and 1.21 for ρ =0.01 and 0.02, respectively. These scalings are in accord with a crude derivation for the lower limit α =1.2. For the asymmetrical pore precise scaling breaks down, when the density exceeds the value for complete confinement by the capsid, ρ ⪆0.25. The high-resolution data show that the capsid ejection for both pores, analogously to polymer translocation, can be characterized as a multiplicative stochastic process that is dominated by small-scale transitions.

  4. A Flying Ejection Seat

    NASA Technical Reports Server (NTRS)

    Hollrock, R. H.; Barzda, J. J.

    1972-01-01

    To increase aircrewmen's chances for safe rescue in combat zones, the armed forces are investigating advanced escape and rescue concepts that will provide independent flight after ejection and thus reduce the risk of capture. One of the candidate concepts is discussed; namely, a stowable autogyro that serves as the crewman's seat during normal operations and automatically converts to a flight vehicle after ejection. Discussed are (1) the mechanism subsystems that the concept embodies to meet the weight and cockpit-packaging constraints and (2) tests that demonstrated the technical feasibility of the stowage, deployment, and flight operation of the rotor lift system.

  5. Composition of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Zurbuchen, T. H.; Weberg, M.; von Steiger, R.; Mewaldt, R. A.; Lepri, S. T.; Antiochos, S. K.

    2016-01-01

    We analyze the physical origin of plasmas that are ejected from the solar corona. To address this issue, we perform a comprehensive analysis of the elemental composition of interplanetary coronal mass ejections (ICMEs) using recently released elemental composition data for Fe, Mg, Si, S, C, N, Ne, and He as compared to O and H. We find that ICMEs exhibit a systematic abundance increase of elements with first ionization potential (FIP) less than 10 electronvolts, as well as a significant increase of Ne as compared to quasi-stationary solar wind. ICME plasmas have a stronger FIP effect than slow wind, which indicates either that an FIP process is active during the ICME ejection or that a different type of solar plasma is injected into ICMEs. The observed FIP fractionation is largest during times when the Fe ionic charge states are elevated above Q (sub Fe) is greater than 12.0. For ICMEs with elevated charge states, the FIP effect is enhanced by 70 percent over that of the slow wind. We argue that the compositionally hot parts of ICMEs are active region loops that do not normally have access to the heliosphere through the processes that give rise to solar wind. We also discuss the implications of this result for solar energetic particles accelerated during solar eruptions and for the origin of the slow wind itself.

  6. Simulation of Duty Cycle-Based Trapping and Ejection of Massive Ions Using Linear Digital Quadrupoles: the Enabling Technology for High Resolution Time-of-Flight Mass Spectrometry in the Ultra High Mass Range.

    PubMed

    Lee, Jeonghoon; Marino, Maxwell A; Koizumi, Hideya; Reilly, Peter T A

    2011-06-15

    Duty cycle-based trapping and extraction processes have been investigated for linear digitally-driven multipoles by simulating ion trajectories. The duty cycles of the applied waveforms were adjusted so that an effective trapping or ejection electric field was created between the rods and the grounded end cap electrodes. By manipulating the duty cycles of the waveforms, the potentials of the multipole rods can be set equal for part of the waveform cycle. When all rods are negative for this period, the device traps positive ions and when all are positive, it ejects them in focused trajectories. Four Linac II electrodes[1] have been added between the quadrupole rods along the asymptotes to create an electric field along the symmetry axis for collecting the ions near the exit end cap electrode and prompt ejection. This method permits the ions to be collected and then ejected in a concentrated and collimated plug into the acceleration region of a time-of-flight mass spectrometer (TOFMS). Our method has been shown to be independent of mass. Because the resolution of orthogonal acceleration TOFMS depends primarily on the dispersion of the ions injected into the acceleration region and not on the ion mass, this technology will enable high resolution in the ultrahigh mass range (m/z > 20,000).

  7. Simulation of Duty Cycle-Based Trapping and Ejection of Massive Ions Using Linear Digital Quadrupoles: the Enabling Technology for High Resolution Time-of-Flight Mass Spectrometry in the Ultra High Mass Range

    PubMed Central

    Lee, Jeonghoon; Marino, Maxwell A.; Koizumi, Hideya; Reilly, Peter T. A.

    2011-01-01

    Duty cycle-based trapping and extraction processes have been investigated for linear digitally-driven multipoles by simulating ion trajectories. The duty cycles of the applied waveforms were adjusted so that an effective trapping or ejection electric field was created between the rods and the grounded end cap electrodes. By manipulating the duty cycles of the waveforms, the potentials of the multipole rods can be set equal for part of the waveform cycle. When all rods are negative for this period, the device traps positive ions and when all are positive, it ejects them in focused trajectories. Four Linac II electrodes[1] have been added between the quadrupole rods along the asymptotes to create an electric field along the symmetry axis for collecting the ions near the exit end cap electrode and prompt ejection. This method permits the ions to be collected and then ejected in a concentrated and collimated plug into the acceleration region of a time-of-flight mass spectrometer (TOFMS). Our method has been shown to be independent of mass. Because the resolution of orthogonal acceleration TOFMS depends primarily on the dispersion of the ions injected into the acceleration region and not on the ion mass, this technology will enable high resolution in the ultrahigh mass range (m/z > 20,000). PMID:21731427

  8. The clinical applicability of an automated plethysmographic determination of the ankle-brachial index after vascular surgery.

    PubMed

    van der Slegt, Jasper; Verbogt, Nathalie Pa; Mulder, Paul Gh; Steunenberg, Stijn L; Steunenberg, Bastiaan E; van der Laan, Lijckle

    2016-10-01

    An automated ankle-brachial index device could lead to potential time savings and more accuracy in ankle-brachial index-determination after vascular surgery. This prospective cross-sectional study compared postprocedural ankle-brachial indices measured by a manual method with ankle-brachial indices of an automated plethysmographic method. Forty-two patients were included. No significant difference in time performing a measurement was observed (1.1 min, 95% CI: -0.2 to +2.4; P = 0.095). Mean ankle-brachial index with the automated method was 0.105 higher (95% CI: 0.017 to 0.193; P = 0.020) than with the manual method, with limits of agreement of -0.376 and +0.587. Total variance amounted to 0.0759 and the correlation between both methods was 0.60. Reliability expressed as maximum absolute difference (95% level) between duplicate ankle-brachial index-measurements under identical conditions was 0.350 (manual) and 0.152 (automated), although not significant (p = 0.053). Finally, the automated method had 34% points higher failure rate than the manual method. In conclusion based on this study, the automated ankle-brachial index-method seems not to be clinically applicable for measuring ankle-brachial index postoperatively in patients with vascular disease. © The Author(s) 2016.

  9. Heliocentric Distance of Coronal Mass Ejections at the Time of Energetic Particle Release: Revisiting the Ground Level Enhancement Events of Solar Cycle 23

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Natchimuthuk

    2011-01-01

    Using the kinematics of coronal mass ejections (CMEs), onset time of soft X-ray flares, and the finite size of the pre-eruption CME structure, we derive the heliocentric distane at which the energetic particles during the ground level enhancement (GLE) events of Solar Cycle 23. We find that the GLE particles are released when the CMEs reach an average heliocentric distance of approx.3.25 solar radii (Rs). From this we infer that the shocks accelerating the particles are located at similar heights. Type II radio burst observations indicate that the CMEs are at much lower distances (average approx.1.4 Rs) when the CME-driven shock first forms. The shock seems to travel approx.1.8 Rs over a period of approox.30 min on the average before releasing the GLE particles. In deriving these results, we made three assumptions that have observational support: (i) the CME lift off occurs from an initial distance of about 1.25 Rs; (ii) the flare onset and CME onset are one and the same because these are two different manifestations of the same eruption; and (iii) the CME has positive acceleration from the onset to the first appearance in the coronagraphic field of view (2.5 to 6 Rs). Observations of coronal cavities in eclipse pictures and in coronagraphic images justify the assumption (i). The close relationship between the flare reconnection magnetic flux and the azimuthal flux of interplanetary magnetic clouds justify assumption (ii) consistent with the standard model (CSHKP) of solar eruption. Coronagraphic observations made close to the solar surface indicate a large positive acceleration of CMEs to a heliocentric distance of approx.3 Rs before they start slowing down due to the drag force. The inferred acceleration (approx.1.5 km/s/s) is consistent with reported values in the literature.

  10. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort.

    PubMed

    Tan, Christina; Rubenson, David; Srivastava, Ajay; Mohan, Rajeev; Smith, Michael R; Billick, Kristen; Bardarian, Samuel; Thomas Heywood, J

    2017-07-03

    Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.

  11. Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy.

    PubMed

    Blaauw, Gerhard; Slooff, Albert C J

    2003-08-01

    To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

  12. The Ejection Speed of Experimental Pyroclasts

    NASA Astrophysics Data System (ADS)

    Kueppers, U.; Dingwell, D. B.

    2006-12-01

    The multiparametric monitoring of active volcanoes in unrest relies on an ever increasing repertoire of physico- chemical methods. Nevertheless, abrupt changes in the eruptive behaviour of explosive volcanoes is one of the greatest challenges to effective early warning One of the most deadly can be a vulcanian explosive generating significant volcanic hazard and risk from ballistic projectiles. These often come with little warning. Here, in order to investigate the relationship between explosion characteristics and the kinetics of pyroclast ejection, we performed a series of rapid decompression experiments at well-constrained and reproducible physical conditions. To do this, we adapted the low-pressure section of the "fragmentation bomb" and suited it with two pairs of a laser beam source and a receptor arranged horizontally in the path of the vertically ejected pyroclasts. From the known distance (0.76 and 1.76 m above the original sample surface) of the laser beams and the time delay between the pressure decay and the partial shadowing of the two laser beams, we calculated the ejection speed of the experimental pyroclasts. To the best of our knowledge, this is first experimental quantification of the ejection speed of pyroclasts from rapidly decompressed magma. The evaluated ejection speed values are in the range of up to 100s of meters per second. They reveal a clear influence of the physical properties of the samples and the applied pressure. The transfer of potential fragmentation energy into ejection velocity is being analysed. The ejection speed (together with the ejection angle) has a major influence on the potentially hazardous area around a volcano. In combination with systematic seismic monitoring and interpretation, these results may one day become the basis for a tool to determine the pressurisation state of a volcano in quasi-real-time using ballistic data.

  13. Hand Sensorimotor Function in Older Children With Neonatal Brachial Plexus Palsy.

    PubMed

    Brown, Susan H; Wernimont, Cory W; Phillips, Lauren; Kern, Kathy L; Nelson, Virginia S; Yang, Lynda J-S

    2016-03-01

    Routine sensory assessments in neonatal brachial plexus palsy are infrequently performed because it is generally assumed that sensory recovery exceeds motor recovery. However, studies examining sensory function in neonatal brachial plexus palsy have produced equivocal findings. The purpose of this study was to examine hand sensorimotor function in older children with neonatal brachial plexus palsy using standard clinical and research-based measures of tactile sensibility. Seventeen children with neonatal brachial plexus palsy (mean age: 11.6 years) and 19 age-matched controls participated in the study. Functional assessments included grip force, monofilament testing, and hand dexterity (Nine-Hole Peg, Jebsen-Taylor Hand Function). Tactile spatial perception involving the discrimination of pin patterns and movement-enhanced object recognition (stereognosis) were also assessed. In the neonatal brachial plexus palsy group, significant deficits in the affected hand motor function were observed compared with the unaffected hand. Median monofilament scores were considered normal for both hands. In contrast, tactile spatial perception was impaired in the neonatal brachial plexus palsy group. This impairment was seen as deficits in both pin pattern and object recognition accuracy as well as the amount of time required to identify patterns and objects. Tactile pattern discrimination time significantly correlated with performance on both functional assessment tests (P < 0.01). This study provides evidence that tactile perception deficits may accompany motor deficits in neonatal brachial plexus palsy even when measures of tactile registration (i.e., monofilament testing) are normal. These results may reflect impaired processing of somatosensory feedback associated with reductions in goal-directed upper limb use and illustrate the importance of including a broader range of sensory assessments in neonatal brachial plexus palsy. Copyright © 2016 Elsevier Inc. All rights

  14. Brachial Plexopathy After Cervical Spine Surgery.

    PubMed

    Than, Khoi D; Mummaneni, Praveen V; Smith, Zachary A; Hsu, Wellington K; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective, multicenter case-series study and literature review. To determine the prevalence of brachial plexopathy after cervical spine surgery and to review the literature to better understand the etiology and risk factors of brachial plexopathy after cervical spine surgery. A retrospective case-series study of 12 903 patients at 21 different sites was performed to analyze the prevalence of several different complications, including brachial plexopathy. A literature review of the US National Library of Medicine and the National Institutes of Health (PubMed) database was conducted to identify articles pertaining to brachial plexopathy following cervical spine surgery. In our total population of 12 903 patients, only 1 suffered from postoperative brachial plexopathy. The overall prevalence rate was thus 0.01%, but the prevalence rate at the site where this complication occurred was 0.07%. Previously reported risk factors for postoperative brachial plexopathy include age, anterior surgical procedures, and a diagnosis of ossification of the posterior longitudinal ligament. The condition can also be due to patient positioning during surgery, which can generally be detected via the use of intraoperative neuromonitoring. Brachial plexopathy following cervical spine surgery is rare and merits further study.

  15. [Secondary replacement operations for reconstruction of elbow joint function after lesion of the brachial plexus].

    PubMed

    Berger, A; Hierner, R; Becker, M H

    1997-07-01

    Elbow flexion plays a key role in the overall function of the upper extremity. In the case of unilateral complete brachial plexus lesion, restoration of elbow flexion will dramatically increase the patient's chances of regaining bimanual prehension. Furthermore, depending on the type of reconstruction, stability of the glenohumeral joint as well as some supination function of the forearm can be restored to a varying degree at the same time. Depending on the level of brachial plexus lesion and/or reinnervation, different reconstructive procedures are available. In order to select the best treatment option for the patient it is necessary to known the extent of the lesion of the brachial plexus and/or ventral upper arm muscles, to time the operation appropriately, to be aware of all treatment possibilities and to recall the special problems of tendon transfer for brachial plexus patients. Our concept is based on our experience with more than 1100 patients presenting a brachial plexus lesion between 1981 and 1996 and treated in our institution. There were 528 operative revisions of the brachial plexus. Some 225 patients underwent secondary muscle/tendon transfers. In 35 patients elbow flexion was reconstructed by bipolar latissimus dorsi transfer (n = 10), triceps-to-biceps transfer (n = 15), modified flexor/pronator muscle mass proximalization (n = 6) and the multiple-stage free functional muscle transfer after intercostal nerve transfer (n = 4).

  16. Ejection Fraction Heart Failure Measurement

    MedlinePlus

    ... Thromboembolism Aortic Aneurysm More Ejection Fraction Heart Failure Measurement Updated:Feb 15,2017 The ejection fraction (EF) is an important measurement in determining how well your heart is pumping ...

  17. Exposure of the retroclavicular brachial plexus by clavicle suspension for birth brachial plexus palsy.

    PubMed

    Tse, Raymond; Pondaag, Willem; Malessy, Martijn

    2014-06-01

    Surgical exploration and reconstruction of the brachial plexus requires adequate exposure beyond the zone of injury. In the case of extensive lesions, some authors advocate clavicle osteotomy for an extensile approach. Such an osteotomy introduces further morbidity and may impact upon the delicate nerve reconstruction. A new simple but effective method of clavicle elevation is described that provides access to the retroclavicular brachial plexus during exploration for birth brachial plexus palsy.

  18. Coronal mass ejections

    SciTech Connect

    Steinolfson, R.S.

    1990-01-01

    Coronal mass ejections (CMEs) are now recognized as an important component of the large-scale evolution of the solar corona. Some representative observations of CMEs are reviewed with emphasis on more recent results. Recent observations and theory are examined as they relate to the following aspects of CMEs: (1) the role of waves in determining the white-light signature; and (2) the mechanism by which the CME is driven (or launched) into the corona.

  19. Brachial plexus lesions in patients with cancer: 100 cases

    SciTech Connect

    Kori, S.H.; Foley, K.M.; Posner, J.B.

    1981-01-01

    In patients with cancer, brachial plexus signs are usually caused by tumor infiltration or injury from radiation therapy (RT). We analyzed 100 cases of brachial plexopathy to determine which clinical criteria helped differentiate tumor from radiation injury. Seventy-eight patients had tumor and 22 had radiation injury. Severe pain occurred in 80% of tumor patients but in only 19% of patients with radiation injury. The lower trunk was involved in 72% of the tumors. Seventy-eight percent of the radiation injuries affected the upper plexus (C5-6). Horner syndrome was more common in tumor, and lymphedema in radiation injury. The time from RT to onset of plexus symptoms, and the dose of RT, also differed.

  20. Neurinomas of the brachial plexus: case report.

    PubMed

    Forte, A; Gallinaro, L S; Bertagni, A; Montesano, G; Prece, V; Illuminati, G

    1999-01-01

    Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves, a low proportion of which arise from the brachial plexus. Authors report a case of an ancient schwannoma arising from the brachial plexus. The tumour, usually asymptomatic, may cause sensory radicular symptoms, or rarely motor deficits in the involved arm. Enucleation of the tumour from the nerve without damage to any of the fascicles is the correct treatment.

  1. Lack of evidence of the effectiveness of primary brachial plexus surgery for infants (under the age of two years) diagnosed with obstetric brachial plexus palsy.

    PubMed

    Bialocerkowski, Andrea; Gelding, Bronwyn

    2006-12-01

    secondary deformities. Data collection and analysis  Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were also assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results  Twenty-one studies were included in the review. Most were ranked low on the hierarchy of evidence (no randomised controlled trials were found), and most had only fair methodological quality. Surgical intervention was variable, as were the eligibility criteria for surgery, the timing of surgery and the outcome instruments used to evaluate the effect of surgery. Therefore, it is difficult to draw conclusions regarding the effectiveness of primary brachial plexus surgery for infants with obstetric brachial plexus palsy. Conclusions  Although there is a wealth of information regarding the outcome following primary brachial plexus surgery it was not possible to determine whether this treatment is effective in increasing functional recovery in infants with obstetric brachial plexus palsy. Further research is required to develop standardised surgical criteria, and standardised outcome measures should be used at specific points in time during the recovery process to facilitate comparison between studies. Moreover, comparison groups are required to determine the relative effectiveness of surgery compared with other forms of management.

  2. Brachial artery aneurysms associated with arteriovenous access for hemodialysis.

    PubMed

    Chemla, Eric; Nortley, Mei; Morsy, Mohamed

    2010-01-01

    Brachial artery aneurysm (BAA) is a rare condition. We describe a series of cases of BAA with arteriovenous access. Thirteen patients were retrospectively identified between January 2006 and July 2009 using a patient database. All were associated with brachio-cephalic fistulas. Mean age was 51.2 +/- 13.8 years. Twelve males (93.3%) were identified. Characteristics were: diabetes 1, hypertension 8, hypercholesterolemia 2, ischemic heart disease 2, family history of aneurysmal disease 2. Five BAA developed after access ligation, eight while it was working, one after trauma. One was associated with a venous aneurysm. While the average life of the access was 161 +/- 115 months, the average time for BAA formation was 40 +/- 35.8 months. BAA was asymptomatic in three patients, whereas 10 presented with ischemic and neurologic symptoms. None presented with a rupture. All patients underwent surgical repair, seven an aneurysm excision and end-to-end reconstruction of the brachial artery. Venous conduits were utilized: four long saphenous veins, one cephalic, and one basilic vein. All patients had patent brachial arteries with a complete relief of symptoms at 14 months. BAA is a rare but significant complication of vascular access. The surgical approaches presented offer a reasonable outcome.

  3. The association of ankle-brachial index with silent cerebral small vessel disease: results of the Atahualpa Project.

    PubMed

    Del Brutto, Oscar H; Sedler, Mark J; Mera, Robertino M; Lama, Julio; Gruen, Jadry A; Phelan, Kelsie J; Cusick, Elizabeth H; Zambrano, Mauricio; Brown, David L

    2015-06-01

    An abnormal ankle-brachial index has been associated with overt stroke and coronary heart disease, but little is known about its relationship with silent cerebral small vessel disease. To assess the value of ankle-brachial index as a predictor of silent small vessel disease in an Ecuadorian geriatric population. Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Ankle-brachial index determinations and brain magnetic resonance imaging were performed in consented persons. Ankle-brachial index ≤0.9 and ≥1.4 were proxies of peripheral artery disease and noncompressible arteries, respectively. Using logistic regression models adjusted for age, gender, and cardiovascular health status, we evaluated the association between abnormal ankle-brachial index with silent lacunar infarcts, white matter hyperintensities, and cerebral microbleeds. Mean age of the 224 participants was 70 ± 8 years, 60% were women, and 80% had poor cardiovascular health status. Ankle-brachial index was ≤0.90 in 37 persons and ≥1.4 in 17. Magnetic resonance imaging showed lacunar infarcts in 27 cases, moderate-to-severe white matter hyperintensities in 47, and cerebral microbleeds in 26. Adjusted models showed association of lacunar infarcts with ankle-brachial index ≤ 0.90 (OR: 3.72, 95% CI: 1.35-10.27, P = 0.01) and with ankle-brachial index ≥ 1.4 (OR: 3·85, 95% CI: 1.06-14.03, P = 0.04). White matter hyperintensities were associated with ankle-brachial index ≤ 0.90 (P = 0.03) and ankle-brachial index ≥ 1.4 (P = 0.02) in univariate analyses. There was no association between ankle-brachial index groups and cerebral microbleeds. In this population-based study conducted in rural Ecuador, apparently healthy individuals aged ≥60 years with ankle-brachial index values ≤0.90 and ≥1.4 are almost four times more likely to have a silent lacunar infarct. Ankle-brachial index screening might allow recognition

  4. Transscalene brachial plexus block: a new posterolateral approach for brachial plexus block.

    PubMed

    Nguyen, Hoang C; Fath, Erwin; Wirtz, Sebastian; Bey, Tareg

    2007-09-01

    Depending on the approach to the upper brachial plexus, severe complications have been reported. We describe a novel posterolateral approach for brachial plexus block which, from an anatomical and theoretical point of view, seems to offer advantages. Twenty-seven patients were scheduled to undergo elective major surgery of the upper arm or shoulder using this new transscalene brachial plexus block. The success rate was 85.2% for surgery. Two patients required additional analgesia with IV sufentanil. In two others, regional anesthesia was inadequate. The side effects of this technique included reversible recurrent laryngeal nerve blockade in two patients and a reversible Horner syndrome in one patient. Further studies are needed to compare the transscalene brachial plexus block with other approaches to the brachial plexus.

  5. Dermatoglyphs and brachial plexus palsy.

    PubMed

    Polovina, Svetislav; Cvjeticanin, Miljenko; Milicić, Jasna; Proloscić, Tajana Polovina

    2006-09-01

    Perinatal brachial plexus palsy (PBPP) is a handicap quite commonly encountered in daily routine. Although birth trauma is considered to be the major cause of the defect, it has been observed that PBPP occurs only in some infants born under identical or nearly identical conditions. The aim of this study was to test the hypothesis of genetic predisposition for PBPP. It is well known that digito-palmar dermatoglyphs can be used to determine hereditary roots of some diseases. Thus, we found it meaningful to do a study analysis of digito-palmar dermatoglyphs in this disease as well, conducting it on 140 subjects (70 males and 70 females) diagnosed with PBPP. The control group was composed of fingerprints obtained from 400 adult and phenotypically healthy subjects (200 males and 200 females) from the Zagreb area. The results of multivariate and univariate analysis of variance have shown statistically significant differences between the groups observed. In spite of lower percentage of accurately classified female subjects by discriminant analysis, the results of quantitative analysis of digito-palmar dermatoglyphs appeared to suggest a genetic predisposition for the occurrence of PBPP.

  6. Whipple's ejection model and the Geminid stream

    NASA Astrophysics Data System (ADS)

    Jones, J.; Poole, L. M. G.; Webster, A. R.

    2016-02-01

    Many attempts to model the Geminid meteor stream have been based on Whipple's model for the ejection of meteoroids from comets. Using the most accurate data available from the IAU photographic meteor data base and by considering the scatter of the secularly near-invariant quantities of the simulated ejected test particles predicted by applying Whipple's model to the asteroid Phaethon - the prime candidate for the progenitor of the Geminid stream - we show that the model predicts ejection speeds that are about a factor of at least 3 too low. We have considered the other candidate progenitors: the asteroids 2005 UD and 1999 YC, and find neither of these to be credible candidates although we find that 2005 is the likely parent of the day-time Sextantid stream.

  7. Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis.

    PubMed

    Franko, O I; Khalpey, Z; Gates, J

    2008-09-01

    Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia.

  8. DRAMATIC INFRARED VARIABILITY OF WISE J1810-3305: CATCHING EARLY-TIME DUST EJECTION DURING THE THERMAL PULSE OF AN ASYMPTOTIC GIANT BRANCH STAR?

    SciTech Connect

    Gandhi, Poshak; Yamamura, Issei; Takita, Satoshi

    2012-05-20

    We present the discovery of a source with broadband infrared photometric characteristics similar to Sakurai's object. WISE J180956.27-330500.2 (hereafter J1810-3305) shows very red WISE colors, but a very blue 2MASS [K] versus WISE [W1 (3.4 {mu}m)] color. It was not visible during the IRAS era, but now has a 12 {mu}m flux well above the IRAS point-source catalog detection limit. There are also indications of variability in historical optical photographic plates as well as in multi-epoch AKARI mid-infrared measurements. The broadband infrared spectral energy distribution (SED) shape, post-IRAS brightening, and multiwavelength variability are all characteristics also shared by Sakurai's object-a post-asymptotic giant branch (post-AGB) star which underwent a late thermal pulse and recently ejected massive envelopes of dust that are currently expanding and cooling. Optical progenitor colors suggest that J1810-3305 may have been of late spectral class. Its dramatic infrared brightening and the detection of a late-type optical counterpart are consistent with a scenario in which we have caught an extremely massive dust ejection event (in 1998 or shortly before) during the thermal pulse of an AGB star, thus providing a unique opportunity to observe stellar evolution in this phase. J1810-3305 is the only source in the entire WISE preliminary data release with similar infrared SED and variability, emphasizing the rarity of such sources. Confirmation of its nature is of great importance.

  9. Systematic evaluation of brachial plexus injuries.

    PubMed

    Haynes, S

    1993-01-01

    Brachial plexus injuries offer a unique challenge to the athletic trainer because of their relatively high frequency rate in contact sports and because of the complexity of the neuroanatomy in the cervical area. During a game, athletic trainers must make a fast, accurate decision regarding a player's return to competition. It is imperative that the athletic trainer be able to quickly differentiate between minor injuries and more serious injuries warranting removal from the game and/or physician referral. A systematic approach to the evaluation of a brachial plexus injury is essential to ensure proper treatment. This paper will present a structured approach to an on-the-field assessment of brachial plexus injuries.

  10. Herpetic Brachial Plexopathy: Application of Brachial Plexus Magnetic Resonance Imaging and Ultrasound-Guided Corticosteroid Injection.

    PubMed

    Kim, Jeong-Gil; Chung, Sun G

    2016-05-01

    Herpes zoster, commonly known as shingles, is an infectious viral disease characterized by painful, unilateral skin blisters occurring in specific sensory dermatomes. Motor paresis is reported in 0.5% to 5% of patients. Although the mechanism of zoster paresis is still unclear, the virus can spread from the dorsal root ganglia to the anterior horn cell or anterior spinal nerve roots. It rarely involves the brachial plexus. We report a case of brachial plexitis following herpes zoster infection in which pathological lesions were diagnosed using brachial plexus magnetic resonance imaging and treated with ultrasound-guided perineural corticosteroid injection.

  11. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade.

    PubMed

    Movafegh, Ali; Razazian, Mehran; Hajimaohamadi, Fatemeh; Meysamie, Alipasha

    2006-01-01

    Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

  12. Delayed brachial artery dilation response and increased resting blood flow velocity in young children with mild sleep-disordered breathing.

    PubMed

    Kontos, Anna; van den Heuvel, Cameron; Pamula, Yvonne; Martin, James; Lushington, Kurt; Baumert, Mathias; Willoughby, Scott; Gent, Roger; Couper, Jenny; Kennedy, Declan

    2015-12-01

    This study aimed to evaluate whether the vascular dysfunction perceived in adults with sleep-disordered breathing (SDB) was also evident in children with snoring referred for evaluation of clinically suspected SDB. This study compared flow-mediated dilatation (FMD), measured at the brachial artery, at rest and during hyperaemic stress between children who snore [n = 23; mean standard deviation (SD) age = 7.51 (1.3) years] and healthy, non-snoring children [n = 11; age = 8.0 (1.3) years]. Children with suspected obstructive sleep apnoea (OSA) and healthy non-snoring controls underwent overnight polysomnography (PSG). Using standard techniques, non-invasive FMD and brachial arterial blood flow velocity during rest and hyperaemia were subsequently measured by ultrasound imaging Resting and hyperaemic velocity time integral (area under the curve of mean systolic velocity × ejection time), maximal dilation response (highest percentage difference from baseline diameter) and the time taken to reach maximal dilation were calculated. Children awaiting adenotonsillectomy compared to healthy non-snoring control children had higher velocity time integrals at rest (14 ± 3 m vs. 20 ± 8 m, p < 0.01) and during hyperaemic stress (56 ± 6m vs. 63 ± 13m, p < 0.01) despite having only mild SDB on polysomnographic assessment. Lower nadir oxygen saturation values during non-rapid eye movement sleep were negatively associated with higher resting (r = -0.58, p <0.001) and hyperaemic (r = -0.36, p < 0.05) velocity time integrals. Maximal FMD dilatation response was not significantly different between snoring and non-snoring groups, but the estimated time to reach maximal dilation was significantly delayed in children who snored (60.7 ± 28.4 vs. 39.2 ± 13.2 s, p < 0.05). Children with mild SDB showed increased blood flow velocity at rest and during hyperaemic stress suggesting altered cardiovascular and

  13. Magnetic resonance neurography of the brachial plexus

    PubMed Central

    Upadhyaya, Vaishali; Upadhyaya, Divya Narain; Kumar, Adarsh; Pandey, Ashok Kumar; Gujral, Ratni; Singh, Arun Kumar

    2015-01-01

    Magnetic Resonance Imaging (MRI) is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Recent refinements in MRI protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve lesions with greater confidence than was possible till now. This article on Magnetic Resonance Neurography (MRN) is based on the authors’ experience of imaging the brachial plexus and peripheral nerves using these protocols over the last several years. PMID:26424974

  14. Early transient radiation-induced brachial plexopathy in locally advanced head and neck cancer

    PubMed Central

    Etiz, Durmus

    2016-01-01

    Aim of the study Early transient brachial plexopathy following radiotherapy (RT) in patients with head and neck cancer may be underreported and associated with a dose-response. Our purpose was to determine the incidence of early transient radiation-ınduced brachial plexopathy (RIBP) in patients receiving primary RT (± chemotherapy) for locally advanced head and neck cancer (HNC). Material and methods Twenty-seven locally advanced HNC patients who have no finding of brachial plexopathy at the diagnosis were evaluated 3 times by a specifically developed 13-item questionnaire for determining early transient RIBP. The 54 brachial plexus in 27 patients were delineated and dose volume histograms were calculated. Results Median follow-up period was 28 (range: 15–40) months. The mean BP volume was 7.9 ±3.6 cm3, and the mean and maximum doses to the BP were 45.3 (range: 32.3–59.3) Gy, and 59.4 (range: 41.4–70.3) Gy, respectively. Maximum dose to the BP was ≥ 70 Gy only in 2 nasopharyngeal cancer patients. Two (7%) early transient RIBP were reported at 7th and 8th month after RT under maximum 67.17 and 55.37 Gy, and mean 52.95 and 38.60 Gy RT doses. Conclusions Two (7%) early RIBP were seen in the patient group, although brachial plexus maximum doses were ≥ 66 Gy in 75% of patients. PMID:27095943

  15. Relation between Flare-associated X-Ray Ejections and Coronal Mass Ejections.

    PubMed

    Nitta; Akiyama

    1999-11-01

    In an attempt to identify the direct signatures of coronal mass ejections (CMEs) in soft X-ray wavelengths, we have searched for plasma ejections in Yohkoh soft X-ray telescope (SXT) images in a total of 17 limb flares, and compared the results with the Solar and Heliospheric Observatory LASCO data. A general correlation exists between the presence/absence of the X-ray ejection and the CME. Although the height versus time relation often indicates (under the assumption of constant speed) that the CME onset coincides with the X-ray ejection, the latter probably does not represent the CME front, because the CME speed must result from acceleration, which would put the estimated onset at an earlier time. In some cases, the estimated CME onset time comes well before the impulsive phase of the associated flare. Although the role of the flare-associated plasma ejection in a CME is still unclear, we propose that its occurrence depends on the presence of open field lines, which can be due to a preceding CME. Lastly, we present a rare example of SXT observations of what appeared to be the three-part structure of a CME, which was seen a few minutes before a major flare started.

  16. Clinical Profile and Prognostic Value of Anemia at the Time of Admission and Discharge Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

    PubMed Central

    Mentz, Robert J.; Greene, Stephen J.; Ambrosy, Andrew P.; Vaduganathan, Muthiah; Subacius, Haris P.; Swedberg, Karl; Maggioni, Aldo P.; Nodari, Savina; Ponikowski, Piotr; Anker, Stefan D.; Butler, Javed; Gheorghiade, Mihai

    2014-01-01

    Background Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. Methods and Results An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05–1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76–1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37–2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73–1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). Conclusions Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular

  17. [Ipsilateral brachial plexus C7 root transfer. Presentation of a case and a literature review].

    PubMed

    Vergara-Amador, Enrique; Ramírez, Alejandro

    2014-01-01

    The C7 root in brachial plexus injuries has been used since 1986, since the first description by Gu at that time. This root can be used completely or partially in ipsilateral or contralateral lesions of the brachial plexus. A review of the literature and the case report of a 21-month-old girl with stab wounds to the neck and section of the C5 root of the right brachial plexus are presented. A transfer of the anterior fibres of the ipsilateral C7 root was performed. At 9 months there was complete recovery of abduction and external rotation of the shoulder. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  18. Shoulder deformities in obstetric brachial plexus paralysis: a computed tomography study.

    PubMed

    Terzis, Julia K; Vekris, Marios D; Okajima, Seiichiro; Soucacos, Panayiotis N

    2003-01-01

    Obstetric brachial plexus palsy invariably involves the upper roots. If left untreated, characteristic deformities of the shoulder are common sequelae. The most objective way to investigate these shoulder deformities is computed tomographic (CT) scanning of bilateral upper limbs. In this study, specific measurements on CT scans of bilateral upper extremities were performed in a population of patients with obstetric brachial plexus palsy before and after reconstruction (nerve repairs and secondary procedures). The measurements showed that the restoration of external rotation and the scapula stabilization procedure correct the inclination of the humeral head, improve the joint congruency significantly, and decrease the winging of the scapula, thus improving the kinetics of the shoulder. Periodic CT measurement is an objective method of measuring the changes at the shoulder joint that occur over time during the natural evolution of the obstetric brachial plexus palsy lesion and of documenting the benefits of microsurgical intervention.

  19. Postoperative analgesia comparing levobupivacaine and ropivacaine for brachial plexus block

    PubMed Central

    Watanabe, Kunitaro; Tokumine, Joho; Lefor, Alan Kawarai; Moriyama, Kumi; Sakamoto, Hideaki; Inoue, Tetsuo; Yorozu, Tomoko

    2017-01-01

    Abstract Background: On a pharmacologic basis, levobupivacaine is expected to last longer than ropivacaine. However, most reports of these anesthetics for brachial plexus block do not suggest a difference in analgesic effect. The aim of this study is to compare the postoperative analgesic effects of levobupivacaine and ropivacaine when used for treating ultrasound-guided brachial plexus block. Methods: A total of 62 patients undergoing orthopedic surgery procedures were prospectively enrolled and randomized to receive levobupivacaine (group L, N = 31) or ropivacaine (group R, N = 31). The duration of analgesia, offset time of motor block, need for rescue analgesics, and sleep disturbance on the night of surgery were recorded. Pain score was recorded on the day of surgery, and on postoperative days 1 and 2. Results: There was no difference in the time interval until the first request for pain medication comparing the two groups (group L: 15.6 [11.4, 16.8] hours; group R: 12.5 [9.4, 16.0] hours, P = 0.32). There was no difference in the duration of motor block (group L: 12.2 [7.6, 14.4] hours; group R: 9.4 [7.9, 13.2] hours, P = 0.44), pain score (P = 0.92), need for rescue analgesics (group L: 55%; group R: 65%, P = 0.6), or rate of sleep disturbance (group L: 61%, group R: 58%, P = 1.0) on comparing the two groups. Conclusions: There was no difference in postoperative analgesia comparing levobupivacaine and ropivacaine when used for brachial plexus block. PMID:28328862

  20. What has changed in brachial plexus surgery?

    PubMed Central

    de Rezende, Marcelo Rosa; Silva, Gustavo Bersani; de Paula, Emygdio José Leomil; Junior, Rames Mattar; de Camargo, Olavo Pires

    2013-01-01

    Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes. In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury. PMID:23644864

  1. [Idiopathic brachial neuralgia after cesarean section].

    PubMed

    Rihane, B; Le Borgne, J M; Bélair, C

    2002-11-01

    We report a case of idiopathic brachial nevralgia of the right shoulder in a 30-year-old female, after caesarean section, under spinal anaesthesia. Two days after surgery, intense cervical pain appeared on the second day, associated with rapid collapse of muscular shoulder belt. Full recovery occurred in four months.

  2. Spontaneous Capillarity-Driven Droplet Ejection

    NASA Astrophysics Data System (ADS)

    Wollman, Drew; Snyder, Trevor; Pettit, Donald; Weislogel, Mark

    2012-11-01

    The first large length-scale capillary rise experiments were conducted by R. Siegel fifty years ago using a drop tower at NASA LeRC. Siegel was curious if the wetting fluid would expel itself from the end of short capillary tubes in low-gravity. He observed that although the fluid partially left the tubes, it was always pulled back by surface tension, which caused it to remain pinned at the tubes' end. By exploiting tube geometry and fluid properties, we demonstrate that such capillary flows can in fact `auto-eject' a variety of jets and drops. Multiple and stationary drops, encapsulations, and a wide range of deployed drop diameters are demonstrated using a drop tower (diameters up to ~10mm). Terrestrial gravity experiments are demonstrated as well as droplets ejected aboard the International Space Station--drops one million times larger than their 1-g counterparts. Scaling arguments reveal the single dimensionless group that best identifies the ejection criteria. The general auto-ejection approach provides a novel mechanism from which to investigate jets, droplets, bubbles, and other large length-scale capillary phenomena. NASA NNX09AP66A: GRC, NASA NNX10AK68H: Oregon Space Grant Consortium.

  3. MR neurography in traumatic brachial plexopathy.

    PubMed

    Upadhyaya, Vaishali; Upadhyaya, Divya N; Kumar, Adarsh; Gujral, Ratni B

    2015-05-01

    Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus-roots, trunks and cords. Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative findings at all three levels, any two levels or at any one level, respectively. MR neurography is an extremely useful modality to image the traumatized brachial plexus. It influences both surgical planning and outcome/prognosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Forecasting of radiation hazard: 2. On-line determination of diffusion coefficient in the interplanetary space, time of ejection and energy spectrum at the source; on-line using of neutron monitor and satellite data

    NASA Astrophysics Data System (ADS)

    Dorman, L. I.; Iucci, N.; Murat, M.; Parisi, M.; Pustil'Nik, L. A.; Sternlieb, A.; Villoresi, G.; Zukerman, I. G.

    In Paper 1 [Dorman, L.I., Pustil’nik, L.A., Sternlieb, A., Zukerman, I.G. Forecasting of Radiation Hazard: 1. Alerts on Great FEP Events Beginning; Probabilities of False and Missed Alerts; on-Line Determination of Solar Energetic Particle Spectrum by using Spectrographic Method, Paper tCOSPAR tPSW1-0022-04, This Issue, 2005] it was described the behavior of programs “FEP-Search” and “FEP-Research/Spectrum” estimating, on the basis of on-line one-minute NM data, the beginning of event and FEP spectrum out of the Earth’s magnetosphere. We show that after these two steps it is possible to determine the time of ejection, diffusion coefficient in the interplanetary space, and energy spectrum at the source of FEP. We consider the following possibilities: (1) one of the above parameters is unknown; (2) two parameters are unknown; (3) all three parameters are unknown. We show that in the first case it is necessary to determine the energy spectrum of FEP on the Earth in two different times and automatically, from two equations, the unknown parameter can be determined (energy spectrum at the source or diffusion coefficient, or time of ejection; the determination is done by one equation, and the other is used for control of the model). In the second case it is necessary to determine the energy spectrum of FEP on the Earth in three different times and from three equations two parameters can be determined automatically (for example, the energy spectrum at the source and diffusion coefficient in the interplanetary space). In the third case, by using data for four different times all three unknown parameters can be determined (time of ejection, diffusion coefficient in the interplanetary space and energy spectrum at the source of FEP), and one equation can be used for control of the model. We describe in detail the algorithms of the programs “FEP-Research/Time of Ejection”, “FEP-Research/Source” and “FEP-Research/Diffusion”. We show the behavior of these

  5. Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters.

    PubMed

    Sluyter, John D; Hughes, Alun D; Lowe, Andrew; Parker, Kim H; Camargo, Carlos A; Hametner, Bernhard; Wassertheurer, Siegfried; Scragg, Robert K R

    2016-09-15

    Comparing the relationships of antihypertensive medications with brachial blood pressure (BP) and aortic waveform parameters may help clinicians to predict the effect on the latter in brachial BP-based antihypertensive therapy. We aimed to make such comparisons with new waveform measures and a wider range of antihypertensive regimens than examined previously. Cross-sectional analysis of 2933 adults (61% male; aged 50-84years): 1637 on antihypertensive treatment and 1296 untreated hypertensives. Sixteen medicine regimens of up to 4 combinations of drugs from 6 antihypertensive classes were analysed. Aortic systolic BP, augmentation index (AIx), excess pressure integral (EPI), backward pressure amplitude (Pb), reflection index (RI) and pulse wave velocity (PWV) were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. Forest plots of single-drug class comparisons across regimens with the same number of drugs (for between 1- and 3-drug regimens) revealed that AIx, Pb, RI and/or loge(EPI) were higher (maximum difference=5.6%, 2.2mmHg, 0.0192 and 0.13 loge(mmHg⋅s), respectively) with the use of a beta-blocker compared with vasodilators and diuretics, despite no brachial systolic and diastolic BP differences. These differences were reduced (by 34-57%) or eliminated after adjustment for heart rate, and similar effects occurred when controlling for systolic ejection period or diastolic duration. Beta-blocker effects on brachial BP may overestimate effects on aortic waveform parameters. Compared to other antihypertensives, beta-blockers have weaker associations with wave reflection measures and EPI; this is predominantly due to influences on heart rate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Are all brachial plexus injuries caused by shoulder dystocia?

    PubMed

    Doumouchtsis, Stergios K; Arulkumaran, Sabaratnam

    2009-09-01

    Obstetric brachial plexus palsy (OBPP), is an injury of the brachial plexus at childbirth affecting the nerve roots of C5-6 (Erb-Duchenne palsy-nearly 80% of cases) or less frequently the C8-T1 nerve roots (Klumpke palsy). OBPP often has medicolegal implications. In the United Kingdom and the Republic of Ireland the incidence is 0.42, in the United States 1.5, and in other western countries 1 to 3 per 1000 live births. Most infants with OBPP have no known risk factors. Shoulder dystocia increases the risk for OBPP 100-fold. The reported incidence of OBPP after shoulder dystocia varies widely from 4% to 40%. Other risk factors include birth weight >4 kg, maternal diabetes mellitus, obesity or excessive weight gain, prolonged pregnancy, prolonged second stage of labor, persistent fetal malposition, operative delivery, and breech extraction of a small baby. OBPP after caesarean section accounts for 1% to 4% of cases. Historically, OBPPs have been considered to result from excessive lateral traction and forceful deviation of the fetal head from the axial plane of the fetal body, usually in association with shoulder dystocia, which increases the necessary applied peak force and time to deliver the fetal shoulders. Direct compression of the fetal shoulder on the symphysis pubis may also cause injury. However a significant proportion of OBPPs occurs in utero, as according to some studies more than half of the cases are not associated with shoulder dystocia. Possible mechanisms of intrauterine injury include the endogenous propulsive forces of labor, intrauterine maladaptation, or failure of the shoulders to rotate, and impaction of the posterior shoulder behind the sacral promontory. Uterine anomalies, such as fibroids, an intrauterine septum, or a bicornuate uterus may also result in OBPP. It is not possible to reliably predict which fetuses will experience OBPP. Future research should be directed in prospective evaluation of the mechanisms of injury, to enable

  7. Asynchronous milk ejection in human lactating breast: case series.

    PubMed

    Gardner, Hazel; Kent, Jacqueline C; Hartmann, Peter E; Geddes, Donna T

    2015-05-01

    Milk production is under the influence of autocrine control such that the rate of milk synthesis decreases as the breast fills with milk. Effective elimination of milk from the alveoli via the milk ejection reflex will therefore result in increased milk synthesis. It has been assumed that milk ejection occurs in all alveoli simultaneously; however, animal studies have indicated that full alveoli eject milk sooner than less full alveoli, suggesting heterogeneous emptying of the mammary gland. The aim of this study was to determine whether milk ejection occurs asynchronously in the human lactating breast. Retrospective analysis of videos made of ultrasound monitoring of milk ducts during pumping. Six video clips (4 women) of ultrasound monitored milk ejections showed obvious differences in the timing of milk flow between different main milk ducts. Duct diameter was simultaneously measured every second in 2 different ducts that drained 2 separate lobes of the breast. For 5 of 6 ultrasound duct monitoring sessions, both duct dilation and visualization of milk flow in the 2 separate main milk ducts differed by 2 to 8 seconds. For the remaining woman, milk was observed to eject from 1 part of the lobe, and when not removed, it flowed in a retrograde fashion into a different part of the lobe. Asynchrony of milk ejection occurs in the human lactating breast, suggesting that the timing of myoepithelial cell response differs, resulting in heterogeneous emptying of the gland. © The Author(s) 2015.

  8. Magnetohydrodynamic simulations of the ejection of a magnetic flux rope

    NASA Astrophysics Data System (ADS)

    Pagano, P.; Mackay, D. H.; Poedts, S.

    2013-06-01

    Context. Coronal mass ejections (CME's) are one of the most violent phenomena found on the Sun. One model to explain their occurrence is the flux rope ejection model. In this model, magnetic flux ropes form slowly over time periods of days to weeks. They then lose equilibrium and are ejected from the solar corona over a few hours. The contrasting time scales of formation and ejection pose a serious problem for numerical simulations. Aims: We simulate the whole life span of a flux rope from slow formation to rapid ejection and investigate whether magnetic flux ropes formed from a continuous magnetic field distribution, during a quasi-static evolution, can erupt to produce a CME. Methods: To model the full life span of magnetic flux ropes we couple two models. The global non-linear force-free field (GNLFFF) evolution model is used to follow the quasi-static formation of a flux rope. The MHD code ARMVAC is used to simulate the production of a CME through the loss of equilibrium and ejection of this flux rope. Results: We show that the two distinct models may be successfully coupled and that the flux rope is ejected out of our simulation box, where the outer boundary is placed at 2.5 R⊙. The plasma expelled during the flux rope ejection travels outward at a speed of 100 km s-1, which is consistent with the observed speed of CMEs in the low corona. Conclusions: Our work shows that flux ropes formed in the GNLFFF can lead to the ejection of a mass loaded magnetic flux rope in full MHD simulations. Coupling the two distinct models opens up a new avenue of research to investigate phenomena where different phases of their evolution occur on drastically different time scales. Movies are available in electronic form at http://www.aanda.org

  9. Measuring FMD in the brachial artery: how important is QRS gating?

    PubMed Central

    Kizhakekuttu, Tinoy J.; Gutterman, David D.; Phillips, Shane A.; Jurva, Jason W.; Arthur, Emily I. L.; Das, Emon

    2010-01-01

    Recommendations for the measurement of brachial flow-mediated dilation (FMD) typically suggest images be obtained at identical times in the cardiac cycle, usually end diastole (QRS complex onset). This recommendation presumes that inter-individual differences in arterial compliance are minimized. However, published evidence is conflicting. Furthermore, ECG gating is not available on many ultrasound systems; it requires an expensive software upgrade or increased image processing time. We tested whether analysis of images acquired with QRS gating or with the more simplified method of image averaging would yield similar results. We analyzed FMD and nitroglycerin-mediated dilation (NMD) in 29 adults with type 2 diabetes mellitus and in 31 older adults and 12 young adults without diabetes, yielding a range of brachial artery distensibility. FMD and NMD were measured using recommended QRS-gated brachial artery diameter measurements and, alternatively, the average brachial diameters over the entire R-R interval. We found strong agreement between both methods for FMD and NMD (intraclass correlation coefficients = 0.88–0.99). Measuring FMD and NMD using average diameter measurements significantly reduced post-image-processing time (658.9 ± 71.6 vs. 1,024.1 ± 167.6 s for QRS-gated analysis, P < 0.001). FMD and NMD measurements based on average diameter measurements can be performed without reducing accuracy. This finding may allow for simplification of FMD measurement and aid in the development of FMD as a potentially useful clinical tool. PMID:20671033

  10. Measuring FMD in the brachial artery: how important is QRS gating?

    PubMed

    Kizhakekuttu, Tinoy J; Gutterman, David D; Phillips, Shane A; Jurva, Jason W; Arthur, Emily I L; Das, Emon; Widlansky, Michael E

    2010-10-01

    Recommendations for the measurement of brachial flow-mediated dilation (FMD) typically suggest images be obtained at identical times in the cardiac cycle, usually end diastole (QRS complex onset). This recommendation presumes that inter-individual differences in arterial compliance are minimized. However, published evidence is conflicting. Furthermore, ECG gating is not available on many ultrasound systems; it requires an expensive software upgrade or increased image processing time. We tested whether analysis of images acquired with QRS gating or with the more simplified method of image averaging would yield similar results. We analyzed FMD and nitroglycerin-mediated dilation (NMD) in 29 adults with type 2 diabetes mellitus and in 31 older adults and 12 young adults without diabetes, yielding a range of brachial artery distensibility. FMD and NMD were measured using recommended QRS-gated brachial artery diameter measurements and, alternatively, the average brachial diameters over the entire R-R interval. We found strong agreement between both methods for FMD and NMD (intraclass correlation coefficients = 0.88-0.99). Measuring FMD and NMD using average diameter measurements significantly reduced post-image-processing time (658.9 ± 71.6 vs. 1,024.1 ± 167.6 s for QRS-gated analysis, P < 0.001). FMD and NMD measurements based on average diameter measurements can be performed without reducing accuracy. This finding may allow for simplification of FMD measurement and aid in the development of FMD as a potentially useful clinical tool.

  11. The Accretion Flow-Discrete Ejection Connection in GRS 1915+105

    NASA Astrophysics Data System (ADS)

    Punsly, Brian; Rodriguez, Jérôme; Trushkin, Sergei A.

    2016-07-01

    The microquasar GRS 1915+105 is known for its spectacular discrete ejections. They occur unexpectedly, thus their inception has escaped direct observation. It has been shown that the X-ray flux increases in the hours leading up to a major ejection. In this article, we consider the serendipitous interferometric monitoring of a modest version of a discrete ejection described in Reid et al. that would have otherwise escaped detection in daily radio light curves. The observation begins ˜1 hr after the onset of the ejection, providing unprecedented accuracy on the estimate of the ejection time. The astrometric measurements allow us to determine the time of ejection as {{MJD}} {56436.274}-0.013+0.016, i.e., within a precision of 41 minutes (95% confidence). Just like larger flares, we find that the X-ray luminosity increases in last 2-4 hr preceding ejection. Our finite temporal resolution indicates that this elevated X-ray flux persists within {21.8}-19.1+22.6 minutes of the ejection with 95% confidence, the highest temporal precision of the X-ray-superluminal ejection connection to date. This observation provides direct evidence that the physics that launches major flares occurs on smaller scales as well (lower radio flux and shorter ejection episodes). The observation of a X-ray spike prior to a discrete ejection, although of very modest amplitude, suggests that the process linking accretion behavior to ejection is general from the smallest scales to high luminosity major superluminal flares.

  12. Myokymia in obstetrically related brachial plexopathy.

    PubMed

    Sclar, Gary; Maniker, Allen; Danto, Joseph

    2004-06-01

    Myokymic discharges are spontaneous bursts of semirhythmic potentials that are sometimes correlated with rippling movements of skin and muscle. They have been reported in limb muscles in patients with Guillain-Barré syndrome, spinal stenosis, nerve root and nerve compression, and envenomations. They commonly occur with radiation induced plexopathies (approximately 60% of patients), but have not been reported in obstetrically related brachial plexopathies. We report 2 instances of myokymia in children with obstetric brachial plexus palsies. Each child was studied twice, and it was only at the later study, when the child was 10 or 11 months of age, that these potentials were noted. This could represent ongoing recovery from lesions incurred at birth or developmental changes. The final common pathway of all causes of myokymia could be to generate axonal membrane hyperexcitability.

  13. Microsurgical reconstruction of obstetric brachial plexus palsy.

    PubMed

    Chen, Liang; Gu, Yu-Dong; Wang, Huan

    2008-01-01

    The incidence of obstetric brachial plexus palsy is not declining. Heavy birth weight of the infant and breech delivery are considered two important risk factors and Caesarean section delivery seems to be a protective factor. There are two clinical appearances, that is, paralysis of the upper roots and that of total roots, and Klumpke's palsy involving the C8 and T1 roots is rarely seen. Computed tomography myelography (CTM) is still the best way of visualizing nerve roots. Surgical intervention is needed for 20-25% of all patients and clinical information is decisive for the indication of surgery. Most often, a conducting neuroma of the upper trunk is encountered, and it is believed that neuroma resection followed by microsurgical reconstruction of the brachial plexus gives the best results. Copyright 2008 Wiley-Liss, Inc. Microsurgery, 2008.

  14. The safety of brachial artery puncture for arterial blood sampling.

    PubMed

    Okeson, G C; Wulbrecht, P H

    1998-09-01

    This study was designed to determine the incidence of complications in a sample of 6,185 brachial artery punctures for arterial blood gas analysis. The study sample was comprised of adult patients who had arterial blood gas analysis ordered in the course of their clinical evaluations in a multispecialty clinic and hospital affiliated with a university school of medicine. Subjects were entered prospectively at the time the procedure was done. The overall incidence of all complications was 2.0%. Immediate limb pain or parenthesias occurred in 1.1%, while the onset of symptoms was delayed up to 24 h in 0.9%. Hematoma formation occurred in only 0.06%. None of the complications was considered to be of major impact, in that none was associated with limb ischemia or other objective abnormalities. Only one subject required analgesic medication to control pain that ultimately subsided spontaneously without deficit. We believe that brachial artery puncture, when properly performed, is a safe and reliable alternative route for obtaining arterial blood for gas analysis.

  15. Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies.

    PubMed

    Goubier, Jean-Noël; Teboul, Frédéric; Khalifa, Heba

    2011-01-01

    Restoration of flexion in the elbow is the priority in the management of brachial plexus injuries. Current techniques of reconstructions, combining both nerve grafting and nerve transfer, allow more extensive repair, with additional targets: shoulder, elbow extension, hand. The transfer of intercostal nerves onto the nerve of the triceps long head is used to restore elbow extension. The aim of this retrospective study is to evaluate the results of this procedure, in total brachial plexus palsies with uninjured C5 and C6 roots. Eleven patients with total brachial plexus injury were reviewed 24 months in average after intercostal nerves transfer. The average age of the patients was twenty-nine years. The average time to surgery after occurrence of the injury was 5 months. Triceps re-innervation and strength of elbow extension were evaluated. The averaged time required for triceps re-innervation after intercostal nerve transfer was 9 months. Seven patients achieved M4 elbow extension according to the Medical Research Council grading system. Two patients achieved M3 elbow extension. Two patients had poor results (M2 and M0). Transfer of intercostal nerves onto the nerve of the triceps long head is a reliable procedure for the restoration of elbow extension in total brachial plexus palsy. Copyright © 2010 Wiley-Liss, Inc.

  16. Effect of upper arm brachial basilic and prosthetic forearm arteriovenous fistula on left ventricular hypertrophy.

    PubMed

    Keuter, X H A; Kooman, J P; Habets, J; Van Der Sande, F M; Kessels, A G H; Cheriex, E C; Tordoir, J H M

    2007-01-01

    Creation of an arteriovenous fistula (AVF) may increase left ventricular hypertrophy in the hemodialysis population. Aim of this study was to compare the effects of a brachial-basilic (BB) AVF and the prosthetic brachial-antecubital forearm loop access (PTFE) on cardiac performance. Patients were randomized to receive BB-AVF or prosthetic brachial-antecubital forearm loop access. Before and three months after AVF creation patients underwent an echocardiographic examination. Mann-Whitney U-test was used to compare relative increase between the measured cardiac parameters for the two groups. Twenty-seven patients participated in the study. The relative increase in left ventricular parameters was not significantly different between the two groups. Only left ventricular end-diastolic diameter tended to be of significance. Mean blood flow through the brachial artery was 1680+/-156 and 1450+/-221 mL/min three months after surgery for the PTFE and the BB-AVF group, respectively. After three months of follow-up, changes in cardiac structure were comparable between patients with BB and PTFE AVFs. Also access flow was comparable at this time. In general, the effects of creation of a fistula on LV structure were limited. Longer follow up time may be needed to explore the long term effects of different vascular accesses on cardiac function.

  17. MHD shocks in coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Steinolfson, R. S.

    1991-01-01

    The primary objective of this research program is the study of the magnetohydrodynamic (MHD) shocks and nonlinear simple waves produced as a result of the interaction of ejected lower coronal plasma with the ambient corona. The types of shocks and nonlinear simple waves produced for representative coronal conditions and disturbance velocities were determined. The wave system and the interactions between the ejecta and ambient corona were studied using both analytic theory and numerical solutions of the time-dependent, nonlinear MHD equations. Observations from the SMM coronagraph/polarimeter provided both guidance and motivation and are used extensively in evaluating the results. As a natural consequence of the comparisons with the data, the simulations assisted in better understanding the physical interactions in coronal mass ejections (CME's).

  18. Qualitative dermatoglyphic traits in brachial plexus palsy.

    PubMed

    Polovina, Svetislav; Milicić, Jasna; Cvjeticanin, Miljenko; Proloscić, Tajana Polovina

    2007-12-01

    It has been considered for many years that the cause of perinatal brachial plexus palsy (PBPP) is excessive lateral traction applied to the fetal head at delivery, in association with anterior shoulder dystocia, but this do not explain all cases of brachial plexus palsy. The incidence found in several family members could be suggestive for inheritance with variable expression. The aim of this study was to prove early found confirmations of genetic predisposition for PBPP In the previous studies, the quantitative dermatoglyphic analysis showed some differences in digito-palmar dermatoglyphs between patients with PBPP and healthy controls. Now this qualitative analysis will try to determine hereditary of those diseases. We analyzed digito-palmar dermatoglyphics from 140 subjects (70 males and 70 females) diagnosed with PBPP and 400 phenotypically healthy adults (200 males and 200 females) from Zagreb area as control group. The results of Chi-square test showed statistically significant differences for frequencies of patterns on fingers in females between the groups observed. Statistically significant differences were found on palms in III and IV interdigital areas in both males and females and in thenar and I interdigital area only in females. As it was found in previous researches on quantitative dermatoglyphic traits, more differences are found between females with PBPP and control group, than between males. The fact, that the main presumed cause of PBPP is obstetrical trauma, it could be associated with congenital variability in formation of brachial plexus.

  19. Evidence linking coronal mass ejections with interplanetary magnetic clouds

    NASA Technical Reports Server (NTRS)

    Wilson, R. M.; Hildner, E.

    1983-01-01

    Using proxy data for the occurrence of those mass ejections from the solar corona which are directed earthward, we investigate the association between the post-1970 interplanetary magnetic clouds of Klein and Burlaga and coronal mass ejections. The evidence linking magnetic clouds following shocks with coronal mass ejections is striking; six of nine clouds observed at Earth were preceded an appropriate time earlier by meter-wave type II radio bursts indicative of coronal shock waves and coronal mass ejections occurring near central meridian. During the selected periods when no clouds were detected near Earth, the only type II bursts reported were associated with solar activity near the limbs. Where the proxy solar data to be sought are not so clearly suggested, that is, for clouds preceding interaction regions and clouds within cold magnetic enhancements, the evidence linking the clouds and coronal mass ejections is not as clear; proxy data usually suggest many candidate mass-ejection events for each cloud. Overall, the data are consistent with and support the hypothesis suggested by Klein and Burlaga that magnetic clouds observed with spacecraft at 1 AU are manifestations of solar coronal mass ejection transients.

  20. Transient ion ejection during nanocomposite thermite reactions

    NASA Astrophysics Data System (ADS)

    Zhou, Lei; Piekiel, Nicholas; Chowdhury, Snehaunshu; Lee, Donggeun; Zachariah, Michael R.

    2009-10-01

    We observe an intense ion pulse from nanocomposite thermite reactions, which we temporally probe using a recently developed temperature jump/time of flight mass spectrometer. These ion pulses are observed to be much shorter in duration than the overall thermite reaction time. Ion ejection appears in stages as positive ions are ejected prior to nanocomposite thermite ignition, and ignition of the thermite mixtures leads to a second ionization step which is primarily dominated by negative species. The positive species are identified from mass spectrometric measurements and the results show that the positive ion species are comprised of Na ions with minor species of Al and K ions. This observation can be explained by a diffusion based ion-current mechanism, in which strong Al ion diffusion flux formed through the oxide shell, and the surface Na and K ions from salt contaminations are ejected by the strong electrostatic repulsion. The fact that the negative ionization step occurs during the ignition event suggests a strong relation between the nanocomposite thermite reaction and the negative ionization process.

  1. Intrauterine shoulder weakness and obstetric brachial plexus palsy.

    PubMed

    Alfonso, Israel; Papazian, Oscar; Shuhaiber, Hans; Yaylali, Ilker; Grossman, John A I

    2004-09-01

    Obstetrical brachial plexus injury occurs when the forces preventing the stretch of the brachial plexus are overcome by the forces stretching it. This report describes an 8-day-old male delivered by uncomplicated cesarean section with right obstetrical brachial plexus palsy and congenital arm atrophy. The patient had a history of decreased right arm movement detected by fetal ultrasound at 18 to 20 weeks of gestation. The purpose of this article is to report that stretching of brachial plexus at birth sufficient to produce a plexus injury may occur in a patient with a vulnerable plexus even in the absence of traction during delivery.

  2. Surgical treatment of brachial plexus injuries in adults.

    PubMed

    Ricardo, Monreal

    2005-12-01

    We carried out a retrospective review of 32 consecutive patients (30 adults and two children) with total or partial lesions of the brachial plexus who had surgical repair using nerve grafting, neurotisation, and neurolysis between January 1991 and December 2003. The outcome measures of muscular strength were correlated with the type of lesion, age, preoperative time, length and number of grafts, and time to reinnervation of the biceps. The function of the upper limb was also evaluated. There was a significant correlation between muscular strength after surgical repair and both the preoperative time and the length of the nerve graft. There was also a significant correlation between muscular strength and the number of grafts. Muscular strength was better when the neurolysis was done before six months. When neurosurgical repair and reconstructive procedures were performed, the function of the upper limb was improved.

  3. The Solar Mass Ejection Imager

    NASA Technical Reports Server (NTRS)

    Jackson, B. V.; Buffington, A.; Hick, P. L.; Kahler, S. W.; Altrock, R. C.; Gold, R. E.; Webb, D. F.

    1995-01-01

    We are designing a Solar Mass Ejection Imager (SMEI) capable of observing the Thomson-scattered signal from transient density features in the heliosphere from a spacecraft situated near AU. The imager is designed to trace these features, which include coronal mass ejections. corotating structures and shock waves, to elongations greater than 90 deg from the Sun. The instrument may be regarded as a progeny of the heliospheric imaging capability shown possible by the zodiacal-light photometers of the HELIOS spacecraft. The instrument we are designing would make more effective use of in-situ solar wind data from spacecraft in the vicinity of the imager by extending these observations to the surrounding environment. The observations from the instrument should allow deconvolution of these structures from the perspective views obtained as they pass the spacecraft. An imager at Earth could allow up to three days warning of the arrival of a mass ejection from the Sun .

  4. Mass ejections from the Sun

    NASA Astrophysics Data System (ADS)

    Green, Lucie M.

    Coronal mass ejections are the most spectacular form of solar activity and they play a key role in driving space weather at the Earth. These eruptions are associated with active regions and occur throughout an active region's entire lifetime. All coronal mass ejection models invoke the presence of a twisted magnetic field configuration known as a magnetic flux rope either before or after eruption onset. The observational identification of magnetic flux ropes in the solar atmosphere using remote sensing data represents a challenging task, but theoretical models have led to the understanding that there are signatures that reveal their presence. The range of coronal mass ejection models are helping build a more complete picture of both the trigger and drivers of these eruptions.

  5. The influence of seatbelts on the types of operated brachial plexus lesions caused by car accidents.

    PubMed

    Kaiser, Radek; Haninec, Pavel

    2012-08-01

    To determine whether there is a relationship between seatbelt use and type of brachial plexus injury seen in automobile accidents. Knowledge of such a relationship may help guide the surgical management of these patients. We retrospectively evaluated 43 surgical patients with brachial plexus palsy caused by car accidents. We recorded sex, age, and type of injury for each case. We also obtained data regarding the patients' position in the car at the time of the accident and whether they were wearing a seatbelt. We obtained data on 39 men and 4 women. Of the seatbelted patients, 24 (100%) had upper plexus palsy on the side where the seatbelt crossed the shoulder. Of those who were not wearing seatbelts, 17 (86%) had complete plexus injuries. We also found 1 upper and 1 lower plexus injury in the unbelted group. We found a relationship between the type of brachial plexus injury sustained by the accident victim and the use and position of the seatbelt. Complete plexus injuries were more common in those who were not wearing seatbelts. We saw upper plexus injuries for those wearing seatbelts. Information about seatbelt use may be useful in clinical practice. When treating an unbelted car accident victim with a brachial plexus injury, it is reasonable to anticipate a more serious form of the injury. Prognostic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. The cause of brachial plexopathy in robot-assisted transaxillary thyroidectomy-A neurophysiological investigation.

    PubMed

    Alkan, Uri; Zarchi, Omer; Rabinovics, Naomi; Nachalon, Yuval; Feinmesser, Raphael; Bachar, Gideon

    2016-09-01

    During robot-assisted transaxillary thyroidectomy, the patient's arm is maintained in an overhead flexed position for a prolonged time, which poses a risk of postoperative brachial plexopathy. The aim of the study was to identify the causes of brachial plexopathy and to assess the benefit of intraoperative neurophysiological monitoring (IONM) in preventing positional brachial plexopathy in this setting. Retrospective case series. The computerized database of a tertiary medical center was searched for all consecutive patients who underwent robot-assisted transaxillary thyroidectomy between 2012 and 2014. Clinical, operative, and outcome parameters were collected from the medical files. Findings were compared between patients operated with and without IONM. The cohort included 30 patients, 14 operated with IONM and 16 without. Three events of impending brachial plexopathy were detected in the monitored group. The monitored group had significantly better shoulder movement (P = .003), a lower rate of hypoesthesia (P = .011), less pain (P = .001) in the early postoperative period than the nonmonitored group and higher quality of life in the early postoperative period (P = .012). The monitored group was significantly younger than the nonmonitored one (P = .02) and had a significantly larger diameter of thyroid nodule than the nonmonitored group (P = .043). IONM during robot-assisted transaxillary thyroidectomy may improve short-term postoperative pain and shoulder movement and longer-term quality of life. 4 Laryngoscope, 126:2187-2193, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Valproic acid protects neurons and promotes neuronal regeneration after brachial plexus avulsion

    PubMed Central

    Li, Qiang; Wu, Dianxiu; Li, Rui; Zhu, Xiaojuan; Cui, Shusen

    2013-01-01

    Valproic acid has been shown to exert neuroprotective effects and promote neurite outgrowth in several peripheral nerve injury models. However, whether valproic acid can exert its beneficial effect on neurons after brachial plexus avulsion injury is currently unknown. In this study, brachial plexus root avulsion models, established in Wistar rats, were administered daily with valproic acid dissolved in drinking water (300 mg/kg) or normal water. On days 1, 2, 3, 7, 14 and 28 after avulsion injury, tissues of the C5–T1 spinal cord segments of the avulsion injured side were harvested to investigate the expression of Bcl-2, c-Jun and growth associated protein 43 by real-time PCR and western blot assay. Results showed that valproic acid significantly increased the expression of Bcl-2 and growth associated protein 43, and reduced the c-Jun expression after brachial plexus avulsion. Our findings indicate that valproic acid can protect neurons in the spinal cord and enhance neuronal regeneration following brachial plexus root avulsion. PMID:25206605

  8. Our experience with triceps nerve reconstruction in patients with brachial plexus injury.

    PubMed

    Terzis, Julia K; Barmpitsioti, Antonia

    2012-05-01

    Although elbow extension is facilitated by gravity, triceps muscle provides elbow joint stability; in patients with brachial plexus injuries stable elbow is necessary for obtaining useful hand function. This study presents the senior author's experience with triceps nerve reconstruction and the functional results in patients with brachial plexus injuries. Outcomes were analyzed in relation to denervation time, severity score, length of the interposition nerve graft and donor nerves used. One hundred and sixty two patients with brachial plexus injury had triceps nerve neurotization and elbow extension recovery between 1978 and 2006. The mean patient's age was 25.45 ± 9.90 years and the mean denervation time was 16.90 ± 26.95 months. Two hundred and thirty two motor donors were used in 156 patients; 6 patients underwent neurolysis; 86 intercostal nerves were transferred in 41 patients. Interposition nerve grafts were used in 130 patients. Results were good or excellent in 31.65% of patients. The age of patients and the severity of the brachial plexus lesion are among the factors that significantly influenced functional results. Intraplexus motor donors are always preferable achieving better functional outcomes than extraplexus donors. Intercostal nerves and the posterior division of contralateral C7 proved preferred donors for elbow extension restoration in multiple avulsions. Although it is difficult to restore strong elbow extension, triceps nerve reconstruction is suggested in brachial plexus management, since it provides elbow stability. Satisfactory elbow extension strength was restored in young patients with high severity score. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Gas Ejection from Spiral Galaxy Disks

    NASA Astrophysics Data System (ADS)

    Durelle, Jeremy

    We present the results of three proposed mechanisms for ejection of gas from a spiral arm into the halo. The mechanisms were modelled using magnetohydrodynamics (MHD) as a theoretical template. Each mechanism was run through simulations using a Fortran code: ZEUS-3D, an MHD equation solver. The first mechanism modelled the gas dynamics with a modified Hartmann flow which describes the fluid flow between two parallel plates. We initialized the problem based on observation of lagging halos; that is, that the rotational velocity falls to a zero at some height above the plane of the disk. When adopting a density profile which takes into account the various warm and cold H I and HII molecular clouds, the system evolves very strangely and does not reproduce the steady velocity gradient observed in edge-on galaxies. This density profile, adopted from Martos and Cox (1998), was used in the remaining models. However, when treating a system with a uniform density profile, a stable simulation can result. Next we considered supernova (SN) blasts as a possible mechanism for gas ejection. While a single SN was shown to be insufficient to promote vertical gas structures from the disk, multiple SN explosions proved to be enough to promote gas ejection from the disk. In these simulations, gas ejected to a height of 0.5 kpc at a velocity of 130 km s--1 from 500 supernovae, extending to an approximate maximum height of 1 kpc at a velocity of 6.7 x 103 km s--1 from 1500 supernovae after 0.15 Myr, the approximate time of propagation of a supernova shock wave. Finally, we simulated gas flowing into the spiral arm at such a speed to promote a jump in the disk gas, termed a hydraulic jump. The height of the jump was found to be slightly less than a kiloparsec with a flow velocity of 41 km s--1 into the halo after 167 Myr. The latter models proved to be effective mechanisms through which gas is ejected from the disk whereas the Hartmann flow (or toy model) mechanism remains unclear as the

  10. [Analysis of risk factors for perinatal brachial plexus palsy].

    PubMed

    Gosk, Jerzy; Rutowski, Roman

    2005-04-01

    Risk factors of obstetrical brachial plexus palsy include: (1) large birth weight, (2) shoulder dystocia and prolonged second stage of labour, (3) instrumental vaginal delivery (forceps delivery, vacuum extraction), (4) diabetes mellitus and mother's obesity, (5) breech presentation, (6) delivery and infant with obstetrical brachial plexus palsy in antecedent delivery. The purpose was analysis of the classical risk factors for brachial plexus palsy based on our own clinical material. Clinical material consists of 83 children with obstetrical brachial plexus palsy treated at the Department of Trauma and Hand Surgery (surgically--54, conservatively--29). Control group consists of 56 healthy newborns. Data recorded included: birth weight, body length, head and chest circumference, Apgar test at 1 min., type of brachial palsy and side affected, type of birth, presentation, duration of delivery (II stage), age of mother, mother's diseases, parity. The infants treated surgically have had a significantly higher birth weight, body height, head and chest circumference, in compression with control group and group treated conservatively. The differences were statistically important. Shoulder dystocia occurred in 32.9% of all vaginal delivery. Instrumental vaginal delivery was observed in 11.3% and breech presentation in 4.9% cases. There were no incidences of obstetrical brachial plexus palsy recurrence. Diabetes mellitus and mother's obesity was found in 3 cases. (1) Fetal macrosomia is the important risk factor of the obstetrical brachial plexus palsy. (2) Obstetrical brachial plexus palsy may occur also in the absence of the classical risk factors.

  11. Combined Spinal Cord Stimulation and Peripheral Nerve Stimulation for Brachial Plexopathy: A Case Report.

    PubMed

    Choi, Ji Hye; Choi, Shu Chung; Kim, Dong Kyu; Sung, Choon Ho; Chon, Jin Young; Hong, Sung Jin; Lee, Ji Young; Moon, Ho Sik

    2016-03-01

    Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action.Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8 years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal mass. However, his brachial plexus was damaged during the surgery. Although he had received various treatments, the pain did not improve. For the management of intractable severe pain, he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale (NRS) 10/10 to NRS 4 - 5/10, but the pain then gradually increased, reaching NRS 8/10, 6 months ago. At that time, he was refractory to other treatments, and we therefore applied PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 - 4/10) was caused intermittently by light touch. Furthermore, the patient's need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy.

  12. Arachnoid cyst masquerading as obstetric brachial plexus palsy.

    PubMed

    Muthukumar, Natarajan; Santhanakrishnan, Alwar Govindan; Sivakumar, Krishnaswamy

    2012-07-01

    Obstetric brachial plexus palsy is not uncommon. However, lesions masquerading as obstetric brachial plexus palsy are rare. A child with a cervicothoracic arachnoid cyst masquerading as obstetric brachial plexus palsy is presented, and the relevant literature is reviewed. A girl born by vaginal delivery at full term without any antecedent risk factors for obstetric brachial plexus palsy was noted to have decreased movements of the right upper extremity. After 7 months, there was no improvement. An MRI scan was obtained, which revealed a cervicothoracic spinal extradural arachnoid cyst. During surgery, the cyst was found to communicate with the dura at the axilla of the C-7 nerve root. The cyst was excised in toto. Six months later, there was improvement in the infant's neurological status. This case illustrates that spinal arachnoid cysts should be entertained in the differential diagnosis when a child presents with obstetric brachial plexus palsy without known antecedent risk factors for obstetric palsy.

  13. Lightning strike-induced brachial plexopathy

    PubMed Central

    Bhargava, Amita N.; Kasundra, Gaurav M.; Khichar, Subhakaran; Bhushan, Bharat S. K.

    2014-01-01

    We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered. PMID:25288846

  14. Lightning strike-induced brachial plexopathy.

    PubMed

    Bhargava, Amita N; Kasundra, Gaurav M; Khichar, Subhakaran; Bhushan, Bharat S K

    2014-10-01

    We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered.

  15. Brachial plexopathy: recurrent cancer or radiation

    SciTech Connect

    Lederman, R.J.; Wilbourn, A.J.

    1984-10-01

    We reviewed clinical and electrodiagnostic features of 16 patients with neoplastic brachial plexopathy (NBP) and 17 patients with radiation-induced plexopathy (RBP). The groups were similar in symptom-free interval after cancer diagnosis and location of the plexus lesions. NBP patients had pain and Horner's syndrome; RBP patients had paresthesias, but rarely Horner's. NBP patients presented earlier after symptom onset and had a shorter course. RBP patients more frequently had abnormal sensory and normal motor nerve conduction studies and characteristically had fasciculations or myokymia on EMG.

  16. Case report. Bee sting brachial block.

    PubMed Central

    Hay, S M; Hay, F A; Austwick, D H

    1992-01-01

    A case of brachial plexus block is presented, following a bee sting in the posterior triangle of the neck. The onset of neurological symptoms was rapid as was their subsequent resolution. Delayed peripheral neurological symptoms believed to have an immunological basis have been reported in response to stings from bees and other Hymenoptera both in the central and peripheral nervous systems (Goldstein et al., 1960; Means et al., 1973; Bachman et al., 1982; Weatherall et al., 1987; Van Antwerpen et al., 1988), but to the authors' knowledge no similar case of immediate peripheral block has been reported. PMID:1492899

  17. Effect of Enhanced External Counter Pulsation Treatment on Aortic Blood Pressure, Arterial Stiffness and Ejection Fraction in Patients with Coronary Artery Disease

    PubMed Central

    Nayar, Sushma; Meyyappan, Chokkalingam; Ganesh, N; Chandrakasu, Arumugam; Nayar, Pradeep G

    2016-01-01

    Introduction Enhanced External Counter Pulsation (EECP) is a non-invasive treatment option for patients with Coronary Artery Disease (CAD). The treatment has shown to augment diastolic pressure and reduce Left Ventricular (LV) after-load by reducing systemic vascular resistance. The effect of EECP in standard brachial blood pressure and central haemodynamic parameters are not known. Aim We hypothesized that EECP may have differential effect in CAD patients with low systolic blood pressure when compared to normal systolic pressure and the mechanism underlying this differential effect may be due to improvement in LV function. Materials and Methods A total of 72 consecutive patients who underwent EECP treatment for symptomatic CAD with LV dysfunction were divided into two groups based on cut-off value of 100mmHg for systolic blood pressure. First group had patients with brachial systolic blood pressure of >100mmHg and second group had patients with brachial systolic blood pressure of ≤100mmHg. We measured central aortic systolic pressure, pulse pressure, augmentation index and augmentation pressure by SphygmoCor device and Ejection Fraction (EF) was measured by echo-cardiography. All these measurements were carried out prior to and after completion of 35 days of EECP sessions. Results Central systolic pressure, brachial systolic pressure, aortic pulse pressure, augmentation pressure and augmentation index significantly decreased in patients with normal brachial systolic pressure with baseline moderate LV dysfunction. Brachial systolic, aortic systolic and aortic pulse pressure significantly increased with no change in augmentation index and pressure is observed in patients with baseline severe LV dysfunction associated with low systolic pressure post EECP treatment. Conclusion EECP treatment has haemodynamically favourable differential effect in normal and low brachial systolic pressure and this is mainly driven by improvement in LV function in patients with

  18. A new Doppler method of assessing left ventricular ejection force in chronic congestive heart failure.

    PubMed

    Isaaz, K; Ethevenot, G; Admant, P; Brembilla, B; Pernot, C

    1989-07-01

    A noninvasive method using Doppler echocardiography was developed to determine the force exerted by the left ventricle in accelerating the blood into the aorta. The value of this new Doppler ejection index in the assessment of left ventricular (LV) performance was tested in 36 patients with chronic congestive heart disease undergoing cardiac catheterization and in 11 age-matched normal control subjects. The 36 patients were subgrouped into 3 groups based on angiographic ejection fraction (LV ejection fraction greater than 60, 41 to 60 and less than or equal to 40%). According to Newton's second law of motion (force = mass X acceleration), the LV ejection force was derived from the product of the mass of blood ejected during the acceleration time with the mean acceleration undergone during that time. In patients with LV ejection fraction less than or equal to 40%, LV ejection force, peak aortic velocity and mean acceleration were severely depressed when compared with the other groups (p less than 0.001). In patients with LV ejection fraction of 41 to 60%, LV ejection force was significantly reduced (22 +/- 3 kdynes) when compared with normal subjects (29 +/- 5 kdynes, p = 0.002) and with patients with LV ejection fraction greater than 60% (29 +/- 7 kdynes, p = 0.009); peak velocity and mean acceleration did not differ between these 3 groups. The LV ejection force showed a good linear correlation with LV ejection fraction (r = 0.86) and a better power fit (r = 0.91). Peak aortic blood velocity and mean acceleration showed less good linear correlations with LV ejection fraction (r = 0.73 and r = 0.66, respectively). The mass of blood ejected during the acceleration time also showed a weak linear correlation with LV ejection fraction (r = 0.64). An LV ejection force less than 20 kdynes was associated with a depressed LV performance (LV ejection fraction less than 50%) with 91% sensitivity and 90% specificity. Thus, these findings suggest that LV ejection force is a new

  19. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    PubMed Central

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. Participants The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. Outcome measures An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. Results 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. Conclusions The process established a new network of opinion leaders and researchers for further

  20. Drop Ejection From an Oscillating Rod

    NASA Technical Reports Server (NTRS)

    Wilkes, E. D.; Basaran, O. A.

    1999-01-01

    The dynamics of a drop of a Newtonian liquid that is pendant from or sessile on a solid rod that is forced to undergo time-periodic oscillations along its axis is studied theoretically. The free boundary problem governing the time evolution of the shape of the drop and the flow field inside it is solved by a method of lines using a finite element algorithm incorporating an adaptive mesh. When the forcing amplitude is small, the drop approaches a limit cycle at large times and undergoes steady oscillations thereafter. However, drop breakup is the consequence if the forcing amplitude exceeds a critical value. Over a wide range of amplitudes above this critical value, drop ejection from the rod occurs during the second oscillation period from the commencement of rod motion. Remarkably, the shape of the interface at breakup and the volume of the primary drop formed are insensitive to changes in forcing amplitude. The interface shape at times close to and at breakup is a multi-valued function of distance measured along the rod axis and hence cannot be described by recently popularized one-dimensional approximations. The computations show that drop ejection occurs without the formation of a long neck. Therefore, this method of drop formation holds promise of preventing formation of undesirable satellite droplets.

  1. Lateral approach for supraclavicular brachial plexus block

    PubMed Central

    Sahu, DK; Sahu, Anjana

    2010-01-01

    A lateral approach described by Volker Hempel and Dr. Dilip Kotharihas been further studied, evaluated and described in detail in the present study. The aim of this study was to evaluate lateral approach of supraclavicular brachial plexus block, mainly in terms of successes rate and complication rate. The study was conducted in secondary level hospital and tertiary level hospital from 2004 to 2008. It was a prospective nonrandomized open-level study. Eighty-two patients of both sexes, aged between 18 and 65 years with ASA Grade I and II scheduled to undergo elective major surgery of the upper limb below the midarm, were selected for this new lateral approach of brachial plexus block. The onset and duration of sensory and motor block, any complications and need for supplement anaesthesia were observed. Success and complication rate were calculated in percentage. Average onset and duration of sensory and motor block was calculated as mean ± SD and percentage. Out of 82 patients, 75 (92%) have got successful block with no significant complication in any case. PMID:20885867

  2. Shoulder pain and isolated brachial plexopathy

    PubMed Central

    Kishan, Amar U; Syed, Sana; Fiorito-Torres, Franchesca; Thakore-James, Manisha

    2012-01-01

    Pancoast syndrome, classically considered as a constellation of (1) pain along the C8–T2 dermatomes, (2) weakness and atrophy of the hand and (3) Horner's syndrome, often presents a diagnostic challenge. In fact, it may manifest as a singular orthopaedic complaint, prompting a futile barrage of tests and referrals. The authors present the case of an elderly man who initially presented with severe shoulder pain. Due to progressive pain and weakness, he was referred to rheumatology and was treated with corticosteroid injections for a presumed musculoskeletal lesion. Ultimately, he manifested gross muscular atrophy and worsening pain, prompting a referral to neurology. An electromyogram (EMG) suggested a lower brachial plexopathy, and a follow-up brachial plexus MRI identified a large Pancoast tumour. Unfortunately, his disease was rapidly progressive, and he passed away within 2 months. While the MRI remains the gold standard for diagnosing Pancoast syndrome, an EMG can facilitate diagnosis in difficult cases such as this one. PMID:22744250

  3. Motor Cortex Neuroplasticity Following Brachial Plexus Transfer

    PubMed Central

    Dimou, Stefan; Biggs, Michael; Tonkin, Michael; Hickie, Ian B.; Lagopoulos, Jim

    2013-01-01

    In the past decade, research has demonstrated that cortical plasticity, once thought only to exist in the early stages of life, does indeed continue on into adulthood. Brain plasticity is now acknowledged as a core principle of brain function and describes the ability of the central nervous system to adapt and modify its structural organization and function as an adaptive response to functional demand. In this clinical case study we describe how we used neuroimaging techniques to observe the functional topographical expansion of a patch of cortex along the sensorimotor cortex of a 27-year-old woman following brachial plexus transfer surgery to re-innervate her left arm. We found bilateral activations present in the thalamus, caudate, insula as well as across the sensorimotor cortex during an elbow flex motor task. In contrast we found less activity in the sensorimotor cortex for a finger tap motor task in addition to activations lateralized to the left inferior frontal gyrus and thalamus and bilaterally for the insula. From a pain perspective the patient who had experienced extensive phantom limb pain (PLP) before surgery found these sensations were markedly reduced following transfer of the right brachial plexus to the intact left arm. Within the context of this clinical case the results suggest that functional improvements in limb mobility are associated with increased activation in the sensorimotor cortex as well as reduced PLP. PMID:23966938

  4. Aerodynamic Forces Experienced during Ejection.

    DTIC Science & Technology

    1981-03-01

    BIOMECHANICAL DATA The blomechanical properties of long bones vary significantly with geometry, material properties , loading method, pathology, etc...side if neceseesary and Identify by block number) Ejection F -4 Aircraft Acceleration (abrupt Windblast Injury Biomechanical data Long bones 20...Ligaments-medial collateral tear-dislocation Menisci-medlal meniscus tear e Frequency: 44% e Mechanism: The function of the ligament Is to prevent abnormal

  5. Dose–Volume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    SciTech Connect

    Chen, Allen M.; Wang, Pin-Chieh; Daly, Megan E.; Cui, Jing; Hall, William H.; Vijayakumar, Srinivasan; Phillips, Theodore L.; Farwell, D. Gregory; Purdy, James A.

    2014-03-15

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose–volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dose–volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.

  6. Localization of the brachial plexus: Sonography versus anatomic landmarks.

    PubMed

    Falyar, Christian R; Shaffer, Katherine M; Perera, Robert A

    2016-09-01

    Interscalene brachial plexus blocks are performed for perioperative management of surgeries involving the shoulder. Historically, these procedures employed anatomic landmarks (AL) to determine the location of the brachial plexus as it passes between the anterior and middle scalene muscles in the neck. In this study, we compared the actual location of the brachial plexus as found with sonography (US) to the anticipated location using AL. The location of the brachial plexus was evaluated using US and AL in 96 subjects. The distance between the two locations was measured. A multivariate analysis of variance was used to determine the significance of the difference and a 2 × 2 analysis of variance was used to compare differences in gender, height, and body mass index. The brachial plexus was located on average 1.8 cm inferior (p = 0.0001) and 0.2 cm lateral (p = 0.09) to the location determined with AL. A significant difference was also associated with gender (p = 0.03), but not with height or body mass index. US is a reliable method that accurately pinpoints the roots of the brachial plexus. The brachial plexus is often located inferior to the location anticipated using AL. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:411-415, 2016. © 2016 Wiley Periodicals, Inc.

  7. Microanatomy of the brachial plexus roots and its clinical significance.

    PubMed

    Zhong, Li-Yuan; Wang, Ai-Ping; Hong, Li; Chen, Sheng-Hua; Wang, Xian-Qin; Lv, Yun-Cheng; Peng, Tian-Hong

    2017-06-01

    To provide the anatomical basis of brachial plexus roots for the diagnosis and treatment of brachial plexus root avulsion injury. The morphological features of brachial plexus roots were observed and measured on 15 cervicothoracic spine of adult cadavers. The relationship of brachial plexus nerve roots and the surrounding tissues also were observed, as well as the blood supply of anterior and posterior roots of the brachial plexus. Origination of the nerve roots in the dorsal-ventral direction from the midline was fine-tuned at each level along the spinal cord. The minimum distance of the origin of the nerve root to midline was 2.2 mm at C 5, while the maximum was 3.1 mm at T 1. Inversely, the distance between the origin of the posterior root and the midline of the spinal cord gradually decreased, the maximum being 4.2 mm at C 5 and minimum 2.7 mm at T 1. Meanwhile, there was complicated fibrous connection among posterior roots of the brachial plexus. The C 5-6 nerve roots interlaced with tendons of the scalenus anterior and scalenus medius and fused with the transverse-radicular ligaments in the intervertebral foramina. However, these ligaments were not seen in C 7-8, and T 1. The blood supply of the anterior and posterior roots of the brachial plexus was from the segmental branches of the vertebral artery, deep cervical artery and ascending cervical artery, with a mean outer diameter of 0.61 mm. The systematic and comprehensive anatomic data of the brachial plexus roots provides the anatomical basis to diagnose and treat the brachial plexus root avulsion injury.

  8. Brachial-brachial autogenous arteriovenous fistula in a dialysis patient with Staphylococcus aureus bacteremia.

    PubMed

    Sato, Yuichi; Miyamoto, Masahito; Yazawa, Masahiko; Nakazawa, Ryuto; Sasaki, Hideo; Miyano, Satetsu; Tsutsumi, Hisashi; Kimura, Kenjiro; Chikaraishi, Tatsuya

    2010-04-01

    As the number of patients on hemodialysis increases, there will also be an increase in the number of patients with inadequate superficial veins for the creation of an autogenous arteriovenous fistula (AVF). In those patients, medical devices such as vascular prostheses or tunneled-cuffed catheters are necessary to maintain dialysis access. However, these devices are frequently associated with bacterial infection. We recently encountered a dialysis patient who underwent tunneled-cuffed catheter insertion because of the lack of usable superficial veins for autogenous access, and this patient subsequently developed catheter-related Staphylococcus aureus bacteremia with multiple metastatic infections. Despite immediate removal of the catheter, the infection persisted over an extended period, which was a condition precluding the further use of catheters or other prosthetic materials. To handle this situation, we utilized the deep brachial vein to construct an autogenous AVF. After ligating numerous branches, the vein was anastomosed to the brachial artery and then transposed to the subcutaneous space. The newly constructed autogenous AVF, which successfully kept the patient free from foreign materials, greatly contributed to the relief of persistent infection. Although the brachial vein is rarely used for AVF creation, we suggest that it can serve as an option to create an alternative AVF in a patient with inadequate superficial veins.

  9. Analysis of melt ejection during long pulsed laser drilling

    NASA Astrophysics Data System (ADS)

    Ting-Zhong, Zhang; Zhi-Chao, Jia; Hai-Chao, Cui; De-Hua, Zhu; Xiao-Wu, Ni; Jian, Lu

    2016-05-01

    In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction. Project supported by the Natural Science Foundation of Jiangsu Province, China (Grant No. KYLX_0341) and the National Natural Science Foundation of China (Grant No. 61405147).

  10. Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

    SciTech Connect

    Eblan, Michael J.; Corradetti, Michael N.; Lukens, J. Nicholas; Xanthopoulos, Eric; Mitra, Nandita; Christodouleas, John P.; Grover, Surbhi; Fernandes, Annemarie T.; Langer, Corey J.; Evans, Tracey L.; Stevenson, James; Rengan, Ramesh; Apisarnthanarax, Smith

    2013-01-01

    Purpose: Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Methods and Materials: Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received {>=}50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Results: Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received {<=}78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving {>=}1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively. Conclusions: RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of

  11. Footrests on Upward Ejection Seats

    DTIC Science & Technology

    1952-09-01

    consisted of a curved pipe suspended below the seat pan which supplied support to the arch . The feet were placed in this stirrup just prior to ejection...support is applied to the heel as well as the arch , this is shown in Figure lb. This design offered adequate support but it has the disadvantage that the...in a41 cases resembled a catenary . Even though a different catapult vas used on the vs subject in three successive tests, the path of the toes was

  12. Bilateral obstetric brachial plexus paralysis: a case report.

    PubMed

    Dragu, A; Horch, R E; Wirth, S; Ingianni, G

    2009-01-01

    Whereas cases of unilateral obstetric brachial plexus paralysis have been sufficiently described and discussed in the literature cases of bilateral obstetric brachial plexus paralysis are extremely rare and so far have not been mentioned and discussed satisfactorily. We present a case of bilateral obstetric brachial plexus paralysis in an 8-months-old white boy. We performed a neurotisation of the Nervus suprascapularis with the Nervus accessorius and an Oberlin procedure on both sides in two operative steps. In an early follow-up 6 months after the second operation and intensive physiotherapy the little patient was able to crawl with the active help of both arms. Bilateral obstetric brachial plexus paralysis is a very rare incidence in infants. An interdisciplinary approach including paediatrics, plastic surgeons, neurosurgeons, neurologists, radiologists and physiotherapists is essential for the success of treatment strategies in such cases.

  13. MEMEX: Mechanisms of Energetic Mass Ejection Explorer

    NASA Astrophysics Data System (ADS)

    Moore, T. E.; Chappell, C. R.; Clemmons, J. H.; Cully, C. M.; Donovan, E.; Earle, G. D.; Heelis, R. A.; Kistler, L. M.; Kepko, L.; Khazanov, G. V.; Knudsen, D. J.; Lessard, M.; McFadden, J. P.; Nicolls, M. J.; Pollock, C. J.; Pfaff, R. F.; Rankin, R.; Rowland, D. E.; Semeter, J. L.; Thayer, J. P.; Winglee, R.

    2013-12-01

    MEMEX is designed to find out how gravitationally-trapped volatile matter is being lost from atmospheres by energetic processes, depleting them of key constituents, as has occurred most dramatically at Mars. This process is exemplified in geospace by the dissipation of solar energy to produce ionospheric outflows that feed back on dynamics of the solar wind interaction with Earth's magnetosphere. Kinetic and electromagnetic energy flow from the Sun into the coupled (auroral) ionosphere, where resultant electron, ion, and gas heating give rise to upwelling, ionization, and mass ejection. Proposed mechanisms involve wave-particle heating interactions, upward ambipolar electric fields, or ponderomotive forces. A large number of free energy sources have been identified, but empirical guidance remains weak concerning their relative importance. Moreover, it is unclear if the waves interact with particles primarily in a cyclotron resonant mode, or in a lower hybrid exchange of electron (parallel) and ion (perpendicular) energy, or in a bulk ponderomotive mode. MEMEX will answer the questions raised by these issues: Where do the waves that produce mass ejection grow? How do they propagate and transport energy? How can wave amplitudes, heating, and escape rates be derived from solar wind conditions? Is the heating a cyclotron resonant process or a bulk ponderomotive forcing process? To obtain answers, MEMEX will for the first time simultaneously observe the magnetospheric and atmospheric boundary conditions applied to the topside or exobase layer, and the response of ions and electrons to the ensuing battle between electrodynamic forcing and collisional damping.

  14. Restoration of elbow extension after primary reconstruction in obstetric brachial plexus palsy.

    PubMed

    Terzis, Julia K; Kokkalis, Zinon T

    2010-03-01

    Elbow extension is important for the elbow joint, and it is more difficult to restore with microsurgery than elbow flexion. The purpose of this article is to describe the experience of the authors with elbow extension reconstruction in obstetric brachial plexus palsy patients. The outcomes were analyzed in relation to the type of brachial plexus lesion, timing of surgery, and the type of nerve reconstruction. Fifty-five children with obstetric brachial plexus palsy who underwent nerve reconstruction for elbow extension restoration were studied. The mean follow-up period was 6.4 years (range, 2-22 y). Reinnervation of the triceps muscle was accomplished with indirect neurotization of the posterior cord from intraplexus donors or with direct neurotization from extraplexus donors, such as the contralateral C7 and the intercostal nerves. Thirty-seven (67%) of the 55 cases showed good or excellent results (>or=M3+). The average postoperative muscle grading for the triceps was 3.34+/-0.99 compared with 1.19+/-1.29 preoperatively (P<0.0001). Patients with C5 to C7 palsy achieved significantly stronger elbow extension than those with C5 to T1 palsy. In addition, the timing of surgery significantly influenced the final outcome. Elbow extension is one of big challenges to be restored, especially in obstetric brachial plexus palsy. In early cases (within 6 mo) intraplexus reconstruction of the posterior cord can give excellent results. In later cases, or in cases of multiple avulsions, extraplexus motor donors, which selectively targeted the triceps, can give variable results.

  15. Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications.

    PubMed

    Singh, Asha; Bahadorani, Bobby; Wakefield, Brett J; Makarova, Natalya; Kumar, Priya A; Tong, Michael Zhen-Yu; Sessler, Daniel I; Duncan, Andra E

    2017-06-01

    Brachial arterial catheters better estimate aortic pressure than radial arterial catheters but are used infrequently because complications in a major artery without collateral flow are potentially serious. However, the extent to which brachial artery cannulation promotes complications remains unknown. The authors thus evaluated a large cohort of cardiac surgical patients to estimate the incidence of related serious complications. The institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database and Perioperative Health Documentation System Registry of the Cleveland Clinic were used to identify patients who had brachial artery cannulation between 2007 and 2015. Complications within 6 months after surgery were identified by International Classification of Diseases, Ninth Revision diagnostic and procedural codes, Current Procedural Terminology procedure codes, and Society of Thoracic Surgeons variables. The authors reviewed electronic medical records to confirm that putative complications were related plausibly to brachial arterial catheterization. Complications were categorized as (1) vascular, (2) peripheral nerve injury, or (3) infection. The authors evaluated associations between brachial arterial complications and patient comorbidities and between complications and in-hospital mortality and duration of hospitalization. Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications. Peripheral arterial disease was associated with increased risk of complications. Brachial catheter complications were associated with prolonged hospitalization and in-hospital mortality. Brachial artery cannulation for

  16. Brachial plexopathy as a rare presenting manifestation of scorpion envenomation.

    PubMed

    Rubin, Devon I; Vavra, Michael

    2011-07-01

    We report a patient who experienced a rare manifestation of an acute, severe brachial plexopathy as the initial complication of scorpion (presumed Hemiscorpius lepturus species) envenomation. Features suggesting conduction block, due to either proximal demyelination or ion channel dysfunction, along with axonal loss were seen on serial electrophysiological studies. Possible mechanisms of the brachial plexopathy include direct compression from tissue edema or a toxic effect on the membrane channels along the nerve.

  17. Fractionation of hydrogen and deuterium on Venus due to collisional ejection

    NASA Technical Reports Server (NTRS)

    Gurwell, Mark A.; Yung, Yuk L.

    1993-01-01

    The collisional ejection process for hydrogen on Venus is reanalyzed. Improved values for the efficiency of H and D escape as a function of the ionospheric temperature are reported. It is proposed that the reduction of the hydrogen flux for collisional ejection be reduced from 8 to 3.5 x 10 exp 6/sq cm/s, and a revised D/H fractional factor of 0.47 due to collisional ejection is suggested. The resulting deuterium flux is 3.1 x 10 exp 4/sq cm/s, roughly six times the flux due to charge exchange, making collisional ejection the dominant escape mechanism for deuterium on Venus.

  18. Fractionation of hydrogen and deuterium on Venus due to collisional ejection

    NASA Astrophysics Data System (ADS)

    Gurwell, M. A.; Yung, Y. L.

    1993-02-01

    The collisional ejection process for hydrogen on Venus is reanalyzed. Improved values for the efficiency of H and D escape as a function of the ionospheric temperature are reported. It is proposed that the reduction of the hydrogen flux for collisional ejection be reduced from 8 to 3.5 x 10 exp 6/sq cm/s, and a revised D/H fractional factor of 0.47 due to collisional ejection is suggested. The resulting deuterium flux is 3.1 x 10 exp 4/sq cm/s, roughly six times the flux due to charge exchange, making collisional ejection the dominant escape mechanism for deuterium on Venus.

  19. Risk factors for clavicle fracture concurrent with brachial plexus injury.

    PubMed

    Karahanoglu, Ertugrul; Kasapoglu, Taner; Ozdemirci, Safak; Fadıloglu, Erdem; Akyol, Aysegul; Demirdag, Erhan; Yalvac, E Serdar; Kandemir, N Omer

    2016-04-01

    The aim of this study was to evaluate the risk factors for clavicle fracture concurrent with brachial plexus injuries. A retrospective study was conducted at a tertiary centre. The hospital records of 62,288 vaginal deliveries were evaluated retrospectively. There were 35 cases of brachial plexus injury. Of these patients, nine had brachial plexus injuries with clavicle fracture and 26 without clavicle fracture. The analysed risk factors for clavicle fracture concurrent with brachial plexus injury were gestational diabetes, labour induction and augmentation, prolonged second stage of labour, estimated foetal weight above 4000 g, birth weight above 4000 g, risky working hours, and the requirement of manoeuvres to free the impacted shoulder from behind the symphysis pubis. Labour augmentation with oxytocin increased the risk of clavicle fracture in cases of brachial plexus injury (OR 6.67; 95% CI 1.26-35.03). A birth weight higher than 4000 g also increased the risk of clavicle fracture. Risky working hours, gestational diabetes, estimated foetal weight higher than 4000 g, and requirement of shoulder dystocia manoeuvres did not increase the risk of clavicle fracture. Labour augmentation and actual birth weight higher than 4000 g were identified as risk factors for clavicle fracture in cases of brachial plexus injury.

  20. Limb preference in children with obstetric brachial plexus palsy.

    PubMed

    Yang, Lynda J-S; Anand, Praveen; Birch, Rolfe

    2005-07-01

    Brachial plexus palsy affects children differently than adults. In children with obstetric brachial plexus palsy, motor development must depend on nervous system adaptation. Previous studies report sensory plasticity in these children. This noninvasive study provides support for neural plasticity (the general ability of the brain to reorganize neural pathways based on new experiences) in children with obstetric brachial plexus palsy by considering upper limb preference. As in the general population, we expect that 90% of children would prefer their right upper limb. However, only 17% of children affected by right obstetric brachial plexus palsy prefer the right upper limb for overall movement; children with left obstetric brachial plexus palsy did not significantly differ from the general population in upper limb preference. This study also provides the first evidence of a significant correlation between actual task performance and select obstetric brachial plexus palsy outcome measurement systems, thereby justifying the routine use of these outcome measurement systems as a reflection of the practical utility of the affected limb to the patient.

  1. Factors affecting ejection risk in rollover crashes.

    PubMed

    Funk, James R; Cormier, Joseph M; Bain, Charles E; Wirth, Jeffrey L; Bonugli, Enrique B; Watson, Richard A

    2012-01-01

    Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 - 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size.

  2. Factors Affecting Ejection Risk in Rollover Crashes

    PubMed Central

    Funk, James R.; Cormier, Joseph M.; Bain, Charles E.; Wirth, Jeffrey L.; Bonugli, Enrique B.; Watson, Richard A.

    2012-01-01

    Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 – 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size. PMID:23169130

  3. Vibration sensation as an indicator of surgical anesthesia following brachial plexus block

    PubMed Central

    Jindal, Seema; Sidhu, Gurkaran Kaur; Sood, Dinesh; Grewal, Anju

    2016-01-01

    Background: Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power. Materials and Methods: This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach. The baseline values of vibration sense perception using 128 Hz Rydel–Seiffer tuning fork, motor power using formal motor power of wrist flexion and wrist extension, and sensory score by pinprick method were recorded preoperatively and every 5 min after giving block till the onset of complete surgical anesthesia. Results: The mean ± standard deviation of time (in minutes) for sensory, motor, and vibration block was 13.33 ± 3.26, 21.10 ± 3.26, and 25.50 ± 2.02, respectively (P < 0.05). Although all the patients achieved complete sensory and motor block after 25 min, 14% of the patients still had vibration sensations intact and 100% of the patients achieved complete sensory, motor, and vibration block after 30 min. Conclusions: Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel–Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block. PMID:27833488

  4. Shoulder function following primary axillary nerve reconstruction in obstetrical brachial plexus patients.

    PubMed

    Terzis, Julia K; Kokkalis, Zinon T

    2008-11-01

    In obstetrical brachial plexus palsy, suprascapular nerve reinnervation is a priority. For the most favorable outcomes in shoulder function, it is the authors' policy to also reconstruct the axillary nerve with intraplexus donors to the posterior cord (early cases) or directly with intraplexus or extraplexus motor donors (late cases). Between 1979 and 2003, 80 consecutive patients (82 brachial plexuses) underwent plexus exploration and nerve reconstruction for obstetrical palsy. Axillary nerve reconstruction was performed in 60 plexuses, and evaluation of the results was carried out for 55 patients (56 plexuses) with adequate follow-up (mean follow-up, 6.5 years). Overall, there were good and excellent results (>/=M3+) in 49 of 56 plexuses (87.5 percent) for the deltoid muscle, and the average postoperative muscle grade for the deltoid was 3.89 +/- 0.79. The average shoulder abduction increased from 35 +/- 31 degrees preoperatively to 109 +/- 35 degrees postoperatively (average gain, 74 degrees), and the average external rotation increased from -13 +/- 28 degrees preoperatively to 47 +/- 18 degrees postoperatively (average gain, 60 degrees). The timing of surgery and the type of paralysis significantly influenced the final outcome. Reconstruction of the axillary nerve should always be performed to maximize the final outcome of shoulder function in obstetrical brachial plexus patients. The best results were seen in early cases (

  5. Early post-operative results after repair of traumatic brachial plexus palsy.

    PubMed

    Mohammad-Reda, Ahmad

    2013-01-01

    Treatment options for traumatic brachial plexus injuries include nerve grafting, or neurotization. The type of lesion and the reconstructive procedures affect functional results and postoperative pain relief. A total number of twenty five patients suffering from post-traumatic brachial plexus injury were included in the study. The patients underwent exploration and primary repair of the affected plexus, based on case by case policy. Spinal accessory nerve transfer to suprascapular nerve procedure regained 78.95% of functional muscle power, 10.50% of non functional muscle power and only 10.5 % of non innervated muscle. The Oberlin procedure regained 83.33% with elbow flexion muscle power, 16.67% with non functional muscle power. Intercostal nerve transfer to musculocutaneous nerve regained 62.5% with functional muscle power, 25% with non functional muscle power and only 12.5 % with non innervated muscle. The shoulder, elbow and wrist extension functions were significantly improved early post-operatively. In addition, the post-operative improvement of shoulder, elbow and wrist extension functions had significant negative correlations with the pre-operative elapsed time, and accompanied by a significant positive correlation with post-operative follow up period. Early intervention for traumatic brachial plexus palsy is recommended to get good results with pain relief.

  6. Prospective evaluation of ischemia in brachial-basilic and forearm prosthetic arteriovenous fistulas for hemodialysis.

    PubMed

    Keuter, X H A; Kessels, A G H; de Haan, M H; van der Sande, F M; Tordoir, J H M

    2008-05-01

    Ischemia is a devastating complication after arteriovenous fistula (AVF) creation. When not timely corrected, it may lead to amputation. Symptomatic ischemia occurs in 3.7-5% of the hemodialysis population. Upper arm AVFs have a higher incidence of ischemia compared to forearm AVFs. As more patients may need upper arm AVFs in the growing and older hemodialysis population, occurrence of symptomatic ischemia may increase. The purpose of this study is to identify predictors for occurrence of ischemia. A prospective evaluation of ischemia was performed in patients randomised for either a brachial-basilic (BB-) AVF or a prosthetic forearm loop AVF. Clinical parameters, preoperative vessel diameters, access flows, digital blood pressures, digit-to-brachial indices (DBI) and interventions for ischemia were recorded. Sixty-one patients (BB-AVF 28) were studied. Seventeen patients (BB-AVF 8) developed ischemic symptoms. Six patients (BB-AVF 3) needed interventions for severe symptoms. Age, history of peripheral arterial reconstruction and radial artery volume flow were significant predictors for the occurrence of ischemia. Symptomatic ischemia occurred in 28% of patients with brachial-basilic and prosthetic forearm AVFs. Age, history of peripheral arterial reconstruction and radial artery volume flow might be important for prediction of ischemia.

  7. Results of ulnar nerve neurotization to biceps brachii muscle in brachial plexus injury

    PubMed Central

    Rezende, Marcelo Rosa De; Rabelo, Neylor Teofilo Araújo; Silveira, Clóvis Castanho; Petersen, Pedro Araújo; Paula, Emygdio José Leomil De; Mattar, Rames

    2012-01-01

    OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachii biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachii biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term. Level of Evidence: IV, Case Series. PMID:24453624

  8. Non-Sedated Rapid Volumetric Proton Density MRI Predicts Neonatal Brachial Plexus Birth Palsy Functional Outcome.

    PubMed

    Shen, Peter Y; Nidecker, Anna E; Neufeld, Ethan A; Lee, Paul S; James, Michelle A; Bauer, Andrea S

    2017-03-01

    The current prognostic biomarker of functional outcome in brachial plexus birth palsy is serial clinical examination throughout the first 6 months of age. This can delay surgical treatment and prolong parental anxiety in neonates who will recover spontaneously. A potentially superior biomarker is a volumetric proton density MRI performed at clinical presentation and within the first 12 weeks of life, providing a high spatial and contrast resolution examination in 4 minutes. Nine neonates ranging in age from 4 to 9 weeks who presented with brachial plexus birth palsy were enrolled. All subjects underwent non-sedated 3 Tesla MRI with Cube Proton Density MRI sequence at the same time as their initial clinical visit. Serial clinical examinations were conducted at routine 4 week intervals and the functional performance scores were recorded. MRI findings were divided into pre-ganglionic and post-ganglionic injuries and a radiological scoring system (Shriners Radiological Score) was developed for this study. Proton Density MRI was able to differentiate between pre-ganglionic and post-ganglionic injuries. Radiological scores (Shriners Radiological Score) correlated better with functional performance at 6 months of age (P = .022) than the initial clinical examinations (Active Movement Scale P = .213 and Toronto P = .320). Rapid non-sedated volumetric Cube Proton Density MRI protocol performed at initial clinical presentation can accurately grade severity of brachial plexus birth palsy injury and predict functional performance at 6 months of age. Copyright © 2016 by the American Society of Neuroimaging.

  9. Electronic circuit detects left ventricular ejection events in cardiovascular system

    NASA Technical Reports Server (NTRS)

    Gebben, V. D.; Webb, J. A., Jr.

    1972-01-01

    Electronic circuit processes arterial blood pressure waveform to produce discrete signals that coincide with beginning and end of left ventricular ejection. Output signals provide timing signals for computers that monitor cardiovascular systems. Circuit operates reliably for heart rates between 50 and 200 beats per minute.

  10. Mass ejections. [during solar flares

    NASA Technical Reports Server (NTRS)

    Rust, D. M.; Hildner, E.; Hansen, R. T.; Dryer, M.; Mcclymont, A. N.; Mckenna-Lawlor, S. M. P.; Mclean, D. J.; Schmahl, E. J.; Steinolfson, R. S.; Tandberg-Hanssen, E.

    1980-01-01

    Observations and model simulations of solar mass ejection phenomena are examined in an investigation of flare processes. Consideration is given to Skylab and other observations of flare-associated sprays, eruptive prominences, surges and coronal transients, and to MHD, gas dynamic and magnetic loop models developed to account for them. Magnetic forces are found to confine spray material, which originates in preexisting active-region filaments, within steadily expanding loops, while surges follow unmoving, preexisting magnetic field lines. Simulations of effects of a sudden pressure pulse at the bottom of the corona are found to exhibit many characteristics of coronal transients associated with flares, and impulsive heating low in the chromosphere is found to be able to account for surges. The importance of the magnetic field as the ultimate source of energy which drives eruptive phenomena as well as flares is pointed out.

  11. Modeling Interplanetary Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Riley, Pete

    2004-01-01

    Heliospheric models of Coronal Mass Ejection (CME) propagation and evolution provide an important insight into the dynamics of CMEa and are a valuable tool for interpreting interplanetary in situ observations. Moreover, they represent a virtual laboratory for exploring conditions and regions of space that are not conveniently or currently accessible by spacecraft. In this review I summarize recent advances in modeling the properties and evolution of CMEs in the solar wind. In particular, I will focus on: (1) the types of ICME models; (2) the boundary conditions that are imposed, (3) the role of the ambient solar wind; (4) predicting new phenomena; and (5) distinguishing between competing CME initiation mechanisms. I will conclude by discussing what topics will likely be important for models to address in the future.

  12. Uniform description of polymer ejection dynamics from capsid with and without hydrodynamics

    NASA Astrophysics Data System (ADS)

    Piili, J.; Suhonen, P. M.; Linna, R. P.

    2017-05-01

    We use stochastic rotation dynamics (SRD) to examine the dynamics of the ejection of an initially strongly confined flexible polymer from a spherical capsid with and without hydrodynamics. The results obtained using stochastic rotation dynamics (SRD) are compared to similar Langevin simulations. Inclusion of hydrodynamic modes speeds up the ejection but also allows the part of the polymer outside the capsid to expand closer to equilibrium. This shows as higher values of radius of gyration when hydrodynamics are enabled. By examining the waiting times of individual polymer beads, we find that the waiting time tw grows with the number of ejected monomers s as a sum of two exponents. When ≈63 % of the polymer has ejected, the ejection enters the regime of slower dynamics. The functional form of tw versus s is universal for all ejection processes starting from the same initial monomer densities. Inclusion of hydrodynamics only reduces its magnitude. Consequently, we define a universal scaling function h such that the cumulative waiting time t =N0h (s /N0) for large N0. Our unprecedentedly precise measurements of force indicate that this form for tw(s ) originates from the corresponding force toward the pore decreasing superexponentially at the end of the ejection. Our measured tw(s ) explains the apparent superlinear scaling of the ejection time with the polymer length for short polymers. However, for asymptotically long polymers, tw(s ) predicts linear scaling.

  13. Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff.

    PubMed

    Trachet, B; Reymond, P; Kips, J; Swillens, A; De Buyzere, M; Suys, B; Stergiopulos, N; Segers, P

    2010-03-01

    Recently a new method has been proposed as a tool to measure arterial pulse wave velocity (PWV), a measure of the stiffness of the large arteries and an emerging parameter used as indicator of clinical cardiovascular risk. The method is based on measurement of brachial blood pressure during supra-systolic pressure inflation of a simple brachial cuff [the device is known as the Arteriograph (Tensiomed, Budapest, Hungary)]. This occlusion yields pronounced first and secondary peaks in the pressure waveform, the latter ascribed to a reflection from the aortic bifurcation, and PWV is calculated as the ratio of twice the jugulum-symphysis distance and the time difference between the two peaks. To test the validity of this working principle, we used a numerical model of the arterial tree to simulate pressures and flows in the normal configuration, and in a configuration with an occluded brachial artery. A pronounced secondary peak was indeed found in the brachial pressure signal of the occluded model, but its timing was only related to brachial stiffness and not to aortic stiffness. We also compared PWV's calculated with three different methods: PWVATG (approximately Arteriograph principle), PWVcar-fem (approximately carotid-femoral PWV, the current clinical gold standard method), and PWVtheor (approximately Bramwell-Hill equation). Both PWVATG (R2=0.94) and PWVcar-fem (R2=0.95) correlated well with PWVtheor, but their numerical values were lower (by 2.17+/-0.42 and 1.08+/-0.70 m/s for PWVATG and PWVcar-fem, respectively). In conclusion, our simulations question the working principle of the Arteriograph. Our data indicate that the method picks up wave reflection phenomena confined to the brachial artery, and derived values of PWV rather reflect the stiffness of the brachial arteries.

  14. Flux Accretion and Coronal Mass Ejection Dynamics

    NASA Astrophysics Data System (ADS)

    Welsch, Brian

    2017-08-01

    Coronal mass ejections (CMEs) are the primary drivers of severe space weather disturbances in the heliosphere. The equations of ideal magnetohydrodynamics (MHD) have been used to model the onset and, in some cases, the subsequent acceleration of ejections. Both observations and numerical modeling, however, suggest that magnetic reconnection likely plays a major role in most, if not all, fast CMEs. Here, we theoretically investigate the dynamical effects of accretion of magnetic flux onto a rising ejection by reconnection involving the ejection's background field. This reconnection alters the magnetic structure of the ejection and its environment, thereby modifying forces acting during the eruption, generically leading to faster acceleration of the CME. Our ultimate aim is to characterize changes in CME acceleration in terms of observable properties of magnetic reconnection, such as the amount of reconnected flux, deduced from observations of flare ribbons and photospheric magnetic fields.

  15. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    SciTech Connect

    Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel; Farwell, D. Gregory; Lau, Derick H.; Purdy, James A.

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

  16. Morphology of brachial plexus and axillary artery in bonobo (Pan paniscus).

    PubMed

    Kikuchi, Y; Oishi, M; Shimizu, D

    2011-02-01

    A left brachial plexus and axillary artery of bonobo (Pan paniscus) were examined, and the interrelation between the brachial plexus and the axillary artery was discussed. This is the first report of the brachial plexus and the axillary artery of bonobo. The bonobo brachial plexus formed very similar pattern to that of other ape species and human. On the other hand, the branches of the bonobo axillary artery had uncommon architecture in comparison with human case. The axillary artery did not penetrate the brachial plexus and passes through all way along anterior to the brachial plexus. Only 4.9% of human forelimbs have this pattern. Moreover, the brachial artery runs through superficially anterior to branches of the brachial plexus.

  17. Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report.

    PubMed

    Ferrero-Manzanal, Francisco; Lax-Pérez, Raquel; López-Bernabé, Roberto; Betancourt-Bastidas, José Ramiro; Iñiguez de Onzoño-Pérez, Alvaro

    2016-01-01

    Shoulder surgery is often performed with the patient in the so called "beach-chair position" with elevation of the upper part of the body. The anesthetic procedure can be general anesthesia and/or regional block, usually interscalenic brachial plexus block. We present a case of brachial plexus palsy with a possible mechanism of traction based on the electromyographic and clinical findings, although a possible contribution of nerve block cannot be excluded. We present a case of a 62 year-old female, that suffered from shoulder fracture-dislocation. Open reduction and internal fixation were performed in the so-called "beach-chair" position, under combined general-regional anesthesia. In the postoperative period complete motor brachial plexus palsy appeared, with neuropathic pain. Conservative treatment included analgesic drugs, neuromodulators, B-vitamin complex and physiotherapy. Spontaneous recovery appeared at 11 months. DISCUSION: in shoulder surgery, there may be complications related to both anesthetic technique and patient positioning/surgical maneuvers. Regional block often acts as a confusing factor when neurologic damage appears after surgery. Intraoperative maneuvers may cause eventual traction of the brachial plexus, and may be favored by the fixed position of the head using the accessory of the operating table in the beach-chair position. When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Sizes and locations of coronal mass ejections - SMM observations from 1980 and 1984-1989

    NASA Technical Reports Server (NTRS)

    Hundhausen, A. J.

    1993-01-01

    A statistical description of the sizes and locations of 1209 mass ejections observed with the SMM coronagraph/polarimeter in 1980 and 1984-1989 is presented. The average width of the coronal mass ejections detected with this instrument was close to 40 deg in angle for the entire period of SMM observations. No evidence was found for a significant change in mass ejection widths as reported by Howard et al. (1986). There is clear evidence for changes in the latitude distribution of mass ejections over this epoch. Mass ejections occurred over a much wider range of latitudes at the times of high solar activity (1980 and 1989) than at times of low activity (1985-1986).

  19. Sizes and locations of coronal mass ejections - SMM observations from 1980 and 1984-1989

    NASA Technical Reports Server (NTRS)

    Hundhausen, A. J.

    1993-01-01

    A statistical description of the sizes and locations of 1209 mass ejections observed with the SMM coronagraph/polarimeter in 1980 and 1984-1989 is presented. The average width of the coronal mass ejections detected with this instrument was close to 40 deg in angle for the entire period of SMM observations. No evidence was found for a significant change in mass ejection widths as reported by Howard et al. (1986). There is clear evidence for changes in the latitude distribution of mass ejections over this epoch. Mass ejections occurred over a much wider range of latitudes at the times of high solar activity (1980 and 1989) than at times of low activity (1985-1986).

  20. [Treatment of early and late obstetric brachial plexus palsy].

    PubMed

    Degliūte, Ramune; Pranckevicius, Sigitas; Cekanauskas, Emilis; Buinauskiene, Jūrate; Kalesinskas, Romas Jonas

    2004-01-01

    The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.

  1. Observation of particle ejection behavior following laser-induced breakdown on the rear surface of a sodium chloride optical window

    NASA Astrophysics Data System (ADS)

    Shen, Chao; Cheng, Xiang'ai; Xu, Zhongjie; Wei, Ke; Jiang, Tian

    2017-01-01

    Laser-induced rear surface breakdown process of sodium chloride (NaCl) optical window was investigated based on the time-resolved shadowgraphy and interferometry. Violent particle ejection behavior lasting from tens of nanoseconds to tens of microseconds after the breakdown was observed. Classified by the particle velocity and propagating direction, the ejection process can be divided into three phases: (1) high-speed ejection of liquid particles during the first 100-ns delay; (2) micron-sized material clusters ejection from ˜100-ns to ˜1-μs delay; (3) larger and slower solid-state particles ejection from ˜1 μs to tens of microseconds delay. The moving directions of particles in the first and third phases are both perpendicular to the sample surface while particles ejected in the second phase exhibits angular ejection and present a V-like particle pattern. Mechanisms include explosive boiling, impact ejection, and shockwave ejection are discussed to explain this multiple phase ejection behavior. Our results highlight the significance of impact ejection induced by recoil pressure and backward propagating internal shockwave for laser-induced rear surface breakdown events of optical materials with low melting point.

  2. A smart pinless ejection mechanism using dual-resonance excitation Langevin piezoelectric transducers

    NASA Astrophysics Data System (ADS)

    Wang, Yu-Jen; Fu, Kuo-Chieh; Wang, Chun-Chieh

    2016-01-01

    This study investigated a smart pinless ejection mechanism comprising two dual-resonance excitation Langevin piezoelectric transducers (DRELPTs) for keeping the injection parts intact and protecting their top and bottom surfaces from scarring during plastic injection molding. The dimensions of each DRELPT were determined using longitudinal vibration models, and an optimization method was used to set the frequency ratio of the first to the second longitudinal mode to 1:2. This concept enables the driving of DRELPT in its two longitudinal modes consistent with the ejection direction in resonant-type smooth impact drive mechanisms. During the ejection process, DRELPT provides an ejection force, which is applied on the sidewalls of the injection parts to protect their top and bottom surfaces from scarring. Considering individual differences in the resonance frequencies of DRELPTs, a resonance frequency tracking circuit based on a phase-locked loop was designed to keep DRELPT actuating in resonance. The ejection velocity of the injection part was estimated using the kinetic models derived from the dynamic behavior of the mold cavity and injection parameters. A characteristic number S was defined to evaluate the average velocity of the injection part during ejection. Proof-of-concept experimental results of the pinless ejection mechanism are presented. The ejection time, that is, the time from triggering the composite wave to the full departure of the injection part from the mold cavity, was 72 ms.

  3. Analgesic Effects and Neuropathology Changes of Electroacupuncture on Curing a Rat Model of Brachial Plexus Neuralgia Induced by Cobra Venom.

    PubMed

    Liu, Hui; Qian, Xiao-Yan; An, Jian-Xiong; Liu, Cai-Cai; Jiang, Yi-De; Cope, Doris K; Williams, John P

    2016-03-01

    Electroacupuncture (EA) is widely applied to treat neuropathic pain. Brachial plexus neuralgia (BPN) is a common form of chronic persistent pain. Few studies have evaluated the analgesic effects and mechanism of EA using the novel animal model of BPN. To observe the curative effects of repeated EA on curing BPN induced by administration of cobra venom to the lower trunk of the right brachial plexus. Controlled animal study. Department of Anesthesiology, Pain Medicine & Critical Care Medicine, Aviation General Hospital of China Medical University. Sixty-six adult male Sprague-Dawley rats were equally and randomly divided into the following groups: normal control (NC), brachial plexus neuralgia (BPN), BPN with sham EA stimulation, BPN with EA stimulation starting on postoperative day 1 (EA1), and BPN with EA stimulation starting on postoperative day 12 (EA12). The BPN model was established by administration of cobra venom to the lower trunk of the right brachial plexus. On postoperative day 1 or day 12, EA (constant aquare wave, 2 Hz and 100 Hz alternating frequencies, intensities ranging from 1 - 1.5 - 2 mA) was applied to the right "Shousanli" (LI10) and "Quchi" (LI11) acupoints for 30 minutes, once every other day for 12 times in both groups. Mechanical withdrawal thresholds (MWT) were tested with von Frey filaments. Video recordings were conducted to analyze the spontaneous exploratory behaviors. Moreover, the organizational and structural alterations of the right brachial plexus and cervical cord (C8-T1) were examined via light and electron microscopy. Following the production of the BPN model, the MWT of both ipsilateral and contralateral paws demonstrated a profound decrease (P < 0.05). But after EA interventions, the MWT showed a significant increase (P < 0.05). In comparison to the EA12 group, the analgesic effects of the EA1 group were more significant, and similar results were observed in exploratory behaviors. However, grooming behaviors did not

  4. Initiation of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Moore, Ronald L.; Sterling, Alphonse C.

    2005-01-01

    This paper is a synopsis of the initiation of the strong-field magnetic explosions that produce large, fast coronal mass ejections. Cartoons based on observations are used to describe the inferred basic physical processes and sequences that trigger and drive the explosion. The magnetic field that explodes is a sheared-core bipole that may or may not be embedded in surrounding strong magnetic field, and may or may not contain a flux rope before it starts to explode. We describe three different mechanisms that singly or in combination trigger the explosion: (1) runaway internal tether-cutting reconnection, (2) runaway external tether-cutting reconnection, and (3) ideal MHD instability or loss or equilibrium. For most eruptions, high-resolution, high-cadence magnetograms and chromospheric and coronal movies (such as from TRACE and/or Solar-B) of the pre-eruption region and of the onset of the eruption and flare are needed to tell which one or which combination of these mechanisms is the trigger. Whatever the trigger, it leads to the production of an erupting flux rope. Using a simple model flux rope, we demonstrate that the explosion can be driven by the magnetic pressure of the expanding flux rope, provided the shape of the expansion is "fat" enough.

  5. Models for coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Jacobs, Carla; Poedts, Stefaan

    2011-06-01

    Coronal mass ejections (CMEs) play a key role in space weather. The mathematical modelling of these violent solar phenomena can contribute to a better understanding of their origin and evolution and as such improve space weather predictions. We review the state-of-the-art in CME simulations, including a brief overview of current models for the background solar wind as it has been shown that the background solar wind affects the onset and initial evolution of CMEs quite substantially. We mainly focus on the attempt to retrieve the initiation and propagation of CMEs in the framework of computational magnetofluid dynamics (CMFD). Advanced numerical techniques and large computer resources are indispensable when attempting to reconstruct an event from Sun to Earth. Especially the simulations developed in dedicated event studies yield very realistic results, comparable with the observations. However, there are still a lot of free parameters in these models and ad hoc source terms are often added to the equations, mimicking the physics that is not really understood yet in detail.

  6. Initiation of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Moore, Ronald L.; Sterling, Alphonse C.

    2005-01-01

    This paper is a synopsis of the initiation of the strong-field magnetic explosions that produce large, fast coronal mass ejections. Cartoons based on observations are used to describe the inferred basic physical processes and sequences that trigger and drive the explosion. The magnetic field that explodes is a sheared-core bipole that may or may not be embedded in surrounding strong magnetic field, and may or may not contain a flux rope before it starts to explode. We describe three different mechanisms that singly or in combination trigger the explosion: (1) runaway internal tether-cutting reconnection, (2) runaway external tether-cutting reconnection, and (3) ideal MHD instability or loss or equilibrium. For most eruptions, high-resolution, high-cadence magnetograms and chromospheric and coronal movies (such as from TRACE and/or Solar-B) of the pre-eruption region and of the onset of the eruption and flare are needed to tell which one or which combination of these mechanisms is the trigger. Whatever the trigger, it leads to the production of an erupting flux rope. Using a simple model flux rope, we demonstrate that the explosion can be driven by the magnetic pressure of the expanding flux rope, provided the shape of the expansion is "fat" enough.

  7. Characteristics of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Talukder, F.; Marchese, A. K.; Tulsee, T.

    2014-12-01

    A coronal mass ejection (CME) is a release of charged particles resulting from solar activity. These charged particles can affect electronics on spacecraft, airplanes, global positioning systems, and communication satellites. The purpose of this research was to study CME data from satellites and correlate these to other properties. Solar wind data collected by STEREO A/B and ACE satellites were analyzed. The data consisted of solar wind flux for various elements (helium through iron), as well as the components of the interplanetary magnetic field. CME events are known to cause a surge in the helium flux, as well as other particles. It is hypothesized that a CME event will cause an increase in the number of lighter elements relative to heavier particles. This is because for a given input of energy, lighter elements are expected to be accelerated to a greater extent than heavier elements. A significant increase was observed in the ratio between helium to oxygen (He/O) prior to intense CMEs. A CME event on November 4, 2003 caused an eleven-fold increase in the He/O ratio, while for another event on April 2, 2001 the He/O ratio increased from 80 to 700. A significant increase in He/O ratio is not observed during weaker CMEs. Furthermore, it was also observed that not all increases in the ratio were accompanied by CMEs. The increase in He/O ratio prior to the CME arrival might be used as a way to predict future events.

  8. Oberlin's ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results.

    PubMed

    Noaman, Hassan Hamdy; Shiha, Anis Elsayed; Bahm, Jörg

    2004-01-01

    We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left-side brachial plexus was affected in 4 patients, and the right side in 3 patients. All children had vaginal delivery; two of them presented with shoulder dystocia. The average birth weight was 4300 g (range, 3620-5500 g). Average age at time of operation was 16 months (range, 11-24 months). The indication for the operation was absent active elbow flexion with active shoulder abduction against gravity in 4 cases, and no biceps function and bad shoulder function in 3 cases. Oberlin's ulnar nerve transfer was done in 4 cases without brachial plexus exploration in those children with good shoulder function, and exploration of the brachial plexus was performed in the other 3 cases with bad shoulder function. The average follow-up was 19 months (range, 13-30 months). Five children had biceps muscle >or=M(3) with active elbow flexion against gravity, and 2 children had biceps muscle brachial plexus palsy in 1). breech delivery with avulsion of C5 and C6 nerve roots,) late presentation with good recovery of shoulder function, and 3). neuroma-in-continuity of the upper trunk with intraoperative good nerve conduction for the shoulder muscles, the same as preoperative good shoulder function but with no biceps action. Copyright 2004 Wiley-Liss, Inc.

  9. Discovery of collimated ejection from the symbiotic binary BF Cygni

    NASA Astrophysics Data System (ADS)

    Skopal, A.; Tomov, N. A.; Tomova, M. T.

    2013-03-01

    Context. Detection of collimated ejection from white dwarfs (WD) in symbiotic binaries is very rare and has employed a variety of methods in X-ray, radio, optical imagery, and spectroscopy. To date, its signature in the optical spectra has only been recorded for four objects (MWC 560, Hen 3-1341, StHα 190, and Z And). Aims: We present the first observational evidence of highly-collimated bipolar ejection from the symbiotic binary BF Cyg, which developed during its current (2006-12) active phase, and determine their physical parameters. Methods: We monitored the outburst with the optical high-resolution spectroscopy and multicolour UBVRCIC photometry. Results: During 2009, three years after the 2006-eruption of BF Cyg, satellite components to Hα and Hβ lines emerged in the spectrum. During 2012, they became stable and were located symmetrically with respect to the main emission core of the line. Spectral properties of these components suggest bipolar ejection collimated within an opening angle of ≲15°, whose radiation is produced by an optically thin medium with the emission measure of 1-2 × 1059 (d/3.8 kpc)2 cm-3. Conclusions: Formation of the collimated ejection a few years after the eruption and its evolution on a time scale of years at a constant optical brightness can aid us in better understanding the accretion process during the active phases of symbiotic stars. Based on data collected with 2-m telescope at the Rozhen National Astronomical Observatory and the David Dunlap Observatory.

  10. Constraints on the original ejection velocity fields of asteroid families

    NASA Astrophysics Data System (ADS)

    Carruba, V.; Nesvorný, D.

    2016-04-01

    Asteroid families form as a result of large-scale collisions among main belt asteroids. The orbital distribution of fragments after a family-forming impact could inform us about their ejection velocities. Unfortunately, however, orbits dynamically evolve by a number of effects, including the Yarkovsky drift, chaotic diffusion, and gravitational encounters with massive asteroids, such that it is difficult to infer the ejection velocities eons after each family's formation. Here, we analyse the inclination distribution of asteroid families, because proper inclination can remain constant over long time intervals, and could help us to understand the distribution of the component of the ejection velocity that is perpendicular to the orbital plane (vW). From modelling the initial break up, we find that the distribution of vW of the fragments, which manage to escape the parent body's gravity, should be more peaked than a Gaussian distribution (i.e. be leptokurtic) even if the initial distribution was Gaussian. We surveyed known asteroid families for signs of a peaked distribution of vW using a statistical measure of the distribution peakedness or flatness known as kurtosis. We identified eight families whose vW distribution is significantly leptokurtic. These cases (e.g. the Koronis family) are located in dynamically quiet regions of the main belt, where, presumably, the initial distribution of vW was not modified by subsequent orbital evolution. We suggest that, in these cases, the inclination distribution can be used to obtain interesting information about the original ejection velocity field.

  11. Primary Brachial Plexus Tumors: Clinical Experiences of 143 Cases.

    PubMed

    Jia, Xiaotian; Yang, Jianyun; Chen, Lin; Yu, Cong; Kondo, Tadashi

    2016-09-01

    Primary brachial plexus tumors are extremely rare and the treatment is challengeable. Our aim is to share the experiences in the treatment of primary brachial plexus tumors. A retrospective analysis of 143 patients with primary brachial plexus tumors was made in our department from January 2001 to December 2012. The clinical presentation of the patients, the characteristics and pathological results of the tumors and the prognosis were described. Seventy-eight males and sixty-five female were enrolled. The mean age was 48.17 years old. A palpable mass was the most common clinical presentation occurred in 129 patients. The trunks of the brachial plexus were the locations where the tumors originated with high possibility, with 68 cases. Benign tumors were composed of 119 schwannomas and 12 neurofibromas, while malignant tumors were composed of 8 malignant peripheral nerve sheath tumors, 2 malignant granular cell tumors, 1 synovial sarcoma and 1 peripheral primitive neuroectodermal tumor. Appropriate surgical method, radiotherapy and chemotherapy were used according to the condition during operation, preoperative examinations and pathological result. The survival rate was 50.00% with a 3-year follow-up. Local recurrence happened in 7 patients. Five patients presented Metastasis. Appropriate surgical method is the key for the treatment of different brachial plexus tumors. Surgery has a great effect on the treatment of benign tumors. For malignant tumors, adjuvant radiotherapy or chemotherapy should be used according to the pathological result. The general prognosis for malignant brachial plexus tumors is less than ideal. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. An Analysis of Complications of Brachial and Axillary Artery Punctures.

    PubMed

    Tong, Zhu; Gu, Yongquan; Guo, Lianrui; Guo, Jianming; Gao, Xixiang; Li, Jianxin; Wang, Zhonggao; Zhang, Jian

    2016-12-01

    To examine the complications of brachial and axillary artery punctures and the precautionary measures taken to lower their incidences. Retrospective analysis of 266 cases of brachial and axillary artery punctures was performed for angiography or angioplasty between January 2009 and December 2013 at the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University. Complications and their causes were assessed. Among all brachial artery punctures (n = 140), there were complications in 3.6 per cent of cases, including local hematoma in 1.4 per cent, pseudoaneurysm in 0.7 per cent, acute arterial thrombosis in 0.7 per cent, and median nerve injury in 0.7 per cent. Among all axillary artery punctures (n = 126), there were complications in 10.3 per cent of cases, including local hematoma in 4.8 per cent, pseudoaneurysm in 0.8 per cent, acute arterial thrombosis in 0.8 per cent, acute venous thrombosis in 0.8 per cent, and nerve injury in 3.2 per cent. The incidence of complications was significantly lower in brachial axillary artery puncture compared with axillary artery puncture (P < 0.05). The main factors associated with complications might be patient's vascular condition, perioperative medication, anatomical features of the artery, puncture site, successful rate of first-attempt puncture, and bandage strength. Incidence of complications of brachial and axillary artery punctures could be lowered by strengthening the choice of indications, improving the perioperative managements, being fully aware of the anatomical characteristics of the brachial and axillary arteries, and applying the standardized techniques of puncture and compression hemostasis.

  13. Permanent upper trunk plexopathy after interscalene brachial plexus block.

    PubMed

    Avellanet, Merce; Sala-Blanch, Xavier; Rodrigo, Lidia; Gonzalez-Viejo, Miguel A

    2016-02-01

    Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia.

  14. Treatment of peripheral arterial disease via percutaneous brachial artery access.

    PubMed

    Franz, Randall W; Tanga, Christopher F; Herrmann, Joseph W

    2017-08-01

    This review was conducted to evaluate the types of endovascular procedures that can be performed via brachial artery access, evaluate the access success rate, and determine the incidence of technical complications. A retrospective 10-year record review at a tertiary facility from January 1, 2005, through June 30, 2015, was completed. Patients who underwent attempted brachial artery access were eligible for review. Outcomes intended to be evaluated included ability to access the vessel, reach an identified lesion, and perform an indicated procedure, while describing the incidence and type of complications that occurred to clarify the utility and safety of brachial artery access. The review included 265 access cases in 179 patients. The access success rate was 98.9%. Intervention was performed in 223 cases (84.2%). Angioplasty was the most common intervention (59%, [154 cases]), with stents, atherectomy, coiling, and percutaneous thrombectomy having also been performed. Complications included hematoma (2.3%) and pseudoaneurysm (1.5%). Complications requiring intervention occurred in 1.9% of procedures. Interventions were performed on all major vessels as distal as the dorsalis pedis. Sheath sizes ranged from 4F to 7F. Intervention was performed on bilateral lower extremities in 38 cases (14.5%). A femoral bypass graft was present in 141 patients (53%) as the main indication for brachial artery access. Brachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated

  15. Two billion years of magmatism recorded from a single Mars meteorite ejection site

    PubMed Central

    Lapen, Thomas J.; Righter, Minako; Andreasen, Rasmus; Irving, Anthony J.; Satkoski, Aaron M.; Beard, Brian L.; Nishiizumi, Kunihiko; Jull, A. J. Timothy; Caffee, Marc W.

    2017-01-01

    The timing and nature of igneous activity recorded at a single Mars ejection site can be determined from the isotope analyses of Martian meteorites. Northwest Africa (NWA) 7635 has an Sm-Nd crystallization age of 2.403 ± 0.140 billion years, and isotope data indicate that it is derived from an incompatible trace element–depleted mantle source similar to that which produced a geochemically distinct group of 327- to 574-million-year-old “depleted” shergottites. Cosmogenic nuclide data demonstrate that NWA 7635 was ejected from Mars 1.1 million years ago (Ma), as were at least 10 other depleted shergottites. The shared ejection age is consistent with a common ejection site for these meteorites. The spatial association of 327- to 2403-Ma depleted shergottites indicates >2 billion years of magmatism from a long-lived and geochemically distinct volcanic center near the ejection site. PMID:28164153

  16. Compressed wormlike chain moving out of confined space: A model of DNA ejection from bacteriophage

    NASA Astrophysics Data System (ADS)

    Wang, Ji-Zeng; Li, Long; Gao, Hua-Jian

    2012-08-01

    The molecular biomechanics of DNA ejection from bacteriophage is of interest to not only fundamental biological understandings but also practical applications such as the design of advanced site-specific and controllable drug delivery systems. In this paper, we analyze the viscous motion of a semiflexible polymer chain coming out of a strongly confined space as a model to investigate the effects of various structure confinements and frictional resistances encountered during the DNA ejection process. The theoretically predicted relations between the ejection speed, ejection time, ejection length, and other physical parameters, such as the phage type, total genome length and ionic state of external buffer solutions, show excellent agreement with in vitro experimental observations in the literature.

  17. Two billion years of magmatism recorded from a single Mars meteorite ejection site.

    PubMed

    Lapen, Thomas J; Righter, Minako; Andreasen, Rasmus; Irving, Anthony J; Satkoski, Aaron M; Beard, Brian L; Nishiizumi, Kunihiko; Jull, A J Timothy; Caffee, Marc W

    2017-02-01

    The timing and nature of igneous activity recorded at a single Mars ejection site can be determined from the isotope analyses of Martian meteorites. Northwest Africa (NWA) 7635 has an Sm-Nd crystallization age of 2.403 ± 0.140 billion years, and isotope data indicate that it is derived from an incompatible trace element-depleted mantle source similar to that which produced a geochemically distinct group of 327- to 574-million-year-old "depleted" shergottites. Cosmogenic nuclide data demonstrate that NWA 7635 was ejected from Mars 1.1 million years ago (Ma), as were at least 10 other depleted shergottites. The shared ejection age is consistent with a common ejection site for these meteorites. The spatial association of 327- to 2403-Ma depleted shergottites indicates >2 billion years of magmatism from a long-lived and geochemically distinct volcanic center near the ejection site.

  18. Two-stage brachial-basilic transposition fistula provides superior patency rates for dialysis access in a safety-net population

    PubMed Central

    Gonzalez, Eduardo; Kashuk, Jeffry L.; Moore, Ernest E.; Linas, Stuart; Sauaia, Angela

    2015-01-01

    Background Guidelines of the National Kidney Foundation recommending aggressive pursuit of autogenous fistulae for dialysis access in lieu of prosthetic arteriovenous grafts have stimulated a renewed interest in transposed brachial-basilic fistulae as an alternative technique for upper arm access in patients who may not be candidates for a lower arm radial-cephalic or forearm brachial-cephalic fistula. We hypothesized that in our safety-net population, where radial-cephalic and brachial-cephalic often are not possible, brachial-basilic would provide patency rates superior to arteriovenous grafts and equivalent to radial-cephalic and brachial-cephalic fistulae. Methods We analyzed retrospectively our most recent 2.5-year experience with dialysis access procedures at our metropolitan safety-net hospital. Procedures were grouped as follows: radial-cephalic, brachial-cephalic, brachial-basilic, and arteriovenous grafts. The access outcomes measured were primary failure, time to use, need for intervention, and primary as well as secondary patency. Differences in age, sex, race, renal function (Modification of Diet in Renal Disease), baseline diagnoses (diabetes mellitus, hypertension, coronary artery disease, and peripheral vascular disease), as well as the number of previous accesses, were adjusted in the analysis. Logistic regression was used to identify independent predictors of primary failure, and Kaplan-Meier plots assessed differences in primary patency rates. A log of the time variables was used to approximate normal distribution. Results In all, 193 patients were included in this study as follows: radial-cephalic, 75 (39%) patients; brachial-cephalic, 35 (18%) patients; brachial-basilic, 33 (17%) patients; and arteriovenous grafts, 50 (26%) patients. Primary patency means differed marginally between groups (P = .08), and when grafts were excluded from the analysis, no difference was found between primary patency in all autogenous fistula techniques (P = .88

  19. Acute presentation of brachial plexus schwannoma secondary to infarction.

    PubMed

    Sidani, Charif; Saraf-Lavi, Efrat; Lyapichev, Kirill A; Nadji, Mehrdad; Levi, Allan D

    2015-06-01

    Schwannomas of the brachial plexus are rare and typically present as slowly growing masses. We describe a case of a 37-year-old female who presented with acute onset of severe left upper extremity pain. Magnetic resonance imaging (MRI) showed a 2.3 × 2.1 cm peripherally enhancing centrally cystic lesion in the left axilla, along the cords of the left brachial plexus, with significant surrounding edema and enhancement. The mass was surgically removed. Pathology was consistent with a schwannoma with infarction. The pain completely resolved immediately after surgery.

  20. Paravertebral blockade of the brachial plexus in dogs.

    PubMed

    Lemke, Kip A; Creighton, Catherine M

    2008-11-01

    Local anesthetic techniques have the unique ability to block peripheral nociceptive input associated with surgical trauma and inflammation and to prevent sensitization of central nociceptive pathways and the development of pathologic pain. Complete neural blockade of the canine brachial plexus is difficult to achieve using the traditional axillary technique. This article describes paravertebral blockade of the brachial plexus in dogs and a new modified paravertebral technique. Both techniques are relatively easy to perform and produce complete blockade of the forelimb, including the shoulder. A review of relevant clinical anatomy and guidelines for using electrical nerve locators are also included.

  1. Massive hemothorax: A rare complication after supraclavicular brachial plexus block.

    PubMed

    Singh, Shiv Kumar; Katyal, Surabhi; Kumar, Amit; Kumar, Pawan

    2014-01-01

    Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques.

  2. Young Star Probably Ejected From Triple System

    NASA Astrophysics Data System (ADS)

    2003-01-01

    Astronomers analyzing nearly 20 years of data from the National Science Foundation's Very Large Array radio telescope have discovered that a small star in a multiple-star system in the constellation Taurus probably has been ejected from the system after a close encounter with one of the system's more-massive components, presumed to be a compact double star. This is the first time any such event has been observed. Path of Small Star, 1983-2001 "Our analysis shows a drastic change in the orbit of this young star after it made a close approach to another object in the system," said Luis Rodriguez of the Institute of Astronomy of the National Autonomous University of Mexico (UNAM). "The young star was accelerated to a large velocity by the close approach, and certainly now is in a very different, more remote orbit, and may even completely escape its companions," said Laurent Loinard, leader of the research team that also included Monica Rodriguez in addition to Luis Rodriguez. The UNAM astronomers presented their findings at the American Astronomical Society's meeting in Seattle, WA. The discovery of this chaotic event will be important for advancing our understanding of classical dynamic astronomy and of how stars evolve, including possibly providing an explanation for the production of the mysterious "brown dwarfs," the astronomers said. The scientists analyzed VLA observations of T Tauri, a multiple system of young stars some 450 light-years from Earth. The observations were made from 1983 to 2001. The T Tauri system includes a "Northern" star, the famous star that gives its name to the class of young visible stars, and a "Southern" system of stars, all orbiting each other. The VLA data were used to track the orbit of the smaller Southern star around the larger Southern object, presumed to be a pair of stars orbiting each other closely. The astronomers' plot of the smaller star's orbit shows that it followed an apparently elliptical orbit around its twin companions

  3. Comparison between Conventional and Ultrasound-Guided Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

    PubMed Central

    Honnannavar, Kiran Abhayakumar; Mudakanagoudar, Mahantesh Shivangouda

    2017-01-01

    Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. Subjects and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. Conclusion: Ultrasound guidance is the safe and

  4. Histopathological basis of Horner's syndrome in obstetric brachial plexus palsy differs from that in adult brachial plexus injury.

    PubMed

    Huang, Yi-Gang; Chen, Liang; Gu, Yu-Dong; Yu, Guang-Rong

    2008-05-01

    Although Horner's syndrome is usually taken as an absolute indicator of avulsions of the C8 and T1 ventral roots in adult brachial plexus injury, its pathological basis in obstetric brachial plexus palsy (OBPP) is unclear. We therefore examined the morphological mechanism for the presence of Horner's syndrome in brachial plexus injury in infants and adults. Some axons of sympathetic preganglionic neurons in T1 innervate the superior cervical ganglion via the C7 ventral root in infants but not in adults. Therefore, the presence of Horner's syndrome may relate in part to avulsion of the C7 root in OBPP. These findings suggest that Horner's syndrome in OBPP is not necessarily indicative of avulsions of the C8 and T1 roots, as it can occur with avulsion of the C7 root.

  5. Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial.

    PubMed

    Galos, David K; Taormina, David P; Crespo, Alexander; Ding, David Y; Sapienza, Anthony; Jain, Sudheer; Tejwani, Nirmal C

    2016-05-01

    Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients' postoperative course and experience. We asked: (1) Did patients receiving general anesthesia or brachial plexus blockade have worse pain scores at 2, 12, and 24 hours after surgery? (2) Was there a difference in operative suite time between patients who had general anesthesia or brachial plexus blockade, and was there a difference in recovery room time? (3) Did patients receiving general anesthesia or brachial plexus blockade have higher narcotic use after surgery? (4) Do patients receiving general anesthesia or brachial plexus blockade have higher functional assessment scores after distal radius fracture repair at 6 weeks and 12 weeks after surgery? A randomized controlled study was performed between February, 2013 and April, 2014 at a multicenter metropolitan tertiary-care referral center. Patients who presented with acute closed distal radius fractures (Orthopaedic Trauma Association 23A-C) were potentially eligible for inclusion. During the study period, 40 patients with closed, displaced, and unstable distal radius fractures were identified as meeting inclusion criteria and offered enrollment and randomization. Three patients (7.5%), all with concomitant injuries, declined to participate at the time of randomization as did one additional patient (2.5%) who chose not to participate, leaving a final sample of 36 participants. There were no dropouts after randomization, and analyses were performed according to an intention-to-treat model. Patients were randomly assigned to one of two groups, general anesthesia or brachial plexus blockade, and among the 36 patients

  6. Aug. 31, 2012 Coronal Mass Ejection

    NASA Image and Video Library

    This two part movie shows an Aug. 31 coronal mass ejection (CME) from the sun , the same event that caused depletion and refilling of the radiation belts just after the Relativistic Electron-Proton...

  7. Sept. 28, 2012 Coronal Mass Ejection

    NASA Image and Video Library

    This Sept. 28 coronal mass ejection (CME) from the sun, captured by NASA’s Solar Dynamics Observatory (SDO), is the event which caused the near total annihilation of the new radiation belt and sl...

  8. Nerve transfers in brachial plexus birth palsies: indications, techniques, and outcomes.

    PubMed

    Kozin, Scott H

    2008-11-01

    The advent of nerve transfers has greatly increased surgical options for children who have brachial plexus birth palsies. Nerve transfers have considerable advantages, including easier surgical techniques, avoidance of neuroma resection, and direct motor and sensory reinnervation. Therefore, any functioning nerve fibers within the neuroma are preserved. Furthermore, a carefully selected donor nerve results in little or no clinical deficit. However, some disadvantages and unanswered questions remain. Because of a lack of head-to-head comparison between nerve transfers and nerve grafting, the window of opportunity for nerve grafting may be missed, which may degrade the ultimate outcome. Time will tell the ultimate role of nerve transfer or nerve grafting.

  9. Omnidirectional and Controllable Wing Using Fluid Ejection

    DTIC Science & Technology

    1996-10-22

    the air flow over the wing ’ ^ surfaces is directed internally within the fuselage. The tangential ejection of fluid outflow over Coanda edge...tangential ejection 2 outflow from a Coanda edge of a lift wing independently of its translation direction through an d ambient fluid so as...the ambient fluid. 6 SUMMARY OF THE INVENTION 7 In accordance with the present invention, a planform tvpe of wing is provided with a Coanda 8

  10. Comparison of the patterns of milk ejection during repeated breast expression sessions in women.

    PubMed

    Prime, Danielle K; Geddes, Donna T; Hepworth, Anna R; Trengove, Naomi J; Hartmann, Peter E

    2011-08-01

    This study aimed to investigate the consistency of milk ejections and milk expression characteristics within mothers at repeated expression sessions. Twenty-five breastfeeding mothers expressed their breasts simultaneously on three occasions within 3 weeks, and follow-up visits were performed at 6, 9, and 12 months of lactation. During the 15-minute expression, milk was collected onto a continuous weigh balance to measure milk flow rate. The number of milk ejections was similar at the three sessions (5.1±2.0), decreasing at the 12-month follow-up (3.3±1.2). Mothers had a similar pattern of milk ejection at each session. The time that each milk ejection occurred was consistent for the first 9 months of lactation. Of the four milk ejection patterns identified, each removed a similar percentage of available milk but varied in the time to reach 80% of the total expression volume. The first two milk ejections produced the greatest percentage (62%) of total milk volume during breast expression. For each individual mother, the timing, pattern, and number of milk ejections were consistent, suggesting a predetermined release of oxytocin. In light of the innate oxytocin release and milk removal characteristics in women, there is potential for individual tailoring of the duration of expression.

  11. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications.

    PubMed

    Van de Velde, Joris; Bogaert, Stephanie; Vandemaele, Pieter; Huysse, Wouter; Achten, Eric; Leijnse, Joris; De Neve, Wilfried; Van Hoof, Tom

    2016-03-01

    The present study aimed to establish a baseline for detailed 3D brachial plexus reconstruction from magnetic resonance imaging (MRI). Concretely, the goal was to determine the individual brachial plexus anatomy with maximum detail and accuracy achievable, as yet irrespective of whether the methods used could be economically and practically applied in the clinical setting. Six embalmed cadavers were randomly taken for MRI imaging of the brachial plexus. Detailed two-dimensional (2D) segmentation for all brachial plexus parts was done. The 2D brachial plexus segmentations were 3D reconstructed using Mimics(®) software. Then, these 3D reconstructions were anatomically validated by dissection of the cadavers. After finalising the cadaver experiments, brachial plexus MRIs were obtained in three healthy male volunteers and the same reconstruction procedure as in vitro was followed. A procedure was developed for brachial plexus 3D reconstruction based on MRI without the use of any contrast agent. Anatomical validation of six cadaver brachial plexus reconstructions showed high correspondence with the dissected brachial plexuses. Anatomical variations of the main branches were equally present in the 3D reconstructions generated. However, there were also some differences that related to the difference between the surface anatomy of the nerve and the internal nerve structure. In vivo, it was possible to reconstruct the complete brachial plexus in such a manner that normal-appearing BPs were derived in a reproducible way. This study showed that the described procedure results in accurate and reproducible brachial plexus 3D reconstructions.

  12. Solar origins of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Kahler, Stephen

    1987-01-01

    The large scale properties of coronal mass ejections (CMEs), such as morphology, leading edge speed, and angular width and position, have been cataloged for many events observed with coronagraphs on the Skylab, P-78, and SMM spacecraft. While considerable study has been devoted to the characteristics of the SMEs, their solar origins are still only poorly understood. Recent observational work has involved statistical associations of CMEs with flares and filament eruptions, and some evidence exists that the flare and eruptive-filament associated CMEs define two classes of events, with the former being generally more energetic. Nevertheless, it is found that eruptive-filament CMEs can at times be very energetic, giving rise to interplanetary shocks and energetic particle events. The size of the impulsive phase in a flare-associated CME seems to play no significant role in the size or speed of the CME, but the angular sizes of CMEs may correlate with the scale sizes of the 1-8 angstrom x-ray flares. At the present time, He 10830 angstrom observations should be useful in studying the late development of double-ribbon flares and transient coronal holes to yield insights into the CME aftermath. The recently available white-light synoptic maps may also prove fruitful in defining the coronal conditions giving rise to CMEs.

  13. CFD Simulations of Vibration Induced Droplet Ejection.

    NASA Astrophysics Data System (ADS)

    James, Ashley; Smith, Marc K.; Glezer, Ari

    1998-11-01

    Vibration-induced droplet ejection is a process that occurs when a liquid droplet is placed on a vibrating membrane. Above a critical value of the excitation amplitude, Faraday waves form on the surface of the drop. As the amplitude is increased secondary drops are ejected from the wave crests. A Navier-Stokes solver designed to simulate the transient fluid mechanics of the process is presented. The solver is based on a MAC method on a staggered grid. A volume of fluid method is implemented to track the free surface. The volume fraction is advected via a second-order, unsplit method that minimizes numerical diffusion of the interface. Surface tension is incorporated as a continuum surface force. This work is intended to provide a comprehensive description of the fluid dynamics involved in vibration-induced droplet ejection, with the aim of understanding the mechanism behind the ejection process. The evolution of the interface through droplet ejection will be simulated. The dependence of the ejection process on the driving parameters will be evaluated and the resonance characteristics of the drop will be determined. The results of the computations will be compared with experimental results.

  14. Postoperative analgesic efficacy of different volumes and masses of ropivacaine in posterior brachial plexus block.

    PubMed

    de Morais, Bruno Salome; Cruvinel, Marcos Guilherme Cunha; Carneiro, Fabiano Soares; Lago, Flavio; Silva, Yerkes Pereira

    2012-01-01

    The efficacy of posterior brachial plexus block for shoulder surgeries is demonstrated by different authors. However, there is no consensus on the ideal mass and volume of local anesthetic to be employed. The objetive of this study was to compare different volumes and masses of ropivacaine in posterior brachial plexus block in arthroscopic surgeries of the shoulder. Sixty patients > 18 years, physical status ASA I and II, scheduled for unilateral arthroscopic surgeries of the shoulder were randomly placed in three groups: A (10 mL to 0.5%), B (20 mL to 0.5%), C (5 mL to 1%). The block was performed with a 22G needle of 100 mm connected to neurostimulator, in a point 3 cm lateral to the midpoint of C6 and C7 interspace, being injected the solution corresponding to each group. The postoperative pain was evaluated at the recovery room and within the first 24 hours of the postoperative period. The groups were compared on length of time until the first complaint of pain, visual numeric scale (VNS) score and morphine consumption within the first 24 hours. There was no statistically significant difference between the three groups related to age, weight and height. There was no difference in length of time until the first complaint of pain, VNS scores over three and morphine consumption in the postoperative period between the groups. This study concluded that 5 mL of 1% ropivacaine promoted analgesic efficacy similar to 10 mL or 20 mL of 0.5% ropivacaine in the posterior brachial plexus block using neurostimulator. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  15. The evolution of intraventricular vortex during ejection studied by using vector flow mapping.

    PubMed

    Zhang, Haibin; Liu, Liwen; Chen, Lulu; Ma, Na; Zhou, Liping; Liu, Ying; Li, Zhiguo; Liu, Chengguo; Hou, Rui; Zhu, Suyang

    2013-01-01

    The purpose of this study was to assess the evolution of intraventricular vortex during left ventricular (LV) ejection. Vector flow mapping was performed in 51 patients with coronary artery disease and LV ejection fraction (EF) >50%, 70 patients with EF <50% (13 with coronary artery disease and 57 with dilated cardiomyopathy), and 62 healthy volunteers. In normals and patients with EF >50%, the intraventricular vortex dissipated quickly during early ejection. In patients with EF <50%, the vortex stayed mainly at apex and persisted for a significantly longer time. The evolution of vortex during ejection was significantly correlated with QRS width, EF, fractional shortening, LV outflow velocity time integral, wall motion score index (WMSI), LV dimensions, left atrial diameter, and diastolic mitral annular velocities. LV end-diastolic short diameter and WMSI were the independent determinants of the duration of vortex (R(2) = 0.482, P < 0.001). End-systolic short diameter and apical WMSI were the independent determinants of duration of vortex corrected for ejection time (R(2) = 0.565, P < 0.001). End-systolic short diameter was the independent determinant of percentage change in vortex area during early ejection (R(2) = 0.355, P < 0.001). End-systolic short diameter and ejection time were the independent determinants of percentage change in vortex flow volume (R(2) = 0.415, P < 0.001). In patients with LV systolic dysfunction, the vortex persists during ejection and stays mainly at apex. The vortex evolution during ejection is closely associated with LV dimensions and functions. © 2012, Wiley Periodicals, Inc.

  16. The natural history and management of brachial plexus birth palsy.

    PubMed

    Buterbaugh, Kristin L; Shah, Apurva S

    2016-12-01

    Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

  17. Axillary Brachial Plexus Blockade for the Reflex Sympathetic Dystrophy Syndrome.

    ERIC Educational Resources Information Center

    Ribbers, G. M.; Geurts, A. C. H.; Rijken, R. A. J.; Kerkkamp, H. E. M.

    1997-01-01

    Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain syndrome characterized by pain, vasomotor and dystrophic changes, and often motor impairments. This study evaluated the effectiveness of brachial plexus blockade with local anaesthetic drugs as a treatment for this condition. Three patients responded well; three did not. (DB)

  18. Forward Canopy Feasibility and Thru-the-Canopy (TTC) Ejection System Study

    DTIC Science & Technology

    1990-01-01

    eleapsed time between rocket motor ignition and canopy sep- aration from aircraft is only 0.083 seconds. Canopy separ- ation from the F-18 occurs...jettison of the canopy before ejection. Without this time delay the rocket motors may not clear the canopy from the ejection path, resulting in...THE GOVERNMENT MAY HAVE FORMULATED OR IN ANY WAY SUPPLIED THE SAID DRAWINGS, SPECIFICATIONS, OR OTHER DATA, IS NOT TO BE REGARDED BY IMPUCATION, OR

  19. Spontaneous recovery of non-operated traumatic brachial plexus injury.

    PubMed

    Lim, S H; Lee, J S; Kim, Y H; Kim, T W; Kwon, K M

    2017-06-27

    We investigated the spontaneous recovery of non-operated traumatic brachial plexus injury (BPI). A total of 25 cases of non-operated traumatic BPI were analysed by retrospective review of medical records; in all cases, consecutive electrodiagnostic studies (ES) were conducted from 1 to 4 months and 18 to 24 months post-trauma. Injury severity was assessed using a modified version of Dumitru and Wilbourn's scale (DWS) based on ES. Spontaneous recovery of brachial plexus components per subject was analysed using Wilcoxon's signed-rank test. A two-tailed Fisher's exact or Pearson's Chi-square test was used to examine the associations between initial injury severity (DWS grade 2 vs. 3, complete vs. incomplete), accompanying injury type (open vs. closed), main lesion location (supraclavicular vs. infraclavicular lesion), and spontaneous recovery. The most common cause of BPI was traffic accident (TA) (15 cases, 60%), and the most common type of TA-induced BPI was a motorcycle TA (5 cases), accounting for 20% of all injuries. The second most common type of injury was an occupational injury (6 cases, 24%). Thirty-eight (69%) of 55 injured brachial components in 25 cases had DWS grade 3 and 17 brachial components (31%) had grade 2. The DWS grade of brachial plexus components per subject significantly differed between the first and follow-up ES (p = 0.000). However, initial injury severity, accompanying injury type, and main lesion location were not statistically associated with spontaneous recovery (p > 0.05). Spontaneous recovery may be possible even in severe traumatic BPI. Multiple factors should be considered when predicting the clinical course of traumatic BPI.

  20. Nontraumatic determination of left ventricular ejection fraction by radionuclide angiocardiography.

    PubMed

    Schelbert, H R; Verba, J W; Johnson, A D; Brock, G W; Alazraki, N P; Rose, F J; Ashburn, W L

    1975-05-01

    Previous reports have suggested that left ventricular ejection fraction can be assessed by recording the passage of peripherally administered radioactive bolus through the heart. The accuracy and validity of this technique were examined in 20 patients undergoing diagnostic cardiac catheterization. 99m-Tc-human serum albumin was injected via a central venous catheter into the superior vena cava and precordial activity recorded with a gamma scintillation camera interfaced to a small digital computer. A computer program was designed to generate time-activity curves from the left ventricular blood pool and to calculate left ventricular ejection fractions from the cyclic fluctuations of the left ventricular time-activity curve which correspond to left ventricular volume changes during each cardiac cycle. The results correlated well with those obtained by biplane cineangiocardiography (r equals 0.94) and indicated that the technique should allow accurate and reproducible determination of left ventricular ejection fraction. The findings, however, demonstrated that the time-activity curve must be generated from a region-of-interest which fits the left ventricular blood pool precisely and must be corrected for contributions arising from noncardiac background structures. This nontraumatic and potentially noninvasive technique appears particularly useful for serial evaluation of the acutely ill patient and for follow-up studies in nonhospitalized patients.

  1. Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients.

    PubMed

    Aszmann, Oskar C; Roche, Aidan D; Salminger, Stefan; Paternostro-Sluga, Tatjana; Herceg, Malvina; Sturma, Agnes; Hofer, Christian; Farina, Dario

    2015-05-30

    Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Brachial Artery Reconstruction in Trauma Using Reversed Arm Vein from the Injured Upper Limb

    PubMed Central

    Harnarayan, Patrick

    2016-01-01

    Background: Brachial artery repair may be technically challenging with a paucity of guidelines. The use arm vein (AV) from the traumatized limb is herein described. Methods: Data were prospectively collected from 2002 to 2016 on brachial artery injury including age, sex, mechanism/site of injury, and repair technique. Categories included AV and non-arm vein (NAV) groups. One-year outcomes were noted. Results: All 31 cases studied were of men with an age range of 16 to 73 years (mean = 28). Injuries included 13 gunshots, 7 stabbings, 6 glass injuries, 2 dislocated elbows, 1 crush, 1 impalement, and 1 avulsion. Site of injuries included the antecubital region in 25, midbrachial in 5, and proximal brachial in 1, with 4 associated fractures. Repair was done using reversed AV from the traumatized limb in 15 cases and NAV in 16. In the AV group, the adjacent basilic vein was used in 9 cases, the adjacent cephalic vein in 3, and the distal (or wrist area) cephalic vein in 3. The limb salvage rates in the AV versus NAV groups were 100% and 94%, respectively (Fisher’s exact t test, P = 1.00), with no major technique-related complications. Conclusions: The outcomes of using reversed AV from the traumatized limb are equivalent to those of other standard techniques such as primary repair, polytetrafluoroethylene, or reversed great saphenous vein, with a 1-year limb salvage rate of 100%. Additionally, advantages include decreased wound complications, better vein graft--artery caliber match, and shorter operating times while maintaining acceptable patency rates. PMID:27826464

  3. Association of clonidine and ropivacaine in brachial plexus block for shoulder arthroscopy.

    PubMed

    Faria-Silva, Raphael; de Rezende, Daniel Câmara; Ribeiro, Juarez Mundim; Gomes, Telmo Heleno; Oliveira, Braulio Antônio Maciel Faria Mota; Pereira, Fábio Maciel R; de Almeida Filho, Ildeu Afonso; de Carvalho Junior, Antônio Enéas Rangel

    2016-01-01

    Arthroscopy for shoulder disorders is associated with severe and difficult to control pain, postoperatively. The addition of clonidine to local anesthetics for peripheral nerve block has become increasingly common, thanks to the potential ability of this drug to reduce the mass of local anesthetic required and to prolonging analgesia postoperatively. The present study aimed to evaluate the success of brachial plexus block for arthroscopic rotator cuff surgery using local anesthetic with or without clonidine. 53 patients of both genders, between 18 and 70 years old, American Society of Anesthesiologists I or II, who were scheduled to undergo arthroscopic shoulder surgery were selected. Patients were then randomized into two groups. The verbal numerical pain scale and the presence of motor block were obtained in the post-anesthetic recovery room and 6, 12, 18 and 24h postoperatively. The association of clonidine (0.15mg) to a solution of 0.33% ropivacaine (30mL) in brachial plexus block for shoulder arthroscopy has not diminished the visual numeric pain scale values, nor the need for opioid rescue postoperatively. There was a lower incidence of nausea/vomiting postoperatively and a significant motor block time prolongation in the group of patients who received clonidine as adjuvant. The use of brachial plexus block with local anesthetic for analgesic postoperative control is well established in the literature. The addition of clonidine in the dose proposed for prolongation of the analgesic effect and reduction of opioid rescue proved unhelpful. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Brachial arterial pressure to assess cardiovascular structural damage: an overview and lessons from clinical trials.

    PubMed

    London, Gérald M

    2008-01-01

    Epidemiological studies have emphasized the relationship between blood pressure (BP) and the incidence of cardiovascular diseases. Severity of hypertension was in the past judged on the basis of diastolic BP. More recent epidemiological studies have directed attention to systolic pressure as a better guide to cardiovascular and all-cause mortality. Traditionally, hypertension was appreciated by measures of BP recorded in peripheral arteries, usually brachial artery which was assumed to reflect pressures in all parts of arterial system. All these studies neglected that peripheral systolic BP differs from pressure recorded in the aorta and central arteries. While mean and diastolic pressures are almost constant along the arterial tree, due to the stiffness and geometric heterogeneity of large arteries and the timing and magnitude of wave reflections systolic BP and pulse pressure are amplified from the aorta to peripheral arteries, and brachial systolic BP only indirectly reflects the systolic BP in the aorta and central arteries. Several recent studies have shown that the effects of antihypertensive drugs are not the same in peripheral and central arteries, fact which could account for different effects of various drugs on end-organ damage, such as regression of left ventricular hypertrophy. Moreover, it has been shown that aortic and central artery pressure (or their determinants) are stronger predictors of end-organ damage and cardiovascular outcome than conventionally measured brachial pressure. These studies have focused the attention on the physical properties of large arteries and on the way they influence the level of systolic and pulse pressures along the arterial tree.

  5. Coronal Mass Ejections and Solar Radio Emissions

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2010-01-01

    Coronal mass ejections (CMEs) have important connections to various types of radio emissions from the Sun. The persistent noise storm radiation (type I storm at metric wavelengths, type III storms at longer wavelengths) can be clearly interrupted by the occurrence of a CME in the active region that produces the storm. Sometimes the noise storm completely disappears and other times, it reappears in the active region. Long-lasting type III bursts are associated with CME eruption, thought to be due to the reconnection process taking place beneath the erupting CME. Type II bursts are indicative of electron acceleration in the CME-driven shocks and hence considered to be the direct response of the CME propagation in the corona and interplanetary medium. Finally type IV bursts indicate large-scale post-eruption arcades containing trapped electrons that produce radio emission. This paper summarizes some key results that connect CMEs to various types of radio emission and what we can learn about particle acceleration in the corona) and interplanetary medium. Particular emphasis will be placed on type If bursts because of their connection to interplanetary shocks detected in situ.

  6. EIT Observations of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Gurman, J. B.; Fisher, Richard B. (Technical Monitor)

    2000-01-01

    Before the Solar and Heliospheric Observatory (SOHO), we had only the sketchiest of clues as to the nature and topology of coronal mass ejections (CMEs) below 1.1 - 1.2 solar radii. Occasionally, dimmings (or 'transient coronal holes') were observed in time series of soft X-ray images, but they were far less frequent than CME's. Simply by imaging the Sun frequently and continually at temperatures of 0.9 - 2.5 MK we have stumbled upon a zoo of CME phenomena in this previously obscured volume of the corona: (1) waves, (2) dimmings, and (3) a great variety of ejecta. In the three and a half years since our first observations of coronal waves associated with CME's, combined Large Angle Spectroscopic Coronagraph (LASCO) and extreme ultra-violet imaging telescope (EIT) synoptic observations have become a standard prediction tool for space weather forecasters, but our progress in actually understanding the CME phenomenon in the low corona has been somewhat slower. I will summarize the observations of waves, hot (> 0.9 MK) and cool ejecta, and some of the interpretations advanced to date. I will try to identify those phenomena, analysis of which could most benefit from the spectroscopic information available from ultraviolet coronograph spectrometer (UVCS) observations.

  7. Particle Heating Resulting from Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Paul, Suman; Sundar De, Syam; Guha, Gautam

    2016-07-01

    Coronal Mass Ejection (CME) is a continuous phenomena occurring from the entire solar coronal zone responsible for the outflow of solar masses, viz., protons, electrons, neutrons and solar wind in the form of plasma. These perturb the Earth's atmosphere via magnetopause. Very high temperature plasma generator in the solar atmosphere produces huge magnetic dipoles with intense magnetic field. It traps the energetic charged particles released from the solar corona. These particles gyrate along the magnetic field lines and are gradually elongated outwards from the Sun. Due to this, the field lines get detached at some critical limit thereby enhancing the magnetic reconnection with the interplanetary magnetic field releasing huge energy in the form of X-rays and γ-rays. This perturbs the Earth's atmosphere. In this work, the situation has been investigated by momentum balance equation, energy balance equation along with the equations of continuity and states. From the analyses, the dispersive nature of the thermospheric medium is studied. Variation of normalized electron temperature with dimensionless time has been critically contemplated. The altitude dependent electric field in the medium is also investigated.

  8. EIT Observations of Coronal Mass Ejections

    NASA Technical Reports Server (NTRS)

    Gurman, J. B.; Fisher, Richard B. (Technical Monitor)

    2000-01-01

    Before the Solar and Heliospheric Observatory (SOHO), we had only the sketchiest of clues as to the nature and topology of coronal mass ejections (CMEs) below 1.1 - 1.2 solar radii. Occasionally, dimmings (or 'transient coronal holes') were observed in time series of soft X-ray images, but they were far less frequent than CME's. Simply by imaging the Sun frequently and continually at temperatures of 0.9 - 2.5 MK we have stumbled upon a zoo of CME phenomena in this previously obscured volume of the corona: (1) waves, (2) dimmings, and (3) a great variety of ejecta. In the three and a half years since our first observations of coronal waves associated with CME's, combined Large Angle Spectroscopic Coronagraph (LASCO) and extreme ultra-violet imaging telescope (EIT) synoptic observations have become a standard prediction tool for space weather forecasters, but our progress in actually understanding the CME phenomenon in the low corona has been somewhat slower. I will summarize the observations of waves, hot (> 0.9 MK) and cool ejecta, and some of the interpretations advanced to date. I will try to identify those phenomena, analysis of which could most benefit from the spectroscopic information available from ultraviolet coronograph spectrometer (UVCS) observations.

  9. Coronal Mass Ejections and Solar Radio Emissions

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2010-01-01

    Coronal mass ejections (CMEs) have important connections to various types of radio emissions from the Sun. The persistent noise storm radiation (type I storm at metric wavelengths, type III storms at longer wavelengths) can be clearly interrupted by the occurrence of a CME in the active region that produces the storm. Sometimes the noise storm completely disappears and other times, it reappears in the active region. Long-lasting type III bursts are associated with CME eruption, thought to be due to the reconnection process taking place beneath the erupting CME. Type II bursts are indicative of electron acceleration in the CME-driven shocks and hence considered to be the direct response of the CME propagation in the corona and interplanetary medium. Finally type IV bursts indicate large-scale post-eruption arcades containing trapped electrons that produce radio emission. This paper summarizes some key results that connect CMEs to various types of radio emission and what we can learn about particle acceleration in the corona) and interplanetary medium. Particular emphasis will be placed on type If bursts because of their connection to interplanetary shocks detected in situ.

  10. Kinematical properties of coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Temmer, M.

    2016-11-01

    Coronal mass ejections (CMEs) are the most dynamic phenomena in our solar system. They abruptly disrupt the continuous outflow of solar wind by expelling huge clouds of magnetized plasma into interplanetary space with velocities enabling to cross the Sun-Earth distance within a few days. Earth-directed CMEs may cause severe geomagnetic storms when their embedded magnetic fields and the shocks ahead compress and reconnect with the Earth's magnetic field. The transit times and impacts in detail depend on the initial CME velocity, size, and mass, as well as on the conditions and coupling processes with the ambient solar wind flow in interplanetary space. The observed CME parameters may be severely affected by projection effects and the constant changing environmental conditions are hard to derive. This makes it difficult to fully understand the physics behind CME evolution, preventing to do a reliable forecast of Earth-directed events. This short review focusing on observational data, shows recent methods which were developed to derive the CME kinematical profile for the entire Sun-Earth distance range as well as studies which were performed to shed light on the physical processes that CMEs encounter when propagating from Sun to Earth.

  11. Hunting for Stellar Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Korhonen, Heidi; Vida, Krisztián; Leitzinger, Martin; Odert, Petra; Kovács, Orsolya Eszter

    2017-10-01

    Coronal mass ejections (CMEs) are explosive events that occur basically daily on the Sun. It is thought that these events play a crucial role in the angular momentum and mass loss of late-type stars, and also shape the environment in which planets form and live. Stellar CMEs can be detected in optical spectra in the Balmer lines, especially in Hα, as blue-shifted extra emission/absorption. To increase the detection probability one can monitor young open clusters, in which the stars are due to their youth still rapid rotators, and thus magnetically active and likely to exhibit a large number of CMEs. Using ESO facilities and the Nordic Optical Telescope we have obtained time series of multi-object spectroscopic observations of late-type stars in six open clusters with ages ranging from 15 Myrs to 300 Myrs. Additionally, we have studied archival data of numerous active stars. These observations will allow us to obtain information on the occurrence rate of CMEs in late-type stars with different ages and spectral types. Here we report on the preliminary outcome of our studies.

  12. Dynamic simulation of coronal mass ejections

    NASA Technical Reports Server (NTRS)

    Steinolfson, R. S.; Wu, S. T.

    1980-01-01

    A model is developed for the formation and propagation through the lower corona of the loop-like coronal transients in which mass is ejected from near the solar surface to the outer corona. It is assumed that the initial state for the transient is a coronal streamer. The initial state for the streamer is a polytropic, hydrodynamic solution to the steady-state radial equation of motion coupled with a force-free dipole magnetic field. The numerical solution of the complete time-dependent equations then gradually approaches a stationary coronal streamer configuration. The streamer configuration becomes the initial state for the coronal transient. The streamer and transient simulations are performed completely independent of each other. The transient is created by a sudden increase in the pressure at the base of the closed-field region in the streamer configuration. Both coronal streamers and coronal transients are calculated for values of the plasma beta (the ratio of thermal to magnetic pressure) varying from 0.1 to 100.

  13. Nanodust dynamics during a coronal mass ejection

    NASA Astrophysics Data System (ADS)

    Czechowski, Andrzej; Kleimann, Jens

    2017-09-01

    The dynamics of nanometer-sized grains (nanodust) is strongly affected by electromagnetic forces. High-velocity nanodust was proposed as an explanation for the voltage bursts observed by STEREO. A study of nanodust dynamics based on a simple time-stationary model has shown that in the vicinity of the Sun the nanodust is trapped or, outside the trapped region, accelerated to high velocities. We investigate the nanodust dynamics for a time-dependent solar wind and magnetic field configuration in order to find out what happens to nanodust during a coronal mass ejection (CME). The plasma flow and the magnetic field during a CME are obtained by numerical simulations using a 3-D magnetohydrodynamic (MHD) code. The equations of motion for the nanodust particles are solved numerically, assuming that the particles are produced from larger bodies moving in near-circular Keplerian orbits within the circumsolar dust cloud. The charge-to-mass ratios for the nanodust particles are taken to be constant in time. The simulation is restricted to the region within 0.14 AU from the Sun. We find that about 35 % of nanodust particles escape from the computational domain during the CME, reaching very high speeds (up to 1000 km s-1). After the end of the CME the escape continues, but the particle velocities do not exceed 300 km s-1. About 30 % of all particles are trapped in bound non-Keplerian orbits with time-dependent perihelium and aphelium distances. Trapped particles are affected by plasma ion drag, which causes contraction of their orbits.

  14. [Characteristics of mepivacaine axillary brachial plexus block performed at 2800 m of altitude].

    PubMed

    Fuzier, R; Fourcade, O; Fuzier, V; Gonzalez, H; Albert, N; Riviere, D; Capdevila, X

    2007-01-01

    We evaluated the feasibility and pharmacodynamic profile of axillary brachial plexus nerve blocks performed in high altitude. A prospective study was performed in healthy volunteers. Ten male volunteers received 20 ml of 1.5% mepivacaine on radial and median nerves (total 40 ml), first at altitude of 150 then at 2877 m. Onset and offset times for sensory, motor and sympathetic blocks were recorded. Blood was sampled up to 60 min after injection to measure plasma concentrations of mepivacaine. At 150 and 2877 m of altitude, onset times for blocks were similar. Duration of sensory and motor blocks was not different at low and high altitude (193+/-35 min and 180+/-47 min; and 237+/-32 min and 217+/-44 min, respectively). Plasma mepivacaine concentrations were significantly lower at 20 minutes in high altitude (p<0.05). At higher altitude, one patient showed clinical signs of neurological toxicity, with plasma concentrations of mepivacaine ranging from 0.94 to 1.21 mug/ml. At altitude of 2877 m, axillary brachial plexus block with 1.5% mepivacaine is feasible, with onset and offset times for sensory and motor effects similar to those performed at 150 m.

  15. [Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics].

    PubMed

    Contreras-Domínguez, V; Carbonell-Bellolio, P; Sanzana Salamanca, E; Ojeda-Grecie, A

    2006-11-01

    The axillary brachial plexus block is a frequently performed anesthetic technique. Adding a variety of coadjuvant drugs has been shown to improve results. This study evaluated the addition of sodium bicarbonate (NaHCO3) and/or clonidine to mepivacaine for performing the block. Sixty patients between 18 and 70 years old, ASA 1-3 in stable condition received axillary brachial plexus blocks in a randomized controlled study. Four groups of 15 patients each were formed: group I (control group) received 40 mL of 1% mepivacaine with adrenaline plus 5 mL of saline; group II, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 1 mL of saline; group III, 40 mL of 1% mepivacaine with 150 microg of clonidine plus 4mL of saline; and group IV, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 150 microg of clonidine. The onset time was significantly shorter in groups 2 and 4. The duration of the block was longer in group 3 and the analgesic effect was significantly better. Adding NaHCO3 to mepivacaine shortens the time of onset of an axillary brachial plexus block. Including clonidine prolongs the duration of anesthesia and analgesia. The addition of both NaHCO3 and clonidine shortens time to onset but does not prolong duration of anesthesia or analgesia.

  16. Sex Specific Effects of Habitual Aerobic Exercise on Brachial Artery Flow-Mediated Dilation in Middle-Aged and Older Adults

    PubMed Central

    Pierce, Gary L.; Eskurza, Iratxe; Walker, Ashley E.; Fay, Tara N.; Seals, Douglas R.

    2013-01-01

    Brachial artery flow-mediated dilation (FMD) is impaired with aging and is associated with increased risk for cardiovascular disease (CVD). We determined if regular aerobic exercise improves brachial artery FMD in middle-aged/older (MA/O) men and postmenopausal women. In sedentary MA/O adults (age 55 – 79 years) without CVD, 8 weeks of brisk walking (6 days/week for ~50 min/day; randomized, controlled design) increased treadmill time ~20% in both MA/O men (n=11) and postmenopausal women (n=15) (P<0.01), without altering body composition or circulating CVD risk factors. Brachial artery FMD increased > 50% in the MA/O men (4.6 ± 0.6 to 7.1 ± 0.6%, P < 0.01), but did not change in the postmenopausal women (5.1 ± 0.8 vs. 5.4 ± 0.7%, P = 0.50). No changes occurred in the non-exercising controls. In a separate cross-sectional study (n =167), brachial artery FMD was ~50% greater in endurance exercise-trained (6.4 ± 0.4%, n = 45) vs. sedentary (4.3 ± 0.3%, n = 60) MA/O men (P < 0.001), whereas there were no differences between endurance-trained (5.3 ± 0.7%, n = 20) and sedentary (5.6 ± 0.5%, n = 42) postmenopausal women (P = 0.70). Brachial artery lumen diameter, peak hyperemic shear rate and endothelium independent dilation did not differ with exercise intervention or in the endurance-exercise vs. sedentary groups. Regular aerobic exercise is consistently associated with enhanced brachial artery FMD in MA/O men, but not in postmenopausal women. Some postmenopausal women without CVD may be less responsive to habitual aerobic exercise than MA/O men. PMID:20642454

  17. Numerical Simulations of a Flux Rope Ejection

    NASA Astrophysics Data System (ADS)

    Pagano, P.; Mackay, D. H.; Poedts, S.

    2015-03-01

    Coronal mass ejections (CMEs) are the most violent phenomena observed on the Sun. One of the most successful models to explain CMEs is the flux rope ejection model, where a magnetic flux rope is expelled from the solar corona after a long phase along which the flux rope stays in equilibrium while magnetic energy is being accumulated. However, still many questions are outstanding on the detailed mechanism of the ejection and observations continuously provide new data to interpret and put in the context. Currently, extreme ultraviolet (EUV) images from the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamic Observatory (SDO) are providing new insights into the early phase of CME evolution. In particular, observations show the ejection of magnetic flux ropes from the solar corona and how they evolve into CMEs. However, these observations are difficult to interpret in terms of basic physical mechanisms and quantities, thus, we need to compare equivalent quantities to test and improve our models. In our work, we intend to bridge the gap between models and observations with our model of flux rope ejection where we consistently describe the full life span of a flux rope from its formation to ejection. This is done by coupling the global non-linear force-free model (GNLFFF) built to describe the slow low- β formation phase, with a full MHD simulation run with the software MPI-AMRVAC, suitable to describe the fast MHD evolution of the flux rope ejection that happens in a heterogeneous β regime. We also explore the parameter space to identify the conditions upon which the ejection is favoured (gravity stratification and magnetic field intensity) and we produce synthesised AIA observations (171 Å and 211 Å). To carry this out, we run 3D MHD simulation in spherical coordinates where we include the role of thermal conduction and radiative losses, both of which are important for determining the temperature distribution of the solar corona during a CME. Our model of

  18. Retraction Statement: Unrecognized High Brachial Artery Bifurcation is Associated with Higher Rate of Dialysis Access by Dr. Lee Kirksey.

    PubMed

    2017-03-01

    The above article from Seminars in Dialysis, published online on 4 September 2011 in Wiley Online Library (http://wileyonlinelibrary.com) has been retracted by agreement among the journal's Editor-in-Chief, Richard A. Sherman MD, the journal's North American editor of ASDIN content at the time, Arif Asif MD, and Wiley Periodicals, Inc. The decision to retract was agreed upon following notification by Dr. HeeJun Yang, the author of an article published in 2008, "Variations of the Superficial Brachial Artery in Korean Cadavers." Figure 1 (A & B) and Figure 2 (A-C) in the Kirksey article (1), which originally appeared in the 2008 article by Dr. Yang, were used without authorization or permission from Dr. Yang or the article's publisher. Reference Kirksey L: Unrecognized high brachial artery bifurcation is associated with higher rate of dialysis access. Semin Dial 24(6):698-702, 2011. doi: 10.1111/j.1525-139X.2011.00923.x.

  19. Ankle-brachial blood pressure differences in the beach-chair position of the shoulder surgery

    PubMed Central

    Lee, Jong-Hyuk; Lee, Young-Don; Kim, Soon Yul; Chang, Sei-Jin

    2012-01-01

    Background During shoulder surgery, blood pressure is frequently measured at the ankle. Anesthetic complications may result when ankle blood pressure is higher than brachial blood pressure and anesthesiologists misinterpret ankle blood pressure as brachial blood pressure. Therefore, we investigated whether ankle blood pressure is significantly higher than brachial blood pressure before anesthesia induction, during induction, after tracheal intubation, before beach chair position, and in the beach chair position. Methods Thirty patients requiring general anesthesia for shoulder surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Results Ankle blood pressure was higher than brachial blood pressure before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Ankle-brachial blood pressure differences in the beach chair condition were much higher than in four other conditions. The correlation coefficient between mean ankle-brachial blood pressure differences before the beach chair position and mean ankle-brachial blood pressure differences in the beach chair position was 0.616. Brachial systolic blood pressure could be predicted by regression equations (R2 = 0.306-0.771). Conclusions These results suggest that anesthesiologists should consider these ankle-brachial blood pressure differences when monitoring anesthesia in the beach chair position. PMID:23277812

  20. Ankle-brachial blood pressure differences in the beach-chair position of the shoulder surgery.

    PubMed

    Choi, Jae Chan; Lee, Jong-Hyuk; Lee, Young-Don; Kim, Soon Yul; Chang, Sei-Jin

    2012-12-01

    During shoulder surgery, blood pressure is frequently measured at the ankle. Anesthetic complications may result when ankle blood pressure is higher than brachial blood pressure and anesthesiologists misinterpret ankle blood pressure as brachial blood pressure. Therefore, we investigated whether ankle blood pressure is significantly higher than brachial blood pressure before anesthesia induction, during induction, after tracheal intubation, before beach chair position, and in the beach chair position. Thirty patients requiring general anesthesia for shoulder surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Ankle blood pressure was higher than brachial blood pressure before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Ankle-brachial blood pressure differences in the beach chair condition were much higher than in four other conditions. The correlation coefficient between mean ankle-brachial blood pressure differences before the beach chair position and mean ankle-brachial blood pressure differences in the beach chair position was 0.616. Brachial systolic blood pressure could be predicted by regression equations (R(2) = 0.306-0.771). These results suggest that anesthesiologists should consider these ankle-brachial blood pressure differences when monitoring anesthesia in the beach chair position.

  1. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial

    PubMed Central

    Vazin, Mojgan; Jensen, Kenneth; Kristensen, Danja L.; Hjort, Mathias; Tanggaard, Katrine; Karmakar, Manoj K.; Bendtsen, Thomas F.

    2016-01-01

    Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group (P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration was significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events. PMID:27990435

  2. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.

    PubMed

    Parrington, Simon J; O'Donnell, Dermot; Chan, Vincent W S; Brown-Shreves, Danielle; Subramanyam, Rajeev; Qu, Melody; Brull, Richard

    2010-01-01

    Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

  3. Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial.

    PubMed

    Mentz, Robert J; Greene, Stephen J; Ambrosy, Andrew P; Vaduganathan, Muthiah; Subacius, Haris P; Swedberg, Karl; Maggioni, Aldo P; Nodari, Savina; Ponikowski, Piotr; Anker, Stefan D; Butler, Javed; Gheorghiade, Mihai

    2014-05-01

    Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization. URL: http

  4. The clinical characteristics of neuropathic pain in patients with total brachial plexus avulsion: A 30-case study.

    PubMed

    Zhou, Yingjie; Liu, Peixi; Rui, Jing; Zhao, Xin; Lao, Jie

    2016-08-01

    Neuropathic pain in patients with total brachial plexus avulsion has always been a sophisticated problem in clinical practice. For further researches on objective diagnosis, alleviation or even cure of neuropathic pain, we need to conclude the basic clinical features including pain intensity, distribution, type and possible risk factors. Thirty cases of patients with total brachial plexus avulsion were included and their baseline information was collected. Pain was evaluated by Present Pain Index using a visual analog scale; Douleur Neuropathique 4 was used for screening neuropathic pain. For more detailed pain description, the Neuropathic Pain Symptoms Inventory questionnaire and a picture showing the exact pain district were both fulfilled by all the eligible participants. The relationship between neuropathic pain and basic information, injury conditions, accompanied conditions and quality of life was tested. All the participants were male in both groups. The neuropathic pain group contained 22 patients (73.33%) with the mean age of 30.18±9.47; while 29.00±7.95 in the other group. Patients with neuropathic pain presented variously in pain degree, location, type and time phase, according to the results of the Neuropathic Pain Symptoms Inventory questionnaire. Nevertheless, most pain distributed on the region of hand. Among several related factors, alcohol abuse may be possible risk factors of neuropathic pain (p=0.03). Quality of life was significantly affected by pain (p<0.01). Neuropathic pain in patients with total brachial avulsion was characterized with heterogeneity in pain distribution, intensity, type and also time phase. Bad life habits might be risk factors associated with neuropathic pain. Neuropathic pain might affect quality of life of the patients with total brachial plexus avulsion remarkably. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Electrohydodynamic ejection without using nozzle electrode

    NASA Astrophysics Data System (ADS)

    Dat Nguyen, Vu; Byun, Doyoung

    2009-11-01

    The electrohydrodynamic (EHD) ejection technique has been applied to inkjet printing technology for fabrication of printed electronics. The conventional EHD inkjet device is based on dc voltage and requires two electrodes: a nozzle electrode and an extractor electrode. This study notes several drawbacks of the conventional EHD printing device such as electrical breakdown and demonstrates stable jetting by using the extractor electrode alone without the nozzle electrode and ac voltage. The continuous ejection of droplets can be obtained only by ac voltage, showing consistent ejection at every peak of electrical signal. The suggested EHD inkjet device prevents electrical breakdown and broaden the range of material selection for nozzle design. Experiments with high speed camera also point out that the generated droplets are much smaller than the nozzle size. Using glass capillary, we show various printing patterns of lines and characters.

  6. Bipolar Ejection of Matter from Hot Stars

    NASA Technical Reports Server (NTRS)

    Pismis, P.

    1985-01-01

    A general program on the internal velocities in H II regions was carried out within the past decade by the use of photographic Fabry-Perot interferometry, in the H (alpha) line and lately also in the N IIlambda 6584 line. Among the score of objects studied three H II regions and one planetary nebula possess pronounced symmetry around their ionizing stars. Velocity data combined with morphological properties suggest strongly that the nebulae were formed essentially by matter ejected from the central star and that ejection occurred preferentially from diametrially opposite regions on the star, that is, in a bi-polar fashion. The nebulae are discussed individually and a model for the ejection mechanism is presented.

  7. Coronal mass ejections and coronal structures

    NASA Technical Reports Server (NTRS)

    Hildner, E.; Bassi, J.; Bougeret, J. L.; Duncan, R. A.; Gary, D. E.; Gergely, T. E.; Harrison, R. A.; Howard, R. A.; Illing, R. M. E.; Jackson, B. V.

    1986-01-01

    Research on coronal mass ejections (CMF) took a variety of forms, both observational and theoretical. On the observational side there were: case studies of individual events, in which it was attempted to provide the most complete descriptions possible, using correlative observations in diverse wavelengths; statistical studies of the properties CMEs and their associated activity; observations which may tell us about the initiation of mass ejections; interplanetary observations of associated shocks and energetic particles even observations of CMEs traversing interplanetary space; and the beautiful synoptic charts which show to what degree mass ejections affect the background corona and how rapidly (if at all) the corona recovers its pre-disturbance form. These efforts are described in capsule form with an emphasis on presenting pictures, graphs, and tables so that the reader can form a personal appreciation of the work and its results.

  8. Stealthy but Geoeffective Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Nitta, Nariaki; Mulligan, Tamitha

    2017-08-01

    We have long known about the existence of "problem" geomagnetic storms whose origins are elusive. In more general terms, not all the 1 AU disturbances can be clearly attributed to coronal mass ejections (CMEs), high speed streams (HSSs) or corotation interaction regions (CIRs.) When interplanetary CME (ICME) signatures are found in in situ data, there is not always a flare or filament eruption on the Sun or even an obvious CME observed close to the Sun that correlates with the ICME within a reasonable time range. These ICMEs sometimes result in intense storms. Furthermore, there is a possibility that some of the more severe storms could be partly contributed by such ICMEs of unclear origin. Therefore space weather prediction will remain incomplete without properly understanding these ICMEs. Even if the ICME is paired with a CME, it is sometimes difficult to find where the latter comes from. This is often called the “stealth CME” that apparently lacks low coronal signatures (LCSs). STEREO's second and third view points have tremendously helped us determine its front-side origin and find when and where it forms and accelerates, which is important for isolating possible LCSs. Although SDO/AIA has been continuously taking full-disk EUV images in a wide temperature range since 2010, there are still a number of stealthy CMEs whose LCSs are unclear or ambiguous. It is assumed that they start at high altitudes, leaving weak or negligible LCSs. Some of them seem to involve multiple magnetic domains, and weak or open field regions. We present AIA observations of several stealthy CMEs, including recent ones, that were responsible for geomagnetic storms, emphasizing the need to compare images with long time differences and to find the periods at which the CME forms and accelerates. We also discuss uncertainties in interpreting in situ data as to whether a CME is present when data are dominated by other solar wind features, such as HSS and CIR.

  9. Visualization of the air ejected from the temporary cavity in brain and tissue simulants during gunshot wounding.

    PubMed

    Lazarjan, M S; Geoghegan, P H; Taylor, M C; Jermy, M C

    2015-01-01

    One hypothesis for the physical mechanism responsible for backspatter during cranial gunshot wounding is that air is ejected by the collapse of the temporary cavity formed around the bullet path. Using bovine and ovine heads and simulant materials, evidence of this ejection was sought by measuring the velocity of the air that was drawn in and ejected from the cavity in front of the wound channel after bullet impact. A laminar flow of fog-laden air was arranged in front of the wound channel and two high speed cameras recording at 30,000 frames/second captured the air motion. All samples were shot with standard 9 mm × 19 mm FMJ ammunition. Different concentrations of ballistic gelatine were used to characterize the effect of elasticity of the material on the velocity of the air. Fresh bovine and ovine heads were shot with the same experimental set up to investigate if there was induction of air into, and ejection of air from the entrance wounds. The results show, for the first time, that the temporary cavity does eject air in gelatine. The velocity of in-drawn air for 3, 5 and 10% concentration of gelatine was 81, 76 and 65 m/s respectively and the velocity of ejected air for 5 and 10% concentration of gelatine were 43 and 72 m/s respectively. The results show that when the concentration of gelatine is increased, the velocity of the air drawn into the cavity decreases and the velocity of the ejected air increases. However, no ejection was observed in 3% gelatine, ovine or bovine heads. Although ejection of air was not observed, ejection of brain from the wound channel was seen. Using the velocity of the ejected brain, the minimum intracranial pressure required to eject the brain tissue was estimated to be 712 kPa and 468 kPa for the sheep and bovine heads respectively.

  10. Halo Coronal Mass Ejections and Geomagnetic Storms

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2009-01-01

    In this letter, I show that the discrepancies in the geoeffectiveness of halo coronal mass ejections (CMEs) reported in the literature arise due to the varied definitions of halo CMEs used by different authors. In particular, I show that the low geoeffectiveness rate is a direct consequence of including partial halo CMEs. The geoeffectiveness of partial halo CMEs is lower because they are of low speed and likely to make a glancing impact on Earth. Key words: Coronal mass ejections, geomagnetic storms, geoeffectiveness, halo CMEs.

  11. Halo Coronal Mass Ejections and Geomagnetic Storms

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2009-01-01

    In this letter, I show that the discrepancies in the geoeffectiveness of halo coronal mass ejections (CMEs) reported in the literature arise due to the varied definitions of halo CMEs used by different authors. In particular, I show that the low geoeffectiveness rate is a direct consequence of including partial halo CMEs. The geoeffectiveness of partial halo CMEs is lower because they are of low speed and likely to make a glancing impact on Earth. Key words: Coronal mass ejections, geomagnetic storms, geoeffectiveness, halo CMEs.

  12. IR Variability During a Shell Ejection of Eta Carinae

    NASA Astrophysics Data System (ADS)

    Smith, Nathan

    2006-02-01

    Every 5.5 years, η Carinae experiences a dramatic ``spectroscopic event'' when high-excitation lines in its UV, optical, and IR spectrum disappear, and its hard X-ray and radio continuum flux crash. This periodicity has been attributed to a very eccentric binary system with a shell ejection occurring at periastron. Mid-IR images and spectra with T-ReCS are needed to measure changes in the current bolometric luminosity and to trace dust formation episodes. This will provide a direct estimate of the mass ejected. Near-IR emission lines trace related changes in the post-event wind and ionization changes in the circumstellar environment needed to test specific models for the cause of η Car's variability as it recovers from its recent ``event''. High resolution near-IR spectra with GNIRS will continue the important work of HST/STIS, investigating changes in the direct and reflected spectrum of the stellar wind, and ionization changes in the nebula. The complex kinematic structure of η Car's ejecta also holds important clues to its mass ejection history, and is essential for interpreting other data. Phoenix can provide a unique kinematic map of the complex density and time-variable ionization structure of η Car's nebula, which is our best example of the pre-explosion environment of very massive stars.

  13. Effects of Slag Ejection on Solid Rocket Motor Performance

    NASA Technical Reports Server (NTRS)

    Whitesides, R. Harold; Purinton, David C.; Hengel, John E.; Skelley, Stephen E.

    1995-01-01

    In past firings of the Reusable Solid Rocket Motor (RSRM) both static test and flight motors have shown small pressure perturbations occurring primarily between 65 and 80 seconds. A joint NASA/Thiokol team investigation concluded that the cause of the pressure perturbations was the periodic ingestion and ejection of molten aluminum oxide slag from the cavity around the submerged nozzle nose which tends to trap and collect individual aluminum oxide droplets from the approach flow. The conclusions of the team were supported by numerous data and observations from special tests including high speed photographic films, real time radiography, plume calorimeters, accelerometers, strain gauges, nozzle TVC system force gauges, and motor pressure and thrust data. A simplistic slag ballistics model was formulated to relate a given pressure perturbation to a required slag quantity. Also, a cold flow model using air and water was developed to provide data on the relationship between the slag flow rate and the chamber pressure increase. Both the motor and the cold flow model exhibited low frequency oscillations in conjunction with periods of slag ejection. Motor and model frequencies were related to scaling parameters. The data indicate that there is a periodicity to the slag entrainment and ejection phenomena which is possibly related to organized oscillations from instabilities in the dividing streamline shear layer which impinges on the underneath surface of the nozzle.

  14. Transplantation of human amniotic epithelial cells repairs brachial plexus injury: pathological and biomechanical analyses

    PubMed Central

    Yang, Qi; Luo, Min; Li, Peng; Jin, Hai

    2014-01-01

    A brachial plexus injury model was established in rabbits by stretching the C6 nerve root. Immediately after the stretching, a suspension of human amniotic epithelial cells was injected into the injured brachial plexus. The results of tensile mechanical testing of the brachial plexus showed that the tensile elastic limit strain, elastic limit stress, maximum stress, and maximum strain of the injured brachial plexuses were significantly increased at 24 weeks after the injection. The treatment clearly improved the pathological morphology of the injured brachial plexus nerve, as seen by hematoxylin eosin staining, and the functions of the rabbit forepaw were restored. These data indicate that the injection of human amniotic epithelial cells contributed to the repair of brachial plexus injury, and that this technique may transform into current clinical treatment strategies. PMID:25657737

  15. Rhabdomyolysis resulting in concurrent Horner's syndrome and brachial plexopathy: a case report.

    PubMed

    Lee, Susan C; Geannette, Christian; Wolfe, Scott W; Feinberg, Joseph H; Sneag, Darryl B

    2017-08-01

    This case report describes a 29-year-old male who presented with immediate onset of Horner's syndrome and ipsilateral brachial plexopathy after sleeping with his arm dangling outside a car window for 8 h. Outside workup and imaging revealed rhabdomyolysis of the left neck musculature. Subsequent electrodiagnostic testing and high-resolution brachial plexus magnetic resonance imaging at the authors' institution attributed the Horner's syndrome and concurrent brachial plexopathy to rhabdomyolysis of the longus colli and scalene musculature, which had compressed-and consequently scar tethered-the cervical sympathetic trunk and brachial plexus. This case of co-existent Horner's syndrome and brachial plexopathy demonstrates the role of high-resolution brachial plexus MRI in diagnosing plexopathy and the importance of being familiar with plexus and paravertebral muscle anatomy.

  16. Recent advances in the management of brachial plexus injuries

    PubMed Central

    Bhandari, Prem Singh; Maurya, Sanjay

    2014-01-01

    Management of brachial plexus injury is a demanding field of hand and upper extremity surgery. With currently available microsurgical techniques, functional gains are rewarding in upper plexus injuries. However, treatment options in the management of flail and anaesthetic limb are still evolving. Last three decades have witnessed significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in the diagnostic modalities, incorporation of intra-operative nerve stimulation techniques, more liberal use of nerve grafts in bridging nerve gaps, and the addition of new nerve transfers, which selectively neurotise the target muscles close to the motor end plates. Newer research works on the use of nerve allografts and immune modulators (FK 506) are under evaluation in further improving the results in nerve reconstruction. Direct reimplantation of avulsed spinal nerve roots into the spinal cord is another area of research in brachial plexus reconstruction. PMID:25190913

  17. Assessment of obstetric brachial plexus injury with preoperative ultrasound.

    PubMed

    Smith, Edward C; Xixis, Kathryn Idol; Grant, Gerald A; Grant, Stuart A

    2016-06-01

    Tools used in the assessment of obstetric brachial plexus injuries (OBPIs) have traditionally included electrodiagnostic studies, computerized tomography with myelography, and MRI. However, the utility of ultrasound (US) in infants for such assessment has not been extensively examined. This retrospective case series reports the preoperative brachial plexus US findings in 8 patients with OBPI and compares US with intraoperative findings. When available, the preoperative US was compared with the preoperative MRI. US revealed abnormalities in all 8 patients. Although MRI detected abnormalities in the majority of patients, US provided accurate information regarding severity and anatomic location of injury in some patients. US is a relatively inexpensive, noninvasive, painless diagnostic modality that can be used to assess OBPI. This case series suggests that US is a valuable adjunct to current diagnostic modalities. Muscle Nerve 53: 946-950, 2016. © 2015 Wiley Periodicals, Inc.

  18. Reoperation for failed shoulder reconstruction following brachial plexus birth injury

    PubMed Central

    2013-01-01

    Background Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure. Case presentations This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation. Conclusions This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction. PMID:23883413

  19. Median nerve neuropraxia by a large false brachial artery aneurysm.

    PubMed

    Lijftogt, Niki; Cancrinus, Ernst; Hoogervorst, Erwin L J; van de Mortel, Rob H W; de Vries, Jean-Paul P M

    2014-10-01

    Peripheral nerve compression is a rare complication of an iatrogenic false brachial artery aneurysm. We present a 72-year-old patient with median nerve compression due to a false brachial artery aneurysm after removal of an arterial catheter. Surgical exclusion of the false aneurysm was performed in order to release traction of the median nerve. At 3-month assessment, moderate hand recovery in function and sensibility was noted. In the case of neuropraxia of the upper extremity, following a history of hospital stay and arterial lining or catheterization, compression due to pseudoaneurysm should be considered a probable cause directly at presentation. Early recognition and treatment is essential to avoid permanent neurological deficit. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Obstetric brachial plexus palsy following routine versus difficult deliveries.

    PubMed

    El-Sayed, Amel A F

    2014-07-01

    Previous bio-engineering studies showed that intrapartum peak forces applied by the clinician were lower in routine deliveries than difficult deliveries. A total of 751 cases of obstetric brachial plexus palsy were included and divided into two groups: group I (248 patients) were born following routine deliveries and group II (503 patients) were born following difficult deliveries. Both groups were compared regarding the type of palsy and the rate of good/poor spontaneous motor recovery from the palsy. Group I subjects were more likely to have upper Erb palsy whereas those in group II were more likely to develop total palsy (P < .0001). The percentage of newborns with poor functional recovery was significantly higher (P < .05) in group II with regards to shoulder, wrist, and hand function. It was concluded that higher peak forces applied by the clinician in difficult deliveries affect the type of obstetric brachial plexus palsy. © The Author(s) 2013.

  1. Obstetric brachial plexus palsy: a clinical and electrophysiologic evaluation.

    PubMed

    Gopinath, M S; Bhatia, M; Mehta, V S

    2002-09-01

    Obstetrical brachial plexus palsy (OBPP) occurs as sequelae of birth-related trauma, antenatal and parturition related complications. It is associated with varying degrees of functional disability. Electrodiagnostic studies (EDS) are an adjunctive tool and help to localise and prognosticate the outcome of OBPP. Fourteen children, presenting with OBPP to the Clinical Neurophysiology Lab, were analyzed. Details of birth history were obtained, and EDS were performed to characterize the lesion. The age ranged from one month to one year. Ten had unilateral and four bilateral brachial palsy. On EDS, five had pan-plexus, six predominantly upper plexus and three lower plexus involvement. A poor re-innervation pattern on EMG correlated with inadequate recovery. OBPP, a condition associated with considerable disability, needs to be prevented. Electrodiagnostic studies are a useful adjunctive tool for characterizing the site of injury and prognostication.

  2. Massive hemothorax: A rare complication after supraclavicular brachial plexus block

    PubMed Central

    Singh, Shiv Kumar; Katyal, Surabhi; Kumar, Amit; Kumar, Pawan

    2014-01-01

    Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques. PMID:25886347

  3. Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction.

    PubMed

    Schelbert, H R; Henning, H; Ashburn, W L; Verba, J W; Karliner, J S; O'Rourke, R A

    1976-10-01

    The left ventricular ejection fraction was determined serially with radioisotope angiography in 63 patients with acute myocardial infarction. After the peripheral injection of a bolus of technetium-99m, precordial radioactivity was recorded with a gamma scintillation camera and the ejection fraction calculated from the high frequency left ventricular time-activity curve. Since this technique requires no assumptions with respect to left ventricular geometry, it is particularly useful in patients with segmental left ventricular dysfunction. Serial measurements during the first 5 days after hospital admission were made in 50 patients, 30 of whom were studied during the subsequent 2 to 39 months (mean 19.9 months). Late follow-up serial studies were also performed in an additional 13 patients who had only one measurement of the left ventricular ejection fraction during the early postinfarction period. Early after infarction, the left ventricular ejection fraction was normal (more than 0.52) in only 15 of the 63 patients, and averaged 0.52 +/- 0.05 (standard deviation) in the 27 patients with an uncomplicated infarct. The ejection fraction was reduced in 24 patients with mild to moderate left ventricular failure (0.40 +/- 0.05, P less than 0.0001) and in the 12 patients with overt pulmonary edema (0.33 +/- 0.07, P less than 0.0001). In 35 patients the ejection fraction correlated with the mean pulmonary arterial wedge pressure (r = 0.72). In 15 patients with normal left ventricular wall motion by heart motion videotracking, the ejection fraction was significantly higher (0.53 +/- 0.08) than in the 26 patients with regional left ventricular dysfunction (0.41 +/- 0.10, P less than 0.0001). During the early postinfarction period, the left ventricular ejection fraction improved in 55 percent of patients and remained unchanged or decreased in 45 percent. A further increase in the ejection fraction was noted in 61 percent of patients during the late follow-up period. Patients

  4. Burden of Recurrent Hospitalizations Following an Admission for Acute Heart Failure: Preserved Versus Reduced Ejection Fraction.

    PubMed

    Santas, Enrique; Valero, Ernesto; Mollar, Anna; García-Blas, Sergio; Palau, Patricia; Miñana, Gema; Núñez, Eduardo; Sanchis, Juan; Chorro, Francisco Javier; Núñez, Julio

    2017-04-01

    Heart failure with preserved ejection fraction and reduced ejection fraction share a high mortality risk. However, differences in the rehospitalization burden over time between these 2 entities remains unclear. We prospectively included 2013 consecutive patients discharged for acute heart failure. Of these, 1082 (53.7%) had heart failure with preserved ejection fraction and 931 (46.2%) had heart failure with reduced ejection fraction. Cox and negative binomial regression methods were used to evaluate the risks of death and repeat hospitalizations, respectively. At a median follow-up of 2.36 years (interquartile range: 0.96-4.65), 1018 patients (50.6%) died, and 3804 readmissions were registered in 1406 patients (69.8%). Overall, there were no differences in mortality between heart failure with preserved ejection fraction and heart failure with reduced ejection fraction (16.7 vs 16.1 per 100 person-years, respectively; P=0794), or all-cause repeat hospitalization rates (62.1 vs 62.2 per 100 person-years, respectively; P=.944). After multivariable adjustment, and compared with patients with heart failure with reduced ejection fraction, patients with heart failure with preserved ejection fraction exhibited a similar risk of all-cause readmissions (incidence rate ratio=1.04; 95%CI, 0.93-1.17; P=.461). Regarding specific causes, heart failure with preserved ejection fraction showed similar risks of cardiovascular and heart failure-related rehospitalizations (incidence rate ratio=0.93; 95%CI, 0.82-1.06; P=.304; incidence rate ratio=0.96; 95% confidence interval, 0.83-1.13; P=.677, respectively), but had a higher risk of noncardiovascular readmissions (incidence rate ratio=1.24; 95%CI, 1.04-1.47; P=.012). Following an admission for acute heart failure, patients with heart failure with preserved ejection fraction have a similar rehospitalization burden to those with heart failure with reduced ejection fraction. However, patients with heart failure with preserved ejection

  5. Isolated latissimus dorsi transfer to restore shoulder external rotation in adults with brachial plexus injury.

    PubMed

    Ghosh, S; Singh, V K; Jeyaseelan, L; Sinisi, M; Fox, M

    2013-05-01

    In adults with brachial plexus injuries, lack of active external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper limb function. There is a paucity of evidence to address this complex issue. We present our experience of isolated latissimus dorsi (LD) muscle transfer to achieve active external rotation. This is a retrospective review of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All patients were male with a mean age of 34 years (21 to 57). All the patients underwent isolated LD muscle transfer using a standard technique to correct external rotational deficit. Outcome was assessed for improvement in active external rotation, arc of movement, muscle strength and return to work. The mean improvement in active external rotation from neutral was 24° (10° to 50°). The mean increase in arc of rotation was 52° (38° to 55°). Mean power of the external rotators was 3.5 Medical Research Council (MRC) grades (2 to 5). A total of 21 patients (88%) were back in work by the time of last follow up. Of these, 13 had returned to their pre-injury occupation. Isolated latissimus dorsi muscle transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial plexus injuries with internal rotational deformity.

  6. Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block.

    PubMed

    Zhang, Yu; Wang, Chang-Song; Shi, Jing-Hui; Sun, Bo; Liu, Shu-Jie; Li, Peng; Li, En-You

    2014-01-01

    To evaluate the hypothesis that adding dexmedetomidine to ropivacaine prolongs axillary brachial plexus block. Forty-five patients of ASA I~II and aged 25-60 yr who were scheduled for elective forearm and hand surgery were randomly divided into 3 equal groups and received 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (50 μg) (Group DR1), 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (100 μg) (group DR2) or 40 ml of 0.33% ropivacaine + 1 ml saline (group R) in a double-blind fashion. The onset and duration of sensory and motor blocks and side effects were recorded. The demographic data and surgical characteristics were similar in each group. Sensory and motor block onset times were the same in the three groups. Sensory and motor blockade durations were longer in group DR2 than in group R (P < 0.05). There was no significant difference in the sensory blockade duration between group DR1 and group R. Bradycardia, hypertension and hypotension were not observed in group R and occurred more often in group DR2 than in group DR1. Dexmedetomidine added to ropivacaine for an axillary brachial plexus block prolongs the duration of the block. However, dexmedetomidine may also lead to side effects such as bradycardia, hypertension, and hypotension.

  7. A comparison of Doppler waveform parameters versus flow-mediated vascular dilation of the brachial artery in pregnant women.

    PubMed

    Landres, Inna V; Small, Maria; Sirjusingh, Adesh; Ramsewak, Samuel; Williams, Keith P

    2014-07-01

    Flow mediated dilation of the brachial artery is impaired with endothelial dysfunction. We previously identified that brachial artery waveforms were changed in preeclamptic women. We therefore sought to compare Doppler waveform analysis with flow mediated vascular dilation (FMVD) measurements in pregnant women. A cross sectional study of 71 pregnant women at >20weeks gestation comparing FMVD measurements with Doppler waveform parameters was performed. Research was conducted at three hospitals and two geographic settings; (1) Yale-New Haven Hospital in New Haven, CT, (2) Mount Hope Maternity and (3) Port of Spain General Hospital in Trinidad. Brachial artery Doppler waveform measurements were done at baseline and 90s post cuff-release. From the Doppler waveforms we assessed percent change in Peak Systolic Velocity (% ΔPSV), systolic acceleration, acceleration time and pulsatility index and compared them with the percent change in FMVD. Statistical analysis using Student's t tests and correlation coefficient was done as necessary. Correlation analysis between the % change in the Doppler waveform parameters and the % change in mean FMVD identified only the waveform parameter of % ΔPSV as significantly correlated (p=0.040). FMVD remains the gold standard for assessment of endothelial dysfunction. A correlation was observed between the Doppler measured % ΔPSV and FMVD, which may allow it to be used to assess endothelial dysfunction changes under different conditions was identified. Copyright © 2014 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  8. Iatrogenic brachial and femoral artery complications following venipuncture in children.

    PubMed

    Dogan, Omer Faruk; Demircin, Metin; Ucar, Ibrahim; Duman, Umit; Yilmaz, Mustafa; Boke, Erkmen

    2006-01-01

    Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from

  9. Ultrasonographic evaluation of brachial plexus tumors in five dogs.

    PubMed

    Rose, Scott; Long, Craig; Knipe, Marguerite; Hornof, Bill

    2005-01-01

    Five dogs with unilateral thoracic limb lameness, neurologic deficits, muscle atrophy, and pain, or a combination of these signs, were examined using ultrasonograghy. Large, hypoechoic tubular masses that displaced vessels and destroyed the normal architecture were found in each dog. The affected axilla of each patient was then imaged with computed tomography or magnetic resonance to fully assess the extent of the masses. We describe the use of ultrasound in screening patients for brachial plexus tumors.

  10. Ankle-brachial index on Kilimanjaro: lessons from high altitude.

    PubMed

    Nault, Patrice; Halman, Samantha; Paradis, Josée

    2009-01-01

    This study investigated the effects of a high-sympathetic stimulus environment (high-altitude hypoxia) on limb-specific systolic blood pressure (sBP) and ankle-brachial index (ABI) in normal volunteers. We hypothesized that currently accepted normal values for ABI may in fact not reflect an actual normal vascular state in all patients. Twenty climbers (17 males, 3 females) from Gatineau-Hull (Québec, Canada) participated in this study and ascended Mount Kilimanjaro, Africa. Ankle-brachial index measurements were performed at sea level and on Mount Kilimanjaro at approximately 4100 m. The data were analyzed using predictive analytics software SPSS 14.0. Data obtained at sea level were compared to those obtained at approximately 4100 m, with participants serving as their own controls. Ankle-brachial indices measured at approximately 4100 m (mean = 1.20) were greater than those measured at sea level (mean = 0.97) (n = -6.23; 95% CI: -.32 to -.17; P < .001). There were no significant differences between the systolic brachial pressures at approximately 4100 m when compared to those at sea level (P = .814). Contrarily, systolic ankle pressures at sea level (mean = 132) were significantly greater than those measured at approximately 4100 m (mean = 152) (t = -3.5, 95% CI: -29 to -7.4; P = .002). This study is the first to physiologically demonstrate that in response to a high adrenergic stimulus in healthy volunteers there is a greater increase in sBP in the legs vs the arms.

  11. Brachial plexus impingement: an unusual complication of bilateral breast augmentation.

    PubMed

    Berry, M G; Stanek, J J

    2008-03-01

    Breast augmentation is one of the most commonly performed aesthetic procedures, with many studies documenting the early and long-term complications that might be expected. This report describes the case of an active young woman who experienced severe pain, particularly with movement. Surgical exploration showed the cause of this pain to be impingement of the patient's lower brachial plexus by the mammary prosthesis. Such a complication has not, to the authors' knowledge, been reported previously.

  12. Brachial plexus sonography: a technique for assessing the root level.

    PubMed

    Martinoli, Carlo; Bianchi, Stefano; Santacroce, Elena; Pugliese, Francesca; Graif, Moshe; Derchi, Lorenzo E

    2002-09-01

    Our study was intended to establish a technique to assess the level of the roots of the brachial plexus using high-resolution sonography. The skeleton of a cervical spine was examined in vitro to determine whether the vertebrae may be identified individually on sonography by means of the evaluation of their transverse processes. Then 20 healthy subjects and five patients who had undergone CT of the cervical spine were evaluated sonographically, and we attempted to identify the level of individual roots of the brachial plexus using the transverse processes as landmarks. To establish the reliability of this method, a blinded review of sonograms of the paravertebral area obtained at various levels was performed independently by three examiners. In vitro, sonography was reliable in depicting the level of the C7 vertebra because of the absence of the anterior tubercle from its transverse processes. In healthy subjects, this feature allowed us to establish the level of the roots outside the spine. In our series, the C4-C7 roots were visible sonographically in all cases, whereas the C8 and T1 levels were seen, respectively, in only 16 of 20 and eight of 20 cases. All examiners correctly identified the C7 level in the blinded review of sonograms. High-resolution sonography can reveal the level of the roots of the brachial plexus on the basis of the different morphology of the transverse processes of the vertebrae. Our study has implications for confirming the exact level of pathologic roots before surgery.

  13. Scapular deformity in obstetric brachial plexus palsy: a new finding

    PubMed Central

    Paizi, Melia

    2007-01-01

    While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months–10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients. PMID:17262175

  14. Hypoglossal nerve transfer in obstetric brachial plexus palsy.

    PubMed

    Blaauw, Gerhard; Sauter, Ymte; Lacroix, Cyrielle L E; Slooff, Albert C J

    2006-01-01

    A cost-benefit analysis was performed of hypoglossal nerve transfer in six patients with obstetric brachial palsy taking into account the factors donor site morbidity and extent of recovery. Hypoglossal nerve transfer was employed in four children for elbow flexion only; in two patients for elbow flexion as well as for elbow extension. The transfer was part of an extended brachial plexus reconstruction for treatment of obstetric brachial plexus palsy. After a mean post-operative interval of 52 months (SD+/-8.1), two professional speech therapists investigated late donor site morbidity by analyzing elementary and communicative functions. The functional result for the arm was assessed using the Mallet scale and by performing a physical examination. Following hypoglossal nerve transfer, early donor site morbidity was significant causing great anxiety in the parents. Late donor site morbidity consisted of serious oral problems in a number of the children. They also showed clear associated movements in the arm during mouth/tongue activity. Recovery of powerful volitional elbow flexion was achieved in four cases only. We do not believe that the sacrifice of such an important function as exerted by the hypoglossal nerve is balanced by the gain demonstrated in our series.

  15. Scapular deformity in obstetric brachial plexus palsy: a new finding.

    PubMed

    Nath, Rahul K; Paizi, Melia

    2007-03-01

    While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months-10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients.

  16. Obstetric brachial plexus palsy--risk factors and predictors.

    PubMed

    Sibiński, Marcin; Synder, Marek

    2007-01-01

    Obstetric brachial plexus palsy is a rare condition occurring in about 1 per thousand of live births. It is caused most often by traction during delivery, although in some cases clear evidence of direct injury to the nerves is not present. The aim of the study was to define risk factors for obstetric brachial plexus palsy and relate the chances of recovery to the severity of the injury. Two prospective databases of patient information and clinical assessment data were used for the study. The first database contained information about pregnancy, labour, severity of injury, operative procedures and coexisting disorders of 162 children. The second comprised information about clinical assessment of the affected limb in 76 patients. The mean age of patients at last follow-up was 6 years and 9 months. High birth weight, shoulder dystocia, forceps delivery and clavicle fracture were important risk factors in obstetric brachial plexus injury. Breech delivery was not associated with a higher incidence of nerve injuries despite literature data pointing to the contrary. A Caesarean incision reduced the risk of plexus palsy but did not eliminate it completely. In Narakas group 1 patients, recovery of biceps function occurred before the age of 4 months. The vast majority of the children will have complete recovery of the affected limb. In group III and IV, return to full function is very unlikely. Our results confirm that Narakas' classification, apart from being very popular for classifying severity of the pathology, is a strong predictor of outcome.

  17. The Automatic Detection of Coronal Mass Ejections Using the Solar Mass Ejection Imager

    DTIC Science & Technology

    2009-10-30

    Res., 112, A09103, doi: 10.1029/2007JA012358, 2007. Low, B.C., Solar activity and the corona , Solar Phys. 167, p217, 1996. Robbrecht, E., and D...AFRL-RV-HA-TR-2009-1104 Q- o o o p o The Automatic Detection of Coronal Mass Ejections Using the Solar Mass Ejection Imager Timothy A. Howard... Solar Mass Ejection Imager 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6340IF 6. AUTHORS Timothy A. Howard S. James Tappin

  18. Dynamics of DNA Ejection from Bacteriophage

    PubMed Central

    Inamdar, Mandar M.; Gelbart, William M.; Phillips, Rob

    2006-01-01

    The ejection of DNA from a bacterial virus (i.e., phage) into its host cell is a biologically important example of the translocation of a macromolecular chain along its length through a membrane. The simplest mechanism for this motion is diffusion, but in the case of phage ejection a significant driving force derives from the high degree of stress to which the DNA is subjected in the viral capsid. The translocation is further sped up by the ratcheting and entropic forces associated with proteins that bind to the viral DNA in the host cell cytoplasm. We formulate a generalized diffusion equation that includes these various pushing and pulling effects and make estimates of the corresponding speedups in the overall translocation process. Stress in the capsid is the dominant factor throughout early ejection, with the pull due to binding particles taking over at later stages. Confinement effects are also investigated, in the case where the phage injects its DNA into a volume comparable to the capsid size. Our results suggest a series of in vitro experiments involving the ejection of DNA into vesicles filled with varying amounts of binding proteins from phage whose state of stress is controlled by ambient salt conditions or by tuning genome length. PMID:16679360

  19. Dynamics of DNA ejection from bacteriophage.

    PubMed

    Inamdar, Mandar M; Gelbart, William M; Phillips, Rob

    2006-07-15

    The ejection of DNA from a bacterial virus (i.e., phage) into its host cell is a biologically important example of the translocation of a macromolecular chain along its length through a membrane. The simplest mechanism for this motion is diffusion, but in the case of phage ejection a significant driving force derives from the high degree of stress to which the DNA is subjected in the viral capsid. The translocation is further sped up by the ratcheting and entropic forces associated with proteins that bind to the viral DNA in the host cell cytoplasm. We formulate a generalized diffusion equation that includes these various pushing and pulling effects and make estimates of the corresponding speedups in the overall translocation process. Stress in the capsid is the dominant factor throughout early ejection, with the pull due to binding particles taking over at later stages. Confinement effects are also investigated, in the case where the phage injects its DNA into a volume comparable to the capsid size. Our results suggest a series of in vitro experiments involving the ejection of DNA into vesicles filled with varying amounts of binding proteins from phage whose state of stress is controlled by ambient salt conditions or by tuning genome length.

  20. How much dust does Enceladus eject?

    NASA Astrophysics Data System (ADS)

    Kempf, Sascha; Srama, Ralf; Postberg, Frank; Schmidt, Juergen

    2016-07-01

    There is an ongoing argument how much dust per second the ice volcanoes on Saturn's ice moon eject. By adjusting their plume model to the dust flux measured by the Cassini dust detector during the close Enceladus flyby in 2005, Schmidt et al. (2008) obtained a total dust production rate in the plumes of about

  1. Do centrioles generate a polar ejection force?

    PubMed

    Wells, Jonathan

    2005-01-01

    A microtubule-dependent polar ejection force that pushes chromosomes away from spindle poles during prometaphase is observed in animal cells but not in the cells of higher plants. Elongating microtubules and kinesin-like motor molecules have been proposed as possible causes, but neither accounts for all the data. In the hypothesis proposed here a polar ejection force is generated by centrioles, which are found in animals but not in higher plants. Centrioles consist of nine microtubule triplets arranged like the blades of a tiny turbine. Instead of viewing centrioles through the spectacles of molecular reductionism and neo-Darwinism, this hypothesis assumes that they are holistically designed to be turbines. Orthogonally oriented centriolar turbines could generate oscillations in spindle microtubules that resemble the motion produced by a laboratory vortexer. The result would be a microtubule-mediated ejection force tending to move chromosomes away from the spindle axis and the poles. A rise in intracellular calcium at the onset of anaphase could regulate the polar ejection force by shutting down the centriolar turbines, but defective regulation could result in an excessive force that contributes to the chromosomal instability characteristic of most cancer cells.

  2. Forces during Bacteriophage DNA Packaging and Ejection

    PubMed Central

    Purohit, Prashant K.; Inamdar, Mandar M.; Grayson, Paul D.; Squires, Todd M.; Kondev, Jané; Phillips, Rob

    2005-01-01

    The conjunction of insights from structural biology, solution biochemistry, genetics, and single-molecule biophysics has provided a renewed impetus for the construction of quantitative models of biological processes. One area that has been a beneficiary of these experimental techniques is the study of viruses. In this article we describe how the insights obtained from such experiments can be utilized to construct physical models of processes in the viral life cycle. We focus on dsDNA bacteriophages and show that the bending elasticity of DNA and its electrostatics in solution can be combined to determine the forces experienced during packaging and ejection of the viral genome. Furthermore, we quantitatively analyze the effect of fluid viscosity and capsid expansion on the forces experienced during packaging. Finally, we present a model for DNA ejection from bacteriophages based on the hypothesis that the energy stored in the tightly packed genome within the capsid leads to its forceful ejection. The predictions of our model can be tested through experiments in vitro where DNA ejection is inhibited by the application of external osmotic pressure. PMID:15556983

  3. Magnetic resonance imaging of traumatic and non-traumatic brachial plexopathies.

    PubMed

    Fan, Yiru Lorna; Othman, Mohamad Isham Bin; Dubey, Niraj; Peh, Wilfred Cg

    2016-10-01

    Adult-onset brachial plexopathy can be classified into traumatic and non-traumatic aetiologies. Traumatic brachial plexopathies can affect the pre- or postganglionic segments of the plexus. Non-traumatic brachial plexopathies may be due to neoplasia, radiotherapy, thoracic outlet syndrome and idiopathic neuralgic amyotrophy. Conventional magnetic resonance imaging (MRI) is useful to localise the area of injury or disease, and identify the likely cause. This review discusses some of the common causes of adult-onset brachial plexopathy and their imaging features on MRI. We also present a series of cases to illustrate some of these causes and their MRI findings. Copyright: © Singapore Medical Association.

  4. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    PubMed Central

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed. PMID:25593443

  5. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries.

    PubMed

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  6. Evaluation of an education day for families of children with obstetrical brachial plexus palsy.

    PubMed

    Ho, Emily S; Ulster, Alissa A

    2011-09-01

    Children with obstetrical brachial plexus palsy may have chronic physical impairment in their affected upper extremity. Affected children and their families may benefit from psychosocial interventions including therapeutic relationships with health professionals, meeting other families living with obstetrical brachial plexus palsy, support groups, and social work. One method of addressing psychosocial needs is through a support and education day. The purpose of this quality improvement project is to evaluate parental perceptions of a support and education day called the "Brachial Plexus Family Day." Families of children with obstetrical brachial plexus palsy who attended the Brachial Plexus Family Day completed a questionnaire to evaluate the different programs offered during the day. The families also ranked the importance of different psychosocial supports offered in the clinic. Sixty-three out of 69 families completed the questionnaire. Each program of the Brachial Plexus Family Day was rated as good or excellent by the respondents. Ninety-seven percent of respondents rated meeting other families and children with obstetrical brachial plexus palsy as helpful supports. Attending a Brachial Plexus Family day event (86%), followed by connecting with a doctor (60%), and physical or occupational therapist (59%) were the highest ranked supports reported by the families. The parents and caregivers that attended the Brachial Plexus Family Day rated the program highly. This group also valued the opportunity to connect with other families and children affected with the same condition.

  7. Delayed rupture of a pseudoaneurysm in the brachial artery of a burn reconstruction patient

    PubMed Central

    2013-01-01

    A brachial artery pseudoaneurysm is a rare but serious condition that can be limb threatening. A number of reports have found that it may be the result of damage to the blood vessels around the brachial artery, either directly or indirectly, due to trauma or systemic diseases. We present our experience of delayed pseudoaneurysm rupture of the brachial artery in a rehabilitation patient with burns of the upper extremity who underwent fasciotomy and musculocutaneous flap coverage. We also provide a review of the brachial artery pseudoaneurysm. PMID:23758847

  8. [Modified grant method protocol for dissecting and identifying the brachial plexus].

    PubMed

    Arakawa, Takamitsu; Setsu, Tomiyoshi; Terashima, Toshio

    2004-03-01

    Dissection of the brachial plexus is an important part in the anatomical course, but it is difficult for medical students to identify individual nerves of the brachial plexus due to its complexity and numerous variations. We have recently adopted the Grant method (1991) to guide students in the successful identification of this plexus. However, according to the Grant method the part of the upper limb including the brachial plexus is dissected before the neck part, which makes it impossible to identify the roots, trunks, and cords of the brachial plexus, and to identify the nerve branches extending from the brachial plexus. Here, we propose of anatomical dissection protocol of the brachial plexus a modified Grant method for medical students and instructors. The points of the modified protocols are: (1) to dissect the brachial plexus after the dissection of the neck part, (2) to identify the nerve trunks at the scalenus gap after dissecting the lateral, medial and posterior cords. The modified Grant method can be adapted to any other dissecting protocol of the brachial plexus, and will allow students to cope with many variations of the brachial plexus when they occur.

  9. Magnetic resonance imaging of traumatic and non-traumatic brachial plexopathies

    PubMed Central

    Fan, Yiru Lorna; Othman, Mohamad Isham Bin; Dubey, Niraj; Peh, Wilfred CG

    2016-01-01

    Adult-onset brachial plexopathy can be classified into traumatic and non-traumatic aetiologies. Traumatic brachial plexopathies can affect the pre- or postganglionic segments of the plexus. Non-traumatic brachial plexopathies may be due to neoplasia, radiotherapy, thoracic outlet syndrome and idiopathic neuralgic amyotrophy. Conventional magnetic resonance imaging (MRI) is useful to localise the area of injury or disease, and identify the likely cause. This review discusses some of the common causes of adult-onset brachial plexopathy and their imaging features on MRI. We also present a series of cases to illustrate some of these causes and their MRI findings. PMID:27779278

  10. Evidence of elevated X-ray absorption before and during major flare ejections in GRS 1915+105

    SciTech Connect

    Punsly, Brian; Rodriguez, Jérôme

    2014-03-10

    We present time-resolved X-ray spectroscopy of the microquasar GRS 1915+105 with the MAXI observatory in order to study the accretion state just before and during the ejections associated with its major flares. Radio monitoring with the RATAN-600 radio telescope from 4.8-11.2 GHz has revealed two large, steep-spectrum major flares in the first eight months of 2013. Since the RATAN has received one measurement per day, we cannot determine the jet-forming time without more information. Fortunately, this is possible since a distinct X-ray light curve signature that occurs preceding and during major ejections has been determined in an earlier study. The X-ray luminosity spikes to very high levels in the hours before ejection, then becomes variable (with a nearly equal X-ray luminosity when averaged over the duration of the ejection) during a brief 3-8 hr ejection process. By comparing this X-ray behavior with MAXI light curves, we can estimate the beginning and end of the ejection episode of the strong 2013 flares to within ∼3 hr. Using this estimate in conjunction with time-resolved spectroscopy from the data in the MAXI archives allows us to deduce that the X-ray absorbing hydrogen column density increases significantly in the hours preceding the ejections and remains elevated during the ejections responsible for the major flares. This finding is consistent with an outflowing wind or enhanced accretion at high latitudes.

  11. Origin of Coronal Shocks without Mass Ejections

    NASA Astrophysics Data System (ADS)

    Shanmugaraju, A.; Moon, Y.-J.; Cho, K.-S.; Dryer, M.; Umapathy, S.

    2006-01-01

    We present an analysis of all the events (around 400) of coronal shocks for which the shock-associated metric type IIs were observed by many spectrographs during the period April 1997 December 2000. The main objective of this analysis is to give evidence for the type IIs related to only flare-blast waves, and thus to find out whether there are any type II-associated coronal shocks without mass ejections. By carefully analyzing the data from multi-wavelength observations (Radio, GOES X-ray, Hα, SOHO/LASCO and SOHO/EIT-EUV data), we have identified only 30 events for which there were actually no reports of CMEs. Then from the analysis of the LASCO and EIT running difference images, we found that there are some shocks (nearly 40%, 12/30) which might be associated with weak and narrow mass ejections. These weak and narrow ejections were not reported earlier. For the remaining 60% events (18/30), there are no mass ejections seen in SOHO/LASCO. But all of them are associated with flares and EIT brightenings. Pre-assuming that these type IIs are related to the flares, and from those flare locations of these 18 cases, 16 events are found to occur within the central region of the solar disk (longitude ≤45^∘). In this case, the weak CMEs originating from this region are unlikely to be detected by SOHO/LASCO due to low scattering. The remaining two events occurred beyond this longitudinal limit for which any mass ejections would have been detected if they were present. For both these events, though there are weak eruption features (EIT dimming and loop displacement) in the EIT images, no mass ejection was seen in LASCO for one event, and a CME appeared very late for the other event. While these two cases may imply that the coronal shocks can be produced without any mass ejections, we cannot deny the strong relationship between type IIs and CMEs.

  12. Linear theory on temporal instability of megahertz faraday waves for monodisperse microdroplet ejection.

    PubMed

    Tsai, Shirley C; Tsai, Chen S

    2013-08-01

    A linear theory on temporal instability of megahertz Faraday waves for monodisperse microdroplet ejection based on mass conservation and linearized Navier-Stokes equations is presented using the most recently observed micrometer- sized droplet ejection from a millimeter-sized spherical water ball as a specific example. The theory is verified in the experiments utilizing silicon-based multiple-Fourier horn ultrasonic nozzles at megahertz frequency to facilitate temporal instability of the Faraday waves. Specifically, the linear theory not only correctly predicted the Faraday wave frequency and onset threshold of Faraday instability, the effect of viscosity, the dynamics of droplet ejection, but also established the first theoretical formula for the size of the ejected droplets, namely, the droplet diameter equals four-tenths of the Faraday wavelength involved. The high rate of increase in Faraday wave amplitude at megahertz drive frequency subsequent to onset threshold, together with enhanced excitation displacement on the nozzle end face, facilitated by the megahertz multiple Fourier horns in resonance, led to high-rate ejection of micrometer- sized monodisperse droplets (>10(7) droplets/s) at low electrical drive power (<;1 W) with short initiation time (<;0.05 s). This is in stark contrast to the Rayleigh-Plateau instability of a liquid jet, which ejects one droplet at a time. The measured diameters of the droplets ranging from 2.2 to 4.6 μm at 2 to 1 MHz drive frequency fall within the optimum particle size range for pulmonary drug delivery.

  13. Dynamic and static light scattering analysis of DNA ejection from the phage λ

    NASA Astrophysics Data System (ADS)

    Löf, David; Schillén, Karin; Jönsson, Bengt; Evilevitch, Alex

    2007-07-01

    With the aid of time-resolved dynamic light scattering (DLS) and static light scattering (SLS), we have analyzed the ejection kinetics from the bacterial virus bacteriophage (or phage) λ , triggered in vitro by its receptor. We have used DLS to investigate the kinetics in such a system. Furthermore, we have shown that both SLS and DLS can be interchangeably used to study the process of phage DNA release. DLS is superior to SLS in that it also allows the change in the light scattering arising from each of the components in the system to be monitored under conditions such that the relaxation times are separable. With help of these two methods we present a model explaining the reason for the observed decrease in the scattering intensity accompanying DNA ejection from phage. We emphasize that ejection from phage capsid occurs through a very long tail (which is nearly three times longer than the capsid diameter), which significantly separates ejected DNA from the scattering volume of the capsid. The scattering intensity recorded during the DNA ejection process is the result of a change in the form factor of the phage particle, i.e., the change in the interference effects between the phage capsid and the DNA confined in the phage particle. When the DNA molecule is completely ejected it remains in the proximity of the phage for some time, thus contributing to the scattering signal as it diffuses away from the phage capsid, into the scattering volume and returns to its unperturbed chain conformation in bulk solution. The free DNA chain does not contribute to the scattered intensity, when measured at a large angle, due to the DNA form factor and the low concentration. Although the final diffusion-controlled step can lead to overestimation of the real ejection time, we can still use both scattering methods to estimate the initial DNA ejection rates, which are mainly dependent on the pressure-driven DNA ejection from the phage, allowing studies of the effects of various

  14. Ultrasound and gross anatomy of the brachial plexus and major nerves of the forelimb. An anesthetic approach using the domestic rabbit (Oyctolagus cuniculus) as an experimental model1.

    PubMed

    Mencalha, Rodrigo; Sousa, Carlos Augusto Dos Santos; Costa, Orlando; Abidu-Figueiredo, Marcelo

    2016-04-01

    To update the gross and sonographic anatomy and propose landmarks to perform ultrasound-guided (US-guided) axillary brachial plexus block (BPB) in rabbits. Forty New Zeeland's rabbit (NZR) cadavers were dissected and the nerves were trimmed, identified, measured, and photographed. Additionally, in twenty NZRs, sonographic images of brachial plexus (BP) were performed through a simple-resolution ultrasound device. The US-guided block was achieved through a minimum volume of lidocaine necessary to surround the BP roots. The effectiveness of the brachial plexus block was assessed on sensitivity and motor functions. The BP resulted from connections between the ventral branches of the last four cervical spinal nerves and the first thoracic spinal nerve. In the axillary sonoanatomy, the BP appeared as an agglomerate of small, round hypoechoic structures surrounded by a thin hyperechoic ring. The amount of time and the minimum volume required to perform was 4.3 ± 2.3 min and 0.8 ± 0.3ml, respectively. The gross and sonographic anatomy of the BP showed uncommon morphological variations. Moreover, from sonographic landmarks, we showed complete reproducibility of the axillary US-guided brachial plexus block with simple resolution equipment and small volume of anesthetics required.

  15. Ejection associated injuries within the German Air Force from 1981-1997.

    PubMed

    Werner, U

    1999-12-01

    From 1981-1997 there were 86 ejections from 56 aircraft within the German Air Force. Of these, 24 accidents were associated with the F-104 Starfighter, 14 with the PA 200 Tornado, 12 from the F-4 Phantom, 5 from the Alpha Jet and 1 from a MiG 29 Fulcrum. One case involved a front seat pilot, who had already sustained fatal injuries from midair collision, being command ejected by the rear seat pilot. The remaining 85 ejections are the basis of this study. One weapons system officer died from hypothermia after landing in the sea and another from bleeding into the medulla oblongata after flailing; all other participants survived. This is an overall success rate of 97.6%. Of all 85 participants, 12 (14%) were uninjured, 41 (48.2%) were slightly injured, and 30 (35.3%) were severely injured. Typical injuries were those of the spine and lower limbs. The most common severe injury was a vertebral fracture caused by ejection acceleration. This is followed by lower limb injuries received during the parachute landing fall. At the time of ejection, all uninjured crews were flying below 3500 ft altitude and below 260 kn airspeed. Of all ejections from each aircraft type, the percentage of vertebral fractures is highest with the F-4 Phantom (31.8%), followed by the F-104 (16.6%) and the PA 200 Tornado with only 14.8%. The PA 200 is equipped with the most modern type of ejection seat of these aircraft. A conclusion of the gained data is that more modern ejection seat types provide lower injury severity but not fewer total injury numbers, and that the medical data taken during accident investigation should be taken more accurately and in a more standarized fashion to be comparable.

  16. Arterial compliance across the spectrum of ankle-brachial index: the Multiethnic Study of Atherosclerosis.

    PubMed

    Lilly, Scott M; Jacobs, David R; Kronmal, Richard; Bluemke, David A; Criqui, Michael; Lima, Joao; Allison, Matthew; Duprez, Daniel; Segers, Patrick; Chirinos, Julio A

    2014-04-01

    A low ankle-brachial index is associated with cardiovascular disease and reduced arterial compliance. A high ankle-brachial index is also associated with an increased risk of cardiovascular events. We tested the hypothesis that subjects with a high ankle-brachial index demonstrate a lower arterial compliance. In addition, we assessed whether pulse pressure amplification is increased among subjects with a high ankle-brachial index. We studied 6814 adults enrolled in the Multiethnic Study of Atherosclerosis who were, by definition, free of clinical cardiovascular disease at baseline. Differences in total arterial compliance (ratio of stroke volume to pulse pressure), aortic and carotid distensibility (measured with magnetic resonance imaging and duplex ultrasound, respectively) were compared across ankle-brachial index subclasses (≤0.90, 0.91-1.29; ≥1.30) with analyses adjusted for cardiovascular risk factors and subclinical atherosclerosis. Peripheral arterial disease was detected in 230 (3.4%) and high ABI in 648 (9.6%) of subjects. Those with high ankle-brachial index demonstrated greater aortic/radial pulse pressure amplification than those with a normal ankle-brachial index. In adjusted models aortic and carotid distensibility as well as total arterial compliance, were lowest among those with ankle-brachial index≤0.9 (p<0.01 vs. all), but were not reduced in subjects with an ankle-brachial index≥1.3. Lower aortic, carotid and total arterial compliance is not present in subjects free of overt cardiovascular disease and with a high ankle-brachial index. However, increased pulse pressure amplification contributes to a greater ankle-brachial index in the general population and may allow better characterization of individuals with this phenotype. Published by Elsevier Ireland Ltd.

  17. Electrostatic Droplet Ejection Using Planar Needle Inkjet Head

    NASA Astrophysics Data System (ADS)

    Hakiai, Kazunori; Ishida, Yuji; Baba, Akiyoshi; Asano, Tanemasa

    2005-07-01

    For the purpose of investigating the electrostatic droplet ejection event, a planar needle inkjet head with a projected cone-shaped needle (3-D head) was prepared to observe the phenomenon of droplet ejection. As the initial approach to developing a liquid ejection monitoring method, electric current was also measured. The ejection was found to take place as a series of single events that are composed of fine droplet ejections forming the Taylor cone and the subsequent swing back of the liquid front owing to the relationship between surface tension and electrostatic force. The critical factors for ejecting fine droplets in the case of using the inkjet head having a protruding needle were back pressure from the reservoir and the wetting control of the structures. The fast Fourier transform of electric current revealed the appearance of periodic signals during ejection, which may be used in developing a technique of sensing droplet ejection.

  18. Observable signatures of a black hole ejected by gravitational-radiation recoil in a galaxy merger.

    PubMed

    Loeb, Abraham

    2007-07-27

    According to recent simulations, the coalescence of two spinning black holes (BHs) could lead to a BH remnant with recoil speeds of up to thousands of km s(-1). Here we examine the circumstances resulting from a gas-rich galaxy merger under which the ejected BH would carry an accretion disk and be observable. As the initial BH binary emits gravitational radiation and its orbit tightens, a hole is opened in the disk which delays the consumption of gas prior to the eventual BH ejection. The punctured disk remains bound to the ejected BH within the region where the gas orbital velocity is larger than the ejection speed. For a approximately 10(7) M[middle dot in circle] BH the ejected disk has a characteristic size of tens of thousands of Schwarzschild radii and an accretion lifetime of approximately 10(7) yr. During that time, the ejected BH could traverse a considerable distance and appear as an off-center quasar with a feedback trail along the path it left behind.

  19. Pyroclast Tracking Velocimetry illuminates bomb ejection and explosion dynamics at Stromboli (Italy) and Yasur (Vanuatu) volcanoes

    NASA Astrophysics Data System (ADS)

    Gaudin, Damien; Taddeucci, Jacopo; Scarlato, Piergiorgio; Moroni, Monica; Freda, Carmela; Gaeta, Mario; Palladino, Danilo Mauro

    2014-07-01

    A new image processing technique—Pyroclast Tracking Velocimetry—was used to analyze a set of 30 high-speed videos of Strombolian explosions from different vents at Stromboli (Italy) and Yasur (Vanuatu) volcanoes. The studied explosions invariably appear to result from the concatenation of up to a hundred individual pyroclast ejection pulses. All these pulses share a common evolution over time, including (1) a non-linear decrease of the pyroclast ejection velocity, (2) an increasing spread of ejection angle, and (3) an increasing size of the ejected pyroclasts. These features reflect the dynamic burst of short-lived gas pockets, in which the rupture area enlarges while pressure differential decreases. We estimated depth of pyroclast release to be approximately 1 and 8 m below the surface at Stromboli and Yasur, respectively. In addition, explosions featuring more frequent pulses also have higher average ejection velocities and larger total masses of pyroclasts. These explosions release a larger overall amount of energy stored in the pressurized gas by a combination of more frequent and stronger ejection pulses. In this context, the associated kinetic energy per explosion, ranging 103-109 J appears to be a good proxy for the explosion magnitude. Differences in the pulse-defining parameters among the different vents suggest that this general process is modulated by geometrical factors in the shallow conduit, as well as magma-specific rheology. Indeed, the more viscous melt of Yasur, compared to Stromboli, is associated with larger vents producing fewer pulses but larger pyroclasts.

  20. The Search for Stellar Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Villadsen, Jacqueline Rose

    2017-05-01

    Coronal mass ejections (CMEs) may dramatically impact habitability and atmospheric composition of planets around magnetically active stars, including young solar analogs and many M dwarfs. Theoretical predictions of such effects are limited by the lack of observations of stellar CMEs. This thesis addresses this gap through a search for the spectral and spatial radio signatures of CMEs on active M dwarfs. Solar CMEs produce radio bursts with a distinctive spectral signature, narrow-band plasma emission that drifts to lower frequency as a CME expands outward. To search for analogous events on nearby stars, I worked on system design, software, and commissioning for the Starburst project, a wideband single-baseline radio interferometry backend dedicated to stellar observations. In addition, I led a survey of nearby active M dwarfs with the Karl G. Jansky Very Large Array (VLA), detecting coherent radio bursts in 13 out of 23 epochs, over a total of 58 hours. This survey's ultra-wide bandwidth (0.23-6.0 GHz) dynamic spectroscopy, unprecedented for stellar observations, revealed diverse behavior in the time-frequency plane. Flare star UV Ceti produced complex, luminous events reminiscent of brown dwarf aurorae; AD Leo sustained long-duration, intense, narrow-band "storms"; and YZ CMi emitted a burst with substructure with rapid frequency drift, resembling solar Type III bursts, which are attributed to electrons moving at speeds of order 10% of the speed of light. To search for the spatial signature of CMEs, I led 8.5-GHz observations with the Very Long Baseline Array simultaneous to 24 hours of the VLA survey. This program detected non-thermal continuum emission from the stars in all epochs, as well as continuum flares on AD Leo and coherent bursts on UV Ceti, enabling measurement of the spatial offset between flaring and quiescent emission. These observations demonstrate the diversity of stellar transients that can be expected in time-domain radio surveys, especially

  1. The Search for Stellar Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Villadsen, Jacqueline; Hallinan, Gregg; Monroe, Ryan; Bourke, Stephen; Starburst Program Team

    2017-01-01

    Coronal mass ejections (CMEs) may dramatically impact habitability and atmospheric composition of planets around magnetically active stars, including young solar analogs and many M dwarfs. Theoretical predictions of such effects are limited by the lack of observations of stellar CMEs. My thesis addresses this gap through a search for the spectral and spatial radio signatures of CMEs on active M dwarfs.Solar CMEs produce radio bursts with a distinctive spectral signature, narrow-band plasma emission that drifts to lower frequency as a CME expands outward. To search for analogous events on nearby stars, I worked on system design, software, and commissioning for the Starburst project, a wideband single-baseline radio interferometry backend dedicated to stellar observations. In addition, I led a survey of nearby active M dwarfs with the Karl G. Jansky Very Large Array (JVLA), detecting 12 bright (>10 mJy) radio bursts in 58 hours. This survey’s ultra-wide bandwidth (0.23-6.0 GHz) dynamic spectroscopy, unprecedented for stellar observations, revealed diverse behavior in the time-frequency plane. Flare star UV Ceti produced complex, luminous events reminiscent of brown dwarf aurorae; AD Leo sustained long-duration, intense, narrow-band "storms"; and YZ CMi emitted a burst with substructure with rapid frequency drift, resembling solar Type III bursts, which are attributed to electrons moving at speeds of order 10% of the speed of light.To search for the spatial signature of CMEs, I led 8.5-GHz observations with the Very Long Baseline Array simultaneous to 24 hours of the JVLA survey. This program detected non-thermal continuum emission from the stars in all epochs, as well as continuum flares on AD Leo and coherent bursts on UV Ceti, enabling measurement of the spatial offset between flaring and quiescent emission.These observations demonstrate the diversity of stellar transients that can be expected in time-domain radio surveys, especially with the advent of large low

  2. From SOHO to STEREO: Understanding Propagation of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Gopalswamy, N.

    2011-12-01

    Direct comparison between coronal mass ejections (CMEs) from near the Sun and their solar wind counterparts became possible roughly a decade after the discovery of CMEs (Lindsay et al. 1999). This comparison revealed that fast CMEs decelerate and slow CMEs accelerate due to the interaction with the solar wind. Gopalswamy et al. (2000) quantified this interaction as an interplanetary acceleration which is useful in predicting the arrival time and speed of CMEs at 1 AU. The interplanetary acceleration is essentially due to the aerodynamic drag between the CME and the solar wind because the propelling force and the solar gravity are effective only near the Sun. Combined remote-sensing and in situ observations from SOHO and Wind/ACE have helped us estimate the influence of the solar wind on the propagation of CMEs. However, these measurements have severe limitations because the remote-sensed and in-situ observations correspond to different portions of the CME. Furthermore, the true speeds of Earth-directed CMEs cannot be measured accurately from a spacecraft located along the Sun-Earth line. There have been attempts to model the CME as a cone and get the space speed of the CME, which did improve the travel time predictions. Instruments on board the Solar Terrestrial Relations Observatory (STEREO) mission were able to provide observations of Earth-arriving CMEs without projection effects, while the same CMEs were observed at Sun-Earth L1 by Wind and ACE spacecraft. The quadrature between STEREO and L1 spacecraft presented an ideal situation to study the interplanetary evolution of CMEs and test earlier model results. The quadrature observations did improve the CME travel time predictions, but additional factors such as the unusually slow solar wind, CME cannibalism, and coronal-hole deflection need to be considered to reconcile the difference between observed and predicted travel times. This point is illustrated using the 2011 February 15 CME. References Gopalswamy, N

  3. Pilot ejection, parachute, and helicopter crash injuries.

    PubMed

    McBratney, Colleen M; Rush, Stephen; Kharod, Chetan U

    2014-01-01

    USAF Pararescuemen (PJs) respond to downed aircrew as a fundamental mission for personnel recovery (PR), one of the Air Force's core functions. In addition to responding to these in Military settings, the PJs from the 212 Rescue Squadron routinely respond to small plane crashes in remote regions of Alaska. While there is a paucity of information on the latter, there have been articles detailing injuries sustained from helicopter crashes and while ejecting or parachuting from fixed wing aircraft. The following represents a new chapter added to the Pararescue Medical Operations Handbook, Sixth Edition (2014, editors Matt Wolf, MD, and Stephen Rush, MD, in press). It was designed to be a quick reference for PJs and their Special Operations flight surgeons to help with understanding of mechanism of injury with regard to pilot ejection, parachute, and helicopter accident injuries. It outlines the nature of the injuries sustained in such mishaps and provides an epidemiologic framework from which to approach the problem. 2014.

  4. Ejection safety for advanced fighter helmets

    NASA Astrophysics Data System (ADS)

    Wiley, Larry L.; Brown, Randall W.; MacMillan, Robert T.

    1995-05-01

    The old saying, `Safety is paramount.' was never more true than it is in the area of ejection safety for high-speed fighter aircraft. The fighter aircraft of today has been designed to endure tremendous structural loading during dogfight or evasive maneuvers. It can fly faster, turn quicker, stay in the air longer (with in-flight refuel) and carry more bombs than its predecessor. Because of human physiological limits, the human has become the weak link in today's fighter aircraft. The fighter pilot must endure and function with peak performance in conditions that are much worse than anything the majority of us will ever encounter. When these conditions reach a point that human endurance is exceeded, devices such as anti-g suits and positive pressure breathing apparatus help the fighter pilot squeeze out that extra percentage of strength necessary to outperform the opponent. As fighter aircraft become more sophisticated, helmet trackers, helmet displays and noise cancellation devices are being added to the helmet. Yet the fighter pilot's helmet must remain lightweight and be aesthetically appealing, while still offering ballistic protection. It must function with existing life support equipment such as the Combined Advanced Technology Enhanced Design g-Ensemble (COMBAT-EDGE). It must not impede the pilot's ability to perform any action necessary to accomplish the planned mission. The helmet must protect the pilot during the harsh environment of ejection. When the pilot's only resort is to pull the handle and initiate the ejection sequence, the helmet becomes his salvation or instant death. This paper discusses the safety concerns relative to the catapult phase of ejecting from a high-speed fighter while wearing an advanced fighter helmet.

  5. Ejectable underwater sound source recovery assembly

    NASA Technical Reports Server (NTRS)

    Irick, S. C. (Inventor)

    1974-01-01

    An underwater sound source is described that may be ejectably mounted on any mobile device that travels over water, to facilitate in the location and recovery of the device when submerged. A length of flexible line maintains a connection between the mobile device and the sound source. During recovery, the sound source is located be particularly useful in the recovery of spent rocket motors that bury in the ocean floor upon impact.

  6. IMPULSIVE ACCELERATION OF CORONAL MASS EJECTIONS. I. STATISTICS AND CORONAL MASS EJECTION SOURCE REGION CHARACTERISTICS

    SciTech Connect

    Bein, B. M.; Berkebile-Stoiser, S.; Veronig, A. M.; Temmer, M.; Muhr, N.; Kienreich, I.; Utz, D.

    2011-09-10

    We use high time cadence images acquired by the STEREO EUVI and COR instruments to study the evolution of coronal mass ejections (CMEs) from their initiation through impulsive acceleration to the propagation phase. For a set of 95 CMEs we derived detailed height, velocity, and acceleration profiles and statistically analyzed characteristic CME parameters: peak acceleration, peak velocity, acceleration duration, initiation height, height at peak velocity, height at peak acceleration, and size of the CME source region. The CME peak accelerations we derived range from 20 to 6800 m s{sup -2} and are inversely correlated with the acceleration duration and the height at peak acceleration. Seventy-four percent of the events reach their peak acceleration at heights below 0.5 R{sub sun}. CMEs that originate from compact sources low in the corona are more impulsive and reach higher peak accelerations at smaller heights. These findings can be explained by the Lorentz force, which drives the CME accelerations and decreases with height and CME size.

  7. EPISODIC EJECTION FROM ACTIVE ASTEROID 311P/PANSTARRS

    SciTech Connect

    Jewitt, David; Agarwal, Jessica; Weaver, Harold; Mutchler, Max; Larson, Stephen

    2015-01-10

    We examine the development of the active asteroid 311P/PANSTARRS (formerly, 2013 P5) in the period from 2013 September to 2014 February using high resolution images from the Hubble Space Telescope. This multi-tailed object is characterized by a single, reddish nucleus of absolute magnitude H ≥ 18.98 ± 0.10, corresponding to an equal-area sphere of radius ≤200 ± 20 m (for assumed geometric albedo 0.29 ± 0.09). We set an upper limit to the radii of possible companion nuclei at ∼10 m. The nucleus ejected debris in nine discrete episodes, spread irregularly over a nine month interval, each time forming a distinct tail. Particles in the tails range from about 10 μm to at least 80 mm in radius, and were ejected at speeds <1 m s{sup –1}. The ratio of the total ejected dust mass to the nucleus mass is ∼3×10{sup –5}, corresponding to a global surface layer ∼2 mm thick, or to a deeper layer covering a smaller fraction of the surface. The observations are incompatible with an origin of the activity by impact or by the sublimation of entrapped ice. This object appears to be shedding its regolith by rotational (presumably YORP-driven) instability. Long-term fading of the photometry (months) is attributed to gradual dissipation of near-nucleus dust. Photometric variations on short timescales (<0.7 hr) are probably caused by fast rotation of the nucleus. However, because of limited time coverage and dilution of the nucleus signal by near-nucleus dust, we have not been able to determine the rotation period.

  8. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    PubMed

    van Geffen, Geert J; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J; Chan, Vincent W; Groen, Gerbrand J

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.

  9. Structure of the brachial plexus root and adjacent regions displayed by ultrasound imaging☆

    PubMed Central

    Li, Zhengyi; Xia, Xun; Rong, Xiaoming; Tang, Yamei; Xu, Dachuan

    2012-01-01

    Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C7 vertebra is a marker for identifying the position of brachial plexus nerve roots. PMID:25624836

  10. Anatomical Variations of Brachial Artery - Its Morphology, Embryogenesis and Clinical Implications

    PubMed Central

    KS, Siddaraju; Venumadhav, Nelluri; Sharma, Ashish; Kumar, Neeraj

    2014-01-01

    Background: Accurate knowledge of variation pattern of the major arteries of upper limb is of considerable practical importance in the conduct of reparative surgery in the arm, forearm and hand however brachial artery and its terminal branches variations are less common. Aim: Accordingly the present study was designed to evaluate the anatomical variations of the brachial artery and its morphology, embryogenesis and clinical implications. Materials and Methods: In an anatomical study 140 upper limb specimens of 70 cadavers (35 males and 35 females) were used and anatomical variations of the brachial artery have been documented. Results: Accessory brachial artery was noted in eight female cadavers (11.43%). Out of eight cadavers in three cadavers (4.29%) an unusual bilateral accessory brachial artery arising from the axillary artery and it is continuing in the forearm as superficial accessory ulnar artery was noted. Rare unusual variant unilateral accessory brachial artery and its reunion with the main brachial artery in the cubital fossa and its variable course in relation to the musculocutaneous nerve and median nerve were also noted in five cadavers (7.14%). Conclusion: As per our knowledge such anatomical variations of brachial artery and its terminal branches with their relation to the surrounding structures are not reported in the modern medical literature. An awareness of such a presence is valuable for the surgeons and radiologists in evaluation of angiographic images, vascular and re-constructive surgery or appropriate treatment for compressive neuropathies. PMID:25653931

  11. Anatomical study of prefixed versus postfixed brachial plexuses in adult human cadaver.

    PubMed

    Guday, Edengenet; Bekele, Asegedech; Muche, Abebe

    2017-05-01

    The brachial plexus is usually formed by the fusion of anterior primary rami of the fifth to eighth cervical and the first thoracic spinal nerves. Variations in the formation of the brachial plexus may occur. Variations in brachial plexus anatomy are important to radiologists, surgeons and anaesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. These variations may lead to deviation from the expected dermatome distribution as well as differences in the motor innervation of muscles of the upper limb. This study is aimed to describe the anatomical variations of brachial plexus in its formation among 20 Ethiopian cadavers. Observational based study was conducted by using 20 cadavers obtained from the Department of Human Anatomy at University of Gondar, Bahir Dar, Addis Ababa, Hawasa, Hayat Medical College and St Paul Hospital Millennium Medical College. Data analysis was conducted using thematic approaches. A total of 20 cadavers examined bilaterally for the formation of brachial plexus. Of the 40 sides, 30 sides (75%) were found normal, seven sides (17.5%) prefixed, three sides (7.5%) postfixed and one side of the cadaver lacks cord formation. The brachial plexus formation in most subjects is found to be normal. Among the variants, the numbers of the prefixed brachial plexuses are greater than the postfixed brachial plexuses. © 2016 Royal Australasian College of Surgeons.

  12. An arterial island pattern of the axillary and brachial arteries: a case report with clinical implications.

    PubMed

    Piagkou, Maria; Totlis, Trifon; Panagiotopoulos, Nikitas-Apollon; Natsis, Konstantinos

    2016-10-01

    The variability of axillary and brachial arteries is often associated with neural anomalies in arrangement of the brachial plexus. The current report is focused on the coexistence of two brachial arteries of axillary origin with an atypical median nerve formatted by three (two lateral and a medial) roots in the right arm of a 68-year-old male cadaver. Medially, the brachial artery located in front of the median nerve was named superficial brachial artery and anastomosed with the brachial artery situated posterolateral to the median nerve, hence it is referred as the main brachial artery or brachial artery. Subsequently, the two arteries were recombined and the created arterial complex, like an island pattern, ended dividing into radial and ulnar arteries, at the level of the radial neck. To our knowledge, the combination of the above-mentioned arterial pattern to an abnormally formatted median nerve has not yet been cited. The current neurovascular abnormalities followed by an embryological explanation may have clinical implications.

  13. 3T MR tomography of the brachial plexus: structural and microstructural evaluation.

    PubMed

    Mallouhi, Ammar; Marik, Wolfgang; Prayer, Daniela; Kainberger, Franz; Bodner, Gerd; Kasprian, Gregor

    2012-09-01

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. Brachial neuropathy after immunosuppression and stem cell transplantation for multiple sclerosis.

    PubMed

    Walker, Melanie; Zunt, Joseph R; Kraft, George H

    2005-02-01

    We present a case of brachial neuritis in an adult male who underwent high-dose immunosuppressive therapy and autologous stem cell transplantation (SCT) for primary progressive multiple sclerosis (MS). Brachial neuropathy following SCT has not previously been reported in patients with MS. The etiology of peripheral nerve dysfunction following SCT remains obscure.

  15. Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries

    PubMed Central

    Ruchelsman, David E.; Ramos, Lorna E.; Alfonso, Israel; Price, Andrew E.; Grossman, Agatha

    2009-01-01

    The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n = 20; interposition graft, n = 5) achieved a minimum follow-up of 24 months. Fourteen children underwent plexus reconstruction with SAN-to-SSN transfer at less than 9 months of age, and 11 underwent surgical reconstruction at the age of 9 months or older. Mean age at the time of nerve transfer was 11.6 months (range, 5–30 months). At latest follow-up, active shoulder external rotation was measured in the arm abducted position and confirmed by review of videos. The Gilbert and Miami shoulder classification scores were utilized to report shoulder-specific functional outcomes. The effects of patient age at the time of nerve transfer and the use of interpositional nerve graft were analyzed. Overall mean active external rotation measured 69.6°; mean Gilbert score was 4.1 and the mean Miami score was 7.1, corresponding to overall good shoulder functional outcomes. Similar clinical and shoulder-specific functional outcomes were obtained in patients undergoing early (<9 months of age, n = 14) and late (>9 months of age, n = 11) SAN-to-SSN transfer and primary plexus reconstruction. Nine patients (27%) were lost to follow-up and are not included in the analysis. Optimum results were achieved following direct transfer (n = 20). Results following the use of an interpositional graft (n = 5) were rated satisfactory. No patient required a secondary shoulder procedure during the study period. There were no postoperative complications. Distal SAN-to-SSN (spinoscapular) nerve transfer is a reliable

  16. Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients.

    PubMed

    Estrella, Emmanuel P; Montales, Tristram D

    2016-11-01

    Restoration of elbow function in traumatic brachial plexus injury patients remains the priority in the reconstruction of the involved extremity. In cases of complete nerve root injuries and in delayed cases, the only option for elbow reconstruction is the functional free muscle transfer. The purpose of this paper was to present the clinical outcomes and complications of functioning free muscle transfers using the gracilis muscle for the restoration of elbow flexion in brachial plexus injury patients in a tertiary institution from January 1, 2005 to January 31, 2014. A retrospective review of all patients who had functioning free muscle transfers for elbow flexion was done with a minimum of 12 months follow-up. Outcome measures were elbow flexion in terms of range of motion in degrees, muscle strength of the transferred muscle, VAS (visual analogue scale) for pain, postoperative DASH scores and complications of the procedure. There were 39 males and three females. The average age at the time of surgery was 28.6 (SD, 8.5) years. The average delay to surgery was 16 months (range, 3-120 months). The flap success rate for viability was achieved in 38 of 42 patients. The average follow-up for the 38 patients was 30 months (range, 12-103 months, SD 19 months). Success rate of at least M3/5 muscle strength was achieved in 37 of 42 patients with an average range of elbow flexion of 107° (SD, 20.4°). The average post-operative VAS for pain was 3.6 (SD, 3.0). The average post-operative DASH score was 43.09 (SD, 14.9). There were a total of 10 minor complications and five major complications. Functioning free muscle transfer using the gracilis muscle was a reliable procedure in the restoration of elbow flexion in patients with incomplete brachial plexus injury treated beyond 6 months from the time of injury and in patients with complete injuries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Membrane-assisted viral DNA ejection.

    PubMed

    Santos-Pérez, Isaac; Oksanen, Hanna M; Bamford, Dennis H; Goñi, Felix M; Reguera, David; Abrescia, Nicola G A

    2017-03-01

    Genome packaging and delivery are fundamental steps in the replication cycle of all viruses. Icosahedral viruses with linear double-stranded DNA (dsDNA) usually package their genome into a preformed, rigid procapsid using the power generated by a virus-encoded packaging ATPase. The pressure and stored energy due to this confinement of DNA at a high density is assumed to drive the initial stages of genome ejection. Membrane-containing icosahedral viruses, such as bacteriophage PRD1, present an additional architectural complexity by enclosing their genome within an internal membrane vesicle. Upon adsorption to a host cell, the PRD1 membrane remodels into a proteo-lipidic tube that provides a conduit for passage of the ejected linear dsDNA through the cell envelope. Based on volume analyses of PRD1 membrane vesicles captured by cryo-electron tomography and modeling of the elastic properties of the vesicle, we propose that the internal membrane makes a crucial and active contribution during infection by maintaining the driving force for DNA ejection and countering the internal turgor pressure of the host. These novel functions extend the role of the PRD1 viral membrane beyond tube formation or the mere physical confinement of the genome. The presence and assistance of an internal membrane might constitute a biological advantage that extends also to other viruses that package their linear dsDNA to high density within an internal vesicle.

  18. Potential Method of Predicting Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Imholt, Timothy

    2001-10-01

    Coronal Mass Ejections (CME) may be described as a blast of gas and highly charged solar mass fragments ejected into space. These ejections, when directed toward Earth, have many different effects on terrestrial systems ranging from the Aurora Borealis to changes in wireless communication. The early prediction of these solar events cannot be overlooked. There are several models currently accepted and utilized to predict these events, however, with earlier prediction of both the event and the location on the sun where the event occurs allows us to have earlier warnings as to when they will affect man-made systems. A better prediction could perhaps be achieved by utilizing low angular resolution radio telescope arrays to catalog data from the sun at different radio frequencies on a regular basis. Once this data is cataloged a better predictor for these CME’s could be found. We propose a model that allows a prediction to be made that appears to be longer than 24 hours.

  19. Potential Method of Predicting Coronal Mass Ejection

    NASA Astrophysics Data System (ADS)

    Imholt, Timothy; Roberts, J. A.; Scott, J. B.; University Of North Texas Team

    2000-10-01

    Coronal Mass Ejections (CME) may be described as a blast of gas and highly charged solar mass fragments ejected into space. These ejections, when directed toward Earth, have many different effects on terrestrial systems ranging from the Aurora Borealis to changes in wireless communications. The importance of an early prediction of these solar events cannot be overlooked. There are several models currently accepted and utilized to predict these events, however, with earlier prediction of both the event and the location on the sun where the event occur allows us to have earlier warnings as to when they will effect man-made systems. A better prediction could perhaps be achieved by utilizing low angular resolution radio telescope arrays to catalog data from the sun at different radio frequencies on a regular basis. Once this data is cataloged a better predictor for these CME's could be found. We propose a model that allows a prediction to be made that appears to be longer than 24 hours.

  20. Gender differences in wall shear-mediated brachial artery vasoconstriction and vasodilation.

    PubMed

    Levenson, J; Pessana, F; Gariepy, J; Armentano, R; Simon, A

    2001-11-15

    We sought to investigate wall shear rate (WSR) and brachial artery diameter (BAD) changes simultaneously and to determine whether any gender differences exist in arterial reactivity. Wall shear rate/stress and arterial reactivity are rarely assessed at the same time. Furthermore, flow-mediated vasoconstriction has received less attention than flow-mediated vasodilation in humans. A new noninvasive evaluation of WSR in the brachial artery, using multigated, pulsed Doppler velocimeter and a double-transducer probe moved and fixed by a robotic system, was developed. The validity of the system was tested in vitro with calibrated tubes and showed a high correlation (r = 0.98, p < 0.001). In 10 men and 10 women of similar age, induction of low and high shear rates by forearm occlusion produced significant vasoconstriction and vasodilation, respectively. The time lag for maximal BAD changes was 3 min for vasoconstriction and 1 min for vasodilation. A greater half-time for vasodilation (96 +/- 6 for men and 86 +/- 12 s for women) than for shear rate (31 +/- 5 s for men and 34 +/- 4 s for women) was observed after discontinuation of occlusion. Relative BAD was correlated with WSR changes, showing a significantly higher slope in women than in men (p < 0.01). Moreover, a larger normalized arterial diameter per shear rate was observed for vasoconstriction (p < 0.01) and vasodilation (p < 0.01) in women than in men. Shear-mediated arterial vasodilation and vasoconstriction were more pronounced in women than in men, suggesting different gender-related sensitivity in the regulation of large-artery vascular tone.

  1. DOES BRACHIAL ARTERY FMD PROVIDE A BIOASSAY FOR NITRIC OXIDE?

    PubMed Central

    Wray, D. Walter; Witman, Melissa A. H.; Ives, Stephen J.; McDaniel, John; Trinity, Joel D.; Conklin, Jamie D.; Supiano, Mark A.; Richardson, Russell S.

    2013-01-01

    This study sought to better define the role of nitric oxide (NO) in brachial artery flow-mediated vasodilation (FMD) in young, healthy humans. Brachial artery blood velocity and diameter were determined (ultrasound Doppler) in eight volunteers (26 ± 1 yrs) before and after 5-min forearm circulatory occlusion with and without intra-arterial infusion of the endothelial nitric oxide synthase (eNOS) inhibitor L-NMMA (0.48 mg/dl/min). Control (CON) and L-NMMA trials were performed with the occlusion cuff placed in the traditional distal position, as well as proximal to the measurement site. FMD was significantly reduced, but not abolished, by L-NMMA in the distal cuff trial (8.9 ± 1.3 to 6.0 ± 0.7%, CON vs. L-NMMA, P = 0.02), with no effect of L-NMMA on FMD with proximal cuff placement (10.6 ± 1.2 to 12.4 ± 1.7%, CON vs. L-NMMA, P = 0.39). When the reduction in shear stimulus following L-NMMA was taken into account, no drug difference was observed for either distal (0.26 ± 0.02 to 0.23 ± 0.03, CON vs. L-NMMA, P = 0.40) or proximal (0.23 ± 0.08 to 0.23 ± 0.03, CON vs. L-NMMA, P = 0.89) FMD trials. These findings challenge the assertion that NO is obligatory for brachial artery FMD, and call into question the sensitivity of this procedure for non-invasive determination of NO bioavailability in young, healthy humans. PMID:23774225

  2. Finger movement at birth in brachial plexus birth palsy

    PubMed Central

    Nath, Rahul K; Benyahia, Mohamed; Somasundaram, Chandra

    2013-01-01

    AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury. METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation. RESULTS: Among 87 patients, 9 (10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion < -12°, whereas only 1 patient (1.1%) with finger movement had a PHHA > 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0° ± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1), when compared to those patients, who had primary surgeries (nerve and muscle surgeries), and lacked finger movement at birth (group 2), (PHHA 10.7% ± 15.8%; Version -8.0° ± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group. CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth. PMID:23362472

  3. Brachial artery aneurysms following brachio-cephalic AV fistula ligation.

    PubMed

    Khalid, Usman; Parkinson, Frances; Mohiuddin, Kamran; Davies, Paula; Woolgar, Justin

    2014-01-01

    Peripheral artery aneurysms proximal to a long-standing arteriovenous (AV) fistula can be a serious complication. It is important to be aware of this and manage it appropriately. Vascular access nurses input all data regarding patients undergoing dialysis access procedures into a securely held database prospectively. This was retrospectively reviewed to identify cases of brachial artery aneurysms over the last 3 years. In Morriston Hospital, around 200 forearm and arm AV fistulas are performed annually for vascular access in renal dialysis patients. Of these, approximately 15 (7.5%) are ligated. Three patients who had developed brachial artery aneurysms following AV fistula ligation were identified. All 3 patients had developed brachial artery aneurysms following ligation of a long-standing brachio-cephalic AV fistula. Two patients presented with pain and a pulsatile mass in the arm, and one presented with pins and needles and discoloration of fingertips. Two were managed with resection of the aneurysm and reconstruction with a reversed long saphenous vein interposition graft, the third simply required ligation of a feeding arterial branch. True aneurysm formation proximal to an AV fistula that has been ligated is a rare complication. There are several reasons for why these aneurysms develop in such patients, the most plausible one being the increase in blood flow and resistance following ligation of the AV fistula. Of note, all the patients in this study were on immunosuppressive therapy following successful renal transplantation. Vigilance by the vascular access team and nephrologists is paramount to identify those patients who may warrant further evaluation and investigation by the vascular surgeon.

  4. On the ejection and dispersion velocities of meteor particles

    NASA Astrophysics Data System (ADS)

    Kresak, L.

    1992-07-01

    This paper is a reaction to the attempts to determine the ejection velocities of meteor particles from cometary nuclei using the statistics of photographic meteor orbits. It is argued that this is essentially impossible. The original dispersion velocities are masked completely by much larger measuring errors, and for all permanent meteor showers also by the accumulated effects of planetary perturbations. The perturbations, appearing after sufficient spread particles along the orbit, are on the average about 25-times more effective in the direction perpendicular to the orbital plane than in the direction of motion, and they are about 50-times more effective for typical comets of Jupiter family than for those of Halley type. The latter disproportion is responsible for the widely different distribution of the revolution periods of comets, annual meteor showers, and temporary meteor storms. In addition to direct spacecraft measurements, the only feasible sources of information on the ejection velocities are meteor storms, like the Draconids or Leonids, appearing only several times per century, and the cometary dust trail discovered by IRAS. Both of them indicate incomparably lower velocities than the meteor data - only a few meters per second - and a substantial role of the solar radiation pressure in the initial dispersion.

  5. Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity

    PubMed Central

    Sun, Guixin; Wu, Zuopei; Wang, Xinhong; Tan, Xiaoxiao; Gu, Yudong

    2014-01-01

    In the treatment of brachial plexus injury, nerves that are functionally less important are transferred onto the distal ends of damaged crucial nerves to help recover neuromuscular function in the target region. For example, intercostal nerves are transferred onto axillary nerves, and accessory nerves are transferred onto suprascapular nerves, the phrenic nerve is transferred onto the musculocutaneous nerves, and the contralateral C7 nerve is transferred onto the median or radial nerves. Nerve transfer has become a major method for reconstructing the brachial plexus after avulsion injury. Many experiments have shown that nerve transfers for treatment of brachial plexus injury can help reconstruct cerebral cortical function and increase cortical plasticity. In this review article, we summarize the recent progress in the use of diverse nerve transfer methods for the repair of brachial plexus injury, and we discuss the impact of nerve transfer on cerebral cortical plasticity after brachial plexus injury. PMID:25657729

  6. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging.

    PubMed

    Cejas, C; Rollán, C; Michelin, G; Nogués, M

    2016-01-01

    The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  7. The analysis of the intra-surgical view of the obstetric brachial plexus palsy.

    PubMed

    Gosk, Jerzy; Rutowski, Roman; Rabczyński, Jerzy

    2005-01-01

    The surgical intervention is necessary in about 20% of all cases of the perinatal brachial plexus palsy. In this study the intra-surgical view and the applied microsurgical techniques were analysed. The clinical material consisted of 49 children with the obstetric brachial plexus palsy treated operatively, on which the following changes were found intra-surgically: compression of the brachial plexus in 21 cases and injuries with discontinuity of the elements of the brachial plexus in 28 cases. The following surgical procedures were performed: neurolysis - 31 cases, direct neurorrhaphy - 7 cases, 2 - 4 sural nerve grafting from 2 to 3 cm - 4 cases, extra-anatomical extra-plexual reconstruction - 6 cases, extra-anatomical intra-plexual reconstruction - 1 case. In all cases the intra-surgical view motivated the operative intervention. The most important problem in treatment of the obstetric brachial plexus palsy is a separate group of children who need a surgical intervention.

  8. Management of Shoulder Problems Following Obstetric Brachial Plexus Injury

    PubMed Central

    Nixon, Matthew; Trail, Ian

    2013-01-01

    Obstetric brachial plexus injuries are common, with an incidence of 0.42 per 1000 live births in the UK, and with 25% of patients being left with permanent disability without intervention. The shoulder is the most commonly affected joint and, as a result of the subsequent imbalance of musculature, the abnormal deforming forces cause dysplasia of the glenohumeral joint. In the growing child, this presents with changing pattern of pathology, which requires a multidisciplinary approach and a broad range of treatment modalities to optimize function. PMID:27582903

  9. Kinetics of Polymer Ejection from Capsid Confinement: Scaling Considerations and Computer Experiment

    NASA Astrophysics Data System (ADS)

    Milchev, A.; Binder, K.

    2012-08-01

    We investigate the ejection dynamics of a flexible polymer chain out of confined environment by means of scaling considerations and Monte Carlo simulations. Situations of this kind arise in different physical contexts, including a flexible synthetic polymer partially confined in a nanopore and a viral genome partially ejected from its capsid. In the case of cylindric confinement the entropic driving force which pulls the chain out of the pore is argued to be constant once a few persistent lengths are out of the pore. We demonstrate that in this case the ejection dynamics follows a √ {t}-law with elapsed time t. The mean ejection time τ depends nonmonotonically on chain length N. However, if the geometric constraints comprise a wider capsid chamber attached to a narrow exit tube, the mechanism of ejection changes and involves the surmounting of an activation barrier. The driving force then varies in time. One finds good agreement of theory and computer simulation with recent experiments with DNA.

  10. Postoperative monitoring in free muscle transfers for reconstruction in brachial plexus injuries.

    PubMed

    Dodakundi, Chaitanya; Doi, Kazuteru; Hattori, Yasunori; Sakamoto, Soutetsu; Yonemura, Hiroshi; Fujihara, Yuki

    2012-03-01

    Free gracilis transfers are done for reanimation of the upper limb in traumatic total brachial plexus palsy. Because of buried nature of the free muscle and monitoring skin flap in the axillary or infraclavicular region, it is always a tricky situation for continuous and repeated monitoring to assess vascular status. Critical ischemia times vary between the muscle and monitoring skin flap because of which signs of ischemic changes in the monitoring skin flap are always delayed with respect to the muscle. We describe a novel method that uses the principle of evoked potentials from the muscle to assess the vascular status of the free muscle and detects vascular compromise early before the skin changes are apparent.

  11. Risk factors for brachial plexus injury in a large cohort with shoulder dystocia.

    PubMed

    Volpe, Katherine A; Snowden, Jonathan M; Cheng, Yvonne W; Caughey, Aaron B

    2016-11-01

    To examine birthweight and other predictors of brachial plexus injury (BPI) among births complicated by shoulder dystocia. A retrospective cohort study of term births complicated by shoulder dystocia in California between 1997 and 2006. Birthweight at time of delivery was stratified into 500-g intervals. Women were further stratified by diabetes status, parity, and race/ethnicity. The perinatal outcome of BPI was assessed. This study included 62,762 deliveries complicated by shoulder dystocia, of which 3168 (5 %) resulted in BPI. The association between birthweight and BPI remained significant regardless of confounders. Each increasing birthweight interval was associated with an increasing risk of BPI compared with 3000-3499-g birthweight. Race/ethnicity, diabetes, and parity were also independently associated with BPI. Increasing birthweight increases the risk of BPI among births with shoulder dystocia, independent of advanced maternal age, race, parity, gestational diabetes, or operative vaginal delivery.

  12. Anatomic Variation of Subclavian Artery Visualized on Ultrasound-Guided Supraclavicular Brachial Plexus Block

    PubMed Central

    Prasad, Arunima; Banerjee, Sumantra Sarathi

    2014-01-01

    Use of ultrasonography for performance of nerve and plexus blocks has made the process simpler and safer. However, at times, variant anatomy of the visualized structures can lead to failure of blocks or complications such as intravascular injections. This is especially true in case of novice operators. We report a case of a variant branch of subclavian artery, possibly the dorsal scapular artery passing through the brachial plexus nerve bundles in the supraclavicular area. Since this variation in anatomy was visualized in the scout scan prior to the performance of the block, it was possible to avoid any accidental puncture. Hence, a thorough knowledge of the ultrasound anatomy is important in order to identify various aberrations and variations. It is also prudent to perform a preliminary scan, prior to performance of the block to localize the target area and avoid any inadvertent complications. PMID:25143765

  13. Contribution of denervated muscle to contractures after neonatal brachial plexus injury: not just muscle fibrosis.

    PubMed

    Nikolaou, Sia; Liangjun, Hu; Tuttle, Lori J; Weekley, Holly; Christopher, Wylie; Lieber, Richard L; Cornwall, Roger

    2014-03-01

    We investigated the contribution of muscle fibrosis to elbow flexion contractures in a murine model of neonatal brachial plexus injury (NBPI). Four weeks after NBPI, biceps and brachialis fibrosis were assessed histologically and compared with the timing of contracture development and the relative contribution of each muscle to contractures. Modulus of elasticity and hydroxyproline (collagen) content were measured and correlated with contracture severity. The effect of halofuginone antifibrotic therapy on fibrosis and contractures was investigated. Elbow contractures preceded muscle fibrosis development. The brachialis was less fibrotic than the biceps, yet contributed more to contractures. Modulus and hydroxyproline content increased in both elbow flexors, but neither correlated with contracture severity. Halofuginone reduced biceps fibrosis but did not reduce contracture severity. Contractures after NBPI cannot be explained solely by muscle fibrosis, arguing for investigation of alternate pathophysiologic targets for contracture prevention and treatment. Copyright © 2013 Wiley Periodicals, Inc.

  14. Intima-media thickness of brachial artery, vascular function, and cardiovascular risk factors.

    PubMed

    Iwamoto, Yumiko; Maruhashi, Tatsuya; Fujii, Yuichi; Idei, Naomi; Fujimura, Noritaka; Mikami, Shinsuke; Kajikawa, Masato; Matsumoto, Takeshi; Kihara, Yasuki; Chayama, Kazuaki; Noma, Kensuke; Nakashima, Ayumu; Higashi, Yukihito

    2012-09-01

    Cardiovascular diseases are associated with impaired flow-mediated vasodilation (FMD) and increase in carotid intima-media thickness (IMT). Both FMD and IMT are independent predictors for cardiovascular outcomes. When measuring FMD and nitroglycerine-induced vasodilation in the brachial artery, IMT can also be simultaneously assessed in the same brachial artery. The purpose of this study was to determine the relationships between IMT of the brachial artery, vascular function, and cardiovascular risk factors. We measured brachial IMT, FMD, and nitroglycerine-induced vasodilation by ultrasound in 388 subjects who underwent health examination (mean age, 45±22 years; age range, 19-86), including patients with cardiovascular diseases. Univariate regression analysis revealed that brachial IMT significantly correlated with age (r=0.71; P<0.001), body mass index (r=0.27; P<0.001), systolic blood pressure (r=0.40; P<0.001), diastolic blood pressure (r=0.31; P<0.001), heart rate (r=0.15; P=0.002), glucose level (r=0.18; P=0.01), and smoking pack-years (r=0.42; P<0.001), as well as Framingham risk score, a cumulative cardiovascular risk index for heart attack (r=0.49; P<0.001). FMD and nitroglycerine-induced vasodilation were inversely associated with brachial IMT (r=-0.39, P<0.001; r=-0.32, P<0.001, respectively). In addition, there was a significant relationship between brachial IMT and carotid IMT (r=0.58; P<0.001). Multivariate analysis revealed that age, sex, hypertension, and brachial artery diameter were independent predictors of brachial IMT. These findings suggest that brachial IMT may be a marker of the grade of atherosclerosis and may be used as a marker of vascular function, providing additive information for stratifying subjects with cardiovascular risk factors.

  15. Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model.

    PubMed

    Gonik, Bernard; Zhang, Ning; Grimm, Michele J

    2003-10-01

    The purpose was to study the impact of maternal endogenous and clinician-applied exogenous delivery forces on brachial plexus stretching during a shoulder dystocia event. A computer software crash dummy model (MADYMO, version 5.4, TNO Automotive, Delft, The Netherlands) was modified on the basis of established maternal pelvis and fetal anatomic specifications. The brachial plexus was modeled as a spring, with mechanical properties that were based on previously reported experimental data. Increasing amounts of endogenous or exogenous loading forces were applied until delivery of the anterior fetal shoulder occurred. Brachial plexus deformation was assessed as percent stretch in the nerve (Change in length/Original length x 100). With lithotomy positioning, both maternal endogenous and clinician-applied exogenous delivery forces were associated with brachial plexus stretching (15.7% vs 14.0%, respectively). McRoberts positioning reduced needed loading forces for delivery and resulted in 53% less brachial plexus stretch (6.6%). Downward lateral displacement of the fetal head was associated with a 30% increase in brachial plexus stretch (18.2%) compared with axial positioning of the head (14.0%). Brachial plexus stretch varied as a result of the load required for delivery, the source of the applied force, pelvic orientation, and fetal head positioning. Maternally derived and clinician-applied delivery forces can both lead to brachial plexus deformation when shoulder dystocia is encountered. The McRoberts maneuver can reduce brachial plexus stretching. Management of fetal head position may also be important in reducing unnecessary brachial plexus stretch.

  16. Evaluation of clonidine as an adjuvant to brachial plexus block and its comparison with tramadol

    PubMed Central

    Kelika, Prakash; Arun, Jamkar Maya

    2017-01-01

    Background and Aims: It has been reported that clonidine when used as an additive in a dose of 90 μg in adults increases the duration of peripheral nerve blocks. Hence, this study was conducted to evaluate the effect of clonidine in brachial plexus blocks and to compare it with tramadol. Material and Methods: Ninety patients posted for upper limb orthopedic surgery were divided randomly into three groups. 40 mL of local anesthetic solution was prepared using 15 mL of 2% lignocaine-adrenaline-sodium bicarbonate solution, 15 mL of 0.5% bupivacaine, and 10 mL distilled water. Patients received a supraclavicular brachial plexus block with 0.7 mL/kg of this solution to which either 1 mg/kg tramadol, 1 μg/kg clonidine, or 1.5 μg/kg clonidine was added. The onset and duration of sensory and motor block and the duration of postoperative analgesia were recorded. Pulse rate, blood pressure, respiratory rate, saturation, sedation, and any side effect were monitored. Results were statistically analyzed using analysis of variance F-test and unpaired t-test. Results: There was a statistically significant difference in the onset of both the sensory and motor components of the block with the fastest onset seen when clonidine was used in a dose of 1.5 μg/kg. The block also lasted statistically significantly longer with clonidine as compared with tramadol although there was no statistically significant increase in the duration of the block when a higher dose of clonidine was used. The time for rescue analgesia was the longest in patients who received 1.5 μg/kg of clonidine (491.8 ± 33.9 min). This duration was also statistically significant. Patients who received tramadol reported a statistically significant higher incidence of nausea. Conclusion: Clonidine in a dose of 1.5 μg/kg body weight provided the fastest onset of sensory as well as motor block and the longest duration of postoperative analgesia and thus is a good additive to local anesthetic solutions for brachial

  17. Evaluation of clonidine as an adjuvant to brachial plexus block and its comparison with tramadol.

    PubMed

    Kelika, Prakash; Arun, Jamkar Maya

    2017-01-01

    It has been reported that clonidine when used as an additive in a dose of 90 μg in adults increases the duration of peripheral nerve blocks. Hence, this study was conducted to evaluate the effect of clonidine in brachial plexus blocks and to compare it with tramadol. Ninety patients posted for upper limb orthopedic surgery were divided randomly into three groups. 40 mL of local anesthetic solution was prepared using 15 mL of 2% lignocaine-adrenaline-sodium bicarbonate solution, 15 mL of 0.5% bupivacaine, and 10 mL distilled water. Patients received a supraclavicular brachial plexus block with 0.7 mL/kg of this solution to which either 1 mg/kg tramadol, 1 μg/kg clonidine, or 1.5 μg/kg clonidine was added. The onset and duration of sensory and motor block and the duration of postoperative analgesia were recorded. Pulse rate, blood pressure, respiratory rate, saturation, sedation, and any side effect were monitored. Results were statistically analyzed using analysis of variance F-test and unpaired t-test. There was a statistically significant difference in the onset of both the sensory and motor components of the block with the fastest onset seen when clonidine was used in a dose of 1.5 μg/kg. The block also lasted statistically significantly longer with clonidine as compared with tramadol although there was no statistically significant increase in the duration of the block when a higher dose of clonidine was used. The time for rescue analgesia was the longest in patients who received 1.5 μg/kg of clonidine (491.8 ± 33.9 min). This duration was also statistically significant. Patients who received tramadol reported a statistically significant higher incidence of nausea. Clonidine in a dose of 1.5 μg/kg body weight provided the fastest onset of sensory as well as motor block and the longest duration of postoperative analgesia and thus is a good additive to local anesthetic solutions for brachial plexus blocks.

  18. Role of osmotic and hydrostatic pressures in bacteriophage genome ejection

    NASA Astrophysics Data System (ADS)

    Lemay, Serge G.; Panja, Debabrata; Molineux, Ian J.

    2013-02-01

    A critical step in the bacteriophage life cycle is genome ejection into host bacteria. The ejection process for double-stranded DNA phages has been studied thoroughly in vitro, where after triggering with the cellular receptor the genome ejects into a buffer. The experimental data have been interpreted in terms of the decrease in free energy of the densely packed DNA associated with genome ejection. Here we detail a simple model of genome ejection in terms of the hydrostatic and osmotic pressures inside the phage, a bacterium, and a buffer solution or culture medium. We argue that the hydrodynamic flow associated with the water movement from the buffer solution into the phage capsid and further drainage into the bacterial cytoplasm, driven by the osmotic gradient between the bacterial cytoplasm and culture medium, provides an alternative mechanism for phage genome ejection in vivo; the mechanism is perfectly consistent with phage genome ejection in vitro.

  19. The distribution of ejected brown dwarfs in clusters

    NASA Astrophysics Data System (ADS)

    Goodwin, S. P.; Hubber, D. A.; Moraux, E.; Whitworth, A. P.

    2005-12-01

    We examine the spatial distribution of brown dwarfs produced by the decay of small-N stellar systems as expected from the embryo ejection scenario. We model a cluster of several hundred stars grouped into 'cores' of a few stars/brown dwarfs. These cores decay, preferentially ejecting their lowest-mass members. Brown dwarfs are found to have a wider spatial distribution than stars, however once the effects of limited survey areas and unresolved binaries are taken into account it can be difficult to distinguish between clusters with many or no ejections. A large difference between the distributions probably indicates that ejections have occurred, however similar distributions sometimes arise even with ejections. Thus the spatial distribution of brown dwarfs is not necessarily a good discriminator between ejection and non-ejection scenarios.

  20. Modeling MHD accretion-ejection: episodic ejections of jets triggered by a mean-field disk dynamo

    SciTech Connect

    Stepanovs, Deniss; Fendt, Christian; Sheikhnezami, Somayeh E-mail: fendt@mpia.de

    2014-11-20

    We present MHD simulations exploring the launching, acceleration, and collimation of jets and disk winds. The evolution of the disk structure is consistently taken into account. Extending our earlier studies, we now consider the self-generation of the magnetic field by an α{sup 2}Ω mean-field dynamo. The disk magnetization remains on a rather low level, which helps to evolve the simulations for T > 10, 000 dynamical time steps on a domain extending 1500 inner disk radii. We find the magnetic field of the inner disk to be similar to the commonly found open field structure, favoring magneto-centrifugal launching. The outer disk field is highly inclined and predominantly radial. Here, differential rotation induces a strong toroidal component, which plays a key role in outflow launching. These outflows from the outer disk are slower, denser, and less collimated. If the dynamo action is not quenched, magnetic flux is continuously generated, diffuses outward through the disk, and fills the entire disk. We have invented a toy model triggering a time-dependent mean-field dynamo. The duty cycles of this dynamo lead to episodic ejections on similar timescales. When the dynamo is suppressed as the magnetization falls below a critical value, the generation of the outflows and also accretion is inhibited. The general result is that we can steer episodic ejection and large-scale jet knots by a disk-intrinsic dynamo that is time-dependent and regenerates the jet-launching magnetic field.

  1. Asymmetric ejection of jets from the symbiotic prototype Z Andromedae

    NASA Astrophysics Data System (ADS)

    Skopal, A.; Tarasova, T. N.; Pribulla, T.; Vanko, M.; Dubovsky, P. A.; Kudzej, I.

    Z And is considered as a prototype symbiotic star. The binary composes of a late-type, M4.5 III, giant and a white dwarf accreting from the giant's wind on the 758-day orbit. From 2000 September, Z And started a series of outbursts with the main optical maxima in 2000 December, 2006 July and 2009 December. During the 2006 optical maximum, highly-collimated bipolar jets were detected for the first time. They were launched asymmetrically with respect to the reference wavelength of the spectral line. Their presence was transient, they disappeared by the end of 2006. During the following re-brightening, from the beginning of 2008 to its end, faint emission satellite components to the Hα and Hβ were observed again. The red component was enhanced relatively to its blue counterpart. During the recent 2009 major outburst, the mass ejection in the form of jet was indicated almost exclusively on the red side of the Hα line with velocities from +1000 (2009/10/01) to +1800 km s-1 (2010/01/05). During the light maxima, our high-time-resolution photometry revealed irregular waves in the star's brightness throughout a night(˜m 0.06mag),while in between the outbursts,they nearly disappeared. Evolution in the rapid photometric variability and asymmetric ejection of jets could be explained by a disruption of the inner parts of the disk ignited by radiation-induced warping of the disk.

  2. Activity associated with coronal mass ejections at solar minimum - SMM observations from 1984-1986

    NASA Technical Reports Server (NTRS)

    St. Cyr, O. C.; Webb, D. F.

    1991-01-01

    Seventy-three coronal mass ejections (CMEs) observed by the coronagraph aboard SMM between 1984 and 1986 were examined in order to determine the distribution of various forms of solar activity that were spatially and temporally associated with mass ejections during solar minimum phase. For each coronal mass ejection a speed was measured, and the departure time of the transient from the lower corona estimated. Other forms of solar activity that appeared within 45 deg longitude and 30 deg latitude of the mass ejection and within +/-90 min of its extrapolated departure time were explored. The statistical results of the analysis of these 73 CMEs are presented, and it is found that slightly less than half of them were infrequently associated with other forms of solar activity. It is suggested that the distribution of the various forms of activity related to CMEs does not change at different phases of the solar cycle. For those CMEs with associations, it is found that eruptive prominences and soft X-rays were the most likely forms of activity to accompany the appearance of mass ejections.

  3. Activity associated with coronal mass ejections at solar minimum - SMM observations from 1984-1986

    NASA Technical Reports Server (NTRS)

    St. Cyr, O. C.; Webb, D. F.

    1991-01-01

    Seventy-three coronal mass ejections (CMEs) observed by the coronagraph aboard SMM between 1984 and 1986 were examined in order to determine the distribution of various forms of solar activity that were spatially and temporally associated with mass ejections during solar minimum phase. For each coronal mass ejection a speed was measured, and the departure time of the transient from the lower corona estimated. Other forms of solar activity that appeared within 45 deg longitude and 30 deg latitude of the mass ejection and within +/-90 min of its extrapolated departure time were explored. The statistical results of the analysis of these 73 CMEs are presented, and it is found that slightly less than half of them were infrequently associated with other forms of solar activity. It is suggested that the distribution of the various forms of activity related to CMEs does not change at different phases of the solar cycle. For those CMEs with associations, it is found that eruptive prominences and soft X-rays were the most likely forms of activity to accompany the appearance of mass ejections.

  4. Rare case of a liposarcoma in the brachial plexus.

    PubMed

    Kosutic, D; Gajanan, K

    2016-09-01

    Introduction A liposarcoma is a rare cancer of connective tissues that resemble fat cells under light microscopy. Case History A 73-year old female patient presented to our tertiary cancer centre with an eight-year history of a large, slow-growing painless mass in the right axilla. Magnetic resonance imaging showed a lipomatous, well-circumscribed mass of dimension 30 × 16 × 10cm extending towards the right clavicle and causing deformation to the right chest wall and right breast. Surgery revealed a large tumour that had stretched all three cords of the brachial plexus. Histopathology was consistent with a diagnosis of a low-grade liposarcoma. After a period of neuropraxia, the patient returned to normal activities 4 months after surgery. Conclusions Although extremely rare, low-grade liposarcomas of the brachial plexus should be considered in the differential diagnosis of a slow-growing axillary mass. Referral to a tertiary sarcoma centre is essential for an appropriate diagnosis, adequate treatment, and long-term follow-up.

  5. Rare case of a liposarcoma in the brachial plexus

    PubMed Central

    Kosutic, D; Gajanan, K

    2016-01-01

    Introduction A liposarcoma is a rare cancer of connective tissues that resemble fat cells under light microscopy. Case History A 73-year old female patient presented to our tertiary cancer centre with an eight-year history of a large, slow-growing painless mass in the right axilla. Magnetic resonance imaging showed a lipomatous, well-circumscribed mass of dimension 30 × 16 × 10cm extending towards the right clavicle and causing deformation to the right chest wall and right breast. Surgery revealed a large tumour that had stretched all three cords of the brachial plexus. Histopathology was consistent with a diagnosis of a low-grade liposarcoma. After a period of neuropraxia, the patient returned to normal activities 4 months after surgery. Conclusions Although extremely rare, low-grade liposarcomas of the brachial plexus should be considered in the differential diagnosis of a slow-growing axillary mass. Referral to a tertiary sarcoma centre is essential for an appropriate diagnosis, adequate treatment, and long-term follow-up. PMID:27241607

  6. Acromioclavicular joint dislocation with associated brachial plexus injury

    PubMed Central

    Gallagher, Charles Alexander; Blakeney, William; Zellweger, René

    2014-01-01

    We present the case of a 32-year-old female who sustained a left acromioclavicular (AC) joint type V injury and brachial plexus injury. The patient's AC joint injury was identified 6 days after she was involved in a motorbike accident where she sustained multiple other injuries. She required operative fixation of the AC joint using a locking compression medial proximal tibial plate. At 3 months post operatively, the patient was found to have a subluxed left shoulder as a result of an axonal injury to the upper trunk of the brachial plexus. In addition, the tibial plate had cut out. The plate was subsequently removed. At 8 months the glenohumeral articulation had been restored and the patient had clinically regained significant shoulder function. After 15 months the patient was pain free and could complete all her activities of daily living without impediment. She returned to playing competitive pool after 24 months. PMID:24855076

  7. Electroacupuncture stimulation of the brachial plexus trunk on the healthy side promotes brain-derived neurotrophic factor mRNA expression in the ischemic cerebral cortex of a rat model of cerebral ischemia/reperfusion injury.

    PubMed

    Guo, Zongjun; Wang, Lumin

    2012-07-25

    A rat model of cerebral ischemia/reperfusion was established by suture occlusion of the left middle cerebral artery. In situ hybridization results showed that the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic rat cerebral cortex increased after cerebral ischemia/ reperfusion injury. Low frequency continuous wave electroacupuncture (frequency 2-6 Hz, current intensity 2 mA) stimulation of the brachial plexus trunk on the healthy (right) side increased the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic cerebral cortex 14 days after cerebral ischemia/reperfusion injury. At the same time, electroacupuncture stimulation of the healthy brachial plexus truck significantly decreased neurological function scores and alleviated neurological function deficits. These findings suggest that electroacupuncture stimulation of the brachial plexus trunk on the healthy (right) side can greatly increase brain-derived neurotrophic factor mRNA expression and improve neurological function.

  8. Ejection of Chondrules from Fluffy Matrices

    NASA Astrophysics Data System (ADS)

    Arakawa, Sota

    2017-09-01

    Chondritic meteorites primarily contain millimeter-sized spherical objects, chondrules; however, the co-accretion process of chondrules and matrix grains is not yet understood. In this study, we investigate the ejection process of chondrules via collisions of fluffy aggregates composed of chondrules and matrices. We reveal that fluffy aggregates cannot grow into planetesimals without losing chondrules if we assume that the chondrite parent bodies are formed via direct aggregation of similar-sized aggregates. Therefore, an examination of other growth pathways is necessary to explain the formation of rocky planetesimals in our solar system.

  9. A Thematic Analysis of Online Discussion Boards for Brachial Plexus Injury.

    PubMed

    Morris, Marie T; Daluiski, Aaron; Dy, Christopher J

    2016-08-01

    Patients with brachial plexus injury (BPI) and their family members contribute to Internet discussion groups dedicated to BPI. We hypothesized that a thematic analysis of posts from BPI Internet discussion groups would reveal common themes related to the BPI patient experience, providing topics for patient education and counseling. Internet discussion boards were identified using the search term "brachial plexus injury support group" in Google, Bing, and Yahoo! search engines. Two discussion boards had substantially more posts than other Web sites and were chosen for analyses. Posts from January 1, 2015, through January 1, 2016, were examined. Using an iterative and established process, 2 investigators (M.T.M. and C.J.D) independently analyzed each post using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. In this process, each post was reviewed 3 times. A total of 328 posts from the 2 leading discussion boards were analyzed. Investigators reached a consensus on themes for all posts. One central theme focused on emotional aspects of BPI. Four other central themes regarding information support were identified: BPI disease, BPI treatment, recovery after BPI treatment, and process of seeking care for BPI. Examination of posts on Internet support groups for BPI revealed recurring concerns, questions, and opinions of patients and their family members. The most common themes related to disease information, treatment, recovery, and the emotional element of BPI. These findings provide a helpful starting point in refining topics for patient education and support that are targeted on patients' interests and concerns. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

    SciTech Connect

    Cary, Theodore W.; Sultan, Laith R.; Sehgal, Chandra M.; Reamer, Courtney B.; Mohler, Emile R.

    2014-02-15

    Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Methods: Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced each phase of the cardiac cycle. Results: FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. Conclusions: FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging.

  11. Brachial artery adaptation to lower limb exercise training: role of shear stress.

    PubMed

    Birk, Gurpreet K; Dawson, Ellen A; Atkinson, Ceri; Haynes, Andrew; Cable, N Timothy; Thijssen, Dick H J; Green, Daniel J

    2012-05-01

    Lower limb exercise increases upper limb conduit artery blood flow and shear stress, and leg exercise training can enhance upper limb vascular function. We therefore examined the contribution of shear stress to changes in vascular function in the nonexercising upper limbs in response to lower limb cycling exercise training. Initially, five male subjects underwent bilateral brachial artery duplex ultrasound to measure blood flow and shear responses to 30-min cycling exercise at 80% of maximal heart rate. Responses in one forearm were significantly (P < 0.05) attenuated via cuff inflation throughout the exercise bout. An additional 11 subjects participated in an 8-wk cycle training study undertaken at a similar intensity, with unilateral cuff inflation around the forearm during each exercise bout. Bilateral brachial artery flow-mediated dilation responses to a 5-min ischemic stimulus (FMD%), an ischemic handgrip exercise stimulus (iEX), and endothelium-independent NO donor administration [glyceryl trinitrate (GTN)] were measured at 2, 4, and 8 wk. Cycle training increased FMD% in the noncuffed limb at week 2, after which time responses returned toward baseline levels (5.8 ± 4.1, 8.6 ± 3.8, 7.4 ± 3.5, 6.0 ± 2.3 at 0, 2, 4 and 8 wk, respectively; ANOVA: P = 0.04). No changes in FMD% were observed in the cuffed arm. No changes were evident in response to iEX or GTN in either the cuffed or noncuffed arms (P > 0.05) across the 8-wk intervention period. Our data suggest that lower limb cycle training induces a transient increase in upper limb vascular function in healthy young humans, which is, at least partly, mediated via shear stress.

  12. Structural and dynamic features of geoeffective coronal ejections

    NASA Astrophysics Data System (ADS)

    Minasyants, G. S.; Minasyants, T. M.

    2011-12-01

    The structure and physical conditions in 104 coronal mass ejections (CMEs) with a clear-cut leading shock front have been considered using satellite data for 1996-2008. In 99% of cases, the action of increased shock front dynamic pressure on the Earth's magnetosphere resulted in the origination of geomagnetic storms with sudden commencement. It has been revealed that decreased magnetic field strength values correspond to denser plasma bunches in an ejection body and vice versa. As a result, gas pressure is decreased in regions with increased magnetic pressure. Thus, a self-consistent interrelationship between plasma parameters, which supports total pressure at mutual changes in gas and magnetic pressures, is observed in the ejection structure. Pronounced differences in variations in the physical parameters in different zones along the front in the Earth-Sun direction have not been detected for each ejection. The maximal distances between the compared ejection zones are 2 million kilometers. This indicates that the ejection structure is stable. The values of the shock front velocity ( V psf), temperature ( T psf), and density ( N psf), as well as the ejection geometrical extension ( L ae), have been compared for the considered ejections. Cases when ejections followed one another at intervals of 3-30 h have been studied. It has been established that a leading ejection is strongly decelerated during its motion, and the next ejection faster covers the distance to the Earth. The next ejections with larger values of the plasma physical parameters are more geoeffective as compared to the previous ejections.

  13. Use of StarClose for brachial artery closure after percutaneous endovascular interventions.

    PubMed

    Puggioni, Alessandra; Boesmans, Evelyne; Deloose, Koen; Peeters, Patrick; Bosiers, Marc

    2008-01-01

    The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.

  14. Anatomical Study of the Brachial Plexus in the Common Marmoset (Callithrix Jacchus).

    PubMed

    Emura, Kenji; Arakawa, Takamitsu; Terashima, Toshio

    2017-07-01

    To elucidate the forelimb phylogeny of primates, anatomical analysis of the brachial plexus in platyrrhines is beneficial. In the present study, six brachial plexuses and the surrounding arteries of four common marmosets were dissected. In five specimens, the brachial plexus consisted of five ventral rami from the fifth cervical nerve (C5) to the first thoracic nerve (T1). In one specimen, the ventral ramus of the fourth cervical nerve joined with the brachial plexus. In five specimens, the upper trunk was composed of C5 and the sixth cervical nerve (C6). In one specimen, the ventral division of C6 merged with the ventral branch of the middle trunk to constitute the lateral cord. The seventh cervical nerve constituted the middle trunk, and the eighth cervical nerve and T1 formed the lower trunk in all specimens. The lateral cord gave rise to the musculocutaneous nerve, and the remaining component merged with the medial cord. The confluence of the lateral and medial cords immediately bifurcated into the median and ulnar nerves. These branching patterns of the musculocutaneous, median, and ulnar nerves were consistent and similar to the human counterparts. In the dorsal division, the single posterior cord as observed in the human brachial plexus was not observed. The axillary artery did not pass between the medial and lateral roots of the median nerve, and the axillary artery bifurcated into the brachial artery and the superficial brachial artery. Anat Rec, 300:1299-1306, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. Incidence of early posterior shoulder dislocation in brachial plexus birth palsy.

    PubMed

    Dahlin, Lars B; Erichs, Kristina; Andersson, Charlotte; Thornqvist, Catharina; Backman, Clas; Düppe, Henrik; Lindqvist, Pelle; Forslund, Marianne

    2007-12-16

    Posterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age. The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000-2005. The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies. All children with a brachial plexus birth lesion (incidence 3.8 per thousand) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28 per thousand) since such a condition may occur in 7% of children with a brachial plexus birth lesion.

  16. Hypoplasia of the trapezius and history of ipsilateral transient neonatal brachial plexus palsy.

    PubMed

    Min, William; Price, Andrew E; Alfonso, Israel; Ramos, Lorna; Grossman, John A I

    2011-03-01

    We present two children with hypoplasia of the left trapezius muscle and a history of ipsilateral transient neonatal brachial plexus palsy without documented trapezius weakness. Magnetic resonance imaging in these patients with unilateral left hypoplasia of the trapezius revealed decreased muscles in the left side of the neck and left supraclavicular region on coronal views, decreased muscle mass between the left splenius capitis muscle and the subcutaneous tissue at the level of the neck on axial views, and decreased size of the left paraspinal region on sagittal views. Three possibilities can explain the association of hypoplasia of the trapezius and obstetric brachial plexus palsy: increased vulnerability of the brachial plexus to stretch injury during delivery because of intrauterine trapezius weakness, a casual association of these two conditions, or an erroneous diagnosis of brachial plexus palsy in patients with trapezial weakness. Careful documentation of neck and shoulder movements can distinguish among shoulder weakness because of trapezius hypoplasia, brachial plexus palsy, or brachial plexus palsy with trapezius hypoplasia. Hence, we recommend precise documentation of neck movements in the initial description of patients with suspected neonatal brachial plexus palsy. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Association of Brachial-Ankle Pulse Wave Velocity with Asymptomatic Intracranial Arterial Stenosis in Hypertension Patients.

    PubMed

    Wang, Yan; Zhang, Jin; Qain, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

    2016-08-01

    Intracranial arterial stenosis is a common cause of ischemic stroke in Asians. We therefore sought to explore the relationship of brachial-ankle pulse wave velocity and intracranial arterial stenosis in 834 stroke-free hypertensive patients. Intracranial arterial stenosis was evaluated through computerized tomographic angiography. Brachial-ankle pulse wave velocity was measured by an automated cuff device. The top decile of brachial-ankle pulse wave velocity was significantly associated with intracranial arterial stenosis (P = .027, odds ratio = 1.82; 95% confidence interval: 1.07-3.10). The patients with the top decile of brachial-ankle pulse wave velocity showed 56% higher risk for the presence of intracranial arterial stenosis to the whole population, which was more significant in patients younger than 65 years old. We also found that brachial-ankle pulse wave velocity related to both intracranial arterial stenosis and homocysteine. Our study showed the association of brachial-ankle pulse wave velocity with asymptomatic intracranial arterial stenosis in hypertension patients, especially in relative younger subjects. Brachial-ankle pulse wave velocity might be a relatively simple and repeatable measurement to detect hypertension patients in high risk of intracranial arterial stenosis. Copyright © 2016. Published by Elsevier Inc.

  18. Transport in the interplanetary medium of coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Borgazzi, A.; Lara, A.; Romero-Salazar, L.; Ventura, A.

    2008-07-01

    Coronal mass ejections (CMEs) are large scale structures of plasma and magnetic field expelled from the Sun to the interplanetary medium and generally observed in white light coronagraphs. During their travel, in the interplanetary medium these structures named interplanetary coronal mass ejections (ICMEs), suffer acceleration or deceleration due to the interaction with the ambient solar wind. This process can be understood as a transference of momentum between the interplanetary CME (ICME) and the solar wind. This process seems to be fundamentally different for `slow' and `fast' ICMEs (compared with the ambient solar wind velocity). In this work, we approach the problem from the fluid dynamics point of view and consider the ICMEs - solar wind system as two interacting fluids under the action of viscous forces. We note that this interaction is a special case of interaction between low density plasmas. Using these viscous forces in the Newtons Second Law, we obtained an analytical solution for the ICME velocity as a function of time. By comparing our analytic results with empirical models found in recent literature, we suggested values for the viscosity and drag parameters in this system. In this first approximation we have neglected the magnetic field.

  19. Spontaneous Aerosol Ejection: Origin of Inorganic Particles in Biomass Pyrolysis.

    PubMed

    Teixeira, Andrew R; Gantt, Rachel; Joseph, Kristeen E; Maduskar, Saurabh; Paulsen, Alex D; Krumm, Christoph; Zhu, Cheng; Dauenhauer, Paul J

    2016-06-08

    At high thermal flux and temperatures of approximately 500 °C, lignocellulosic biomass transforms to a reactive liquid intermediate before evaporating to condensable bio-oil for downstream upgrading to renewable fuels and chemicals. However, the existence of a fraction of nonvolatile compounds in condensed bio-oil diminishes the product quality and, in the case of inorganic materials, catalyzes undesirable aging reactions within bio-oil. In this study, ablative pyrolysis of crystalline cellulose was evaluated, with and without doped calcium, for the generation of inorganic-transporting aerosols by reactive boiling ejection from liquid intermediate cellulose. Aerosols were characterized by laser diffraction light scattering, inductively coupled plasma spectroscopy, and high-speed photography. Pyrolysis product fractionation revealed that approximately 3 % of the initial feed (both organic and inorganic) was transported to the gas phase as aerosols. Large bubble-to-aerosol size ratios and visualization of significant late-time ejections in the pyrolyzing cellulose suggest the formation of film bubbles in addition to the previously discovered jet formation mechanism. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. Ejection Dynamics in Vibration-Induced Droplet Atomization

    NASA Astrophysics Data System (ADS)

    Vukasinovic, Bojan; Smith, Marc K.; Glezer, Ari

    2001-11-01

    A primary sessile liquid drop is atomized into a fine spray of secondary droplets using vibration-induced atomization (VIDA) resulting from forced waves on a free surface of the primary drop. The mechanism of free surface breakup during the VIDA process is investigated using high-speed imaging and laser vibrometry. Secondary droplets result from a localized collapse of surface troughs and the ejection and ultimate breakup of momentary liquid spikes. The characteristic breakup time of these liquid spikes scales with the vibration period and the spike length initially varies like t0.5. The breakup begins with a capillary pinch-off from the tip of the spike that can be followed by additional pinching of liquid droplets. For relatively low-viscosity liquid (e.g., water) a capillary-wave instability of a jet is observed in some cases, while in very viscous liquid (e.g., glycerin-water solution) the first breakup occurs near the stem of the jet. The mechanisms of secondary droplet ejection and the influence of the operating parameters and fluid properties are discussed.

  1. Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes

    PubMed Central

    2014-01-01

    Background We examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM). Methods We recruited 201 patients who were evaluated for central BP, brachial BP, carotid ultrasonography, brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and microvascular complications. Central BP were calculated using a radial automated tonometric system. Results Agreement between central BP and brachial BP was very strong (concordance correlation coefficient between central and brachial SBP = 0.889, between central and brachial PP = 0.816). Central pulse pressure (PP) was correlated with mean carotid intima-media thickness (CIMT), baPWV and ABI, whereas brachial PP was borderline significantly correlated with CIMT. The prevalence of nephropathy(DN) and retinopathy(DR) according to the brachial PP tertiles increased, the prevalences of microvascular complications were not different across central PP tertiles. In multivariate analysis, the relative risks (RRs) for the presence of DR were 1.2 and 4.6 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Also, the RRs for the presence of DN were 1.02 and 3 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Conclusions Agreement of central BP and brachial BP was very strong. Nonetheless, this study showed that higher brachial PP levels are associated with increased probability for the presence of microvascular complications such as DR/DN. However, there are no associations with central SBP and central PP with microvascular complications. Central BP levels than brachial BP are correlated with surrogate marker of macrovascular complications. PMID:24555866

  2. Concomitant Traumatic Spinal Cord and Brachial Plexus Injuries in Adult Patients

    PubMed Central

    Rhee, Peter C.; Pirola, Elena; Hébert-Blouin, Marie-Noëlle; Kircher, Michelle F.; Spinner, Robert J.; Bishop, Allen T.; Shin, Alexander Y.

    2011-01-01

    Background: Combined injuries to the spinal cord and brachial plexus present challenges in the detection of both injuries as well as to subsequent treatment. The purpose of this study is to describe the epidemiology and clinical factors of concomitant spinal cord injuries in patients with a known brachial plexus injury. Methods: A retrospective review was performed on all patients who were evaluated for a brachial plexus injury in a tertiary, multidisciplinary brachial plexus clinic from January 2000 to December 2008. Patients with clinical and/or imaging findings for a coexistent spinal cord injury were identified and underwent further analysis. Results: A total of 255 adult patients were evaluated for a traumatic traction injury to the brachial plexus. We identified thirty-one patients with a combined brachial plexus and spinal cord injury, for a prevalence of 12.2%. A preganglionic brachial plexus injury had been sustained in all cases. The combined injury group had a statistically greater likelihood of having a supraclavicular vascular injury (odds ratio [OR] = 22.5; 95% confidence interval [CI] = 1.9, 271.9) and a cervical spine fracture (OR = 3.44; 95% CI = 1.6, 7.5). These patients were also more likely to exhibit a Horner sign (OR = 3.2; 95% CI = 1.5, 7.2) and phrenic nerve dysfunction (OR = 2.5; 95% CI = 1.0, 5.8) compared with the group with only a brachial plexus injury. Conclusion: Heightened awareness for a combined spinal cord and brachial plexus injury and the presence of various associated clinical and imaging findings may aid in the early recognition of these relatively uncommon injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID:22258773

  3. The velocity field of a coronal mass ejection: The event of September 1, 1980

    SciTech Connect

    Low, B.C.; Hundhausen, A.J. )

    1987-03-01

    A coronal mass ejection with the appearance of two sets of overlapping loops occurred at about 0600 UT on September 1, 1980, over the northwest limb of the sun. It was one of the fastest events observed by the Solar Maximum Mission coronagraph during the 1980 epoch, with apparent radial velocity components of several features approaching 1,000 km s{sup {minus}1}. A study of the slow evolution of H{sub {alpha}} prominence filaments and coronal structures in the northwest solar sector suggests that the mass ejection resulted form the disruption of a helmet streamer in association with, possibly, two filaments to give rise to the double-loop structure. This event is well covered by 10 coronagraph images of good quality so that the complex velocity field, defined by the apparent motions of many different parts of the mass ejection, can be mapped out as a function of space and time. The results of such an analysis are presented and related to current concerns in the theoretical understanding of mass ejections In particular, it is concluded that a self-similar description of the velocity field is a gross oversimplification and that although some evidence of wave propagation can be found, the bright features in this mass ejection are plasma structures moving (presumably) with frozen-in magnetic fields, rather that waves propagating through plasma and magnetic fields.

  4. High-resolution imaging of ejection dynamics in laser-induced forward transfer

    NASA Astrophysics Data System (ADS)

    Pohl, R.; Visser, C. W.; Römer, G. R. B. E.; Sun, C.; Huis in't Veld, A. J.; Lohse, D.

    2014-03-01

    Laser-induced Forward Transfer (LIFT) is a 3D direct-write method suitable for precision printing of various materials. As the ejection mechanism of picosecond LIFT has not been visualized in detail, the governing physics are not fully understood yet. Therefore, this article presents an experimental imaging study on the ejection process of gold-based LIFT. The LIFT experiments were performed using a 6.7 picosecond Yb:YAG laser source equipped with a SHG. The beam was focused onto a 200 nm thick gold donor layer. The high magnification images were obtained using bright field illumination by a 6 ns pulsed Nd:YAG laser source and a 50× long-distance microscope objective that was combined with a 200 mm tube lens. For laser fluence levels up to two times the donor-transfer-threshold, the ejection of a single droplet was observed. The typical droplet radius was estimated to be less than 3 μm. A transition of ejection features towards higher fluence, indicates a second fluence-regime in the ejection process. For higher laser fluence, the formation of an elongated gold jet was observed. This jet fragments into multiple relatively small droplets, resulting in a spray of particles on the receiving substrate.

  5. Ejection of the Corona at State Transitions: a Common Behavior in Microquasars?

    NASA Astrophysics Data System (ADS)

    Prat, L.; Rodriguez, J.

    2009-05-01

    The onset of most microquasar outbursts is characterized by a state transition between a Low/Hard State (LHS) and a High/Soft State (HSS). Besides drastic spectral and timing changes, this transition often shows a discrete ejection event detectable in the radio range. However, the exact nature of the ejected material and the mechanisms that give birth to these phenomena are yet to be unraveled. Recent simultaneous radio and X-ray observations on several sources point to a coronal nature of the ejected material. In the cases of GRS 1915+105, XTE J1550-564, and the 2002 outburst of GX 339-4, the flux of the Compton component decreases sharply just before an ejection is detected in the radio range. Finally, in the case of H1743-322, drastic physical changes occurred in the corona just before the state transition, compatible with the disappearance of part of this medium. Thus, the behavior of at least 4 microquasars points in the direction of an ejection of the corona at the state transition, feature that is yet to be confirmed (or infirmed) in the case of other available sources.

  6. Studies of limb-dislodging forces acting on an ejection seat occupant.

    PubMed

    Schneck, D J

    1980-03-01

    A mathematical theory is being developed in order to calculate the aerodynamic loading to which a pilot is exposed during high-speed ejections. Neglecting the initial effects of flow separation, results thus far indicate that a pilot's musculoskeletal system is not likely to withstand the tendency for limb-flailing if he is ejecting at Mach numbers in excess of about 0.7. This tendency depends very strongly upon the angle at which the pilot's limbs intercept a high-speed flow; the forces that cause limb dislodgement increase dramatically with speed of ejection. Examining the time-course of limb-dislodging forces after the initial onset of windblast, the theory further predicts the generation of a double vortex street pattern on the downstream side of the limbs of an ejection seat occupant. This results in the corresponding appearance of oscillating forces tending to cause lateral motion (vibration) of the limbs. The amplitude and frequency of these oscillating forces are also very dependent on the Mach number of ejection and the angle at which the pilot's limbs intercept the flow. However, even at moderate Mach numbers, the frequency can be as high as 100 cycles per second, and the amplitude rapidly exceeds a pilot's musculo-skeletal resistive powers for Mach numbers above 0.7.

  7. Effect of arc current on droplet ejection from tungsten-based electrode in multiphase AC arc

    NASA Astrophysics Data System (ADS)

    Hashizume, Taro; Tanaka, Manabu; Watanabe, Takayuki

    2017-05-01

    The dynamic behavior of droplet ejection from a tungsten electrode was successfully visualized using a high-speed camera and an appropriate band-pass filter. The effect of arc current on droplet ejection was investigated to understand the electrode erosion mechanism in the multiphase AC arc. The rate of erosion by droplet ejection increased with increasing current. This result was examined on the basis of the time variation in forces on a pending droplet at the electrode tip during the AC cycle. The relationship among electromagnetic force, surface tension, and ion pressure on the molten tip during the cathodic period is crucial for controling droplet ejection. The molten tip becomes hemispherical forming the pending droplet with an increase in the instantaneous value of arc current during the AC cycle. The pending droplet detaches from the electrode surface when electromagnetic force becomes the dominant force. Consequently, a higher rate of erosion by droplet ejection with a higher arc current resulted from a stronger electromagnetic force.

  8. Global Response to Local Ionospheric Mass Ejection

    NASA Technical Reports Server (NTRS)

    Moore, T. E.; Fok, M.-C.; Delcourt, D. C.; Slinker, S. P.; Fedder, J. A.

    2010-01-01

    We revisit a reported "Ionospheric Mass Ejection" using prior event observations to guide a global simulation of local ionospheric outflows, global magnetospheric circulation, and plasma sheet pressurization, and comparing our results with the observed global response. Our simulation framework is based on test particle motions in the Lyon-Fedder-Mobarry (LFM) global circulation model electromagnetic fields. The inner magnetosphere is simulated with the Comprehensive Ring Current Model (CRCM) of Fok and Wolf, driven by the transpolar potential developed by the LFM magnetosphere, and includes an embedded plasmaspheric simulation. Global circulation is stimulated using the observed solar wind conditions for the period 24-25 Sept 1998. This period begins with the arrival of a Coronal Mass Ejection, initially with northward, but later with southward interplanetary magnetic field. Test particles are launched from the ionosphere with fluxes specified by local empirical relationships of outflow to electrodynamic and particle precipitation imposed by the MIlD simulation. Particles are tracked until they are lost from the system downstream or into the atmosphere, using the full equations of motion. Results are compared with the observed ring current and a simulation of polar and auroral wind outflows driven globally by solar wind dynamic pressure. We find good quantitative agreement with the observed ring current, and reasonable qualitative agreement with earlier simulation results, suggesting that the solar wind driven global simulation generates realistic energy dissipation in the ionosphere and that the Strangeway relations provide a realistic local outflow description.

  9. Heart failure with preserved ejection fraction

    PubMed Central

    ElGuindy, Ahmed; Yacoub, Magdi H

    2012-01-01

    Abstract Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies. PMID:25610841

  10. Particle Ejection and Levitation Technology (PELT)

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Each of the six Apollo landers touched down at unique sites on the lunar surface. Aside from the Apollo 12 landing site located 180 meters from the Surveyor III lander, plume impingement effects on ground hardware during the landings were not a problem. The planned return to the Moon requires numerous landings at the same site. Since the top few centimeters of lunar soil are loosely packed regolith, plume impingement from the lander will eject the granular material at high velocities. A picture shows what the astronauts viewed from the window of the Apollo 14 lander. There was tremendous dust excavation beneath the vehicle. With high-vacuum conditions on the Moon (10 (exp -14) to 10 (exp -12) torr), motion of all particles is completely ballistic. Estimates derived from damage to Surveyor III caused by the Apollo 12 lander show that the speed of the ejected regolith particles varies from 100 m/s to 2,000 m/s. It is imperative to understand the physics of plume impingement to safely design landing sites for future Moon missions. Aerospace scientists and engineers have examined and analyzed images from Apollo video extensively in an effort to determine the theoretical effects of rocket exhaust impingement. KSC has joined the University of Central Florida (UCF) to develop an instrument that will measure the 3-D vector of dust flow caused by plume impingement during descent of landers. The data collected from the instrument will augment the theoretical studies and analysis of the Apollo videos.

  11. Energetics of solar coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Subramanian, P.; Vourlidas, A.

    2007-05-01

    Aims:We investigate whether solar coronal mass ejections are driven mainly by coupling to the ambient solar wind or through the release of internal magnetic energy. Methods: We examine the energetics of 39 flux-rope like coronal mass ejections (CMEs) from the Sun using data in the distance range ~2-20 R⊙ from the Large Angle Spectroscopic Coronograph (LASCO) aboard the Solar and Heliospheric Observatory (SOHO). This comprises a complete sample of the best examples of flux-rope CMEs observed by LASCO in 1996-2001. Results: We find that 69% of the CMEs in our sample experience a clearly identifiable driving power in the LASCO field of view. For those CMEs that are driven, we examine if they might be deriving most of their driving power by coupling to the solar wind. We do not find conclusive evidence in favor of this hypothesis. On the other hand, we find that their internal magnetic energy is a viable source of the required driving power. We have estimated upper and lower limits on the power that can possibly be provided by the internal magnetic field of a CME. We find that, on average, the lower limit to the available magnetic power is around 74% of what is required to drive the CMEs, while the upper limit can be as much as an order of magnitude larger.

  12. ARTIST CONCEPT - SUBSATELLITE EJECTION (APOLLO XV) - MSC

    NASA Image and Video Library

    1971-07-08

    S71-39481 (July 1971) --- An artist's concept showing TRW's small lunar subsatellite being ejected into lunar orbit from the SIM bay of the Apollo 15 Service Module. The 80-pound satellite will remain in orbit a year or more, carrying scientific experiments to study space in the vicinity of the moon. The satellite carries three experiments: S-Band Transponder; Particle Shadows/Boundary Layer Experiment; and Subsatellite Magnetometer Experiment. The subsatellite is housed in a container resembling a rural mailbox, and when deployed is spring-ejected out-of-plane at 4 fps with a spin rate of 140 rpm. After the satellite booms are deployed, the spin rate is stabilized at about 12 rpm. The subsatellite is 31 inches long and has a 14 inch hexagonal diameter. The exact weight is 78.5 pounds. The folded booms deploy to a length of five feet. Subsatellite electrical power is supplied by a solar cell array outputting 25 watts for dayside operation and a rechargeable silver-cadmium battery for nightside passes.

  13. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG

    SciTech Connect

    Harper, C.M. Jr.; Thomas, J.E.; Cascino, T.L.; Litchy, W.J.

    1989-04-01

    The results of clinical, radiologic, and electrophysiologic studies are retrospectively reviewed for 55 patients with neoplastic and 35 patients with radiation-induced brachial plexopathy. The presence or absence of pain as the presenting symptom, temporal profile of the illness, presence of a discrete mass on CT of the plexus, and presence of myokymic discharges on EMG contributed significantly to the prediction of the underlying cause of the brachial plexopathy. The distribution of weakness and the results of nerve conduction studies were of no help in distinguishing neoplastic from radiation-induced brachial plexopathy.

  14. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    USGS Publications Warehouse

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  15. Vibration-induced drop atomization and the numerical simulation of low-frequency single-droplet ejection

    NASA Astrophysics Data System (ADS)

    James, Ashley J.; Smith, Marc K.; Glezer, Ari

    2003-02-01

    Vibration-induced droplet ejection is a novel way to create a spray. In this method, a liquid drop is placed on a vertically vibrating solid surface. The vibration leads to the formation of waves on the free surface. Secondary droplets break off from the wave crests when the forcing amplitude is above a critical value. When the forcing frequency is small, only low-order axisymmetric wave modes are excited, and a single secondary droplet is ejected from the tip of the primary drop. When the forcing frequency is high, many high-order non-axisymmetric modes are excited, the motion is chaotic, and numerous small secondary droplets are ejected simultaneously from across the surface of the primary drop. In both frequency regimes a crater may form that collapses to create a liquid spike from which droplet ejection occurs. An axisymmetric, incompressible, Navier Stokes solver was developed to simulate the low-frequency ejection process. A volume-of-fluid method was used to track the free surface, with surface tension incorporated using the continuum-surface-force method. A time sequence of the simulated interface shape compared favourably with an experimental sequence. The dynamics of the droplet ejection process was investigated, and the conditions under which ejection occurs and the effect of the system parameters on the process were determined.

  16. On interplanetary coronal mass ejection identification at 1 AU

    NASA Astrophysics Data System (ADS)

    Mulligan, T.; Russell, C. T.; Gosling, J. T.

    1999-06-01

    Coronal mass ejections are believed to be produced in the corona from closed magnetic regions not previously participating in the solar wind expansion. At 1 AU their interplanetary counterparts (ICMEs) generally have a number of distinct plasma and field signatures that distinguish them from the ambient solar wind. These include heat flux dropouts, bi-directional streaming, enhanced alpha particle events, times of depressed proton temperatures, intervals of distorted or enhanced magnetic field, and times of large magnetic field rotations characteristic of magnetic clouds. The first three of these signatures are phenomena that occur at some point within the ICME, but do not necessarily persist throughout the entire ICME. The large scale magnetic field rotations, distortions and enhancements, and the proton temperature depressions tend to mark more accurately the beginning and end of the ICME proper. We examine herein the reliability with which each of these markers identifies ICMEs utilizing ISEE-3 data from 1978-1980.

  17. STOCHASTICITY AND PERSISTENCE OF SOLAR CORONAL MASS EJECTIONS

    SciTech Connect

    Telloni, D.; Antonucci, E.; Carbone, V.; Lepreti, F.

    2014-01-20

    The study of the statistical properties of coronal mass ejections (CMEs) reveals that their properties depend on the period of solar activity. In particular, when investigating the origin of the waiting time distribution between CMEs, a significant departure from a Poisson process during periods of high solar activity has been found, thus suggesting the existence of at least two physical processes underlying the origin of CMEs. One acts continuously, perhaps related to randomly occurring magnetic reconfigurations of the solar corona at large scales. The other plays a role only during the solar maximum, probably due to the photospheric emergence of magnetic flux as a statistically persistent mechanism, which generates long correlation times among CME events strong enough not to be destroyed by the former random process.

  18. Dipole Field Effects on Ion Ejections from a Paul Ion Trap

    NASA Technical Reports Server (NTRS)

    MacAskill, J. A.; Chutjian, A.

    2011-01-01

    Attempts at improving the quality of mass spectra obtained from a Paul trap mass spectrometer prompted an investigation of the effects of additional fields to supplement the primary rf quadrupole trapping field. Reported here are the results of the first in a series of tests that focuses on the application of a single dipole field to augment the trapping and subsequent ejections of ions stored within a Paul trap. Measurements are presented for a fixed quadrupole frequency with varying dipole frequencies. The presence of the dipole field during the quadrupole trapping phase causes ion ejections of single m/z species at discrete dipole frequencies. During the mass analysis phase, the varying dipole frequency produces a complex set of resonant structures that impact ejection time (mass range), as well as mass spectral peak intensity and width

  19. Density and white light brightness in looplike coronal mass ejections - Temporal evolution

    NASA Technical Reports Server (NTRS)

    Steinolfson, R. S.; Hundhausen, A. J.

    1988-01-01

    Three ambient coronal models suitable for studies of time-dependent phenomena were used to investigate the propagation of coronal mass ejections initiated in each atmosphere by an identical energy source. These models included those of a static corona with a dipole magnetic field, developed by Dryer et al. (1979); a steady polytropic corona with an equatorial coronal streamer, developed by Steinolfson et al. (1982); and Steinolfson's (1988) model of heated corona with an equatorial coronal streamer. The results indicated that the first model does not adequately represent the general characteristics of observed looplike mass ejections, and the second model simulated only some of the observed features. Only the third model, which included a heating term and a streamer, was found to yield accurate simulation of the mess ejection observations.

  20. Ultrafast probing of ejection dynamics of Rydberg atoms and molecular fragments from electronically excited helium nanodroplets.

    PubMed

    Bünermann, Oliver; Kornilov, Oleg; Haxton, Daniel J; Leone, Stephen R; Neumark, Daniel M; Gessner, Oliver

    2012-12-07

    The ejection dynamics of Rydberg atoms and molecular fragments from electronically excited helium nanodroplets are studied with time-resolved extreme ultraviolet ion imaging spectroscopy. At excitation energies of 23.6 ± 0.2 eV, Rydberg atoms in n = 3 and n = 4 states are ejected on different time scales and with significantly different kinetic energy distributions. Specifically, n = 3 Rydberg atoms are ejected with kinetic energies as high as 0.85 eV, but their appearance is delayed by approximately 200 fs. In contrast, n = 4 Rydberg atoms appear within the time resolution of the experiment with considerably lower kinetic energies. Major features in the Rydberg atom kinetic energy distributions for both principal quantum numbers can be described within a simple elastic scattering model of localized perturbed atomic Rydberg atoms that are expelled from the droplet due to their repulsive interaction with the surrounding helium bath. Time-dependent kinetic energy distributions of He(2) (+) and He(3) (+) ions are presented that support the formation of molecular ions in an indirect droplet ionization process and the ejection of neutral Rydberg dimers on a similar time scale as the n = 3 Rydberg atoms.

  1. Sex-specific effects of habitual aerobic exercise on brachial artery flow-mediated dilation in middle-aged and older adults.

    PubMed

    Pierce, Gary L; Eskurza, Iratxe; Walker, Ashley E; Fay, Tara N; Seals, Douglas R

    2011-01-01

    Brachial artery FMD (flow-mediated dilation) is impaired with aging and is associated with an increased risk of CVD (cardiovascular disease). In the present study, we determined whether regular aerobic exercise improves brachial artery FMD in MA/O (middle-aged/older) men and post-menopausal women. In sedentary MA/O adults (age, 55-79 years) without CVD, 8 weeks of brisk walking (6 days/week for approx. 50 min/day; randomized controlled design) increased treadmill time approx. 20% in both MA/O men (n=11) and post-menopausal women (n=15) (P<0.01), without altering body composition or circulating CVD risk factors. Brachial artery FMD increased >50% in the MA/O men (from 4.6±0.6 to 7.1±0.6%; P<0.01), but did not change in the post-menopausal women (5.1±0.8 compared with 5.4±0.7%; P=0.50). No changes occurred in the non-exercising controls. In a separate cross-sectional study (n=167), brachial artery FMD was approx. 50% greater in endurance-exercise-trained (6.4±0.4%; n=45) compared with sedentary (4.3±0.3%; n=60) MA/O men (P<0.001), whereas there were no differences between endurance-trained (5.3±0.7%, n=20) and sedentary (5.6±0.5%, n=42) post-menopausal women (P=0.70). Brachial artery lumen diameter, peak hyperaemic shear rate and endothelium-independent dilation did not differ with exercise intervention or in the endurance exercise compared with sedentary groups. In conclusion, regular aerobic exercise is consistently associated with enhanced brachial artery FMD in MA/O men, but not in post-menopausal women. Some post-menopausal women without CVD may be less responsive to habitual aerobic exercise than MA/O men.

  2. Space probe/satellite ejection apparatus for spacecraft

    NASA Technical Reports Server (NTRS)

    Smyly, H. M.; Miller, C. D.; Cloyd, R. A.; Heller, C. (Inventor)

    1984-01-01

    An ejection apparatus for spinning and propelling objects for ejection from a spacecraft at a desired velocity and rotational speed is discussed. The apparatus includes a launch cradle on which the space object to be ejected rests. The cradle is rotatably supported by a central hub secured to the upper end of the pneumatic cylinder piston shaft. Release mechanisms consisting of a retractable pin and locking lug is utilized to hold the cradle and object to be ejected. The release mechanism has a fixed barrier member which holds the retractable pin in engagement with the locking lug until release by upward movement of the launch cradle beyond the barrier height.

  3. Space probe/satellite ejection apparatus for spacecraft

    NASA Technical Reports Server (NTRS)

    Smyly, H. M.; Miller, C. D.; Cloyd, R. A.; Heller, C. (Inventor)

    1985-01-01

    An ejection apparatus for spinning and propelling objects for ejection from a spacecraft at a desired velocity and rotational speed is discussed. The apparatus includes a launch cradle on which the space object to be ejected rests. The cradle is rotatably supported by a central hub secured to the upper end of the pneumatic cylinder piston shaft. Release mechanisms consisting of a retractable pin and locking lug is utilized to hold the cradle and object to be ejected. The release mechanism has a fixed barrier member which holds the retractable pin in engagement with the locking lug until release by upward movement of the launch cradle beyond the barrier height.

  4. Acoustic and aerodynamic characteristics of ejectives in Amharic

    NASA Astrophysics Data System (ADS)

    Demolin, Didier

    2004-05-01

    This paper invetsigates the main phonetic characteristics that distinguishes ejectives from pulmonic sounds in Amharic. In this language, there are five ejectives that can be phonemically singleton or geminate. Duration measurements have been made in intervocalic position for pulmonic stops and for each type of ejective, taking into account the overall duration and VOT. Results show that ejective stops have a higher amplitude burst than pulmonic stops. The duration of the noise is shorter for ejective fricatives compared to pulmonic fricatives. At the end of ejective fricatives, there is a 30-ms glottal lag that is not present in pulmonic fricatives. Geminate ejectives are realized by delaying the elevation of the larynx. This can be observed on the spectrographic data by an increase of the noise at the end of the geminate ejectives. Aerodynamic data have been collected in synchronization with the acoustic recordings. The main observations are that pharyngeal pressures values are much higher than what is usually assumed (up to 40 CmH2O for velars) and that the delayed command in the elevation of the larynx of geminate ejectives is shown by two phases in the rise of pharyngeal pressure.

  5. Upper Limb Multifactorial Movement Analysis in Brachial Plexus Birth Injury

    PubMed Central

    Bahm, Jorg

    2016-01-01

    Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II. PMID:28077954

  6. Temporal pattern of pulse wave velocity during brachial hyperemia reactivity

    NASA Astrophysics Data System (ADS)

    Graf, S.; Valero, M. J.; Craiem, D.; Torrado, J.; Farro, I.; Zócalo, Y.; Valls, G.; Bía, D.; Armentano, R. L.

    2011-09-01

    Endothelial function can be assessed non-invasively with ultrasound, analyzing the change of brachial diameter in response to transient forearm ischemia. We propose a new technique based in the same principle, but analyzing a continuous recording of carotid-radial pulse wave velocity (PWV) instead of diameter. PWV was measured on 10 healthy subjects of 22±2 years before and after 5 minutes forearm occlusion. After 59 ± 31 seconds of cuff release PWV decreased 21 ± 9% compared to baseline, reestablishing the same after 533 ± 65 seconds. There were no significant changes observed in blood pressure. When repeating the study one hour later in 5 subjects, we obtained a coefficient of repeatability of 4.8%. In conclusion, through analysis of beat to beat carotid-radial PWV it was possible to characterize the temporal profiles and analyze the acute changes in response to a reactive hyperemia. The results show that the technique has a high sensitivity and repeatability.

  7. Brachial plexus injury: the London experience with supraclavicular traction lesions.

    PubMed

    Birch, Rolfe

    2009-01-01

    In this article, the author details the experiences of his hospital and other London hospitals in treating brachial plexus injury. As noted, important advances have been made in methods of diagnosis and repair. Myelography was replaced by CT scan and later by MRI. Among the topics the author explores are diagnosis (including pain, the presence or absence of the Tinel sign, and the irradiation of pins and needles) and the principles of repair. The author emphasizes that it is imperative that ruptured nerves be repaired as soon as possible, with the closed traction lesion coming, in urgency, close behind reattachment of the amputated hand or repair of a great artery and a trunk nerve in the combined lesion. Finally, the article concludes that the surgeon must be actively engaged in the whole process of rehabilitation and treatment of pain. This is part of a Point-Counterpoint discussion with Dr. David G. Kline's presentation of "A Personal Experience."

  8. Functional scoring system for obstetric brachial plexus palsy.

    PubMed

    Basheer, H; Zelic, V; Rabia, F

    2000-02-01

    We suggest a new scoring system that measures the upper limb function both as a unit and in separate parts. Our system was designed to study the recovery in patients with obstetric brachial plexus palsy (OBPP). It measures active limb movements and compares them with the normal side to obtain a ratio, which is then converted to a score. Fifty-two patients with OBPP were studied with a follow-up of 2 years. The progress of the patients was monitored using the system. Thirty-seven patients (71%) achieved very good recovery, eight patients (15%) achieved a good score, and five patients (10%) achieved a poor score. Most of the recovery occurred before the age of 6 months.

  9. A giant plexiform schwannoma of the brachial plexus: case report

    PubMed Central

    2011-01-01

    We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed. PMID:22044580

  10. Morphometric Atlas Selection for Automatic Brachial Plexus Segmentation

    SciTech Connect

    Van de Velde, Joris; Wouters, Johan; Vercauteren, Tom; De Gersem, Werner; Duprez, Fréderic; De Neve, Wilfried; Van Hoof, Tom

    2015-07-01

    Purpose: The purpose of this study was to determine the effects of atlas selection based on different morphometric parameters, on the accuracy of automatic brachial plexus (BP) segmentation for radiation therapy planning. The segmentation accuracy was measured by comparing all of the generated automatic segmentations with anatomically validated gold standard atlases developed using cadavers. Methods and Materials: Twelve cadaver computed tomography (CT) atlases (3 males, 9 females; mean age: 73 years) were included in the study. One atlas was selected to serve as a patient, and the other 11 atlases were registered separately onto this “patient” using deformable image registration. This procedure was repeated for every atlas as a patient. Next, the Dice and Jaccard similarity indices and inclusion index were calculated for every registered BP with the original gold standard BP. In parallel, differences in several morphometric parameters that may influence the BP segmentation accuracy were measured for the different atlases. Specific brachial plexus-related CT-visible bony points were used to define the morphometric parameters. Subsequently, correlations between the similarity indices and morphometric parameters were calculated. Results: A clear negative correlation between difference in protraction-retraction distance and the similarity indices was observed (mean Pearson correlation coefficient = −0.546). All of the other investigated Pearson correlation coefficients were weak. Conclusions: Differences in the shoulder protraction-retraction position between the atlas and the patient during planning CT influence the BP autosegmentation accuracy. A greater difference in the protraction-retraction distance between the atlas and the patient reduces the accuracy of the BP automatic segmentation result.

  11. OCT/PS-OCT imaging of brachial plexus neurovascular structures

    NASA Astrophysics Data System (ADS)

    Raphael, David T.; Zhang, Jun; Zhang, Yaoping; Chen, Zhongping; Miller, Carol; Zhou, Li

    2004-07-01

    Introduction: Optical coherence tomography (OCT) allows high-resolution imaging (less than 10 microns) of tissue structures. A pilot study with OCT and polarization-sensitive OCT (PS-OCT) was undertaken to image ex-vivo neurovascular structures (vessels, nerves) of the canine brachial plexus. Methods: OCT is an interferometry-based optical analog of B-mode ultrasound, which can image through non-transparent biological tissues. With approval of the USC Animal Care and Use Committee, segments of the supra- and infraclavicular brachial plexus were excised from euthanized adult dogs, and the ex-vivo specimens were placed in cold pH-buffered physiologic solution. An OCT beam, in micrometer translational steps, scanned the fixed-position bisected specimens in transverse and longitudinal views. Two-dimensional images were obtained from identified arteries and nerves, with specific sections of interest stained with hematoxylin-eosin for later imaging through a surgical microscope. Results: with the beam scan direction transverse to arteries, the resulting OCT images showed an identifiable arterial lumen and arterial wall tissue layers. By comparison, transverse beam OCT images of nerves revealed a multitude of smaller nerve bundles contained within larger circular-shaped fascicles. PS-OCT imaging was helpful in showing the characteristic birefringence exhibited by arrayed neural structures. Discussion: High-resolution OCT imaging may be useful in the optical identification of neurovascular structures during attempted regional nerve blockade. If incorporated into a needle-shaped catheter endoscope, such a technology could prevent intraneural and intravascular injections immediately prior to local anesthetic injection. The major limitation of OCT is that it can form a coherent image of tissue structures only to a depth of 1.5 - 2 mm.

  12. Upright MRI of glenohumeral dysplasia following obstetric brachial plexus injury.

    PubMed

    Nath, Rahul K; Paizi, Melia; Melcher, Sonya E; Farina, Kim L

    2007-11-01

    The purpose of this study was to evaluate the role of upright magnetic resonance imaging (MRI) shoulder scanning in the diagnosis of glenohumeral deformity following obstetric brachial plexus injury (OBPI). Eighty-nine children (ages 0.4 to 17.9 years) with OBPI who have medial rotation contracture and reduced passive and active lateral rotation of the shoulder were evaluated via upright MRI of the affected glenohumeral joint. Qualitative impressions of glenoid form were recorded, and quantitative measurements were made of glenoid version and posterior subluxation. Glenoid version of the affected shoulder averaged -16.8 +/- 11.0 degrees (range, -55 degrees to 1 degrees ), and percentage of the humeral head anterior to the glenoid fossa (PHHA) averaged 32.6 +/- 16.5% (range, -17.8% to 52.4%). The glenoid form was normal in 43 children, convex in 19 children and biconcave in 27 children. Standard MRI protocols were used to obtain bilateral images from 14 of these patients. Among the patients with bilateral MR images, glenoid version and PHHA were significantly different between the involved and uninvolved shoulders (P<.000). Glenoid version in the involved shoulder averaged -19.0 +/- 13.1 degrees (range, -52 degrees to -3 degrees ), and PHHA averaged 29.7 +/- 18.4% (range, -16.2% to 48.7%). In the uninvolved shoulder, the average glenoid version and PHHA were -5.2 +/- 3.7 degrees (range, -12 degrees to -1 degrees ) and 47.7 +/- 3.0% (range, 43% to 54%), respectively. The relative beneficial aspects of upright MRI include lack of need for sedation, low claustrophobic potential and, most important, natural, gravity-influenced position, enabling the surgeon to visualize the true preoperative picture of the shoulder. It is an effective tool for demonstrating glenohumeral abnormalities resulting from brachial plexus injury worthy of surgical exploration.

  13. Particulate-steroid betamethasone added to ropivacaine in interscalene brachial plexus block for arthroscopic rotator cuff repair improves postoperative analgesia.

    PubMed

    Watanabe, Kunitaro; Tokumine, Joho; Yorozu, Tomoko; Moriyama, Kumi; Sakamoto, Hideaki; Inoue, Tetsuo

    2016-10-04

    Dexamethasone added to local anesthetic for brachial plexus block improves postoperative pain after arthroscopic rotator cuff repair, as compared with the use of local anesthetic alone. Dexamethasone is present in non-particulate form in local anesthetic solution, while betamethasone is partially present in particulate form. The particulate betamethasone gradually decays and is expected to cause its longer-lasting effect. This study investigated the postoperative analgesic effect of betamethasone added to ropivacaine for brachial plexus block in patients who underwent arthroscopic rotator cuff repair. This was a prospective, randomized, triple-blind study of 44 patients undergoing arthroscopic rotator cuff repair surgery. Ultrasound-guided interscalene brachial plexus block, involving 20 mL of 0.375 % ropivacaine (group R) or 19 mL of 0.375 % ropivacaine with 4 mg (1 mL) of betamethasone (group BR), was administered and surgery was performed under general anesthesia. After surgery, the pain score was recorded at 12 h after surgery, and on the first, second, and seventh postoperative day. Analgesia duration, offset time of motor block, frequency of rescue analgesic administration, postoperative nausea/vomiting, and sleep disturbance during the night after surgery were recorded. The numerical values were expressed as median [interquartile range]. P values < 0.05 were considered statistically significant. The duration of analgesia was significantly prolonged in group BR (group BR: 19.1 h [16.6, 20.9 h], group R: 13.3 h [11.6, 16.5 h], p < 0.001). The pain scores at 12 h after surgery and on the first and seventh day after surgery were significantly lower in group BR than in group R. The duration of motor block was significantly prolonged in group BR. The frequency of rescue analgesic administration and the sleep disturbance rate were significantly lower in group BR. There was no difference in postoperative nausea/vomiting between the two groups

  14. Pain relief from preganglionic injury to the brachial plexus by late intercostal nerve transfer.

    PubMed

    Berman, J; Anand, P; Chen, L; Taggart, M; Birch, R

    1996-09-01

    We performed intercostal nerve transfer in 19 patients to relieve pain from preganglionic injury to the brachial plexus. The procedure was successful in 16 patients at a mean of 28.6 months (12 to 68) after the injury.

  15. Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy.

    PubMed

    Zermeño-Rivera, Jaime; Gutiérrez-Amavizca, Bianca Ethel

    2015-06-01

    Brachial plexus avulsion results from excessive stretching and can occur secondary to motor vehicle accidents, mainly in motorcyclists. In a 28-year-old man with panavulsive brachial plexus palsy, we describe an alternative technique to repair brachial plexus avulsion and to stabilize and preserve shoulder function by transferring the contralateral spinal accessory nerve to the suprascapular nerve. We observed positive clinical and electromyographic results in sternocleidomastoid, trapezius, supraspinatus, infraspinatus, pectoralis, triceps, and biceps, with good outcome and prognosis for shoulder function at 12 months after surgery. This technique provides a unique opportunity for patients suffering from severe brachial plexus injuries and lacking enough donor nerves to obtain shoulder stability and mobility while avoiding bone fusion and preserving functionality of the contralateral shoulder with favorable postoperative outcomes.

  16. Restoration and protection of brachial plexus injury: hot topics in the last decade.

    PubMed

    Zhang, Kaizhi; Lv, Zheng; Liu, Jun; Zhu, He; Li, Rui

    2014-09-15

    Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the development of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for protection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimulation, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this field change according to the hot topic of research.

  17. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    MedlinePlus

    Understanding Task Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults The U.S. Preventive Services Task Force (Task Force) has issued a ...

  18. Neuroanatomy of the brachial plexus: normal and variant anatomy of its formation.

    PubMed

    Johnson, Elizabeth O; Vekris, Marios; Demesticha, Theano; Soucacos, Panayotis N

    2010-03-01

    The brachial plexus is the complex network of nerves, extending from the neck to the axilla, which supplies motor, sensory, and sympathetic fibers to the upper extremity. Typically, it is formed by the union of the ventral primary rami of the spinal nerves, C5-C8 & T1, the so-called "roots" of the brachial plexus. By examining the neural architecture of the brachial plexus, the most constant arrangement of nerve fibers can be delineated, and the most predominate variations in the neural architecture defined. A thorough understanding of the neuroanatomy of the brachial plexus, with an appreciation of the possible anatomic variations that may occur is necessary for effective clinical practice.

  19. Restoration and protection of brachial plexus injury: hot topics in the last decade

    PubMed Central

    Zhang, Kaizhi; Lv, Zheng; Liu, Jun; Zhu, He; Li, Rui

    2014-01-01

    Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the development of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for protection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimulation, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this field change according to the hot topic of research. PMID:25374596

  20. Reliability of 3D upper limb motion analysis in children with obstetric brachial plexus palsy.

    PubMed

    Mahon, Judy; Malone, Ailish; Kiernan, Damien; Meldrum, Dara

    2017-03-01

    Kinematics, measured by 3D upper limb motion analysis (3D-ULMA), can potentially increase understanding of movement patterns by quantifying individual joint contributions. Reliability in children with obstetric brachial plexus palsy (OBPP) has not been established.

  1. Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

    SciTech Connect

    Shankar, Sridhar Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Flanagan, Hugh L.; Whang, Edward E.

    2005-06-15

    Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication.

  2. Investigation of brachial plexus traction lesions by peripheral and spinal somatosensory evoked potentials.

    PubMed Central

    Jones, S J

    1979-01-01

    Peripheral, spinal and cortical somatosensory evoked potentials were recorded in 26 patients with unilateral traction injuries of the brachial plexus ganglia. Of 10 cases explored surgically the recordings correctly anticipated the major site of the lesion in eight. PMID:422958

  3. Solar Eruptions: Coronal Mass Ejections and Flares

    NASA Technical Reports Server (NTRS)

    Gopalswamy, Nat

    2012-01-01

    This lecture introduces the topic of Coronal mass ejections (CMEs) and solar flares, collectively known as solar eruptions. During solar eruptions, the released energy flows out from the Sun in the form of magnetized plasma and electromagnetic radiation. The electromagnetic radiation suddenly increases the ionization content of the ionosphere, thus impacting communication and navigation systems. Flares can be eruptive or confined. Eruptive flares accompany CMEs, while confined flares hav only electromagnetic signature. CMEs can drive MHD shocks that accelerate charged particles to very high energies in the interplanetary space, which pose radiation hazard to astronauts and space systems. CMEs heading in the direction of Earth arrive in about two days and impact Earth's magnetosphere, producing geomagnetic storms. The magnetic storms result in a number of effects including induced currnts that can disrupt power grids, railroads, and underground pipelines

  4. Geometrical Properties of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Cremades, Hebe; Bothmer, Volker

    Based on the SOHO/LASCO dataset, a collection of "structured" coronal mass ejections (CMEs) has been compiled within the period 1996-2002, in order to analyze their three-dimensional configuration. These CME events exhibit white-light fine structures, likely indicative of their possible 3D topology. From a detailed investigation of the associated low coronal and photospheric source regions, a generic scheme has been deduced, which considers the white-light topology of a CME projected in the plane of the sky as being primarily dependent on the orientation and position of the source region's neutral line on the solar disk. The obtained results imply that structured CMEs are essentially organized along a symmetry axis, in a cylindrical manner. The measured dimensions of the cylinder's base and length yield a ratio of 1.6. These CMEs seem to be better approximated by elliptic cones, rather than by the classical ice cream cone, characterized by a circular cross section.

  5. Coronal Mass Ejections: From Sun to Earth

    NASA Astrophysics Data System (ADS)

    Patsourakos, S.

    2016-06-01

    Coronal Mass Ejections (CMEs) are gigantic expulsions of magnetized plasmas from the solar corona into the interplanetary (IP) space. CMEs spawn ~ 1015 gr of mass and reach speeds ranging between several hundred to a few thousand km/s (e.g., Gopalswamy et al. 2009; Vourlidas et al. 2010). It takes 1-5 days for a CME to reach Earth. CMEs are one of the most energetic eruptive manifestations in the solar system and are major drivers of space weather via their magnetic fields and energetic particles, which are accelerated by CME-driven shocks. In this review we give a short account of recent, mainly observational, results on CMEs from the STEREO and SDO missions which include the nature of their pre-eruptive and eruptive configurations and the CME propagation from Sun to Earth. We conclude with a discussion of the exciting capabilities in CME studies that will soon become available from new solar and heliospheric instrumentation.

  6. Coronal mass ejections and large geomagnetic storms

    NASA Technical Reports Server (NTRS)

    Gosling, J. T.; Bame, S. J.; Mccomas, D. J.; Phillips, J. L.

    1990-01-01

    Previous work indicates that coronal mass ejection (CME) events in the solar wind at 1 AU can be identified by the presence of a flux of counterstreaming solar wind halo electrons (above about 80 eV). Using this technique to identify CMEs in 1 AU plasma data, it is found that most large geomagnetic storms during the interval surrounding the last solar maximum (August 1978 - October 1982) were associated with earth-passage of interplanetary disturbances in which the earth encountered both a shock and the CME driving the shock. However, only about one CME in six encountered by earth was effective in causing a large geomagnetic storm. Slow CMEs which did not interact strongly with the ambient solar wind ahead were particularly ineffective in a geomagnetic sense.

  7. Boulders Ejected From Small Impact Craters

    NASA Astrophysics Data System (ADS)

    Bart, Gwendolyn D.; Melosh, H. J.

    2006-09-01

    We investigate the distribution of boulders ejected from lunar craters by analyzing high resolution Lunar Orbiter images. Our previous study (DPS 2004) of four small craters indicated that larger boulders are more frequently found close to the crater rim rather than far away, and that the size of the ejecta drops off as a power law with distance from the crater. Our current study adds more than ten new bouldery craters that range in size from 200 m to several kilometers and are found on a variety of terrain (mare, highlands, and the Copernicus ejecta blanket.) For each crater we plot the boulder diameter as a function of the ejection velocity of the boulder. We compare this size-velocity distribution with the size-velocity distribution of ejecta from large craters (Vickery 1986, 1987) to ascertain the mechanism of fracture of the substrate in the impact. We also make cumulative plots of the boulders, indicating the number of boulders of each size present around the crater. The cumulative plots allow us to compare our boulder distributions with the distributions of secondary craters from large impacts. Material thrown from a several-hundred-meter diameter crater may land intact as boulders, but material thrown from a tens-of-kilometers diameter crater will travel at a significantly higher velocity, and will form a secondary crater when it impacts the surface. Our data helps elucidate whether the upturn, at small diameters, of the cratering curve of the terrestrial planets is due to secondary impacts or to the primary population. This work is funded by NASA PGG grant NNG05GK40G.

  8. An ice-cream cone model for coronal mass ejections

    NASA Astrophysics Data System (ADS)

    Xue, X. H.; Wang, C. B.; Dou, X. K.

    2005-08-01

    In this study, we use an ice-cream cone model to analyze the geometrical and kinematical properties of the coronal mass ejections (CMEs). Assuming that in the early phase CMEs propagate with near-constant speed and angular width, some useful properties of CMEs, namely the radial speed (v), the angular width (α), and the location at the heliosphere, can be obtained considering the geometrical shapes of a CME as an ice-cream cone. This model is improved by (1) using an ice-cream cone to show the near real configuration of a CME, (2) determining the radial speed via fitting the projected speeds calculated from the height-time relation in different azimuthal angles, (3) not only applying to halo CMEs but also applying to nonhalo CMEs.

  9. Automatic Detection and Classification of Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Qu, Ming; Shih, Frank Y.; Jing, Ju; Wang, Haimin

    2006-09-01

    We present an automatic algorithm to detect, characterize, and classify coronal mass ejections (CMEs) in Large Angle Spectrometric Coronagraph (LASCO) C2 and C3 images. The algorithm includes three steps: (1) production running difference images of LASCO C2 and C3; (2) characterization of properties of CMEs such as intensity, height, angular width of span, and speed, and (3) classification of strong, median, and weak CMEs on the basis of CME characterization. In this work, image enhancement, segmentation, and morphological methods are used to detect and characterize CME regions. In addition, Support Vector Machine (SVM) classifiers are incorporated with the CME properties to distinguish strong CMEs from other weak CMEs. The real-time CME detection and classification results are recorded in a database to be available to the public. Comparing the two available CME catalogs, SOHO/LASCO and CACTus CME catalogs, we have achieved accurate and fast detection of strong CMEs and most of weak CMEs.

  10. The investigation of vertebral injury sustained during aircrew ejection

    NASA Technical Reports Server (NTRS)

    Benedict, J. V.

    1972-01-01

    A series of tests were performed on excised human vertebral segments to determine the static and dynamic response of the thoraco-lumbar spine when loaded in flexion. A total of fifteen tests were performed on eleven specimens. Specimens were obtained from male donors ranging in age from 34 to 60 years. Demographic data pertinent to each specimen and the elapsed time between death of the donor and testing of each corresponding specimen are presented. Only spinal segments comprised of lower thoracic and upper lumbar vertebrae were tested because in aircraft ejection injuries clinical complications in this anatomical region predominate. A complex continuum mathematical model describing the dynamic response of the human spine was formulated, solved, and verified experimentally. Detailed results are presented in figures, tables, and equations.

  11. Ultrasound-guided posterior approach to brachial plexus for the treatment of upper phantom limb syndrome.

    PubMed

    Tognù, A; Borghi, B; Gullotta, S; White, P F

    2012-01-01

    The purpose of the case is to report the clinical value of the ultrasound-guided posterior approach to the brachial plexus in the treatment of phantom limb syndrome after an upper extremity amputation. The author experienced ultrasound guidance as sole technique to localize the brachial plexus for the purpose of placing a catheter for continuous infusion of a local anesthetic in a patient where standard landmark-based nerve stimulation for placement of a continuous perineural block was not possible.

  12. Association of hemoglobin with ankle-brachial index in general population.

    PubMed

    Chenglong, Zhang; Jing, Lei; Xia, Ke; Yang, Tianlun

    2016-07-01

    Previous studies have demonstrated that both low and high hemoglobin concentrations are predictive of adverse cardiovascular outcomes in various populations. However, an association of hemoglobin with the ankle-brachial index, which is widely used as a screening test for peripheral arterial disease, has not yet been identified. We examined 786 subjects (236 women and 550 men) who received routine physical check-ups. The ankle-brachial index and several hematological parameters, including the hemoglobin level, hematocrit and red blood cell count and other demographic and biochemical characteristics were collected. Univariate and multivariate linear regression analyses were performed to assess the relationships between the ankle-brachial index and the independent determinants. Receiver operating characteristic curve analysis was conducted to calculate the cut-off level of hemoglobin for detecting a relatively low ankle-brachial index (less than 20% of all subjects, which was 1.02). The hemoglobin level, hematocrit and red blood cell count were correlated with the ankle-brachial index in the males (r=-0.274, r=-0.224 and r=-0.273, respectively, p<0.001 for all), but these associations were not significant in the females. Multivariate linear regression analysis revealed that the independent determinants of the ankle-brachial index included age, total cholesterol, high-density lipoprotein cholesterol and the white blood cell count for the females and age, hypertension, total cholesterol and hemoglobin (β=-0.001, p<0.001) for the males after adjusting for confounding factors. Receiver operating characteristic curve analysis revealed that the cut-off level of hemoglobin for predicting a low ankle-brachial index was 156.5 g/L in the males. A high hemoglobin concentration was independently correlated with a low ankle-brachial index in the healthy males, indicating that an elevation in this level may be associated with an increased atherosclerosis risk.

  13. Nerve Transfers in Birth Related Brachial Plexus Injuries: Where Do We Stand?

    PubMed

    Davidge, Kristen M; Clarke, Howard M; Borschel, Gregory H

    2016-05-01

    This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve transfers is reviewed and compared with the recent literature on intraplexal distal nerve transfers in obstetrical brachial plexus injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Evidence of the Effectiveness of Primary Brachial Plexus Surgery in Infants With Obstetric Brachial Plexus Palsy–Revisited

    PubMed Central

    2017-01-01

    A recent systematic review questioned the effectiveness of primary surgery in infants with obstetric brachial plexus palsy. At our center, the indication for primary surgery in infants with upper Erb’s obstetric palsy is the lack of active elbow flexion at age 4 months. The current study compares the outcome of motor recovery in 2 groups of infants with upper Erb’s palsy: one group (n = 9) treated surgically between age 4 and 5 months, and another group (n = 9) treated conservatively despite the lack of active elbow flexion at age 4 months. The only reason for not doing the surgery in the latter group was refusal by the parents. The scores of motor recovery were collected at the 2-year follow-up visit, and they were significantly better in the surgical group. The study demonstrates the effectiveness of primary surgery in infants with upper Erb’s obstetric palsy compared to conservative management. PMID:28596982

  15. Heart failure patients demonstrate impaired changes in brachial artery blood flow and shear rate pattern during moderate-intensity cycle exercise.

    PubMed

    Benda, Nathalie M M; Seeger, Joost P H; van Lier, Dirk P T; Bellersen, Louise; van Dijk, Arie P J; Hopman, Maria T E; Thijssen, Dick H J

    2015-04-01

    What is the central question of this study? We explored whether heart failure (HF) patients demonstrate different exercise-induced brachial artery shear rate patterns compared with control subjects. What is the main finding and its importance? Moderate-intensity cycle exercise in HF patients is associated with an attenuated increase in brachial artery anterograde and mean shear rate and skin temperature. Differences between HF patients and control subjects cannot be explained fully by differences in workload. HF patients demonstrate a less favourable shear rate pattern during cycle exercise compared with control subjects. Repeated elevations in shear rate (SR) in conduit arteries, which occur during exercise, represent a key stimulus to improve vascular function. We explored whether heart failure (HF) patients demonstrate distinct changes in SR in response to moderate-intensity cycle exercise compared with healthy control subjects. We examined brachial artery SR during 40 min of cycle exercise at a work rate equivalent to 65% peak oxygen uptake in 14 HF patients (65 ± 7 years old, 13 men and one woman) and 14 control subjects (61 ± 5 years old, 12 men and two women). Brachial artery diameter, SR and oscillatory shear index (OSI) were assessed using ultrasound at baseline and during exercise. The HF patients demonstrated an attenuated increase in mean and anterograde brachial artery SR during exercise compared with control subjects (time × group interaction, P = 0.003 and P < 0.001, respectively). Retrograde SR increased at the onset of exercise and remained increased throughout the exercise period in both groups (time × group interaction, P = 0.11). In control subjects, the immediate increase in OSI during exercise (time, P < 0.001) was normalized after 35 min of cycling. In contrast, the increase in OSI after the onset of exercise did not normalize in HF patients (time × group interaction, P = 0.029). Subgroup analysis of five HF patients and five control

  16. ISAAC: A REXUS Student Experiment to Demonstrate an Ejection System with Predefined Direction

    NASA Astrophysics Data System (ADS)

    Balmer, G.; Berquand, A.; Company-Vallet, E.; Granberg, V.; Grigore, V.; Ivchenko, N.; Kevorkov, R.; Lundkvist, E.; Olentsenko, G.; Pacheco-Labrador, J.; Tibert, G.; Yuan, Y.

    2015-09-01

    ISAAC Infrared Spectroscopy to Analyse the middle Atmosphere Composition — was a student experiment launched from SSC's Esrange Space Centre, Sweden, on 29th May 2014, on board the sounding rocket REXUS 15 in the frame of the REXUS/BEXUS programme. The main focus of the experiment was to implement an ejection system for two large Free Falling Units (FFUs) (240 mm x 80 mm) to be ejected from a spinning rocket into a predefined direction. The system design relied on a spring-based ejection system. Sun and angular rate sensors were used to control and time the ejection. The flight data includes telemetry from the Rocket Mounted Unit (RMU), received and saved during flight, as well as video footage from the GoPro camera mounted inside the RMU and recovered after the flight. The FFUs' direction, speed and spin frequency as well as the rocket spin frequency were determined by analyzing the video footage. The FFU-Rocket-Sun angles were 64.3° and 104.3°, within the required margins of 90°+45°. The FFU speeds were 3.98 mIs and 3.74 mIs, lower than the expected 5± 1 mIs. The FFUs' spin frequencies were 1 .38 Hz and 1 .60 Hz, approximately half the rocket's spin frequency. The rocket spin rate slightly changed from 3. 163 Hz before the ejection to 3.1 17 Hz after the ejection of the two FFUs. The angular rate, sun sensor data and temperature on the inside of the rocket module skin were also recorded. The experiment design and results of the data analysis are presented in this paper.

  17. Tracking Coronal Mass Ejections with a Heliospheric Imager: Case Studies from the Solar Mass Ejection Imager

    NASA Astrophysics Data System (ADS)

    Johnston, J. C.; Mizuno, D. R.; Webb, D. F.; Kuchar, T. A.; Howard, T. A.

    2005-05-01

    The Solar Mass Ejection Imager (SMEI) was launched on board the DoD Space Test Program's Coriolis satellite in January 2003. Two-thirds through its planned 3-year lifetime, SMEI has observed Coronal Mass Ejections (CMEs), comets and asteroids as they move through the heliosphere. More than 140 CMEs have been detected with the SMEI instrument, including well-documented "halo" events that led to geomagnetic storm conditions on Earth. These observations demonstrate the potential of a heliospheric imager for space weather specification and prediction purposes. We present several case studies of CMEs as they propagate through the SOHO LASCO and SMEI fields of view, and examine SMEI's "hit" rate for detection of geoeffective CMEs.

  18. Heliospheric Imagers for Tracking Coronal Mass Ejections: Lessons Learned from the Solar Mass Ejection Imager

    NASA Astrophysics Data System (ADS)

    Johnston, J. C.; Mozer, J. B.; Radick, R. R.; Holladay, P. E.; Kuchar, T. A.; Mizuno, D. R.; Webb, D. F.

    2004-12-01

    The Solar Mass Ejection Imager (SMEI) was launched on board the DoD Space Test Program's Coriolis satellite on January 6, 2003. The SMEI instrument represents a new kind of imager designed specifically to observe Coronal Mass Ejections (CMEs) and other dense structures in the solar wind as they propagate through the heliosphere. Its viewing range starts at 20 degrees elongation from the Sun and extends to beyond 1 A.U.. More than 120 CMEs have been detected with the SMEI instrument, including three well-documented "halo" events that led to geomagnetic storm conditions on Earth. These observations demonstrate the potential of a heliospheric imager for space weather specification and prediction purposes. More than halfway through SMEI's planned three-year lifetime, we look ahead towards an operational heliospheric imager. We will briefly reveal some of the lessons learned from the SMEI mission and offer recommendations for a future system with operational capability.

  19. [Ultrasound-guided axillary block: anatomical variations of terminal branches of the brachial plexus in relation to the brachial artery].

    PubMed

    Silva, M G; Sala-Blanch, X; Marín, R; Espinoza, X; Arauz, A; Morros, C

    2014-01-01

    To describe the distribution of the terminal branches of the brachial plexus at the axillary level and define distribution patterns after ultrasound evaluation. Fifty volunteers underwent ultrasound bilateral axillary brachial plexus scanning exploration. Nerve distribution around the humeral artery was described and the distance between each nerve and the center of the artery was measured. The distance and relationship between the ulnar nerve and the humeral vein were also recorded. The median nerve was located in the anterolateral quadrant (-29±40°) and at a mean distance of 2.1±0.9mm from the artery (85%). The ulnar nerve was found at 53±26° and at 4.2±2.1mm from the artery in the anteromedial quadrant (90%), anterolateral to the vein in 46% of cases, and deep to it in 54%. The radial nerve was at 122±38° and at 3.3±1.7mm from the artery in the posteromedial quadrant (86%). The musculocutaneous nerve was found at -103±22° and 9.3±5.6mm from the artery in the posterolateral quadrant (90%) and in the anterolateral quadrant (-55±16°) at 4.8±2.7mm (10%). There were no differences regarding laterality, gender or overweight patients. Our results allow defining four different anatomical patterns, two based in the position of the musculocutaneous nerve and two based on the disposition of the ulnar nerve with respect to the humeral vein. These patterns were not related to laterality, gender or body weight. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. Full Halo Coronal Mass Ejections: Arrival at the Earth

    NASA Astrophysics Data System (ADS)

    Shen, C.; Wang, Y.; Pan, Z.; Miao, B.; Ye, P.; Wang, S.

    2014-12-01

    A geomagnetic storm is mainly caused by a front-side coronal mass ejection (CME) hitting the Earth and then interacting with the magnetosphere. However, not all front-side CMEs can hit the Earth. Thus, which CMEs hit the Earth and when they do so are important issues in the study and forecasting of space weather. In our previous work (Shen et al., 2013), the de-projected parameters of the full-halo coronal mass ejections (FHCMEs) occurred from 2007 March 1 to 2012 May 31 were obtained, and there are 39 front-side events could be fitted by the GCS model. In this work, we continue to study whether and when these front-side FHCMEs (FFHCMEs) hit the Earth. It is found that 59% of these FFHCMEs hit the Earth, and for central events, whose deviation angles , which are the angles between the propagation direction and the Sun-Earth line, are smaller than 45 degrees, the fraction increases to 75%. After checking the deprojected angular widths of the CMEs, we found that all of the Earth-encountered CMEs satisfy a simple criterion that the angular width (ω) is larger than twice the deviation angle. This result suggests that some simple criteria can be used to forecast whether a CME could hit the Earth. Furthermore, for Earth-encountered CMEs, the transit time is found to be roughly anti-correlated with the de-projected velocity, but some events significantly deviate from the linearity. For CMEs with similar velocities, the differences of their transit times can be up to several days. Such deviation is further demonstrated to be mainly caused by the CME geometry and propagation direction, which are essential in the forecasting of CME arrival.

  1. ISTP observations of plasmoid ejection: IMP 8 and Geotail

    SciTech Connect

    Slavin, J.A.; Fairfield, D.H.; Kuznetsova, M.M.; Lepping, R.P. Owen, C.J. Taguchi, S.; Saito, Y.; Yamamoto, T. Kokubun, S. Lui, A.T.Y. Reeves, G.D.

    1998-01-01

    IMP 8 and Geotail observations of traveling compression regions (TCRs) and plasmoids, respectively, are used to investigate plasmoid formation and ejection. One year of IMP 8 magnetometer measurements taken during the distant tail phase of the Geotail mission were searched for TCRs, which signal the release of plasmoids down the tail. A total of 10 such intervals were identified. Examination of the Geotail measurements showed that this spacecraft was in the magnetotail for only three of the events. However, in all three cases, clear plasmoid signatures were observed at Geotail. These plasmoids were observed at distances of X={minus}170 to {minus}197 R{sub E}. The in situ plasma velocities in these plasmoids are found to exceed the time-of-flight speeds between IMP 8 and Geotail suggesting that some further acceleration may have taken place following release. The inferred lengths of these plasmoids, {approximately}27{endash}40 R{sub E}, are comparable to the downtail distance of IMP 8. This indicates that TCR at IMP 8 can be caused by plasmoids forming not only earthward but also adjacent to or just tailward of the spacecraft. The closeness of IMP 8 to the point of plasmoid formation is confirmed by the small, {approximately}0{endash}3min, time delays between the TCR perturbation and substorm onset. In two of the plasmoid events, high-speed earthward plasma flows and streaming energetic particles were measured in the plasma sheet boundary layer surrounding the plasmoid along with large positive B{sub z} at the leading edge of the plasmoid suggesting that the core of the plasmoid was {open_quotes}snow plowing{close_quotes} into flux tubes recently closed at an active distant neutral line. In summary, these unique two-point measurements clearly show plasmoid ejection near substorm onset, their rapid movement to the distant tail and their further evolution as they encounter preexisting X lines in the distant tail. {copyright} 1998 American Geophysical Union

  2. Episodic mass ejections from common-envelope objects

    NASA Astrophysics Data System (ADS)

    Clayton, Matthew; Podsiadlowski, Philipp; Ivanova, Natasha; Justham, Stephen

    2017-09-01

    After the initial fast spiral-in phase experienced by a common-envelope binary, the system may enter a slow, self-regulated phase, possibly lasting hundreds of years, in which all the energy released by orbital decay can be efficiently transported to the surface, where it is radiated away. If the remaining envelope is to be removed during this phase, this removal must occur through some as-yet-undetermined mechanism. We carried out 1D hydrodynamic simulations of a low-mass red giant undergoing a synthetic common-envelope event in such a slow spiral-in phase, using the stellar evolutionary code mesa. We simulated the heating of the envelope due to frictional dissipation from a binary companion's orbit in multiple configurations and investigated the response of the giant's envelope. We find that our model envelopes become dynamically unstable and develop large-amplitude pulsations, with periods in the range 3-20 yr and very short growth time-scales of similar order. The shocks and associated rebounds that emerge as these pulsations grow are in some cases strong enough to dynamically eject shells of matter of up to 0.1 M⊙, ∼10 per cent of the mass of the envelope, from the stellar surface at above escape velocity. These ejections are seen to repeat within a few decades, leading to a time-averaged mass-loss rate of the order of 10-3 M⊙ yr-1, which is sufficiently high to represent a candidate mechanism for removing the entire envelope over the duration of the slow spiral-in phase.

  3. Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review

    PubMed Central

    Chamata, Edward; Mahabir, Raman; Jupiter, Daniel; Weber, Robert A

    2014-01-01

    BACKGROUND: Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. OBJECTIVE: To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. METHODS: The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). RESULTS: Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. CONCLUSION: The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve. PMID:25535462

  4. Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review.

    PubMed

    Chamata, Edward; Mahabir, Raman; Jupiter, Daniel; Weber, Robert A

    2014-01-01

    Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve.

  5. Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy.

    PubMed

    Somashekar, Deepak K; Di Pietro, Michael A; Joseph, Jacob R; Yang, Lynda J-S; Parmar, Hemant A

    2016-05-01

    Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology. To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies. In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management. Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting. Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.

  6. Fracture Dislocation of Shoulder with Brachial Plexus Palsy: A Case Report and Review of Management Options.

    PubMed

    Rathore, Sameer; Kasha, Srinivas; Yeggana, Srinivas

    2017-01-01

    Injuries causing fracture dislocation of shoulder and brachial plexus palsy are extremely rare. As per authors' knowledge, three part fracture of proximal humerus with shoulder dislocation and brachial plexus palsy has not been reported in the literature. A 53 year old female sustained a three part fracture of right proximal humerus along with dislocation of shoulder joint and brachial plexus palsy following a fall from a flight of stairs. Fracture was managed by plating of proximal humerus and brachial palsy was followed up with electrodiagnostic studies and regular physiotherapy. Fracture united by three months and patient had near complete recovery of brachial palsy. Authors have discussed diagnostic modalities and management options in the article. Clinician should always look for clinical evidence of brachial plexus injury in patients with anterior shoulder dislocation. Signs of nerve injury with shoulder fracture dislocation are easily overlooked or incorrectly attributed to pain due to bony injury. Subsequent loss of shoulder function in elderly is often thought to be due to immobilization and stiffness. Clinical suspicion can help in diagnosing the often missed neurological injuries and can help in improving outcomes.

  7. Fracture Dislocation of Shoulder with Brachial Plexus Palsy: A Case Report and Review of Management Options

    PubMed Central

    Rathore, Sameer; Kasha, Srinivas; Yeggana, Srinivas

    2017-01-01

    Introduction: Injuries causing fracture dislocation of shoulder and brachial plexus palsy are extremely rare. As per authors’ knowledge, three part fracture of proximal humerus with shoulder dislocation and brachial plexus palsy has not been reported in the literature. Case presentation: A 53 year old female sustained a three part fracture of right proximal humerus along with dislocation of shoulder joint and brachial plexus palsy following a fall from a flight of stairs. Fracture was managed by plating of proximal humerus and brachial palsy was followed up with electrodiagnostic studies and regular physiotherapy. Fracture united by three months and patient had near complete recovery of brachial palsy. Authors have discussed diagnostic modalities and management options in the article. Conclusion: Clinician should always look for clinical evidence of brachial plexus injury in patients with anterior shoulder dislocation. Signs of nerve injury with shoulder fracture dislocation are easily overlooked or incorrectly attributed to pain due to bony injury. Subsequent loss of shoulder function in elderly is often thought to be due to immobilization and stiffness. Clinical suspicion can help in diagnosing the often missed neurological injuries and can help in improving outcomes. PMID:28819602

  8. Vascular patterns of upper limb: an anatomical study with accent on superficial brachial artery

    PubMed Central

    Kachlik, David; Konarik, Marek; Baca, Vaclav

    2011-01-01

    The aim of the study was to evaluate the terminal segmentation of the axillary artery and to present four cases of anomalous branching of the axillary artery, the superficial brachial artery (arteria brachialis superficialis), which is defined as the brachial artery that runs superficially to the median nerve. Totally, 130 cadaveric upper arms embalmed by classical formaldehyde technique from collections of the Department of Anatomy, Third Faculty of Medicine, Charles University in Prague, were macroscopically dissected with special focus on the branching arrangement of the axillary artery. The most distal part of the axillary artery (infrapectoral part) terminated in four cases as a bifurcation into two terminal branches: the superficial brachial artery and profunda brachii artery, denominated according to their relation to the median nerve. The profunda brachii artery primarily gave rise to the main branches of the infrapectoral part of the axillary artery. The superficial brachial artery descended to the cubital fossa where it assumed the usual course of the brachial artery in two cases and in the other two cases its branches (the radial and ulnar arteries) passed superficially to the flexors. The incidence of the superficial brachial artery in our study was 5% of cases. The reported incidence is a bit contradictory, from 0.12% to 25% of cases. The anatomical knowledge of the axillary region is of crucial importance for neurosurgeons and specialists using the radiodiagnostic techniques, particularly in cases involving traumatic injuries. The improved knowledge would allow more accurate diagnostic interpretations and surgical treatment. PMID:21342134

  9. 78 FR 55137 - Federal Motor Vehicle Safety Standards; Ejection Mitigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-09

    ...This document responds to petitions for reconsideration of a 2011 final rule that established Federal Motor Vehicle Safety Standard (FMVSS) No. 226, ``Ejection mitigation.'' The standard is intended to reduce complete and partial ejections of vehicle occupants through side windows in crashes, particularly rollover crashes. Generally, the issues raised by the petitioners are of two types. The......

  10. A simultaneous spin/eject mechanism for aerospace payloads

    NASA Technical Reports Server (NTRS)

    Palmer, G. D.; Banks, T. N.

    1976-01-01

    A simultaneous spin/eject mechanism was developed for aerospace applications requiring a compact, passive device which would accommodate payload support and controlled-release functions, and which would provide a highly accurate spin-ejection motion to the payload. The mechanism satisfied the requirements and is adaptable to other deployment applications.

  11. Calculation of momentum distribution of positronium ejected from surfaces

    SciTech Connect

    Shindo, S.; Ishii, A.

    1987-07-01

    The two-dimensional momentum distribution of positronium formed and ejected from a surface is calculated and compared with experimental results. It is shown that the higher-order Born contribution is very important for explaining the experimental momentum distributions of positronium ejected from the surface.

  12. Fighter Pilot Ejection Study as an Educational Tool

    ERIC Educational Resources Information Center

    Robinson, Garry; Jovanoski, Zlatko

    2010-01-01

    In this article, we apply the well-known equations of projectile motion to the case of a fighter pilot ejecting from an aircraft, the aim being to establish under what conditions there is danger of impact with the rear vertical stabilizer. The drag force on the pilot after ejection is assumed to vary as the velocity squared and the aircraft motion…

  13. Fighter Pilot Ejection Study as an Educational Tool

    ERIC Educational Resources Information Center

    Robinson, Garry; Jovanoski, Zlatko

    2010-01-01

    In this article, we apply the well-known equations of projectile motion to the case of a fighter pilot ejecting from an aircraft, the aim being to establish under what conditions there is danger of impact with the rear vertical stabilizer. The drag force on the pilot after ejection is assumed to vary as the velocity squared and the aircraft motion…

  14. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients

    PubMed Central

    Yang, Yi; Yang, Jian-Tao; Fu, Guo; Li, Xiang-Ming; Qin, Ben-Gang; Hou, Yi; Qi, Jian; Li, Ping; Liu, Xiao-Lin; Gu, Li-Qiang

    2016-01-01

    In the study, the functional recovery and relative comprehensive quality of life of cases of global brachial plexus treated with free functioning muscle transfers were investigated. Patients who received functioning gracilis muscle transfer between August 1999 and October 2014 to reconstruct elbow flexion, wrist and fingers extension were recruited. The mean age of the patients was 26.36 (range, 16–42) years. The mean period of time from gracilis transfer to the last follow-up was 54.5 months (range, 12–185 months). Muscle power, active range of motion of the elbow flexion, wrist extension, and total active fingers extension were recorded. SDS, SAS and DASH questionnaires were given to estimate patients’ quality of life. 35.71% reported good elbow flexion and 50.00% reported excellent elbow flexion. The average ROM of the elbow flexion was 106.5° (range, 0–142°) and was 17.00° (range, 0–72°) for wrist extension. The average DASH score was 51.14 (range, 17.5–90.8). The prevalence of anxiety and depression were 42.86% and 45.24%. Thrombosis and bowstringing were the most common short and long-term complications. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in global-brachial-plexus-injured patients. PMID:26935173

  15. Repeated upper limb salvage in a case of severe traumatic soft-tissue and brachial artery defect.

    PubMed

    Noaman, Hassan Hamdy; Shiha, Anis Elsayed

    2002-01-01

    We present the case of a 9-year-old male patient who suffered a gunshot injury to the right arm. The patient arrived in shock, his right arm severely traumatized, with soft-tissue loss involving the anterior surface and both sides of the right arm. The humerus was exposed. There was brachial artery defect and damage to the lateral fibers of the median nerve. The mangled extremity severity score (MESS) was 8 points. The patient was treated with general resuscitation, blood transfusion, and debridement. A venous graft, 12 cm in length, to bridge the brachial artery defect, and tendon transfer, triceps to the biceps, was performed in one step. Postoperatively, there was a normal radial pulse, normal skin color, normal temperature, and normal movement of the fingers without pain. Unfortunately, the patient then sustained a second trauma to the right arm 3 weeks later, rupturing the graft. This time he lost 1,500 cc of blood. After another blood transfusion, we performed a second reverse saphenous vein graft. The patient stayed at the hospital for 3 weeks. At follow-up 12 months later, the limb has good function and, except for the presence of a scar and skin graft, is equal in appearance to the left side.

  16. Permanent brachial plexus birth palsy does not impair the development and function of the spine and lower limbs.

    PubMed

    Kirjavainen, Mikko O; Remes, Ville M; Peltonen, Jari; Helenius, Ilkka J; Rautakorpi, Sanna M; Vähäsarja, Vesa J; Pöyhiä, Tiina H; Nietosvaara, Yrjänä

    2009-11-01

    Permanent brachial plexus birth palsy (BPBP) impairs the function of the affected upper limb. Avulsion type root injuries may damage the cervical spinal cord. Whether abnormal function of an upper limb affected by BPBP has any observable effects on the development of the locomotion system and overall motor function has not been clarified in depth. A total of 111 patients who had undergone brachial plexus surgery for BPBP in infancy were examined after a mean follow-up time of 13 (5-32) years. Patients' physical activities were recorded by a questionnaire. No significant inequalities in leg length were found and the incidence of structural scoliosis (1.7%) did not differ from that of the reference population. Nearly half of the patients (43%) had asynchronous motion of the upper limbs during gait, which was associated with impaired upper limb function. Data obtained from the completed questionnaires indicated that only few patients were unable to participate in normal activities such as: bicycling, cross-country skiing or swimming. Not surprisingly, 71% of the patients reported problems related to the affected upper limb, such as muscle weakness and/or joint stiffness during the aforementioned activities.

  17. Automatic analysis of double coronal mass ejections from coronagraph images

    NASA Astrophysics Data System (ADS)

    Jacobs, Matthew; Chang, Lin-Ching; Pulkkinen, Antti; Romano, Michelangelo

    2015-11-01

    Coronal mass ejections (CMEs) can have major impacts on man-made technology and humans, both in space and on Earth. These impacts have created a high interest in the study of CMEs in an effort to detect and track events and forecast the CME arrival time to provide time for proper mitigation. A robust automatic real-time CME processing pipeline is greatly desired to avoid laborious and subjective manual processing. Automatic methods have been proposed to segment CMEs from coronagraph images and estimate CME parameters such as their heliocentric location and velocity. However, existing methods suffered from several shortcomings such as the use of hard thresholding and an inability to handle two or more CMEs occurring within the same coronagraph image. Double-CME analysis is a necessity for forecasting the many CME events that occur within short time frames. Robust forecasts for all CME events are required to fully understand space weather impacts. This paper presents a new method to segment CME masses and pattern recognition approaches to differentiate two CMEs in a single coronagraph image. The proposed method is validated on a data set of 30 halo CMEs, with results showing comparable ability in transient arrival time prediction accuracy and the new ability to automatically predict the arrival time of a double-CME event. The proposed method is the first automatic method to successfully calculate CME parameters from double-CME events, making this automatic method applicable to a wider range of CME events.

  18. Using milk flow rate to investigate milk ejection in the left and right breasts during simultaneous breast expression in women.

    PubMed

    Prime, Danielle K; Geddes, Donna T; Spatz, Diane L; Robert, Marc; Trengove, Naomi J; Hartmann, Peter E

    2009-10-26

    Milk ejection is essential for a successful lactation, however techniques to measure milk ejection in women are often complex and invasive. Recent research has demonstrated that at milk ejection, milk duct diameter increased in the breast (measured by ultrasound) at the same time as milk flow rate increased (measured using a weigh balance). This study aimed to evaluate a purpose-built continuous weigh balance (Showmilk, Medela AG) to measure changes in milk flow rate from the breast to identify milk ejections during milk expression. In addition, the Showmilk was used to determine if milk ejection occurred simultaneously in both breasts during double pumping. Increased milk flow rates during single pumping were compared to simultaneous ultrasound measurements of increased milk duct diameters in 14 mothers. In addition, increases in milk flow rate were compared between the left and right breasts of 28 mothers during double pumping for 15 minutes with two separate electric breast pumps attached to two Showmilks to record milk flow rate. Increased milk flow rates were associated with increased milk duct diameters during single pumping. The mean number of milk ejections was not different between the Showmilk (4.2 +/- 2.0) and ultrasound (4.5 +/- 1.5) techniques. Overall, 67 milk ejections were measured and of these, 48 (72%) were identified by both techniques. The left and right breasts responded synchronously with 95.5% of the flow rate increases corresponding between the breasts. The mean number of milk ejections identified by an increase in milk flow rate during double pumping was 5.1 +/- 1.7 and 5.0 +/- 1.7 for the left and right breasts, respectively. In addition, mothers chose the same expression vacuum for the left (-198 +/- 31 mmHg) and right (193 +/- 33 mmHg) breasts. The Showmilk can simply and non-invasively record milk ejections by measuring increases in milk flow rate that correspond with increases in milk duct diameter. For the first time measurement of

  19. Using milk flow rate to investigate milk ejection in the left and right breasts during simultaneous breast expression in women

    PubMed Central

    Prime, Danielle K; Geddes, Donna T; Spatz, Diane L; Robert, Marc; Trengove, Naomi J; Hartmann, Peter E

    2009-01-01

    Background Milk ejection is essential for a successful lactation, however techniques to measure milk ejection in women are often complex and invasive. Recent research has demonstrated that at milk ejection, milk duct diameter increased in the breast (measured by ultrasound) at the same time as milk flow rate increased (measured using a weigh balance). This study aimed to evaluate a purpose-built continuous weigh balance (Showmilk, Medela AG) to measure changes in milk flow rate from the breast to identify milk ejections during milk expression. In addition, the Showmilk was used to determine if milk ejection occurred simultaneously in both breasts during double pumping. Methods Increased milk flow rates during single pumping were compared to simultaneous ultrasound measurements of increased milk duct diameters in 14 mothers. In addition, increases in milk flow rate were compared between the left and right breasts of 28 mothers during double pumping for 15 minutes with two separate electric breast pumps attached to two Showmilks to record milk flow rate. Results Increased milk flow rates were associated with increased milk duct diameters during single pumping. The mean number of milk ejections was not different between the Showmilk (4.2 ± 2.0) and ultrasound (4.5 ± 1.5) techniques. Overall, 67 milk ejections were measured and of these, 48 (72%) were identified by both techniques. The left and right breasts responded synchronously with 95.5% of the flow rate increases corresponding between the breasts. The mean number of milk ejections identified by an increase in milk flow rate during double pumping was 5.1 ± 1.7 and 5.0 ± 1.7 for the left and right breasts, respectively. In addition, mothers chose the same expression vacuum for the left (-198 ± 31 mmHg) and right (193 ± 33 mmHg) breasts. Conclusion The Showmilk can simply and non-invasively record milk ejections by measuring increases in milk flow rate that correspond with increases in milk duct diameter. For

  20. Transfer of a fascicle from the posterior cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.

    PubMed

    Martins, Roberto Sergio; Siqueira, Mario Gilberto; Heise, Carlos Otto; Teixeira, Manoel Jacobsen

    2009-10-01

    A new nerve transfer technique using a healthy fascicle of the posterior cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the posterior cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. The posterior cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.

  1. Changes in brachial artery endothelial function and resting diameter with moderate-intensity continuous but not sprint interval training in sedentary men.

    PubMed

    Shenouda, Ninette; Gillen, Jenna B; Gibala, Martin J; MacDonald, Maureen J

    2017-10-01

    Moderate-intensity continuous training (MICT) improves peripheral artery function in healthy adults, a phenomenon that reverses as continued training induces structural remodeling. Sprint interval training (SIT) elicits physiological adaptations similar to MICT, despite a lower exercise volume and time commitment; however, its effect on peripheral artery function and structure is largely unexplored. We compared peripheral artery responses to 12 wk of MICT and SIT in sedentary, healthy men (age = 27 ± 8 yr). Participants performed MICT (45 min of cycling at 70% peak heart rate; n = 10) or SIT (3 × 20-s "all out" cycling sprints with 2 min of recovery; n = 9), and responses were compared with a nontraining control group (CTL, n = 6). Allometrically scaled brachial flow-mediated dilation (FMD) increased 2.2% after 6 wk of MICT and returned to baseline levels by 12 wk, but did not change in SIT or CTL (group × time interaction, P = 0.04). Brachial artery diameter increased after 6 and 12 wk (main effect, P = 0.03), with the largest increases observed in MICT. Neither training protocol affected popliteal relative FMD and diameter, or central and lower limb arterial stiffness (carotid distensibility, central and leg pulse wave velocity) (P > 0.05 for all). Whereas earlier and more frequent measurements are needed to establish the potential presence and time course of arterial responses to low-volume SIT, our findings suggest that MICT was superior to the intense, but brief and intermittent SIT stimulus at inducing brachial artery responses in healthy men.NEW & NOTEWORTHY We compared the effects of 12 wk of moderate-intensity continuous training (MICT) and sprint interval training (SIT) on peripheral artery endothelial function and diameter, and central and lower limb stiffness in sedentary, healthy men. Whereas neither training program affected the popliteal artery or stiffness indexes, we observed changes in brachial artery function and diameter with MICT but not SIT

  2. Air pollution and heart failure: Relationship with the ejection fraction

    PubMed Central

    Dominguez-Rodriguez, Alberto; Abreu-Afonso, Javier; Rodríguez, Sergio; Juarez-Prera, Ruben A; Arroyo-Ucar, Eduardo; Gonzalez, Yenny; Abreu-Gonzalez, Pedro; Avanzas, Pablo

    2013-01-01

    AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m3 vs 4.50 ± 2.34 μg/m3, P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population. PMID:23538391

  3. Air pollution and heart failure: Relationship with the ejection fraction.

    PubMed

    Dominguez-Rodriguez, Alberto; Abreu-Afonso, Javier; Rodríguez, Sergio; Juarez-Prera, Ruben A; Arroyo-Ucar, Eduardo; Gonzalez, Yenny; Abreu-Gonzalez, Pedro; Avanzas, Pablo

    2013-03-26

    To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m(3) vs 4.50 ± 2.34 μg/m(3), P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

  4. CONSEQUENCES OF THE EJECTION AND DISRUPTION OF GIANT PLANETS

    SciTech Connect

    Guillochon, James; Ramirez-Ruiz, Enrico; Lin, Douglas

    2011-05-10

    The discovery of Jupiter-mass planets in close orbits about their parent stars has challenged models of planet formation. Recent observations have shown that a number of these planets have highly inclined, sometimes retrograde orbits about their parent stars, prompting much speculation as to their origin. It is known that migration alone cannot account for the observed population of these misaligned hot Jupiters, which suggests that dynamical processes after the gas disk dissipates play a substantial role in yielding the observed inclination and eccentricity distributions. One particularly promising candidate is planet-planet scattering, which is not very well understood in the nonlinear regime of tides. Through three-dimensional hydrodynamical simulations of multi-orbit encounters, we show that planets that are scattered into an orbit about their parent stars with closest approach distance being less than approximately three times the tidal radius are either destroyed or completely ejected from the system. We find that as few as 9 and as many as 12 of the currently known hot Jupiters have a maximum initial apastron for scattering that lies well within the ice line, implying that these planets must have migrated either before or after the scattering event that brought them to their current positions. If stellar tides are unimportant (Q{sub *} {approx}> 10{sup 7}), disk migration is required to explain the existence of the hot Jupiters present in these systems. Additionally, we find that the disruption and/or ejection of Jupiter-mass planets deposits a Sun's worth of angular momentum onto the host star. For systems in which planet-planet scattering is common, we predict that planetary hosts have up to a 35% chance of possessing an obliquity relative to the invariable plane of greater than 90{sup 0}.

  5. Dynamical mass ejection from binary neutron star mergers

    NASA Astrophysics Data System (ADS)

    Radice, David; Galeazzi, Filippo; Lippuner, Jonas; Roberts, Luke F.; Ott, Christian D.; Rezzolla, Luciano

    2016-08-01

    We present fully general-relativistic simulations of binary neutron star mergers with a temperature and composition dependent nuclear equation of state. We study the dynamical mass ejection from both quasi-circular and dynamical-capture eccentric mergers. We systematically vary the level of our treatment of the microphysics to isolate the effects of neutrino cooling and heating and we compute the nucleosynthetic yields of the ejecta. We find that eccentric binaries can eject significantly more material than quasi-circular binaries and generate bright infrared and radio emission. In all our simulations the outflow is composed of a combination of tidally- and shock-driven ejecta, mostly distributed over a broad ˜60° angle from the orbital plane, and, to a le