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PurposePelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg.Methods60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion.ResultsCumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support.ConclusionZone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

Purpose In the past decade blast injuries have become more prevalent. Blast trauma may cause extensive injuries requiring improved early resuscitation and prevention of haemorrhage. Randomized prospective trials are logistically and ethically challenging, and large animal models are important for further research efforts. Few severe blast trauma models have been described, which is why we aimed to establish a comprehensive polytrauma model in accordance with the criteria of the Berlin definition of polytrauma and with a survival time of > 2 h. Multiple blast injuries to the groin and abdomen were combined with hypoperfusion, respiratory and metabolic acidosis, hypoventilation, hypothermia and inflammatory response. The model was compared to lung contusion and haemorrhage. Methods 16 landrace swine (mean weight 60.5 kg) were randomized to “control” (n = 5), “chest trauma/hem” by lung contusion and class II haemorrhage (n = 5), and “blast polytrauma” caused by multiple blast injuries to the groin and abdomen, class II haemorrhage, lipopolysaccharide (LPS) infusion and hypothermia 32 °C (n = 6). Results The blast polytrauma group had an Injury Severity Score of 57 which resulted in haemodynamic shock, hypothermia, respiratory and metabolic acidosis and inflammatory response. The chest trauma/hem group had an Injury Severity Score of 9 and less profound physiologic effects. Physiologic parameters presented a dose–response relationship corresponding to the trauma levels. Conclusion A comprehensive blast polytrauma model fulfilling the Berlin polytrauma criteria, with a high trauma load and a survival time of > 2 h was established. A severe, but consistent, injury profile was accomplished enabling the addition of experimental interventions in future studies, particularly of immediate resuscitation efforts including whole blood administration, trauma packing and haemostasis.

Behind armor blunt trauma (BABT) is a non-penetrating injury caused by the rapid deformation of body armor, by a projectile, which may in extreme circumstances cause death. Although there is not a high incidence of high energy BABT, the understanding of the mechanisms is still low, in relation to what is needed for safety threshold levels. BABT is also useful as a model for blunt thoracic trauma, with a compressive speed between traffic accidents and blast caused by explosives. High velocity projectile BABT causes severe hypoxia. The mechanisms are not fully known. We investigated the acute pulmonary consequences in the individual lungs, and the effects of alveolar recruitment.12 swine (mean weight 62.5 kg) were randomized to groups BABT by 7.62 × 51 mm NATO-type bullets (mean velocity 803 m/s) to a military grade ceramic plate armor (n = 7) or control (n = 5). Modified double lumen tracheal tubes provided respiratory dynamics in the lungs separately/intermittently for two hours, with alveolar recruitment after one hour.Venous admixture increased 5 min after BABT (p .05) and correlated with increased cardiac output. Static compliance decreased 5 minutes after BABT (p .05) and further by recruitment (p .005). Physiological dead space decreased 5 minutes after BABT (p .01) and further by recruitment (p .01), while not in the contralateral lung. V'A/Q' decreased 5 minutes after BABT (p .05), also shown in phase III volumetric capnography (p .05). Most effects regressed after one hour.High velocity projectile BABT caused hypoxia by a severe and transient decrease in V'A/Q' to1 and increased venous admixture in the exposed lung. Alveolar recruitment was hemodynamically and respiratory tolerable and increased V'A/Q'. Body armor development should aim at ameliorating severe pulmonary consequences from high projectile velocities which also needs to include further understanding of how primary and secondary effects are distributed between the lungs.

β adrenergic receptors mediate effects via activation of G proteins, transactivation of membrane growth factor receptors, or β adrenergic receptor-β arrestin-facilitated scaffold-mediated signaling. Agonist occupancy of the β adrenergic receptor induces desensitization by promoting β adrenergic receptor kinase phosphorylation of the carboxyl terminal domain, facilitating binding of the amino terminal of the β arrestin, which sterically inhibits interactions between β adrenergic receptors and G proteins and induces clathrin-coated pit-mediated receptor endocytosis. Scaffold formation promoted by β arrestin binding to the β adrenergic receptor activates extracellular regulated kinase 1/2 in a manner which elicits cytosolic retention of, and prevents promotion of nuclear transcriptional activity by, mitogen-activated protein kinase. The β adrenergic receptor kinase also interacts with a yet to be determined microsomal membrane protein via high-affinity electrostatic interactions. We evaluate β adrenergic receptor structure, function, and downstream signaling and β arrestin-mediated desensitization, receptor endocytosis, and scaffold-facilitated signal transduction in order to illumine therapeutic strategies designed to modulate these pathways. We trust these approaches may arm us with the capacity to selectively modulate signal transduction pathways regulating cellular proliferation, immunogenicity, angiogenesis, and invasive and metastatic potential implicated in cancer initiation, promotion, and progression.

The degree to which peacekeeping missions impact perceived stress, cognitive performance and cortisol levels: a longitudinal study. Military deployment is often associated with stress. Learning more about deployment stress is relevant for developing both preventive and reactive strategies for managing stress. This study addresses stress before, during and after a peacekeeping mission. Data were collected on perceived stress and the stress biomarker cortisol. A total of 41 soldiers were assessed at three points (prior to deployment, during deployment and at homecoming). Soldiers’ perceived stress, cognitive performance and biomarkers were measured. Contrary to our hypothesis that stress accumulates during deployment, leading to increased perceived stress and levels of cortisol (as measured in the morning by the cortisol awakening response, or CAR), and to decreased results on cognitive tests, the results show that the levels of perceived stress were lower during deployment than before and after deployment, as measured by the soldiers’ pre- and post-deployment scores. The soldiers also had a reduced CAR response at homecoming compared to their pre-deployment levels. The results indicate that peacekeeping missions may contain stress-mitigating factors that have previously been underestimated. Further research addressing stress-mitigating factors might allow a deeper understanding of the deployment environment and, subsequently, new methods of promoting soldiers’ well-being and maintaining high combat fitness.

Purpose. Behind armor blunt trauma (BABT) is a non-penetrating injury caused by the rapid deformation of body armor, by a projectile, which may in extreme circumstances cause death. The understandi...

β adrenergic receptors mediate effects

Background Vein of Galen aneurysmal malformations (VOGMs) are pial arteriovenous fistulas possessing Galenic venous drainage most commonly presenting during the neonatal period and infancy, with initial discovery during adulthood quite rare. Objectives and methods We conducted a literature survey of the PubMed database in order to identify Galenic pial arteriovenous fistulas (GPAVFs) with major manifestation or initial presentation during adulthood. Inclusionary criteria included pial AVFs with Galenic drainage with major manifestation or initial presentation at, or older than, 18 years. Exclusionary criteria included exclusive pediatric onset of symptomatology attributable to GPAVFs without a new onset major presentation during adulthood, exclusive or major dural arterial supply, arteriovenous malformations with Galenic drainage, developmental venous anomalies with Galenic drainage, isolated varices or anomalies of the vein of Galen, and any lesions with uncertainty regarding true GPAVF nature. Results Our search generated 1589 articles. Excluding duplicates, 26 cases met criteria for evaluation. Mean age was 34.1 +/− 2.53 years. Clinical presentations of GPAVFs among adults included headache, intracranial hemorrhage, seizures, and focal neurologic deficits. Management strategies included observation (n = 5), emergent ventriculostomy or Torkildsen shunt (n = 3), cerebrospinal fluid diversion via ventriculoperitoneal shunting (n = 4), microsurgical obliteration or thrombectomy (n = 4), transarterial and/or transvenous embolotherapeutic obliteration (n = 7), and concurrent embolotherapy and radiosurgical irradiation (n = 1). Conclusions GPAVFs in adults often present with symptomatology of mild severity and may be effectively managed conservatively, though occasionally present catastrophically or may be treated via cerebrospinal fluid diversion, microsurgical obliteration, or endovascular embolization. Severity sufficient to require emergent intervention portended a poor outcome.

Background: Severe thoracic trauma affects 55% of patients with multiple traumatic injuries and may lead to acute lung injury or acute respiratory distress syndrome. Pulmonary trauma differs clinic...

Uncontrolled hemorrhage is a leading cause of tactical trauma-related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 minutes is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined. We therefore compared 60-minute and 240-minute applications and release of the AAJT for 30 minutes, with crystalloid fluid therapy, after a Class II hemorrhage.Sixty-kilogram anesthetized pigs were subjected to 900-mL hemorrhage and AAJT application for 60 minutes (n = 5), 240 minutes (n = 5), and fluid therapy only for 240 minutes (n = 5) and reperfusion for 30 minutes.The AAJT application was hemodynamically and respiratory tolerable for 60 minutes and 240 minutes. Cumulative fluid requirements decreased by 64%, comparable to 3000 mL of crystalloids. Mechanical ventilation was impaired. AAJT increased the core temperature by 0.9°C compared with fluid therapy. Reperfusion consequences were reversible after 60 minutes but not after 240 minutes. A 240-minute application resulted in small intestine and liver ischemia, persisting hyperkalemia, metabolic acidosis, and myoglobinemia, suggesting rhabdomyolysis.The AAJT application for 240 minutes with reperfusion was survivable in an intensive care setting and associated with abdominal organ damage. Long time consequences and spinal cord effects was not assessed. We propose an application time limit within 60 minutes to 240 minutes, though further studies are needed to increase the temporal resolution. The AAJT application may be considered as a rescue option to maintain central blood pressure and core temperature in cases of hemorrhagic shock from extremity bleedings, if fluid therapy is unavailable or if the supply is limited.Therapeutic study, level II.

BACKGROUND Traumatic hemorrhage remains a major cause of death in rural civilian and combat environments. Potential interventions to control hemorrhage from the pelvis and lower junctional regions include the abdominal aortic and junctional tourniquet (AAJT) and resuscitative endovascular balloon occlusion of the aorta (REBOA). The AAJT requires low technical skills and may thus be used by nonmedical professionals, but is associated with time-dependent ischemic complications. In combination with delayed patient evacuation, it may therefore be deleterious. Transition to zone 3 REBOA in higher levels of care may be a possibility to maintain hemostasis, mitigate adverse effects and enable surgery in patients resuscitated with the AAJT. It is possible that a transition between the interventions could lead to hemodynamic penalties. Therefore, we investigated the feasibility of replacing the AAJT with zone 3 REBOA in a porcine model of uncontrolled femoral hemorrhage. METHODS Domestic pigs (n = 12) averaging 57 kg were exposed to a class IV uncontrolled hemorrhage from the common femoral artery. The animals were randomized to 60-minute AAJT (n = 6) or 30-minute AAJT with transition to 30-minute zone 3 REBOA. Hemodynamic and metabolic parameters and ultrasonographic measurements of the common femoral artery were collected. RESULTS Transition from AAJT to zone 3 REBOA caused a significant decrease in mean arterial pressure (25 mm Hg). Hemostasis was maintained. The common femoral artery diameter decreased by 1.8 mm (38%) after hemorrhage and further 0.7 mm (23%) after aortic occlusion. CONCLUSION Transition from AAJT to zone 3 REBOA after a class IV bleeding is feasible with hemodynamic support. Vascular access to the femoral artery for REBOA insertion poses a technical challenge after hemorrhage and AAJT application. LEVEL OF EVIDENCE Laboratory animal study, level IV.

Traumatic brain injuries (TBI) because of detonations have become a significant problem in military medicine. Partly because the use of modern body protection has increased the survival of victims subjected to detonations from landmines or improvised explosive devices. Detonations commonly expose these victims to pressure waves, high speed fragments, and bodily accelerations. The pressure wave itself may result in a mild TBI, commonly referred to as primary blast, while penetration of fragments into the brain and head rotations resulting from body accelerations can lead to more severe forms of TBI. The details of the cellular injury mechanisms of primary blast are still debated and studies are needed to understand the propagation and effects of the pressure waves inside the skull. Laboratory experiments with good control for physical parameters can provide information that is difficult to retrieve from real-life cases of blast injury. This study focused on head kinematics and pressure propagation into the animal brain cavity during simulated blast trauma (part 1) and the behavioral outcome (part 2). The rat blast model presented here produced maximum intracranial pressure increases of 6 bar while minimal pressure drops. Violent head-to-head restraint contact occurred at approximately 1.7 ms after the pressure pulse reached the head; this contact did not produce any high intracranial pressures. Working memory error was not significantly changed between the exposed and controls at 1 week after blast while significantly more reference memory errors at 5 days and 2 weeks following injury compared to sham after blast.

Exposure to improvised explosive devices can result in a unique form of traumatic brain injury--blast-induced traumatic brain injury (bTBI). At the mild end of the spectrum (mild bTBI [mbTBI]), there are cognitive and mood disturbances. Similar symptoms have been observed in post-traumatic stress disorder caused by exposure to extreme psychological stress without physical injury. A role of the monoaminergic system in mood regulation and stress is well established but its involvement in mbTBI is not well understood. To address this gap, we used a rodent model of mbTBI and detected a decrease in immobility behavior in the forced swim test at 1 d post-exposure, coupled with an increase in climbing behavior, but not after 14 d or later, possibly indicating a transient increase in anxiety-like behavior. Using in situ hybridization, we found elevated messenger ribonucleic acid levels of both tyrosine hydroxylase and tryptophan hydroxylase 2 in the locus coeruleus and the dorsal raphe nucleus, respectively, as early as 2 h post-exposure. High-performance liquid chromatography analysis 1 d post-exposure primarily showed elevated noradrenaline levels in several forebrain regions. Taken together, we report that exposure to mild blast results in transient changes in both anxiety-like behavior and brain region-specific molecular changes, implicating the monoaminergic system in the pathobiology of mbTBI.

Behind armor blunt trauma (BABT) is defined as the nonpenetrating injury resulting from a ballistic impact on personal body armor. The protective vest may impede the projectile, but some of the kinetic energy is transferred to the body, causing internal injuries and occasionally death. The aim in this study was to investigate changes in electroencephalogram (EEG) and physiologic parameters after high-velocity BABT.Eight anesthetized pigs, wearing body armor (including a ceramic plate) on the right side of their thorax, were shot with a 7.62-mm assault rifle (velocity approximately 800 m/s). The shots did not penetrate the armor and these animals were compared with control animals (n = 4), shot with blank ammunition. EEG and several physiologic parameters were thereafter monitored during a 2-hour period after the shot.All animals survived during the experimental period. Five of the exposed animals showed a temporary effect on EEG. Furthermore, exposed animals displayed decreased cardiac capacity and an impaired oxygenation of the blood. Postmortem examination revealed subcutaneous hematomas and crush injuries to the right lung.The results in our animal model indicate that high-velocity BABT induce circulatory and respiratory dysfunction, and in some cases even transient cerebral functional disturbances.

The symptomatology, mood and cognitive disturbances seen in post-traumatic stress disorder (PTSD) and mild blast-induced traumatic brain injury (mbTBI) overlap considerably. However the pathological mechanisms underlying the two conditions are currently unknown. The neuropeptide galanin has been suggested to play a role in the development of stress and mood disorders. Here we applied bio- and histochemical methods with the aim to elucidate the nature of any changes in the expression of galanin and its receptors in a rodent model of mbTBI. In situ hybridization and quantitative polymerase chain reaction studies revealed significant, injury induced changes, in some cases lasting at least for one week, in the mRNA levels of galanin and/or its three receptors, galanin receptor 1-3 (GalR1-3). Such changes were seen in several forebrain regions, and the locus coeruleus. In the ventral periaqueductal gray GalR1 mRNA levels were increased, while GalR2 were decreased. Analysis of galanin peptide levels using radioimmunoassay demonstrated an increase in several brain regions including the locus coeruleus, dorsal hippocampal formation and amygdala. These findings suggest a role for the galanin system in the endogenous response to mbTBI, and that pharmacological studies of the effects of activation or inhibition of different galanin receptors in combination with functional assays of behavioral recovery may reveal promising targets for new therapeutic strategies in mbTBI. (C) 2016 Elsevier Inc. All rights reserved.

The electromyogram and posture angles of the shoulder and arm were recorded during sitting manipulative work in three positions, with and without the forearm suspended by a balancer. A Selspot system was used to record movements. The results from 12 female subjects (mean age 29 yr) showed that the activity in deltoideus anterior decreased significantly by using a balancer. Lower mean values were also noted for deltoideus lateralis and the trapezius muscles. The neck inclination increased with higher work area position, but was independent of the use of a balancer.

Eight Swedish national class weightlifters performed "high-bar" squats and six national class powerlifters performed "low-bar" squats, with a barbell weight of 65% of their 1 RM, and to parallel- and a deep-squatting depth. Ground reaction forces were measured with a Kistler piezo-electric force platform and motion was analyzed from a video record of the squats. A computer program based on free-body mechanics was designed to calculate moments of force about the hip and knee joints. EMG from vastus lateralis, rectus femoris, and biceps femoris was recorded and normalized. The peak moments of force were flexing both for the hip and the knee. The mean peak moments of force at the hip were for the weightlifters 230 Nm (deep) and 216 Nm (parallel), and for the powerlifters 324 Nm (deep), and 309 Nm (parallel). At the knee the mean peak moments for the weightlifters were 191 Nm (deep) and 131 Nm (parallel), and for the powerlifters 139 Nm (deep) and 92 Nm (parallel). The weightlifters had the load more equally distributed between hip and knee, whereas the powerlifters put relatively more load on the hip joint. The thigh muscular activity was slightly higher for the powerlifters.

BACKGROUND:: Cardiac-related injuries caused by blunt chest trauma remain a severe problem. The aim of this study was to investigate pathophysiological changes in the heart that might arise after behind armor blunt trauma or impacts of nonlethal projectiles. METHODS:: Sixteen pigs were shot directly at the sternum with "Sponge Round eXact I Mpact" (nonlethal ammunition; diameter 40 mm and weight 28 g) or hard-plastic ammunition (diameter 65 mm and weight 58 g) to simulate behind armor blunt trauma. To evaluate the influence of the shot location, seven additional pigs where exposed to an oblique heart shot. Physiologic parameters, electrocardiography, echocardiogram, the biochemical marker troponin I (TnI), and myocardial injuries were analyzed. RESULTS:: Nonlethal kinetic projectiles (101-108 m/s; 143-163 J) did not cause significant pathophysiological changes. Five of 18 pigs shot with 65-mm plastic projectiles (99-133 m/s; 284-513 J) to the front or side of the thorax died directly after the shot. No major physiologic changes could be observed in surviving animals. Animals shot with an oblique heart shot (99-106 m/s; 284-326 J) demonstrated a small, but significant decrease in saturation. Energy levels over 300 J caused increased TnI and myocardial damages in most of the pigs. CONCLUSION:: This study indicates that nonlethal kinetic projectiles "eXact iMpact" does not cause heart-related damage under the examined conditions. On impact, sudden heart arrest may occur independently from the cardiac's electrical cycle. The cardiac enzyme, TnI, can be used as a reliable diagnostic marker to detect heart tissue damages after blunt chest trauma. Language: en

The loading moments of force about the hip and knee joints of ten healthy male subjects were calculated using recorded forces from a force plate and static contribution from body segments. The subjects rose from a chair while using armrests in ten different ways, and, as a reference, without arm aid. The influence of different armrest heights, hand placements and arm forces was studied. Horizontal and vertical forces on the armrests were measured. Irrespective of armrest height and hand placement, the use of armrests significantly reduced the hip and knee moments compared to rising without arm aid (P0.001). However, there were no statistically significant differences between different armrest heights or hand placements. High arm force reduced both hip and knee moments. The greatest reduction occurred for high armrests and high arm force, which reduced the mean peak hip moment from 39 to 17 N m and the knee moment from 83 to 28 N m. Calculation of patellofemoral compressive force and the force on the femoral head due to extensor muscle activity demonstrated that local hip and knee forces were reduced when armrests were used. Horizontal forces applied to the armrests were small. Subjectively 'doubled' arm force resulted in nearly double force on the armrests.

Background: Injured lungs are sensitive to fluid resuscitation after trauma. Such treatment can increase lung water content and lead to desaturation. Hypertonic saline with dextran (HSD) has hyperosmotic properties that promote plasma volume expansion, thus potentially reducing these side effects. The aim of this study was to (1) evaluate whether fluid treatment counteracts hypotension and improves survival after nonhemorrhagic shock caused by lung contusion and (2) analyze whether resuscitation with HSD is more efficient than treatment with Ringer's acetate (RA) in terms of blood oxygenation, the amount of lung water, circulatory effects, and inflammatory response. Methods: Twenty-nine pigs, all wearing body armor, were shot with a 7.62-mm assault rifle to produce a standardized pulmonary contusion. These animals were allocated into three groups: HSD, RA, and an untreated shot control group. Exposed animals were compared with animals not treated with fluid and shot with blank ammunition. For 2 hours after the shot, the inflammatory response and physiologic parameters were monitored. Results: The impact induced pulmonary contusion, desaturation, hypotension, increased heart rate, and led to an inflammatory response. No change in blood pressure was observed after fluid treatment. HSD treatment resulted in significantly less lung water (p < 0.05) and tended to give better Pao 2 (p = 0.09) than RA treatment. Tumor necrosis factor-α release and heart rate were significantly lower in animals given fluids. Conclusion: Fluid treatment does not affect blood pressure or mortality in this model of nonhemorrhagic shock caused by lung contusion. However, our data indicate that HSD, when compared with RA, has advantages for the injured lung.

Background Severe lung contusion is often observed after blunt chest trauma due to traffic accidents or fall from heights, but may also occur after a non-penetrating ballistic impact against body armour. Such trauma has been designated behind armour blunt trauma (BABT). Our aim in the present study has been to evaluate pathophysiological changes and compensatory mechanisms that occur early after such severe lung contusion. Methods Twelve pigs wearing body armour were shot with a 7.62 mm assault rifle to produce a standardised pulmonary contusion. Exposed animals were compared with five control animals shot with blank ammunition. Physiological parameters and levels of potassium, glucose, haemoglobin, calcium, lactate and pH were monitored for two hours after the shot. Results The impact induced severe pulmonary contusion with apnoea, desaturation and hypotension in all exposed animals. Increased haemoglobin, glucose and severe hyperkalaemia were seen shortly after impact. Seven of twelve animals died due to the trauma. Dense cardiac tissue was observed during post mortem examination in six of the animals that died during the experimental course. Conclusion In conclusion, this study has shown that life-threatening hyperkalaemia occurs early after severe lung contusion. Moreover, dense cardiac tissue and early increase of haemoglobin and glucose are intriguing findings that should be investigated in future studies.

Background: Body armor is used by military personnel, police officers, and security guards to protect them from fatal gunshot injuries to the thorax. The protection against high-velocity weapons may, however, be insufficient. Complementary trauma attenuating backings (TAB) have been suggested to prevent morbidity and mortality in high-velocity weapon trauma. Methods: Twenty-four Swedish landrace pigs, protected by a ceramid/aramid body armor without (n = 12) or with TAB (n = 12) were shot with a standard 7.62-mm assault rifle. Morphologic injuries, cardiorespiratory, and electroencephalogram changes as well as physical parameters were registered. Results: The bullet impact caused a reproducible behind armor blunt trauma (BABT) in both the groups. The TAB significantly decreased size of the lung contusion and prevented hemoptysis. The postimpact apnea, desaturation, hypotension, and rise in pulmonary artery pressure were significantly attenuated in the TAB group. Moreover, TAB reduced transient peak pressures in thorax by 91%. Conclusions: Our results indicate that ordinary body armor should be complemented by a TAB to prevent thoracic injuries when the threat is high-velocity weapons.

Background Behind armor blunt trauma (BABT) is defined as the nonpenetrating injury resulting from a ballistic impact on body armor. Some of the kinetic energy is transferred to the body, causing internal injuries and, occasionally, death. The aim of this study was to investigate if apnea and other pathophysiological effects after BABT is a vagally mediated reflex. Methods Sixteen anesthetized pigs wearing body armor, of which five were vagotomized, were shot with a standard 7.62 mm assault rifle. These animals were compared with control animals (n = 8), shot with blank ammunition. We performed bilateral vagotomy before the shot and assessed the outcome on the apnea period, respiration, circulation, and brain function. Animals were monitored during a 2-hour period after the shot. Results Nonvagotomized animals had a mean apnea period of 22 (6-44) seconds. This group also showed a significant decrease in oxygen saturation compared with control animals. Furthermore, electroencephalogram-changes were more pronounced in nonvagotomized animals. In contrast, vagotomized animals were protected from apnea and showed only a minor decrease in oxygen saturation. All exposed animals showed impaired circulation, and postmortem examination revealed a pulmonary contusion. Conclusion This study shows that apnea after BABT is a vagally mediated reflex that can be inhibited by bilateral vagotomy. Our results indicate that the initial apnea period is an important factor for hypoxia after BABT. Supported ventilation should begin immediately if the affected person is unconscious and suffers from apnea. It should continue until the neurologic paralysis disappears and sufficient spontaneous breathing begins.

We investigated the load on the lumbo-sacral and hip joints and muscle activity in the erector spinae, oblique abdominal, rectus femoris, biceps femoris and gluteus maximus muscles in ten professional milkers simulating 20 different standardized machine-milking work postures in our laboratory. A computerized biomechanical sagittal plane model was used for calculations of load moments and compressive forces. Muscle activity was recorded as time-averaged, full-wave-rectified EMGs, and normalized, ie., expressed as a percentage of an isometric test-contraction. Muscle activity was low in the erector spinae and very low in the oblique abdominal muscles. Activity in hip muscles were generally low compared to that in other activities such as lifting a 12 kg burden, descending stairs and walking. The load on the low back ranged between 64 Nm (corresponding to 1.9 times body-weight compressive force at the L5-S1 disc) and 170 Nm (3.8 times body weight). The lowest induced lumbar load occurred with a vertical level difference (pit depth) of 0.85 m or 1.0 m between milker and cow. The peak load moment about the hip was 96 Nm; the lowest, 31Nm, occuring in the posture with a difference in level of 1.0 m between milker and cow. In this posture only 15 percent of the maximum muscle strength was used to counteract the load moment. Because the load during machine milking is relatively static, the recorded muscle activity is considered to be sufficiently high to partially occlude circulation to the muscle and therefore may result in muscle fatigue and pain.

The most-used safety recommendation for protective vests is that the impact should not cause more than a 44-mm impression in plasticine. The aim of this study was to investigate whether this criterion was sufficient if the vest was exposed to a high-velocity projectile. We tested the hypothesis with pigs divided into a 40-mm group (n = 10) and a 34-mm group (n = 8) protected by a vest allowing a 40-mm or 34-mm impression in plasticine, respectively. Five (50%) of 10 animals in the 40-mm group and 2 (25%) of 8 in the 34-mm group died due to the trauma. We observed severe lung hematoma, impaired circulation, desaturation, and electroencephalogram changes. These effects were more aggravated in the 40-mm group compared to the 34-mm group. Based on our results, the overall judgment is that the safety criterion of 44-mm impression is insufficient when a vest is exposed to a high-velocity projectile.

The aim of this study was to evaluate different arm supports by comparing the activity of shoulder and arm muscles during various work tasks, with and without the lower arm supported. Twelve female subjects, aged between 23 and 37 years, were asked to perform three types of tasks: typing, simulated assembly work (in two different positions), and pipetting. The supports used were: fixed arm support (FIX), horizontal movable arm support (HOR), and spring-loaded arm support (SLA). During the experiments, the electromyograms (EMG) of four muscles were simultaneously recorded: m. deltoideus anterior and lateralis, m. trapezius pars descendens and m. extensor carpi radialis brevis. Normalization was made against maximum isometric contraction. The mean values of the normalized EMG levels showed a reduced EMG level of the shoulder muscles when using arm supports in all the tasks, and for all muscles but the wrist extensor, compared to the EMG levels without arm supports. The horizontal movable support was more effective in reducing the EMG levels of the shoulder muscles than other arm supports, in tasks at table height. Thus, it is possible to reduce muscle activity of the shoulder region by using arm supports. Further research is needed to make biomechanical calculations to compare the EMG level of these muscles using suspension and the effects of inclination of work task.

The aim of this study was to determine the power output and work done by different muscle groups at the hip and knee joints during a rising movement, to be able to tell the degree of activation of the muscle groups and the relationship between concentric and eccentric work. Nine healthy male subjects rose from a chair with the seat at knee level. The moments of force about the hip and knee joints were calculated semidynamically. The power output (P) and work in the different muscle groups surrounding the joints was calculated as moment of force times joint angular velocity. Work was calculated as: work = integral of P dt. The mean peak concentric power output was for the hip extensors 49.9 W, hip flexors 7.9 W and knee extensor 89.5 W. This power output corresponded to a net concentric work of 20.7 J, 1.0 J and 55.6 J, respectively. There was no concentric power output from the knee flexor muscles. Energy absorption through eccentric muscle action was produced by the hip extensors and hip flexors with a mean peak power output of 4.8 W and 7.4 W, respectively. It was concluded that during rising, the hip and knee muscles mainly worked concentrically and that the greatest power output and work were produced during concentric contraction of the knee and hip extensor muscles. There was however also a demand for eccentric work by the hip extensors as well as both concentric and eccentric work by the hip flexors. The knee flexor muscles were unloaded.

Nine healthy male subjects rose from four different stools. The 'ordinary' stool (K) was set at normal chair height, approximately 50 cm, and the 'low ordinary' stool (O), the one-legged stool (T), and the pneumatically-sprung stool (S) were all approximately 32 cm high. The moments of force in the hip, knee, and ankle joints were calculated with a semidynamic technique using a Kistler force plate and video. EMG in four leg muscles was recorded. The part of bodyweight carried by the different stools when the subjects were sitting was measured, and the subjects estimated the effort of rising, using the Borg scale. The low ordinary stool gave higher knee and hip moments than the ordinary stool. Use of the pneumatic stool reduced the knee and hip moments to a level comparable with that of the ordinary stool. The reduction in moment compared with the one-legged stool (T) and the low ordinary stool (O) was significant, both in the knee (p0.005) and the hip (p0.001). Rising from the three low stools gave no significant differences in mean maximum muscle activity in any of the muscles investigated. The subjects estimated that the pneumatic stool and the ordinary stool were the easiest to rise from. The part of bodyweight carried by the ordinary stool and the low ordinary stool, both around 80% when sitting, was significantly higher than for the two other stools (p0.005). It was concluded that a pneumatic stool can be a useful device to workers who work in low positions and rise frequently.

The loading moment of force on the hip, knee, and ankle joints of nine healthy men rising from four different types of stools were compared, together with the levels of myoelectrical activity (EMG) in four leg muscles. Two types of stool (stand stools) had higher seats than a normal chair. The other two were of ordinary seat height, but one also had armrests. The bodyweight carried by the different stools when sitting was also measured, and the subject estimated the effort required for each trial. The mean maximum knee moment was over 60% lower when rising from the high stool than from 'ordinary' seat height. The difference between the high and low stand stool was also significant (p less than 0.001). Using the high stool or help of the arms reduced the mean maximum hip moment by about 50%. The mean maximum ankle moment was only marginally influenced by the different stools. Knee moment was influenced more by seat height than was hip moment. Vastus lateralis activity was significantly higher when subjects rose from 'ordinary' height than when rising from either stand stool (p less than 0.001). The rectus femoris muscle was little activated and the semitendinosus muscle was activated earlier when rising from higher seat heights. All subjects estimated the effort of rising from the higher stand stool to be lower than from the lower stand stool or from 'ordinary' height without arm rests. It was concluded that stand stools are good alternatives for workers who change frequently between sitting and standing work.

Biomechanical calculations of loads on the locomotor system in lifting tasks are often based on static models. Several investigators have shown, though, that in a dynamic act like lifting, inertial effects are not generally negligible. A complete dynamic analysis includes the calculation of linear and angular accelerations of body segments and is rather complicated to carry out. So it was of interest to find out whether the contribution of single body segments to the dynamic effects of the whole body might be negligible. Ten male subjects lifted a 12.8 kg box using two different techniques and two speeds. Ground reactions and body segment movements were recorded and reaction forces and net moments at different joints were calculated with static, dynamic and 'semidynamic' methods. The latter method incorporated the ground reaction forces as measured from a force plate but was otherwise equal to the static method. The results from semidynamic analyses agreed well with those from complete dynamic analyses for the ankle, knee, hip, and L5/S1 joints. For example, the semidynamically calculated peak moments at L5/S1 differed on average less than 3% from the dynamically calculated values. The contributions of the lower extremities and the pelvis to the dynamic effects of the whole body seemed to be quite small. The less complicated semidynamic method offers a good alternative to a fully dynamic analysis for estimations of peak moments in the lower back, at least for the studied lifting techniques.

Ten professional milkers simulated 20 different standardized machine-milking work postures. The loading moment of force about the bilateral ankle axis was calculated using a computerized biomechanical sagittal plane model. Leg muscular activity was recorded with time-averaged, full-wave rectified electromyography which was normalized. The muscular activity level was generally low. The calculated loading moment was always dorsifiexing and did not exceed 50 N m. This is not above 50% of the maximum strength capacity and is lower than the load during many daily activities. Straight knee working postures induced lower ankle load compared with flexed knee postures. The model for determining ankle load can be used to investigate similar activities.

The load on the talocrural joint during three different ways of lifting was compared and discussed with biomechanical and ergonomical aspects. Healthy subjects lifted a 12.8kg box from floor to table-level with bent and straight knees. The loading moment of force about the bilateral ankle axis was calculated by means of a computerized static sagittal plane model. Electromyography was recorded from the tibial anterior, gastrocnemius, and soleus muscles. The mean maximum loading moment was found to be 68 newton-meters with an estimated joint compressive force of 2.9 times body weight. The lowest loading moments obtained were associated with lifting the burden between bent knees and close to the pelvis.

Four modes of lifting 12-8 kg from floor to table were studied on healthy subjects. 1EMG was recorded from the lumbar erector spinae, the rectus and oblique abdominis muscles. The loading moment of force for the lumbo-sacral joint was calculated at regular intervals during the course of the lifts and the compressive loading force on the L5-S1 disc was estimated. Lifting with straight knees and lifting with bent knees and burden moved in front of the knees give about the same maximum loading moment of force at the beginning of the lifts, 217 and 200 Nm, respectively. The corresponding compressive forces on the L5-S1 disc were 4390 and 4425 N. Lifting with bent knees, straight back and burden moved between knees and close to the pelvis gave significantly lower values, 160 Nm and 3461 N. The proportion of the mentioned maximum loading moments of force for L5-S1 which is caused by the weights of the body-segments was found of be ∼ 70% for all lifts, and the loading moment of force caused by the burden was onl...

Ten professional milkers simulated 20 different standardized machine-milking work postures. Various differences in level between milkers and cow, and various postures at each level, were studied. Knee muscular activity was recorded electromyographically. In the milking procedure when attaching the teat cups to the udder the body position was photographed and the loading moment of force about the bilateral knee axis was calculated by means of a biomechanical model. Working with straight knees resulted in comparatively high moments tending to extend the knee (with the highest mean of 56 N m). This moment was for some subjects close to their maximum strength capacity. A 65° knee angle in the standing postures with small level-difference between cow and milker gave the least knee loading moment (i.e. around zero) independently of body weight. The horizontal distance between operator and cow showed high importance for the amplitude of the knee load. The model for determining knee load can generally be...

The aim of this study was to calculate the magnitude of the instantaneous muscular power output at the hip, knee and ankle joints during ergometer cycling. Six healthy subjects pedalled a weight-braked bicycle ergometer at 120 watts (W) and 60 revolutions per minute (rpm). The subjects were filmed with a cine camera, and pedal reaction forces were recorded from a force transducer mounted in the pedal. The muscular work at the hip, knee and ankle joint was calculated using a model based upon dynamic mechanics described elsewhere. The mean peak concentric power output was, for the hip extensors, 74.4 W, hip flexors, 18.0 W, knee extensors, 110.1 W, knee flexors, 30.0 W and ankle plantar flexors, 59.4 W. At the ankle joint, energy absorption through eccentric plantar flexor action was observed, with a mean peak power of 11.4 W and negative work of 3.4 J for each limb and complete pedal revolution. The energy production relationships between the different major muscle groups were computed and the contributions to the total positive work were: hip extensors, 27%; hip flexors, 4%; knee extensors, 39%; knee flexors, 10%; and ankle plantar flexors 20%.

Sustained joint load in extreme positions (namely maximally flexed or extended positions) has been described as causing pain. The aim of the present study is to analyse eight different sitting work postures with respect to extreme positions, and to assess the mechanical load and the levels of muscular activity arising in defined extreme positions of the cervical spine. Ten healthy female workers from an electronics plant took part in laboratory experiments. For seven of these, levels of neck and shoulder muscular activity in sitting postures with the cervical spine in different manually-adjusted extreme positions were recorded using surface electrodes. Loading moments of force about the bilateral motion axis of the atlanto-occipital joint (Occ-C1) and the spinal cervico-thoractc motion segments (C7-T1) were calculated. Extreme or almost extreme positions occurred in sitting postures with the thoracolumbar back inclined slightly backwards or with the whole spine flexed. Electromyographic (EMG) act...

In order to analyse the effect of changing the sitting posture on the level of neck and shoulder muscular activity, an electromyographic (EMG) study of ten healthy experienced female workers from an electronics plant was undertaken. A standardized, simulated task was performed in eight different sitting work postures. Using surface electrodes, the level of muscular activity was recorded as normalized, full-wave rectified low-pass filtered EMG. The results showed that the whole spine flexed sitting posture gave higher levels of static activity in several neck and shoulder muscles than the posture with a straight and vertical spine, which in turn gave higher levels than the posture with slightly backward-inclined thoraco-lumbar spine.

Ten professional milkers simulated 20 different machine-milking postures related to different vertical distances between milker and cow. The loading moment with respect to the shoulder joint bilateral axes was calculated, and EMGs from four shoulder muscles were recorded. The loading moments were related to isometric strength and EMG was standardized against an isometric maximum contraction. Muscle activity was low to moderate. Load moment increased with increasing level difference between milker and cow, but the simultaneous increase in strength utilization and muscular activation was lower than expected. About 25% of maximum shoulder flexor strength was required. The study illustrates some effects of the interaction between shoulder loading moment, trunk inclination and shoulder flexion. The method used gives load both in absolute form (loading moment) and in relation to individual capacity (strength utilization and normalized EMG).

The aim of the study was to analyze the effect of different sitting postures on the level of activity in some neck and shoulder muscles in a standardized work cycle involving movement of the arm/hand. Ten experienced female workers volunteered in a laboratory study. Full-wave rectified, low-pass filtered, time-averaged and normalized e.m.g. was used. Surface electrodes were applied unilaterally at six locations. The course of the level of muscle activity during the standardized work cycle is presented. There was a tendency to higher level of activity when the arm/hand was moving along the high part of the work object compared to along the low part. The level of activity during the standardized work movement with the arm/hand was significantly influenced by the sitting postures chosen. The highest activity levels were found in the posture with the whole spine flexed. A marked reduction of the level of activity was obtained when a posture with the thoraco-lumbar spine slightly inclined backward was used.

The aim of this study was to evaluate the effects on the levels on neck and shoulder muscular activity of ergonomic aids used to support or suspend the arm in different sitting postures, both with and without movement of the arm-hand. Ten skilled women workers performed a standardized simulated work cycle similar to assembling printed circuit boards, in different sitting postures with and without ergonomic aids. The elbow was supported by a loosely-mounted, padded plate. For suspension, a new device, the K-block, was used giving an adjustable, constant suspending force. Full-wave rectified, low-pass filtered, time-averaged and normalized EMG was used. Surface electrodes were applied over six neck and shoulder muscles. The results show that a reduction in the level of activity in neck and shoulder muscles can be obtained with either aid. The reduction, whether caused by suspension or support of the arm, was related to the sitting posture. Elbow support might be more efficient than arm suspension in a sitting posture with the whole spine flexed, while arm suspension might be more efficient when the trunk is inclined slightly backward. Elbow support and, particularly, arm suspension may thus be recommended as technical aids in sedentary assembly work for patients with easily elicited cervical spine and/or shoulder pain. It is also suggested that arm suspension may be used to improve ergonomic conditions at workplaces.