Compressive strength of interbody cages in the lumbar spine: the effect of cage shape, posterior instrumentation and bone density

One goal of interbody fusion is to increase the height of the degenerated disc space. Interbody cages in particular have been promoted with the claim that they can maintain the disc space better than other methods. There are many factors that can affect the disc height maintenance, including graft or cage design, the quality of the surrounding bone and the presence of supplementary posterior fixation. The present study is an in vitro biomechanical investigation of the compressive behaviour of three different interbody cage designs in a human cadaveric model. The effect of bone density and posterior instrumentation were assessed. Thirty-six lumbar functional spinal units were instrumented with one of three interbody cages: (1) a porous titanium implant with endplate fit (Stratec), (2) a porous, rectangular carbon-fibre implant (Brantigan) and (3) a porous, cylindrical threaded implant (Ray). Posterior instrumentation (USS) was applied to half of the specimens. All specimens were subjected to axial compression displacement until failure. Correlations between both the failure load and the load at 3 mm displacement with the bone density measurements were observed. Neither the cage design nor the presence of posterior instrumentation had a significant effect on the failure load. The loads at 3 mm were slightly less for the Stratec cage, implying lower axial stiffness, but were not different with posterior instrumentation. The large range of observed failure loads overlaps the potential in vivo compressive loads, implying that failure of the bone-implant interface may occur clinically. Preoperative measurements of bone density may be an effective tool to predict settling around interbody cages.

The relative importance of vertebral bone density and disc degeneration in spinal flexibility and interbody implant performance. An in vitro study

An in vitro biomechanical investigation in the human lumbar spine focuses on the functional significance of vertebral bone density and intervertebral disc degenerations.

A framework for benchmarking of homogenisation algorithm performance on the global scale

The International Surface Temperature Initiative (ISTI) is striving towards substantively improving our ability to robustly understand historical land surface air temperature change at all scales. A key recently completed first step has been collating all available records into a comprehensive open access, traceable and version-controlled databank. The crucial next step is to maximise the value of the collated data through a robust international framework of benchmarking and assessment for product intercomparison and uncertainty estimation. We focus on uncertainties arising from the presence of inhomogeneities in monthly mean land surface temperature data and the varied methodological choices made by various groups in building homogeneous temperature products. The central facet of the benchmarking process is the creation of global-scale synthetic analogues to the real-world database where both the "true" series and inhomogeneities are known (a luxury the real-world data do not afford us). Hence, algorithmic strengths and weaknesses can be meaningfully quantified and conditional inferences made about the real-world climate system. Here we discuss the necessary framework for developing an international homogenisation benchmarking system on the global scale for monthly mean temperatures. The value of this framework is critically dependent upon the number of groups taking part and so we strongly advocate involvement in the benchmarking exercise from as many data analyst groups as possible to make the best use of this substantial effort.

IMAGING DIAGNOSIS-MUSCULAR HYPERTROPHY OF THE SMALL INTESTINE AND PSEUDODIVERTICULA IN A HORSE.

A 14-year-old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall.

A Possible Case of Möller-Barlow Disease in Northwestern Switzerland (7th Century)

The excavation site Reigoldswil is located at 550 m above sea level on the Jura chain hillside in north-western Switzerland. The mountains divide the Rhine valley from an agriculturally rich region. The origin of the village lies in the early medieval time. Until now the skeletons of one cemetery have been morphologically studied. Around 216 individuals were excavated from under the foundation walls of a church and in the open field. They date to the 7/8th up to the 10th century. The striking part is the high amount of subadult (0-18 years) individuals with 58% (n=126). One of these children, an approximately 1.5 year old toddler from the 7th century, was buried in a stone cist. Its bones show morphological traces like porotic lesions of the greater wings of the sphenoidale, the squama, the mandibule and the scapula as new bone formation on both femora and tibiae. These signs could be an indicator for Möller-Barlow disease (Ortner 2003, Brickley and Ives 2008, Stark in press). As scurvy is associated with an insufficient intake of vitamin C, malnutrition must be assumed. A reason might be the geographic location or/and a harsh climat with crop failure and famine the first settler had to face. Besides the morphological diagnose amino acids of the bone collagen have been analyzed (Kramis et. al.). Further examinations, such as radiocarbon dating and stable isotope ratios (C, N, O, S) to specify nutrition, are planned.

Möller-Barlow disease in archaeology: Preliminary study of biochemical detection

Human bone is the most direct source for reconstructing health and living conditions of ancient populations. However, many diseases remain undetected in palaeopathology. Möller-Barlow disease (scurvy) is a historically well-documented metabolic disease and must have been common in clinical and sub-clinical severity. Due to long incubation periods and the subtle nature of bone changes osteological evidence is relatively rare (Brickley & Ives 2008). Möller-Barlow disease is caused by deficiency of dietary vitamin C (ascorbic acid) and evokes symptoms like fatigue, haemorrhage, inflammations, delayed wound healing and pain. Vitamin C is a cofactor for the hydroxylation of the amino acids proline and lysine which are essential for the production of intact connective tissue by cross-linking the propeptides in collagen. In a preliminary study we tested the detectability of Möller-Barlow disease by analysis of relative quantitative variability of hydroxylated amino acids in collagen (Pendery & Koon 2013). Samples (N=9) were taken from children with (n=3, cranium, femur, tibia) and without (n=4, cranium, femur, tibia) apparent bone reactions indicative of Möller-Barlow disease, as well as from adults with lethal traumata (n=2; negative controls). The skeletal remains originated from two early medieval cemeteries from Switzerland. Gas chromatographic (GC) analysis revealed minor differences between the samples. So far children with no pathologic alterations had fairly same values as negative controls while children with bone reactions paradoxically exhibited even slightly higher values of hydroxyproline and hydroxylysine. Future research demands for larger sample size and has to discuss sampling strategies. Beside possible misdiagnosis of Möller-Barlow disease it is arguable if only the newly built bone should be analysed even though this could lead to problems related to small sample quantity. It also remains to be seen to which extent varying turnover rates of different skeletal elements, especially in children, must be taken into account.

Evidence of trepanation in Late Iron Age Switzerland (420–240BC)

In Europe the procedure of trepanation is known since the Neolithic and is still practiced today in East African native tribes. Trepanation is the oldest known surgical intervention and is defined as the intentional penetration of the cranial vault with removal of piece of a skull bone. Therefore, it is believed that neurosurgery is one of the world’s oldest professions. In this study two skulls with lesions from the Late Iron Age cemetery of Münsingen (420–240 BC), Switzerland, are presented. Aim of the study was to analyse the lesions and to assess whether they were caused by surgical interventions. Sex and age of the individuals were determined by current morphologic-anthropological methods. Radiological examinations were performed with a multislice CT-scanner. Different trepanation methods and signs of healing are discussed. In Switzerland about 33 skulls with possible trepanations dating from Neolithic to medieval times are known and are presented in a short review. Studies of ancient surgical interventions provide important information of pre- and early historic populations. Trepanations of the skull such as the presented cases prove a profound understanding of the human body in ancient times.

Resting and reactive blood pressure as predictors of ambulatory blood pressure in older hypertensive adults

Background. A review of the literature suggests that Hypertension (HTN) in older adults is associated with sympathetic stimulation that results in increasing blood pressure (BP) reactivity. If clinical assessment of BP captured sympathetic stimulation, it would be valuable for hypertension management. ^ Objectives. The study examined whether reactive change scores from a short BPR protocol, resting blood pressure (BP), or resting pulse pressure (PP) is a better predictor of 24 hour ambulatory BP and BP load in cardiac patients. ^ Method. The study used a single-group design, with both an experimental clinical component and an observational field component. Both components used repeated measurement methods. The study population consisted of 45 adult patients with a mean age of 64.6 ± 8.5 years who were diagnosed with cardiac disease and who were taking anti-hypertensive medication. Blood pressure reactivity was operationalized with a speech protocol. During the speech protocol, BP was measured with an automatic device (Dinamap 825XT) while subjects talked about their health and about their usual day. Twenty-four hour ambulatory BP measurement (Spacelabs 90207 monitor) followed the speech protocol. ^ Results. Resting SBP and resting PP were significant predictors of 24-hour SBP, and resting SBP was a significant predictor of SBP load. No predictors were significant of 24-hour DBP or DBP load. ^ Conclusions. Initial resting BP and PP may be used in clinical settings to assess hypertension management. Future studies are necessary to confirm the ability of resting BP to predict ABP and BP load in older, medicated hypertensives. ^

The role of cardiorespiratory fitness and weight status on 24-hr ambulatory blood pressure among adolescents

BACKGROUND: This observational research study investigated the association of cardiorespiratory fitness and weight status with repeated measures of 24-hr ambulatory blood pressure (24-hr ABP). Little is known about these associations and few data exist examining the interaction between cardiorespiratory fitness and weight status and the contributions of each on 24-hr ABP in youth. ^ METHODS: This research study used secondary analysis data from the "Adolescent Blood Pressure and Anger: Ethnic Differences" study. This current study sample included 374 African-American, Anglo-American, and Mexican-American adolescents 11-16 years of age. Mixed-effects models were used for testing the relationship between weight status and cardiorespiratory fitness and repeated measures of ambulatory blood pressure over 24 hours (24-hr ABP). Weight status was categorized into "normal weight" (BMI<85th percentile), "overweight" (85th≤BMI<95th), and "obese" (BMI≥95th). Cardiorespiratory fitness, determined by heart rate recovery (HRR), was defined as the difference between heart rate at peak exercise and heart rate at two minutes post-exercise, as measured by a height-adjusted step test and stratified into two groups: low and high fitness, using a median split. Ambulatory blood pressure (ABP) was monitored for a 24-hr period on a school day using the Spacelabs ambulatory monitor (Model 90207). Blood pressure and heart rate were recorded at 30 minute intervals throughout the day of recording and at 60 minute intervals during sleep. ^ RESULTS: No significant associations were found between weight status and mean 24-hr systolic blood pressure (SBP) or mean arterial pressure (MAP). A significant and inverse association between weight status and mean 24-hr diastolic blood pressure (DBP) was revealed. Cardiorespiratory fitness was significantly and inversely associated with mean 24-hr ABP. High fitness adolescents had significantly lower mean 24-hr SPB, DBP, and MAP measurements than low fitness adolescents. Compared to low fitness adolescents, high fitness adolescents had 1.90 mmHg, 1.16 mmHg, and 1.68 mmHg lower mean 24-hr SBP, DBP, and MAP, respectively. Additionally, high fitness appeared to afford protection from higher mean 24-hr SBP and MAP, irrespective of weight status. Among normal weight adolescents, low fitness resulted in higher mean 24-hr SBP and MAP, compared to their fit counterparts. Among adolescents categorized as high fitness, increasing weight status did not appear to result in higher mean 24-hr SBP or MAP. Cardiorespiratory fitness, rather than weight status, appeared to be a more dominant predictor of mean 24-hr SBP and MAP. ^ CONCLUSIONS: To our knowledge, this research is the first study to investigate the independent and combined contributions of cardiorespiratory fitness and weight status on 24-hr ABP, all objectively measured. The results of this study may potentially guide and inform future research. It appears that early cardiovascular disease (CVD) prevention should focus on improving cardiorespiratory fitness levels among all adolescents, particularly those adolescents least fit, regardless of their weight status, while obesity prevention efforts continue.^

Description of sampling sites in Northern Russia

The youngest ice marginal zone between the White Sea and the Ural mountains is the W-E trending belt of moraines called the Varsh-Indiga-Markhida-Harbei-Halmer-Sopkay, here called the Markhida line. Glacial elements show that it was deposited by the Kara Ice Sheet, and in the west, by the Barents Ice Sheet. The Markhida moraine overlies Eemian marine sediments, and is therefore of Weichselian age. Distal to the moraine are Eemian marine sediments and three Palaeolithic sites with many C-14 dates in the range 16-37 ka not covered by till, proving that it represents the maximum ice sheet extension during the Weichselian. The Late Weichselian ice limit of M. G. Grosswald is about 400 km (near the Urals more than 700 km) too far south. Shorelines of ice dammed Lake Komi, probably dammed by the ice sheet ending at the Markhida line, predate 37 ka. We conclude that the Markhida line is of Middle/Early Weichselian age, implying that no ice sheet reached this part of Northern Russia during the Late Weichselian. This age is supported by a series of C-14 and OSL dates inside the Markhida line all of >45 ka. Two moraine loops protrude south of the Markhida line; the Laya-Adzva and Rogavaya moraines. These moraines are covered by Lake Komi sediments, and many C-14 dates on mammoth bones inside the moraines are 26-37 ka. The morphology indicates that the moraines are of Weichselian age, but a Saalian age cannot be excluded. No post-glacial emerged marine shorelines are found along the Barents Sea coast north of the Markhida line.

Age determination of sediment from Lake Komi

Beach and shoreface sediments deposited in the more than 800-km long ice-dammed Lake Komi in northern European Russia have been investigated and dated. The lake flooded the lowland areas between the Barents-Kara Ice Sheet in the north and the continental drainage divide in the south. Shoreline facies have been dated by 18 optical stimulated luminescence (OSL) dates, most of which are closely grouped in the range 80-100 ka, with a mean of 88 +/- 3 ka. This implies that that the Barents-Kara Ice Sheet had its Late Pleistocene maximum extension during the Early Weichselian, probably in the cold interval (Rederstall) between the Brørup and Odderade interstadials of western Europe, correlated with marine isotope stage 5b. This is in strong contrast to the Scandinavian and North American ice sheets, which had their maxima in isotope stage 2, about 20 ka. Field and air photo interpretations suggest that Lake Komi was dammed by the ice advance, which formed the Harbei-Harmon-Sopkay Moraines. These has earlier been correlated with the Markhida moraine across the Pechora River Valley and its western extension. However, OSL dates on fluvial sediments below the Markhida moraine have yielded ages as young as 60 ka. This suggests that the Russian mainland was inundated by two major ice sheet advances from the Barents-Kara seas after the last interglacial: one during the Early Weichselian (about 90 ka) that dammed Lake Komi and one during the Middle Weichselian (about 60 ka). Normal fluvial drainage prevailed during the Late Weichselian, when the ice front was located offshore.

Corg, CaCO3, bulk densities, accumulation rates and ages of ODP Leg 167 sites and three piston cores, California margin

Sediments from five Leg 167 drill sites and three piston cores were analyzed for Corg and CaCO3. Oxygen isotope stratigraphy on benthic foraminifers was used to assign age models to these sedimentary records. We find that the northern and central California margin is characterized by k.y.-scale events that can be found in both the CaCO3 and Corg time series. We show that the CaCO3 events are caused by changes in CaCO3 production by plankton, not by dissolution. We also show that these CaCO3 events occur in marine isotope Stages (MIS) 2, 3, and 4 during Dansgaard/Oeschger interstadials. They occur most strongly, however, on the MIS 5/4 glaciation and MIS 2/1 deglaciation. We believe that the link between the northeastern Pacific Ocean and North Atlantic is primarily transmitted by the atmosphere, not the ocean. Highest CaCO3 production and burial occurs when the surface ocean is somewhat cooler than the modern ocean, and the surface mixed layer is somewhat more stable.

Age models and foraminifer isotopes of four ODP Leg 202 sites

We present benthic isotope stratigraphies for Sites 1236, 1237, 1239, and 1241 that span the late Miocene-Pliocene time interval from 6 to 2.4 Ma. Orbitally tuned timescales were generated for Sites 1237 and 1241 by correlating the high-frequency variations in gamma ray attenuation density, percent sand of the carbonate fraction, and benthic d13C to variations in Earth's orbital parameters. The astronomical timescales for Sites 1237 and 1241 are in agreement with the one from Atlantic Site 925/926 (Ocean Drilling Program Leg 154). The comparison of benthic d18O and d13C records from the east Pacific sites and Atlantic Site 925/926 revealed a surprising clarity of the "41-k.y. signal" in d13C records and a remarkably good correlation between their d13C records. This suggests that the late Miocene-Pliocene amplitudes of obliquity-related d13C cycles reflect a magnitude of global response often larger than that provided by obliquity-related d18O cycles. At Site 1237, the orbitally derived ages of Pliocene magnetic reversal boundaries between the base of Réunion and the top of Thvera confirm astronomical datings of the generally accepted ATNTS2004 timescale, except for the top of Kaena and the base of Sidufjall. Our astronomical age for the top of Kaena is about one obliquity cycle older. The base of Sidufjall appears to be about one precession cycle younger. The age models of Sites 1236 and 1239 were established by correlating their benthic d18O and d13C records directly to the orbitally tuned isotope record of Site 1241.