Search

Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The objective of this study was to determine the lateral bending tolerance of the head-cervical spine with initial head rotation posture using loads at the occipital condyles and lower neck and describe injuries. Using a custom loading device, head-cervical spine complexes from human cadavers were prepared with load cells at the ends. Lateral bending loads were applied to prerotated specimens at 1.5 m/s. At the occipital condyles, peak axial and antero-posterior and medial-lateral shear forces were: 316–954 N, 176–254 N, and 327–508 N, and coronal, sagittal, and axial moments were: 27–38 N·m, 21–38 N·m, and 9.7–19.8 N·m, respectively. At the lower neck, peak axial and shear forces were: 677–1004 N, 115–227 N, and 178–350 N, and coronal, sagittal, and axial moments were: 30–39 N·m, 7.6–21.3 N·m, and 5.7–13.4 N·m, respectively. Ipsilateral atlas lateral mass fractures occurred in four out of five specimens with varying joint diastasis and capsular ligament involvements. Acknowledging that the study used a small sample size, initial tolerances at the occipital condyles and lower neck were estimated using survival analysis. Injury patterns with posture variations are discussed.

Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5–C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5–C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.

To test the primary hypothesis that a CPR video will reduce ICU patients' surrogates' anxiety when deciding code status, as measured by the Hamilton Anxiety Rating (HAM-A) Scale, as compared to the no video group.

Our elderly population is growing and the number of spine fractures in the elderly is also growing. The elderly population in general may be considered as poor surgical candidates experience a high rate of fractures at C1 and C2 compared with the general population. Nonoperative management of upper cervical fractures is not benign as there is a high nonunion rate for both C1 and C2 fractures in the elderly, and orthosis compliance is often suboptimal, or complicated by skin breakdown. The optimal technique for upper cervical stabilization in the elderly may be different than in younger populations as the bone quality is inferior in the elderly. The objective of this basic science study is to determine whether the bone mineral density (BMD) of C1 and C2 vary by region, and if this is a gender difference in this elderly age group.

While radiation therapy (RT) is effective for reducing cancer burden in breast cancer (BC) patients, its side effects promote sedentary behavior and accumulation of adipose mass. Obesity and inactivity further increase the risk for cardiovascular co-morbidities and mortality. To combat these effects, we piloted a 12-week Stay on Track(SOT) exercise and diet intervention for breast cancer patients during their RT. We hypothesize that SOT will positively influence body composition and metabolic and inflammatory biomarkers in BC patients. A prospective, randomized control trial for patients with non-metastatic BC undergoing whole-breast RT was conducted. The intervention (A;21 patients) group participated in 3 personal excercise training sessions, 3 dietary counseling sessions, and received 3 text message reminders per week to adhere to lifestyle recommendations. The control (B;22 patients)group received an informative binder. All patients received a Fitbit, and at baseline, 3months, and 6months, measurements of blood biomarkers and dual-energy x-ray absorptiometry (DXA) scans were conducted. A mixed models analysis with a significance value of 0.05 was conducted, and estimated change from baseline with SE’s are reported. There was trend towards lower BMI (-0.95, 0.49; p=0.06) at 6mo and decreased visceral fat (-2.17, 1.22; p=0.081) at 3mo in Aonly. Bhad an increase in HbA1C at 3mo compared to baseline (0.26, 0.10; p=0.01) which stayed elevated at 6mo (0.22, 0.13; p=0.08). Balso had an increase in glucose levels at 6mo (8.42, 3.94; p=0.04), with a trend towards a decrease in insulin (-14.30, 9.85; p=0.15). Ahad no changes in these levels. There was a significant decrease in leptin levels at 6mo in Bonly (-13583.7, 6184.2, p=0.03). Adiponectin levels trended higher in Acompared to Bat 6mo (3143.42, 2265.1; p=0.17). Analysis of inflammatory cytokines showed a decrease in anti-inflammatory IL-1R-a in B(-3.46, 1.24; p=0.01), and a reduction in pro-inflammatory IL-8 levels in A(-2.77, 1.15; p=0.02). We conclude that SOT may positively influence body composition and metabolic and inflammatory biomarkers in BC patients. Targeted lifestyle interventions during RT are feasible and could help decrease cardiovascular co-morbidities in BC.

Losing a loved one often results in acute grief and depressive symptoms. The vast majority of older individuals are resilient and return to normal functioning within a year after a loss. However, a significant minority develop mental health complications, including prolonged grief disorder and bereavement-related depression. This can lead to adverse consequences, including physical and cognitive decline, impairment in global functioning, and early mortality. The contributing factors that increase the likelihood of adverse mental health outcomes in bereaved individuals have not been fully elucidated. This study explores the relationship of loneliness with grief and depressive symptom trajectories in older adults after an attachment loss.

Many artificial discs for have been introduced to overcome the disadvantages of conventional anterior discectomy and fusion. The purpose of this study was to evaluate the performance of different U.S. Food and Drug Administration (FDA)-approved cervical disc arthroplasty (CDA) on the range of motion (ROM), intradiscal pressure, and facet force variables under physiological loading. A validated three-dimensional finite element model of the human intact cervical spine (C2-T1) was used. The intact spine was modified to simulate CDAs at C5-C6. Hybrid loading with a follower load of 75 N and moments under flexion, extension, and lateral bending of 2 N·m each were applied to intact and CDA spines. From this work, it was found that at the index level, all CDAs except the Bryan disc increased ROM, and at the adjacent levels, motion decreased in all modes. The largest increase occurred under the lateral bending mode. The Bryan disc had compensatory motion increases at the adjacent levels. Intradiscal pressure reduced at the adjacent levels with Mobi-C and Secure-C. Facet force increased at the index level in all CDAs, with the highest force with the Mobi-C. The force generally decreased at the adjacent levels, except for the Bryan disc and Prestige LP in lateral bending. This study demonstrates the influence of different CDA designs on the anterior and posterior loading patterns at the index and adjacent levels with head supported mass type loadings. The study validates key clinical observations: CDA procedure is contraindicated in cases of facet arthroplasty and may be protective against adjacent segment degeneration.

The aims of this investigation were to delineate the internal biomechanics of the spine under vertical impact vector and assess the probability of injury. Male and female whole-body human finite element models were used. The restrained occupants were positioned on the seat, and caudo-cephalad impacts were applied to the base. Different acceleration-time profiles (50–200 ms pulse durations, 11–46 g peak accelerations) were used as inputs in both models. The resulting stress–strain profiles in the cortical and cancellous bones were evaluated at different vertebral levels. Using the peak transmitted forces at the thoracolumbar disc level as the response variable, the probability of injury for the male spine was obtained from experimental risk curves for the various pulses. Results showed that the shorter pulse durations and rise times impart greater loading on the thoracolumbar spine. The analysis of von Mises stress and strain distributions showed that the compression-related fractures are multifaceted with contributions from both the cortical and cancellous bony components of the body. Profiles are provided in the paper. The intervertebral disc may be involved in the fracture mechanism, because it acts as a medium of load transfer between adjacent vertebrae. Injury risks for the shortest pulse was 63%, and for the widest pulse it was close to zero, and injury probabilities for other pulses are given. The present modeling study provides insights into the mechanisms of internal load transfer and describes injury risk levels from caudal to cephalad impacts.

Injury criteria are used in military, automotive, and aviation environments to advance human safety. While injury risk curves (IRCs) for the human pelvis are published under vertical loading, there is a paucity of analysis that describe IRCs under lateral impact. The objective of the present study is to derive IRCs under this mode. Published data were used from 60 whole-body postmortem human surrogate (PMHS) tests that used repeated testing protocols. In the first analysis, from single impact tests, all injury data points were considered as left censored and noninjury points were considered as right censored, while repeated testing results were treated as interval censored data. In the second analysis, injury data were treated uncensored. Peak force was used as the response variable. Age, total body mass, gender, and body mass index (BMI) were used as covariates in different combinations. Bayesian survival analysis model was used to derive the IRCs. Plus-minus 95% credible intervals (CI) and their normalized CI sizes (NCIS) were obtained. This is the first study to develop IRCs in whole body PMHS tests to describe the human pelvic tolerance under lateral impact using Bayesian models.

Hari: BMS: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Spectrum: Consultancy. Fenske:Millennium/Takeda: Research Funding; Seattle Genetics: Honoraria; Pharmacyclics: Honoraria; Celgene: Honoraria.

Hamadani: Celgene: Consultancy; Takeda: Research Funding; MedImmune: Consultancy; Cellerant: Consultancy. Hari:Janssen: Consultancy; Novartis: Consultancy; Spectrum: Consultancy; Sanofi: Consultancy; Takeda: Consultancy; Celgene: Consultancy; BMS: Consultancy. Fenske:Celgene: Honoraria; Seattle Genetics: Honoraria; Millennium/Takeda: Research Funding; Pharmacyclics: Honoraria.

Background: