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Measurement of pressure-volume relations is a commonly used technique to elucidate small intestinal stiffness. There is a lack of data on the relation between stiffness and history-dependent mechanical properties of the gastrointestinal tract. We aimed to distinguish between passive properties of the tissue that depend on the time-history of load (viscoelastic effects) versus those that depend on the maximum previous load (strain softening effects). Ten repeated pressure-volume relations were measured at each peak pressure level in six isolated, passive guinea-pig jejuni in vitro during balloon inflation and deflation cycles. With inflation to a new higher peak pressure (ranging from 3 to 15 mm Hg), the pressure-volume relation became less stiff, particularly in the low pressure range, without a significant change in unloaded jejunal volume. We computed the jejunal normalized volume change as a function of the integrated volume-time history and maximum volume. Analysis of covariance revealed significant dependence of the normalized volume change on the volume-time history (P0.001) and the maximum volume history (P0.001). Multiple linear regression analysis showed that approximately 90% of the history dependence could be attributed to the maximum volume. Most softening (loss of stiffness) happens in the low pressure range of the curve (0-3 mm Hg). We adopted the Johnson and Beatty strain softening theory and computed the volume amplification factor. This factor was shown to be a linear function of the normalized peak volume (r20.999). Since strain softening effects were significantly greater than viscoelastic effects, we conclude that history-dependent changes in jejunal stiffness are more likely to involve alterations to elastic rather than viscous structures in the tissue. These effects must be taken into account when performing balloon distension studies in the gastrointestinal tract for studying physiological and pathophysiological problems in which loading conditions are altered, e.g., mechanoreceptor studies in normal intestine and in acute and chronic obstruction, in order to have an accurate description of the biomechanics.

IN 1974 we described how we had used routine obstetric and perinatal records to construct a scoring system for identifying within 24 h of birth infants at risk of dying unexpectedly, and we reported the results of the first year of a prospective evaluation of the system1. We now have the final results of the study which confirm that the scoring system is effective. The study data and subsequent work suggest that deaths can be reduced by increased surveillance of high risk infants.