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BACKGROUND: Bracing is one of the oldest non-operative treatments for patients with scoliosis. However, a wide variety of braces is used, and some show no effect, while others show conflicting results. OBJECTIVE: We aimed to evaluate the effectiveness of a new orthotic device for the treatment of adult scoliosis. METHODS: Twenty adult patients who were diagnosed with scoliosis and qualified for the study were selected and all participants were treated for 12 hours/day for 12 weeks using a new orthotic device. Various efficacy assessments (Cobb’s angle, spine length, pelvic angle, shoulder angle, thoracic angle, lumbar angle, pelvic sacral angle) were performed before and after the 12-week treatment. The values at each time point were compared. RESULTS: There were significant treatment effects in a time-dependent manner on every efficacy assessment (p< 0.05) after 12 weeks of bracing. CONCLUSION: In this clinical study, it was demonstrated that a new brace that is more comfortable for the wearer reduced scoliosis and may be a useful option for non-operative treatment of scoliosis.

Background The amount of patients with muscle imbalance of the left and right side increases rapidly due to an incorrect lifestyle. Objective We investigated the optimal exercise load required to improve muscle imbalance. Methods Thirty participants were enrolled in the study. They performed squat exercises according to a whole body vibration (WBV) frequency protocol over a period of eight weeks. The exercises were performed three days a week and comprised five sets of fifteen trials per set per day. We validated muscle imbalance improvement using WBV by comparing and analyzing the results at different vibration frequencies. The participants were divided into three WBV protocol groups: no WBV, low-frequency WBV (25 Hz and 5 mm amplitude), and high-frequency WBV (50 Hz and 5 mm amplitude). We estimated the isokinetic muscle functions of the hip, knee, and ankle joints using BIODEX system 3. Ultimately, low-frequency WBV improved balance 10.2 ∼ 26.5% more than high-frequency WBV. Results Continuous load-deviation motions during low-frequency WBV were more effective at improving muscle imbalance than high-frequency WBV. WBV load variation methods improved muscle function and contractility more than external weights or loads by directly transferring kinetic energy into the body. Conclusion In this clinical study, we demonstrated that low-frequency WBV was more effective at improving muscle imbalance. The WBV protocol can be used in rehabilitation programs to improve imbalance without requiring elderly or physically decompensated patients to participate in excessive exercise.

Manual calculation of the cortical thickness index (CI) and canal-to-calcar ratio (CC) using radiographs has been widely used. The purpose of this study was to investigate the difference between manual gold standard and automatic calculation based on deep convolutional neural networks (CNNs) of the proximal femur. We obtained institutional review board approval to utilize previous radiographs for the study and the radiograph images were used to train CNN architecture. The calculation experiment of a dataset of 136 images of the proximal femur to estimate CI and CC was performed using a trained CNN architecture (Automatic). Also, manual segmentation method (Manual) to calculate CI and CC was conducted using the standard protocol by two experts as a reference for the results comparison. The mean values of the Manual and Automatic calculation of CI for the proximal femur were 0.56 and 0.54, respectively, showing a statistically significant difference (p = 0.035). Significant difference (p

Background and Purpose— In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease. Methods— This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation. Results— Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764−95.794], P =0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726−0.880, P Conclusions— Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.

Du-Ri Kim1,2 *, Seunghwan Song1,3 *, Gwon-Min Kim,1 Jae Hyeok Chang,1,4 Young Jin Tak,5 Up Huh,1,3 Jeong Su Cho,3 Yung Liao,6 Kap-Soo Han,7 Myoung-Hwan Ko,7,8 Jong-Hwan Park1 1Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea; 2Department of Occupational Therapy, Graduate School of Inje University, Gimhae, Korea; 3Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea; 4Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea; 5Department of Family Medicine, Pusan National University Hospital, Busan, Korea; 6Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; 7Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea; 8Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea*These authors contributed equally to this workCorrespondence: Myoung-Hwan KoDepartment of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, KoreaTel +82-63-250-1785Email mhko@jbnu.ac.krJong-Hwan ParkHealth Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, KoreaTel +82-51-240-7071Email parkj@pusan.ac.krPurpose: Information and communication technology (ICT)-based training devices for older adults’ care related to dementia are being developed to enhance older adults’ cognitive functions. Older adults who require bicycle training devices can improve muscle strength and balance of lower limbs by continuously contracting and relaxing lower-limb muscles and improving cognitive function to prevent dementia. This study was conducted to investigate the effects of an ICT-based multicomponent program on body composition and cognitive function in older adults.Patients and Methods: In a randomized controlled intervention test on 20 people over the age of 60 (exercise group: n = 10; control: n = 10), the multicomponent program was applied to the exercise group twice per week, once per day for 12 weeks, at 30 min per session, whereas the control group was advised to maintain their usual daily activities.Results: Comparing body composition changes and cognitive function changes before and after intervention exhibited statistically significant differences in skeletal muscle mass (P=0.01) and modified Alzheimer’s disease assessment scale–cognitive score (P=0.01) between the two groups.Conclusion: It can be difficult to be engaged in a simple repetitive exercise program. Therefore, to meet older adults’ interests and expectations, a customized ICT-based multicomponent program, which can improve body composition and cognitive function in older adults and is believed to help prevent dementia, is recommended.Trial Registration: UMIN000042129 (https://www.umin.ac.jp/english/).Keywords: ICT-based multicomponent program, body composition, cognitive function, dementia, older adults

It is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement.Randomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise.40 community-dwelling participants aged 60-85 years.Participants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest.There were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test-30 seconds was scored as 3.60 ± 2.56 (P.015); Five Times Sit to Stand Test-5 times, -1.75 ± 2.04 s (P.015); Berg Balance Scale, 1.05 ± 1.39 (P.015); Timed Up-and-Go test, -0.64 ± 0.64 s (P.015); and 10-m Walking Test, -0.35 ± 0.47 s (P.015). And in group 2, the mean Five Times Sit to Stand Test-30 seconds (s) was scored as 3.70 ± 2.62 (P.015), Five Times Sit to Stand Test-5 times, -1.65 ± 1.59 s (P.015); Berg Balance Scale, 1.05 ± 1.00 (P.015); Timed Up-and-Go test, -0.93 ± 0.68 s (P.015); 10-m Walking Test, -0.41 ± 0.489 s (P.015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P.015); and Korean version of the Falls Efficacy Scale-International, -1.05 ± 1.43 (P.015).The results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.

BACKGROUND Although the elderly have more time and exercise opportunities compared to other age groups, they tend to be inactive and passive towards exercise, resulting in low actual exercise rates. Furthermore, simple repetitive exercise programs fail to engage the elderly to continuously exercise because these programs do not induce their interest or meet their expectations. Meanwhile, information and communication technology (ICT)-based training devices for elderly care related to dementia are being developed to enhance the cognitive functions of elder adults. For elder adults who require bicycle training devices can not only improve muscle strength and balance of lower limbs by continuously contracting and relaxing lower-limb muscles but also improve cognitive function to help prevent dementia. OBJECTIVE This study was conducted to investigate the effects of an information and communication technology (ICT)-based multi-cognition program on body composition and cognitive function in elder adults. METHODS In a randomized controlled intervention test on 20 people over the age of 60 (exercise group: n = 10; control: n = 10), the multi-cognition program was applied on the exercise group twice per week, once per day for 12 weeks, at 30 min per session, whereas the control group was advised to maintain their usual daily activities. RESULTS A comparison of changes in body composition and cognitive function before and after intervention exhibited statistically significant differences in skeletal muscle mass (P=.01) and modified Alzheimer’s disease assessment scale–cognitive score (P=.01) between the two groups. CONCLUSIONS It can be difficult to be engaged in a simple repetitive exercise program. Therefore, to meet the interest and expectations of elder adults, a customized ICT-based multi-cognition program, which can improve body composition and cognitive function in elder adults and is believed to be helpful in the prevention of dementia, is recommended. CLINICALTRIAL UMIN000042129

Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF). Several studies have reported dysphagia’s incidence, severity, and prognosis after ACDF; however, few have investigated the objective effects of dysphagia management. We aimed to elucidate the efficacy of laryngeal rehabilitation therapy for dysphagia following ACDF. This prospective randomized control trial included 20 patients who underwent more than two-level ACDF. Laryngeal rehabilitation therapy was performed on 10 patients for 7 days, whereas the remaining 10 comprised the control group. Pharyngeal transit time (PTT) by videofluoroscopic swallowing study (VFSS) was performed to evaluate the objective state of swallowing. We analyzed Bazaz scale and total variance of prevertebral soft tissue swelling (PSTS) from C2 to C7 on lateral cervical radiographs during hospitalization and at 4 and 8 weeks post-surgery. The PTT of the rehabilitation group was shorter than that of the control group at 7 days and 4 weeks post-surgery (p-value; POD 7D = 0.003, POD 4W = 0.042, POD 8W = 0.097). Perioperative laryngeal rehabilitation therapy effectively reduces postoperative dysphagia after ACDF.

Whole-body vibration training (WBVT) is emerging as an alternative exercise method that be easily performed by older adults. This clinical trial investigates the efficacy of WBVT in improving muscle strength and physical performance before resistance exercise, in comparison to conventional resistance exercise after stretching exercise in older adults. The WBVT group (n = 20) performed WBVT using a vibrating platform (SW-VC15™), followed by strengthening exercises. The control group (n = 20) performed stretching instead of WBVT. Both groups underwent a total of 12 sessions (50 min per session). The primary outcome was isokinetic dynamometer. The secondary outcomes were grip strength, short physical performance battery (SPPB), a 36-Item Short Form Survey (SF-36), and body composition analysis. In all results, only the time effect was significant, and the group effect or time x group effect was not. Both groups showed a significant increase in isokinetic dynamometer. Although there was no significant group effect, the increase in mean peak torque was greater in the WBVT group. The only WBVT group showed significant improvement in SPPB. In SF-36, only the control group showed significant improvements. WBVT can be safely performed by older adults and may be an alternative exercise method to boost the effect of strengthening exercise.

In this paper, a device to analyze gait pattern was developed by using a 2-axis acceleration sensor attached to the foot. The 1st low-pass filter was adapted to limit the frequency band up to 5 Hz. An algorithm to detect the peak value exceeding the threshold voltage of an X-axis acceleration sensor and a Z-axis acceleration sensor was developed and normal and abnormal walking patterns were thus differentiated. Also, MCU and Bluetooth were combined to transfer the data to other MCUs to display on an LCD; the size of the device could then be reduced. The new algorithm and the device allowed the individual walking patterns to be easily measured at a low cost and with less restriction on activities compared to conventional multiple pressure sensors or motion camera system.

Muscle strength may vary depending on the pathological issues and static life habits. These conditions lead to abnormal spinal loads and change muscle strength as well as activation patterns, thereby causing spinal disorders. In this study, the effects of muscle strength on the spine stabilization exercise were analyzed using a whole-body tilt device. Musculoskeletal modeling was performed and the results were validated through a comparison with the electromyography (EMG) analysis results. Based on the validated basic model, modeling was performed for the whole-body tilt device. To examine the exercise effect and muscle activation while the maximum muscle force capacity (MFC) was varied from 30[Formula: see text]N/cm2 to 60[Formula: see text]N/cm2 and 90[Formula: see text]N/cm2, the muscle force was predicted through inverse dynamics analysis. When MFC was 30[Formula: see text]N/cm2, the posterior direction of the tilt could not be analyzed (no solution found). When MFC was 60[Formula: see text]N/cm2, it could be analyzed, but the muscle force was predicted to be higher compared to when MFC was 90[Formula: see text]N/cm2. It was confirmed that muscle strength is a very important element for maintaining postural activities and performing exercise. Therefore, for rehabilitation patients and elderly people with weak muscle strength, hard or extreme exercise may cause musculoskeletal injuries.

We aimed to investigate the effect of basic fitness function according to whole-body vibration (WBV) stimulus with slope during deadlift in adults. A total of 15 subjects performed deadlift exercise with a sound-wave vibrator. The subjects consisted of three groups: no slope and WBV group (control), WBV only group (group 1), and slope and WBV group (group 2). Slope was set at [Formula: see text], and the frequency and amplitude of WBV were 10[Formula: see text]Hz and 5[Formula: see text]mm, respectively. The participants performed Romanian deadlift 2 days a week for 4 weeks, including 10 trials per set and five sets a day. We measured basic fitness function factor including the isokinetic muscle contraction test using biodex system3. All groups showed an increase in strength of approximately [Formula: see text]%. Group 2 showed the highest increase. Moreover, maximal peak torque of the lumbar joint showed an increase trend similar to that of back muscle strength. An increase of 15.72%, 24.86%, and 51.44% was noted in the control, group 1, and group 2, respectively. The findings indicate that WBV exercise with slope is the most efficient exercise protocol for improving muscle function of the trunk. WBV with slope could help stimulate trunk muscles more and efficiently, could result in a more positive effect on muscle function compared with WBV only, and could be included in an exercise program for efficient patient rehabilitation.

The aim of this study was to investigate the effects of silk fibroin scaffold, a natural biodegradable polymer scaffold, on the adhesive and proliferative behaviors of chondrocytes. Various silk fibroin scaffolds were produced using the salt extraction method, and scaffolds with different pore sizes (90-180, 180-250, 250-355, and 355-425 μm) were constructed based on the size of the salt particles. Chondrocytes were seeded on the scaffolds and incubated. The produced scaffolds were analyzed with Fourier transform-infrared spectroscopy and exhibited characteristics similar to those of natural silk in terms of chemical composition and structure. Moreover, we found that the mechanical strength decreased as the pore size increased. Scanning electron microscopy images confirmed the existence of pores in the silk fibroin scaffold. Additionally, scaffolds with smaller pore sizes facilitated improved cell adhesion. Using MTT analysis, we found that scaffold with pore sizes of 90-180 and 180-250 μm provided the best environment for cell proliferation. The amount levels of sulfated glycosaminoglycan (sGAG) and collagen were highest for scaffolds with a pore size of 90-180 μm. In gene expression analysis, scaffolds with pore sizes of 90-180 and 180-250 μm showed the highest expression of the chondrocytes marker aggrecan and type II collagen. Collectively, these data suggest that silk fibroin scaffolds with smaller pore sizes (90-250 μm) provide the best environment for adhesion and proliferation of chondrocytes. Open image in new window

Core spinal muscles are related to trunk stability and assume the main role of stabilizing the spine during daily activities; strengthening of core muscles around the spine can therefore reduce the chance of back pain. The objective of the study was to investigate the effect of core muscle strengthening in the spine during spine stabilization exercise using a whole body tilt device. To achieve this, a validated musculoskeletal (MS) model of the whole body was used to replicate the input motion from the whole body tilting exercise. An inverse dynamics analysis was executed to estimate spine loads and muscle forces depending on the tilting angles of the exercise device. The activation of long and superficial back muscles such as the erector spinae (iliocostalis and longissimus) were mainly affected by the forward direction (-40°) of the tilt, while the front muscles (psoas major, quadratus lumborum, and external and internal obliques) were mainly affected by the backward tilting direction (40°). Deep muscles such as the multifidi and short muscles were activated in most directions of the rotation and tilt. The backward directions of the tilt using this device could be carefully applied for the elderly and for rehabilitation patients who are expected to have less muscle strength. In this study, it was shown that the spine stabilization exercise device can provide considerable muscle exercise effect.

The objective of the study was to investigate the effect of 3-D stabilization exercise using a whole body tilt device. A musculoskeletal (MS) model of the whole body was developed, and used to calculate the forces in the spine, assisted by EMG measurement. The inverse dynamics was solved using the MS model of the whole body with the input data of the eight different directions of the tilt: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R), and left (L), replicating the tilting directions of the whole body device. The anterior and posterior directions of tilt mainly induced superficial back and front muscle activations, respectively. However, deep muscles, such as the semispinalis and mulifidi, were activated in all directions of tilt. The joint resultant forces in the right and left direction of tilt were the least; but some higher activations and more diverse recruitments of muscles were demanded. In the present investigation, 3-D stabilization exercise can provide considerable muscle activation and exercise effect, with the minimum perturbation of structure. Therefore, the proposed direction of tilt can be used to strengthen the targeted muscles, depending on the patient’s muscle conditions.

The aim of the study was to investigate the effects of small intestinal submucosa (SIS) sponges, a natural biodegradable polymer scaffold, on the adhesion behavior and the proliferation of Schwann cells (SCs). SIS sponges were prepared by varying the contents of SIS powders (1%, 2%, and 3% SIS concentration) and SCs were seeded on the sponges and incubated to investigate the adhesion and proliferation of SCs. A series of analytical process was conducted to observe the water absorption rate of sponges and confirmed the proliferation and morphology of SCs by scanning electron microscopy (SEM), 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, reverse transcription polymerase chain reaction (RT-PCR), and histological evaluation. The best adhesion behavior and the proliferation of SCs were observed on the sponge with 2% powder content. Also, analysis of messenger ribonucleic acid (mRNA) expression using the neuron-specific enolase (NSE) and neurofilament protein (NF) nerve markers showed that SC gene expression was excellent in the 2% SIS sponge. In vivo hematoxylin and eosin (H&E) staining and immunofluorescence results showed that cells and tissue formed well in the pores of sponges with 2% and 3% SIS powder contents, compared with formation in the 1% SIS sponge. The SIS sponges provided an unsuitable habitat for the adhesion and proliferation of cells in that the pore size was small. In this study, the adhesion behavior and the proliferation could be changed depending on the pore size and SIS powder content in the sponges. Thus, an appropriate powder content of SIS should be used to prepare SIS sponge scaffolds.

It is known that muscle strength of human body can alter or deteriorate as aging. In this study, we present an inverse dynamics simulation to investigate the effect of muscle strength on performing the daily activities. A 3D musculoskeletal model developed in this study includes several segments of whole body, long and short muscles, ligaments and disc stiffness. Five daily activities such as standing, flexion, finger tip to floor, standing lift close and lifting flexed were simulated with varying the maximum muscle force capacities (MFC) of each muscle fascicles from 30 to 90 N/cm 2 with an increment of 30 N/cm 2 . In the result, no solution can be obtained for finger tip to floor and lifting flexed with 30 N/cm 2 . Even though the solution was available for standing lift close activity in case of 30 N/cm² capacity, many of muscle fascicles hit the upper bound of muscle strength which means that it is not physiologically possible to perform the acvities in reality. For lifing flexed, even the case of 60 N/cm 2 capaciy, represents the moderate healthy people, was not able to find the solutions, showing that 18 muscles among 258 muscle fascicles reached 100% of muscle capacity. The estimated results imply that people who have low muscle strength such as elders or rehabilitation patients were required higher muscle work to perform and maintain the same daily activities than healthy one.

Blood flow simulations can identify arterial regions that are vulnerable to atherosclerotic or thrombotic evolution. To accurately define vulnerable arterial regions, hemodynamic parameters such as arterial geometry, blood flow velocity and blood viscosity (BV) must be measured individually. However, previous numerical studies have largely employed either a single representative value or simply used a nonspecific curve of non-Newtonian characteristics of BV. This study aimed to evaluate whether various BV models could produce similar arterial wall shear stress (WSS) results. We performed a blood flow simulation in carotid arteries obtained from time-of-flight magnetic resonance (TOF MR) angiography using the hemodynamic characteristics of subjects via carotid duplex ultrasonography. The BV models were categorized into the following five types: patient-specific non-Newtonian BV (model 1), representative non-Newtonian BV based on the Carreau model (BV model 2), Newtonian BV measured at a specific shear rate of 300[Formula: see text][Formula: see text] (BV model 3), Newtonian BV obtained from a hematocrit-based equation (BV model 4) and a representative Newtonian BV of 4[Formula: see text]cP (BV model 5). In total, 20 carotid arteries from 20 healthy volunteers (mean age [Formula: see text] SD of [Formula: see text] years; 50% women) were examined. Compared with the mean values of carotid WSS in BV model 1 as the reference model, the other four models showed significant differences in both genders for all carotid segments. To obtain reliable physiological WSS results, patient-specific non-Newtonian BV should be carefully employed.

The purpose of this study was to evaluate muscle function and basal physical fitness in relation to muscle balance pattern using rowing machines. Twenty four subjects participated in this study, using three different rowing machines. Rowing exercises were performed for twenty-five times a set, four sets a day, 3 days a week, for 8 weeks. Biodex system 3(Biodex Medical Systems Co., New York, USA) was used to measure joint torques in the elbow, shoulder, lumbar and knee of subjects, for analyzing muscle function. The evaluation of basal physical fitness included body composition, muscle strength, muscle endurance, muscle reaction, agility, flexibility and explosive power. Before the experiment, significant differences of joint torques in the elbow, shoulder, lumbar and knee were present between subjects in the group. After the rowing exercise, significant improvement in every joint was witnessed. All aspects of basic fitness increased significantly, and the most improvement was observed in muscle strength from the joint torque results. As shown in the following results, every joint it was evident to have improved by more than 30% with the use of dependent load deviation type over the previously used water load method. This means that it is more effective for enhancing muscle strength and endurance to keep the muscle balance using dependent load deviation. The human body maintains motor coordination of muscle contraction during exercise. The muscle balances in the upper-lower and left-right arms could assist with effective activation of motor coordination. In this paper, an exercise method using dependent load deviation was demonstrated to be more efficient for improving muscle imbalance and strengthening muscles.

Knowledge about spinal loading is required for designing and preclinical testing of spinal implants. It is assumed that loading of the spine depends upon body weight and height, as well as on the spine level, but a direct measurement of the loading conditions throughout the spine is not yet possible. Here, computer models can allow an estimation of the forces and moments acting in the spine. The objective of the present study was to calculate spinal loads for different postures and activities at several levels of the thoracolumbar spine for various combinations of body height and weight. A validated musculoskeletal model, together with commercially available software (AnyBody Technology), were used to calculate the segmental loads acting on the centre of the upper endplate of the vertebrae T12 to L5. The body height was varied between 150 and 200 cm and the weight between 50 and 120 kg. The loads were determined for five standard static postures and three lifting tasks. The resultant forces and moments increased approximately linearly with increasing body weight. The body height had a nearly linear effect on the spinal loads, but in almost all loading cases, the effect on spinal loads was stronger for variation of body weight than of body height. Spinal loads generally increased from cranial to caudal. The presented data now allow the estimation of the spinal load during activities of daily living on a subject specific basis, if body height and weight are known.

The aim of the study was to calculate the arterial wall signal intensity gradient (SIG) from time-of-flight MR angiography (TOF-MRA) and represent arterial wall shear stress. We developed a new algorithm that uses signal intensity (SI) of a TOF-MRA to directly calculate the signal intensity gradient (SIG). The results from our phantom study showed that the TOF-MRA SIG could be used to distinguish the magnitude of blood flow rate as high (mean SIG ± SD, 2.2 ± 0.4 SI/mm for 12.5 ± 2.3 L/min) and low (0.9 ± 0.3 SI/mm for 8.5 ± 2.6 L/min) in vessels (p<0.001). Additionally, we found that the TOF-MRA SIG values were highly correlated with various flow rates (β=0.96, p<0.001). Remarkably, the correlation coefficient between the WSS obtained from the computational fluid dynamics (CFD) analysis and the TOF-MRA SIG was greater than 0.8 in each section at the carotid artery (p<0.001 for all β values). This new technique using TOF-MRA could enable the rapid calculation of the TOF-MRA SIG and thereby the WSS. Thus, the TOF-MRA SIG can provide clinicians with an accurate and efficient screening method for making rapid decisions on the risk of vascular disease for a patient in clinical practice.

The ligamentous spinal column buckles under compressive loads of even less than 100 N. Experimental results showed that under the follower load constraint, the ligamentous lumbar spine can sustain large compressive loads without buckling, while at the same time maintaining its flexibility reasonably well. The purpose of this study was to investigate the feasibility of follower loads produced by spinal muscles in the lumbar spine in a quiet standing posture. A three-dimensional static model of the lumbar spine incorporating 232 back muscles was developed and utilized to perform the optimization analysis in order to find the muscle forces, and compressive follower loads (CFLs) along optimum follower load paths (FLPs). The effect of increasing external loads on CFLs was also investigated. An optimum solution was found which is feasible for muscle forces producing minimum CFLs along the FLP located 11 mm posterior to the curve connecting the geometrical centers of the vertebral bodies. Activation of 30 muscles was found to create CFLs with zero joint moments in all intervertebral joints. CFLs increased with increasing external loads including FLP deviations from the optimum location. Our results demonstrate that spinal muscles can create CFLs in the lumbar spine in a neutral standing posture in vivo to sustain stability. Therefore, its application in experimental and numerical studies concerning loading conditions seems to be suitable for the attainment of realistic results.

The aim of this study was to investigate the effect of demineralized bone particle/ poly(lactic-co-glycolic acid) (DBP/PLGA) scaffolds on the proliferation of mesenchymal stem cells (MSCs). DBP/PLGA hybrid scaffolds were fabricated by solvent casting/salt-leaching with DBP contents of 0, 20, 40, and 80 wt%. MSCs were seeded on the DBP/PLGA scaffolds and then evaluated by a series of analytical process: SEM, MTT, RT-PCR, and in vivo histological assay. As the DBP contents increased, the cell attachment behavior and cell viability also increased. A DBP content of 80 wt% marked the best water absorption performance and the highest cell viability. Gene expression of aggrecan on DBP/PLGA scaffolds tended to increase, whereas that on PLGA scaffolds was decreased at 1 week. However, strong expression of aggrecan was observed at 2 weeks regardless of the contents of DBP. Scaffolds showed a trend of increasing type II and I collagen at 2 weeks. The results showed that MSCs on DBP/PLGA scaffolds showed more efficient cell proliferation and tissue formation in the presence of tissue-inductive stimuli. Suitable biomaterials could be more conducive to proliferation of MSCs. These results suggest that the DBP/PLGA scaffolds are a feasible biomaterial for intervertebral disc regeneration.

This study investigated the characteristics of dynamic postural responses when subjects attempted to maintain an upright standing position on a support plate during continuous sinusoidal perturbation in the anterior-posterior direction. Fif- teen healthy young subjects participated in the experiment. Body movement patterns during the perturbation were captured and analyzed using a 3D motion analysis system (APAS 3D motion analysis, Ariel Dynamics Inc.). Seven markers were at- tached on the subject's body to measure and analyze the motion patterns. The markers were positioned at the head, chest, hip, right knee, left knee, right ankle, and left ankle. Five different frequencies of motion were applied to the support surface: 0.1, 0.5, 1.0, 1.5, and 2.0 Hz with a 4-cm path of motion at the base. The experiments measured dynamic postural responses in a condition were subjects had their eyes open. The results showed that the median frequency of the knee and ankle increased in all frequency bands. Following an increase in the frequency of the perturbation, the postural control strategy was changed from the ankle strategy to a combined strategy. These experimental results could be applied to the dynamic postural training for the elderly and to rehabilitation training for patients to improve their ability for postural control.

This study investigated that the spinal MFs can create compressive follower loads (CFLs) in the lumbar spine in a dynamic state. Three-dimensional optimization and finite element (FE) models of the spinal system were developed and validated using reported experimental data. An optimization analysis was performed to determine the MFs that create CFLs in the lumbar spine in various sagittal postures from 10° extension to 40° flexion. Optimization solutions for the MFs, CFLs, and follower load path (FLP) location were feasible for all studied postures. The FE predictions demonstrated that MFs which created CFLs along the base spinal curve connecting the geometrical centers or along a curve in its vicinity (within anterior or posterior shift by 2 mm) produced stable deformation of the lumbar spine in the neutral standing and flexed postures, whereas the MFs which created the smallest CFLs resulted in unstable deformation. For extended postures, however, finding CFLs creating MFs that produce stable deformation of the extended spine was not possible. The results of this study support the hypothesis that the spinal muscles may stabilize the spine via the CFL mechanism.

The placement of artificial disks can alter the center of rotation and kinematic pattern; therefore, forces in the spine during the motion will be affected as a result. The relationship between the location of joint center of artificial disks and forces in the spinal components is not investigated. A musculoskeletal model of the spine was developed, and three location cases of center of rotation were investigated varying 5 mm anteriorly and posteriorly from the default center. Resultant joint forces, ligament forces, facet forces, and muscle forces for each case were predicted during sagittal motion. No considerable difference was observed for joint force (maximum 14%). Anterior shift of center of rotation induced the most ligament forces (200 N) and facet forces (130 N) among the three cases. Posterior and anterior shifts of centers of rotation from the default location caused considerable changes in muscle forces, respectively: 108% and 70% of increase in multifidi muscle and 157% and 187% of increase in short segmental muscle. This study showed that the centers of rotation due to the design and the surgical placement of artificial disk can affect the kinetic results in the spine.

A direct measurement of the complete loads in the spine continues to remain elusive. Analytical musculoskeletal models to predict the internal loading conditions generally neglect or strongly simplify passive soft tissue structures. However, during large intervertebral motions, passive structures such as ligaments and the stiffness of the intervertebral discs are thought to play a critical role on the muscle forces required for equilibrium. The objective of the present study was to add the short segmental muscles, lumbar ligaments and disc stiffnesses to an existing base musculoskeletal model of the spine in order to establish what role passive soft tissue structures play in spinal loading, but also validate these results against experimentally determined load data. The long trunk muscles not included in previous models, short segmental muscles, lumbar ligaments and disc stiffnesses were implemented into a commercially available musculoskeletal spine model construct. For several activities of daily living, the loads acting on the vertebral bodies were then calculated relative to the value for standing, and then compared to the corresponding values measured in vivo. Good agreement between calculated and measured results could be achieved in all cases, with a maximum difference of 9%. The highest muscle forces were predicted in the m. longissimus (146N) for flexion, in the m. rectus abdominis (363N) for extension, and in the m. psoas major (144N and 81N) for lateral bending and axial rotation. This study has demonstrated that the inclusion of the complete set of muscle and ligament structures into musculoskeletal models of the spine is essential before accurate spinal forces can be determined. For the first time, trend validation of spinal loading has been achieved, thus allowing confidence in the precise prediction of muscle forces for a range of activities of daily living.

The objective of the study was to investigate the effects of 3D stabilization exercises using a whole body tilt device on forces in the trunk, such as individual muscle forces and activation patterns, maximum muscle activities and spine loads. For this sake, a musculoskeletal (MS) model of the whole body was developed, and an inverse dynamics analysis was performed to predict the forces on the spine. An EMG measurement experiment was conducted to validate the muscle forces and activation patterns. The MS model was rotated and tilted in eight different directions: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R) and left (L), replicating the directions of the 3D spine balance exercise device, as performed in the experiment. The anterior directions of the tilt primarily induced the activation of long and superficial back muscles and the posterior directions activated the front muscles. However, deep muscles, such as short muscles and multifidi, were activated in all directions of the tilt. The resultant joint forces in the right and left directions of the tilt were the least among the directions, but higher muscle activations and more diverse muscle recruitments than other positions were observed. Therefore, these directions of tilt may be suitable for the elderly and rehabilitation patients who require muscle strengthening with less spinal loads. In the present investigation, it was shown that 3D stabilization exercises could provide considerable muscle exercise effects with a minimum perturbation of structure. The results of this study can be used to provide safety guidelines for muscle exercises using this type of tilting device. Therefore, the proposed direction of tilt can be used to strengthen targeted muscles, depending on the patients' muscular condition.

To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerota's fascia, and dissected five cadavers laying special emphasis on the ascent of Gerota's fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerota's fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.