Extremity Compartment Syndrome in Pigs During Hypobaric Simulation of Aeromedical Evacuation

Kalns, John; Cox, Jennifer; Baskin, Jonathan Z.; Santos, Adrienne; Odland, Rick M.; Fecura, Stephen

doi:10.3357/asem.2853.2011

Cited by 11 publications

(14 citation statements)

References 2 publications

(2 reference statements)

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“…Kalns et al . 30 further reported that there was an increased quantity of some inflammatory cytokines (e.g. interleukin-1 beta, interleukin-6, tumor necrosis factor) in injured muscle tissue exposed to simulated flight.…”

Section: Introductionmentioning

confidence: 94%

17β-estradiol alters mRNA co-expression after murine muscle injury and mild hypobaria

Moore

Voss

Schneider

2019

Exp Biol Med (Maywood)

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Here, we assessed the effects of 17β-estradiol exposure on mRNA co-expression patterns of muscle tissue during recovery in a closed muscle crush injury and hypobaria exposure murine model. Eighteen ovariectomized placebo-treated and 18 ovariectomized 17β-estradiol-treated female mice underwent closed muscle crush injury and hypobaric simulated flight. The mice recovered for 32, 96, or 192 h, and then were euthanized. Their harvested injured lateral gastrocnemius muscles underwent microarray analysis. We used weighted gene co-expression network analysis to construct a co-expression network for the control mice, and then applied the same network to the estrogen-treated mice. We compared the relationships between co-expression in gene modules over time between the two experimental groups. Enriched functional cluster analyses of significant co-expression network modules document a variety of different pathways of interest. Some of the functional cluster enrichments within several of the significantly correlated modules are related to the formation and function of microtubules. Our findings demonstrate that following a closed muscle crush injury in a murine model, the presence of 17β-estradiol alters mRNA co-expression patterns over time. It appears that estrogen promotes the expression of mRNA related to microtubule activity within the cytoskeleton of myofibers and in movement of organelles and receptors. Further study is needed, but the enrichment of these microtubule-related pathways may be integral in the muscle tissue regeneration process, and thus suggests that the presence of estrogen may promote muscle recovery through the work of the microtubules. Impact statement This study uses a murine model to address the clinical situation of transporting soldiers or civilians who have sustained skeletal muscle trauma by air. Our findings show that crush-injured muscle tissue of ovariectomized, 17β-estradiol-treated mice exposed to mild hypobaric hypoxia exhibited mRNA co-expression patterns among pathways associated with microtubule-dependent processes. Palmitoylation and other pathways necessary for movement of estrogen receptors to the cell membrane were also differentially enriched in the estrogen-treated mice. These first findings reframe the discussion regarding estrogen effects during muscle recovery from an inflammation-oriented inquiry to that of a structural, cytoskeletal inquiry and support additional research to understand the non-inflammation-related influences of estrogen during muscle recovery. Also, these results may suggest a role for estrogen or estrogen-like substances to treat muscle trauma.

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Section: Introductionmentioning

confidence: 94%

17β-estradiol alters mRNA co-expression after murine muscle injury and mild hypobaria

Moore

Voss

Schneider

2019

Exp Biol Med (Maywood)

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“…This results in muscle necrosis and nerve damage, which can lead to contractures, amputation, or even death . It has been suggested that the progression of CS results from increased vascular permeability triggered by oxidative and inflammatory responses to the initial trauma . Increased intracompartmental pressure often leads to further decreases in tissue perfusion and can result in a self‐perpetuating cycle that produces the damage described above .…”

mentioning

confidence: 99%

“…[6][7][8] It has been suggested that the progression of CS results from increased vascular permeability triggered by oxidative and inflammatory responses to the initial trauma. 9,10 Increased intracompartmental pressure often leads to further decreases in tissue perfusion and can result in a self-perpetuating cycle that produces the damage described above. 9 On a cellular level, direct muscle injury and indirect damage caused by ischemia can lead to muscle necrosis, edema, 11,12 fibrosis, and a reduction of angiogenesis, which results in minimal regeneration of the musculoskeletal tissues affected.…”

mentioning

confidence: 99%

“…9,10 Increased intracompartmental pressure often leads to further decreases in tissue perfusion and can result in a self-perpetuating cycle that produces the damage described above. 9 On a cellular level, direct muscle injury and indirect damage caused by ischemia can lead to muscle necrosis, edema, 11,12 fibrosis, and a reduction of angiogenesis, which results in minimal regeneration of the musculoskeletal tissues affected. 13 Regardless of the cause of skeletal muscle injury, repair of damaged tissue occurs in 3 distinct phases: degeneration and inflammation 14,15 ; regeneration 16 ; and fibrosis.…”

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confidence: 99%

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Characterization of a compartment syndrome–like injury model

et al. 2015

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INTRODUCTION Acute compartment syndrome (CS) is caused by an elevation of pressure within a muscular compartment which can be caused by numerous factors, including blunt trauma. In this study, we characterized a rodent model of CS-like injury. METHODS Forty male athymic rats received a standardized injury of ischemia and compression to their hindlimbs, while the intracompartmental pressure (ICP) was measured using an implantable transmitter. Tetanic muscle function was evaluated, and histology was performed on the tibialis anterior (TA) muscle. RESULTS ICPs were held at 260.70±2.70mmHg during injury. Injured muscles recovered 59% of their total function 4 weeks after injury, and histology showed high levels of edema, inflammation (CD68+), angiogenesis (CD31+), and fibrosis within 72 hours following injury. DISCUSSION We describe a novel CS-like injury model and a novel method to measure ICP which could potentially be used to develop innovative therapies to manage CS injury in humans.

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“…Flight stressors including hypoxia, barometric pressure, thermal stress, gravitational forces, noise, vibration, dehydration, and fatigue compound the physical stress of the providers functioning in this challenging environment. [13][14][15][16][17][18][19][20] Several past studies have focused on the ergonomic risk factors and MSIs associated with providers in civilian healthcare facilities. Back and joint pain are frequently reported, with 52% of nurses reporting back pain.…”

Section: Introductionmentioning

confidence: 99%

Records Review of Musculoskeletal Injuries in Aeromedical Evacuation Personnel

Serres

Fouts

Dukes

et al. 2015

American Journal of Preventive Medicine

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Background: Aeromedical evacuation providers care for patients during air transport. By applying standard medical practices, oftentimes developed for ground care, these practitioners perform their mission duties under additional physical stress in this unique medical environment. Awkward postures and excessive forces are common occurrences among personnel operating in this domain. Additionally, anecdotal reports highlight the risk of developing musculoskeletal injuries for these providers. Currently, there is limited research focusing on musculoskeletal injuries in aeromedical evacuation providers.Purpose: To determine the prevalence of musculoskeletal injuries and associated symptoms in aeromedical evacuation providers to understand the risk and burden of these injuries to military personnel.Methods: This study utilized a retrospective review of military medical records containing ICD-9 codes to investigate the incidence of musculoskeletal injuries within flight nurses and medical technicians compared to their non-flying counterparts from 2006 through 2011. Data were analyzed from 2013 through 2014. Results: Although musculoskeletal injuries were identified within the test populations, resultsshowed fewer injuries for aeromedical evacuation populations compared to non-aeromedical evacuation counterparts. Conclusions:One contributing factor may be a potential under-reporting of musculoskeletal injuries resulting from the fear of being placed on limited flying status. As flyers, aeromedical evacuation personnel must undergo yearly medical examinations and complete training courses that emphasize proper lifting techniques and physical requirements necessary for the safe and efficient transport of patients on various platforms. These additional requirements may create a healthy worker effect, likely contributing to lower musculoskeletal injuries.

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Extremity Compartment Syndrome in Pigs During Hypobaric Simulation of Aeromedical Evacuation

Abstract: Simulated altitude did not increase incidence of ECS. Inflammatory protein expression was increased in muscle, but some aspects of pathology were less severe following altitude exposure.

Cited by 11 publications

References 2 publications

17β-estradiol alters mRNA co-expression after murine muscle injury and mild hypobaria

17β-estradiol alters mRNA co-expression after murine muscle injury and mild hypobaria

Characterization of a compartment syndrome–like injury model

Records Review of Musculoskeletal Injuries in Aeromedical Evacuation Personnel

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