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BACKGROUND The T1-S1 distance to evaluate spinal length is traditionally measured as a straight line on an anteroposterior radiograph. However, this method may not reflect the true 3-dimensional (3D) spinal length. The objective of the study was to evaluate the difference between the traditional T1-S1 measurement and a 3D reconstruction from standard x-ray imaging. METHODS Radiological assessment and 3D reconstruction of spinal length in pediatric patients with various spine deformities. The 3D reconstruction derived from standard biplanar spine x-ray images using a specialized but free available software and calibration device. Direct comparison of length, intraobserver variance for repeated measurements, as well as interobserver correlation for both measurement methods and between different levels of training were evaluated. Furthermore, the influence on spinal length by the degree of spinal deformity as well as other factors was analyzed. RESULTS A total of 39 x-ray images from 35 patients at a mean age of 15.4 years (8.9-26.8 years) were evaluated. There was excellent agreement for intra- and interobserver correlation for both measurement techniques. Spinal length assessed using 3D reconstruction was significantly longer compared with the traditional T1-S1 distance, on average 2.7 cm (0.5-6.1 cm). There was also a significant positive correlation between the maximum extent of the deformity and the difference in spinal length. CONCLUSIONS Traditional T1-S1 distance significantly underestimates the true length of the spine. A 3D measurement reflects the real length of the spine more adequately. CLINICAL RELEVANCE Such information is relevant to the treating spine surgeon when planning or assessing therapeutic measures, especially in advanced deformities. LEVEL OF EVIDENCE: 4

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XXVIII Congress of the International Society of Biomechanics (ISB). Program & Abstracts

Most countries affected by the COVID-19 pandemic have repeatedly restricted public life to control the contagion. However, the health impact of confinement measures is hitherto unclear. We performed a multinational survey investigating changes in mental and physical well-being (MWB/PWB) during the first wave of the pandemic. A total of 14,975 individuals from 14 countries provided valid responses. Compared to pre-restrictions, MWB, as measured by the WHO-5 questionnaire, decreased considerably during restrictions (68.1 +/- 16.9 to 51.9 +/- 21.0 points). Whereas 14.2% of the participants met the cutoff for depression screening pre-restrictions, this share tripled to 45.2% during restrictions. Factors associated with clinically relevant decreases in MWB were female sex (odds ratio/OR = 1.20, 95% CI: 1.11-1.29), high physical activity levels pre-restrictions (OR = 1.29, 95% CI 1.16-1.42), decreased vigorous physical activity during restrictions (OR = 1.14, 95% CI: 1.05-1.23), and working (partially) outside the home vs. working remotely (OR = 1.29, 95% CI: 1.16-1.44/OR = 1.35, 95% CI: 1.23-1.47). Reductions, although smaller, were also seen for PWB. Scores in the SF-36 bodily pain subscale decreased from 85.8 +/- 18.7% pre-restrictions to 81.3 +/- 21.9% during restrictions. Clinically relevant decrements of PWB were associated with female sex (OR = 1.62, 95% CI: 1.50-1.75), high levels of public life restrictions (OR = 1.26, 95% CI: 1.18-1.36), and young age (OR = 1.10, 95% CI: 1.03-1.19). Study findings suggest lockdowns instituted during the COVID-19 pandemic may have had substantial adverse public health effects. The development of interventions mitigating losses in MWB and PWB is, thus, paramount when preparing for forthcoming waves of COVID-19 or future public life restrictions., DJ-P is supported by a grant from the Spanish Ministry of Science and Innovation-MINECO (RYC-2014-16938). The research fellowship of KH was funded by the German Research Foundation (Grant no. HO 6214/2-1).

Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was per-formed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre-and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 ± 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 80.9% (95% CI: 80.3–81.7) to 62.5% (95% CI: 61.6–63.3). Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic.

CMBBE 2021 Abstract Book

The transport sector is characterised by distinct rises in energy consumption both throughout Europe and globally. In addition to its dependency on limited fossil resources (e.g. mineral oil), the transport sector is further recognised as a key contributor to the anthropogenic greenhouse effect. On a global scale, transport is responsible for about 22% of greenhouse gas (GHG) emissions. In Germany, the contribution of road transport to overall greenhouse gas emissions ranges between 17% and 20%. A successful introduction of renewable energies in combination with a reduction of greenhouse gas emissions in the sectors ship and road transport is associated with a number of special challenges. These include calls for innovations in propulsion technology, infrastructure solutions as well as primary energy diversification. Liquefied natural gas (LNG) presents an alternative for simultaneous application with fossil fuels derived from crude oil (e.g. diesel), with a special focus on means of transport that require an extended operating range or a demand for high performance output. For these reasons, the present study investigates technological components relevant for LNG supply and infrastructure including associated environmental impacts. In a second step, the study explores possible scenarios for the introduction of focal modes of transport: maritime transport, inland naviga-tion and heavy-duty vehicles (HDVs). These scenarios include estimates on resulting future LNG de-mand followed by calculations of local emissions and greenhouse gases. Furthermore, recommenda-tions for action regarding a potential LNG development plan are derived from the findings. However, the present study does not attempt in-depth cost analyses.

Das allergen-induzierte Asthma bronchiale zählt in den Industrienationen zu den häufigsten chronischen Krankheiten bei Kindern und Jugendlichen. Ausgelöst durch multiple Triggerfaktoren liegt der Erkrankung das Zusammenspiel verschiedener prädisponierender Gene und inflammatorischer Pathomechanismen in der Lunge zugrunde. Im Tiermodell kann die akute allergische Reaktion mit Ig-E-vermittelter Mastzell-Degranulation, der Einwanderung von Entzündungszellen und der Ausbildung von Atemwegshyperreagibilität durch die spezifische Atemwegsprovokation von vorher sensibilisierten Tieren nachempfunden werden. Das Modell der Langzeit-Allergenprovokation führt analog zum Menschen zu zellulären und strukturellen Veränderungen, wie einer steigenden peribronchialen Kollagenablagerung, Fibroblastenhyperplasie und vermehrter Schleimproduktion. Um die zugrunde liegenden Mechanismen bei der Entstehung von Entzündung, Hyperreagibilität und strukturellen Veränderungen in der Lunge zu analysieren, wurden von uns zu verschiedenen Zeitpunkten der Allergenprovokation mRNA-Expressionsprofile aus Lungengewebe erstellt. Hierzu wurden Balb/C Mäuse zuerst intraperitoneal mit dem Modellallergen Ovalbumin (OVA) sensibilisiert und anschliessend unterschiedlich lange (akutes Modell: eine Woche; intermediäres Modell: sechs Wochen; chronisches Modell: zwölf Wochen) repetitiv mit OVA über die Atemwege provoziert. Die Analyse der immunologischen, histologischen und physiologischen Parameter ergab folgendes Bild: Die Gesamt-Ig-E Produktion erreichte nach sechs Wochen in den behandelten Tieren ein Maximum und blieb auf diesem hohen Niveau, wohingegen die Menge an OVA-spezifischem Ig-E im zwölfwöchigem Modell wieder abfiel. Die broncho-alveoläre Lavage der Lungen zeigte, dass die Gesamtzellzahl analog zur Provokationsdauer anstieg. Der eosinophile Granulozyt machte hierbei in der akuten Phase, sowie nach sechs Wochen den Großteil der Zellen aus und verringerte sich in der chronischen Phase dann deutlich. Auch die histologische Auswertung der peribronchialen Entzündung und der Becherzellhyperplasie ergab, dass die Entzündungsreaktion im chronischen Modell, im Gegensatz zum akuten und intermediären Zeitpunkt, deutlich zurückging. Als klinischer Parameter wurden Lungenfunktionsmessungen an den Mäusen durchgeführt. Es zeigte sich, dass im zeitlichen Verlauf der Provokation die Hyperreaktivität abnahm. Die mRNA-Expressionsanalysen der Lungen zu den oben beschriebenen Zeitpunkten erfolgte mittels Microarray (Affymetrix, Mouse Genome 430 2.0). Insgesamt wurden 1644 Gene gefunden, die jeweils mindestens zweifach gegenüber der Kontrollgruppe reguliert waren. Durch die Hauptkomponentenanalyse (PCA) ließen sich die einzelnen Zeitpunkte deutlich voneinander abgrenzen. Im Detail zeigten sich im akuten Modell 577 Gene (450up/127down), im sechswöchigen Modell 1176 Gene (730up/446down) und im chronischen Modell 583 Gene (433up/150down) mindestens zweifach reguliert. Zu allen drei Zeitpunkten waren insgesamt 263 Gene (247up/16down) reguliert. Mittels funktioneller Clusteranalysen wurden die einzelnen Zeitpunkte näher charakterisiert; hierbei ließen sich die regulierten Gene verschiedenen Pathways und funktionellen Gruppen zuordnen. Zu allen Zeitpunkten waren Gene aus der Gruppe „response to stimulus“, der Immunantwort und der extrazelluläre Matrix reguliert. Im akuten Modell fanden sich Teile des Toll-like-Rezeptor (z.B. TLR1) und Jak-Stat Rezeptor Pathways reguliert. Die Antikörper-Antigen- Komplexe der Complementkaskade zeigten eine Induktion vor allem in der intermediären Phase. Im akuten sowie im intermediären Modell fanden sich vor allem positiv regulierte Gene des Cytokin-Cytokinrezeptor-Pathway. Verschiedene Kettenanteile von Immunglobulinen waren im intermediären Modell mit am stärksten reguliert. Des Weiteren ließen sich Expressionsverläufe verschiedener, für die Pathogenese des allergischen Asthma bronchiale wichtiger Gene darstellen. Bei den klassischen TH2 Interleukinen wurde für IL-4 und IL-5 ein Maximum im intermediären Modell festgestellt. Interleukin-13 zeigte sich im Verlauf abfallend reguliert. Gene, die positiv auf die B-Zellentwicklung einwirken sowie deren Überleben verlängern – als Beispiel BLNK (b-cell linker) und BCL2A (B-cell leukemia/lymphoma 2a) – waren zu allen Zeitpunkten positiv reguliert. Auch Faktoren, die den durch die allergische Reaktion ausgelösten progredienten Umbau in der Lunge beeinflussen, fanden sich reguliert. So zeigte IL-6, dem eine wichtige Rolle in der Induktion des Remodelings zugesprochen wird, eine Hochregulation in der intermediären Phase. Analog zeigte sich Mmp12 (matrixmetallopeptidase 12) als pro-fibrotischer Faktor im zeitlichen Verlauf ansteigend und deren Gegenspieler Timp1 (tissue inhibitor of metalloendopeptidasen 1) vom akuten zu den chronischen Modellen abfallend reguliert. Analog zu der im Verlauf abnehmenden Inflammation fanden sich Gene, welche inhibitorisch auf an der asthmatischen Reaktion beteiligten Zellen wirken, in den chronischen Versuchen hochreguliert. Als Beispiel LILRB4 (leukocyte immunoglobulin-like receptor subfamily B member 4) mit einer hemmenden Wirkung auf Mastzellen und NKs. Die mittels Mikroarray gefundenen Regulationen einzelner Gene wurde via quantitativer PCR überprüft und konnten bestätigt werden. Zusammenfassend konnten in dieser Arbeit viele dem allergischen Asthma bronchiale bereits zugeordnete Gene bestätigt und zudem neue Gene aufzeigt werden. Aktuell wird deren funktionelle Rolle und möglicher therapeutischer und präventiver Nutzen weiter untersucht. Die Mikroarraytechnologie bietet somit eine valide Möglichkeit, das Verständnis der Pathogenese des Asthma bronchiale zu verbessern und neue Ansatzpunkte für die Intervention aufzuzeigen., Asthma is one of the most common chronic diseases among children. Multiple trigger factors cause a persisting inflammation of the lung with following structural changes. These changes and the pathomechanism can be shown in a mouse model and new targets can be found via gene expression profiling with microarray technology. In our model we used the allergen ovalbumin, after intra-peritoneal sensitization following the challenge via nebulization repetitively twice a week for 1, 6 and 11 weeks. We were able to show immunological parameters of the asthmatic phenotype with elevated immunoglobulines, mucus hypersecretion, bronchial-infiltration and elevation of the main TH2 interleukins IL-4, IL-5 and IL-13. The airway hyper- responsiveness (AHR) decreased during chronification. The microarray gene expression profile showed 1644 genes with a regulation of at least 2 folds. 577 genes (450up/127down) in the acute model (1wk), 1176 genes (730up/446down) at 6 weeks and 583 genes (433up/150down) in the chronic model. The activated pathways are the Toll-like receptor pathway, cytokines and cytokine-receptors and the b-cell pathway. During the acute and intermediate phase the group response to stimulus and the group extra-cellular matrix (ECM) were up- regulated. Within the ECM group genes of the collagen homeostasis showed to be highly inducted. In our quantitative analysis an elevated level of collagen appeared only in the intermediate phase. Furthermore we were able to confirm multiple genes already associated with asthma. New potential targets were discovered while their definite function still needs to be explored. The regulation found via microarray analyses was confirmed through polymerase- chain-reaction (PCR). Concluding, microarray analysis is a powerful tool to show pathomechanism of complex diseases such as asthma and to reveal new potential targets for therapeutical and preventive intervention.

Postural balance can be considered a conjoined parameter of gross motor performance. It is acquired in early childhood and honed until adolescence, but may also be influenced by various conditions. A simplified clinical assessment of balance and posture could be helpful in monitoring motor development or therapy particularly in pediatric patients. While analogue scales are considered unprecise and lab-based force-plate posturography lacks accessibility, we propose a novel kinematic balance assessment based on markerless 3D sensor technology.Can balance and posture be assessed by tracking kinematic data using a single 3D motion tracking camera and are the results representative of normal motor development in a healthy pediatric cohort?A proprietary algorithm was developed and tested that uses skeletal data from the Microsoft Kinect™ V2 3D motion capture camera to calculate and track the center of mass in real time during a set of balance tasks. The algorithm tracks the distance of the COM traveled over time to calculate a balance score (COM speed). For this study, 432 school children aged 4-18 years performed 5 balance tasks and the resulting balance scores were analyzed and correlated with demographic data.Preliminary experiments demonstrated that the system was able to reliably detect differences in COM speed during different balance tasks. The method showed moderate correlation with age and sex. Athletic activity positively correlated with balance skill in the age group8 years, but not in older children. Body mass appeared not to be correlated with balance ability.This study demonstrates that markerless 3D motion analysis can be used for the clinical assessment of coordination and balance and could potentially be used to monitor gross motor performance at the point-of-care.

Objective Intra-articular corticosteroid injections (IACIs) are frequently used to suppress local inflammation, that is, in children with juvenile idiopathic arthritis (JIA). While systemic high-dosage corticosteroids are known to trigger osteonecrosis and result in osteochondral (OC) lesions, the effect of IACIs on joint cartilage and subchondral bone remains unclear. This study was conceived to analyze the coincidence of IACI and the subsequent manifestation of osteochondral lesions in a large cohort of pediatric JIA patients. Design Retrospective data assessment and comparative analysis of skeletally immature JIA patients treated with IACIs between 1993 and 2017. Results A total of 280 JIA patients were included in the analysis, the majority were girls (64%). Osteochondral lesions were present in 16 patients (5.7%) at a mean age of 10.7 years (range 4-14 years) and appeared on average after 63-month duration of disease. The majority was present at atypical locations such as the lateral femoral condyle. Multivariable analysis using cox regression showed that steroid injections were a risk factor to develop an OC lesion (hazard ratio [95%CI] for number of steroid injections per year, 8.20 [3.18, 21.16]). Conclusions Pediatric patients with JIA show a relatively high incidence of osteochondritic lesions, which present at an early age and in rather atypical locations and repetitive steroid injection need to be considered an associated risk factor.