Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane

BACKGROUND The purpose of this study is to compare clinical outcomes in the treatment of deep non-contained intrabony defects (i.e., with ≥70% 1-wall component and a residual 2- to 3-wall component in the most apical part) using deproteinized bovine bone mineral (DBBM) combined with either enamel matrix protein derivative (EMD) or collagen membrane (CM). METHODS Forty patients with multiple intrabony defects were enrolled. Only one non-contained defect per patient with an intrabony depth ≥3 mm located in the interproximal area of single- and multirooted teeth was randomly assigned to the treatment with either EMD + DBBM (test: n = 20) or CM + DBBM (control: n = 20). At baseline and after 12 months, clinical parameters including probing depth (PD) and clinical attachment level (CAL) were recorded. The primary outcome variable was the change in CAL between baseline and 12 months. RESULTS At baseline, the intrabony component of the defects amounted to 6.1 ± 1.9 mm for EMD + DBBM and 6.0 ± 1.9 mm for CM + DBBM sites (P = 0.81). The mean CAL gain at sites treated with EMD + DBBM was not statistically significantly different (P = 0.82) compared with CM + DBBM (3.8 ± 1.5 versus 3.7 ± 1.2 mm). No statistically significant difference (P = 0.62) was observed comparing the frequency of CAL gain ≥4 mm between EMD + DBBM (60%) and CM + DBBM (50%) or comparing the frequency of residual PD ≥6 mm between EMD + DBBM (5%) and CM + DBBM (15%) (P = 0.21). CONCLUSION Within the limitations of the present study, regenerative therapy using either EMD + DBBM or CM + DBBM yielded comparable clinical outcomes in deep non-contained intrabony defects after 12 months.

Intervertebral Disc Repair using Fleece-Membrane Composite Silk Material and Genipin-enhanced Fibrin Hydrogel

Introduction: Treating low back pain (LBP) has become an increasing challenge, as it is one of the main factors causing pain and is accompanied by high costs for the individual and the society. LBP can be caused by trauma of the intervertebral disc (IVD) or IVD degeneration. In the case of disc herniation the inner gelatinous part of the IVD, called nucleus pulposus, is pressed through the fibrous, annulus fibrosus that forms the outer part of the IVD. Today’s gold standard for treatment is extensive surgery as removal of the IVD and fusion of the vertebrae. In order to find a more gentle way to treat LBP and restore the native IVD we use a novel silk fleece-membrane composite from genetically modified silk worms whose silk contains a growth factor (GDF-6) that is associated with pushing stem cells towards a disc like phenotype (1). By combining it with a genipin-enhanced fibrin hydrogel we tested its suitability in organ culture on prior injured bovine IVD in our custom built two-degree of freedom bioreactor to mimic natural loading conditions. Material & Methods: Bovine IVDs of 12-17 months old animals were isolated by first removing all surrounding tissue followed by cutting out the IVDs as previously described (2). Culturing of discs occurred in high glucose Dulbecco's Modified Eagle Medium (HG-DMEM) supplemented with 5% serum as previously described (2). On the next day injury was induced using a 2mm biopsy punch (Polymed, Switzerland). The formed cavity was filled with (0.4%) genipin-enhanced human based fibrin hydrogel (35-55mg/mL human fibrinogen, Baxter, Austria) and sealed with a silk fleece-membrane composite (Spintec Engineering, Germany). Different culture conditions were applied: free swelling, static diurnal load of 0.2MPa for 8h/d and complex loading at 0.2MPa compression combined with ± 2° torsion at 0.2Hz for 8h/d (2). After 14 days of culture cell activity was determined with resazurin assay. Additionally, glycosaminoglycan (dimethyl-methylene blue), DNA (Hoechst) and collagen content (hydroxy- proline) were determined. Finally, real-time qPCR of major IVD marker and inflammation genes was performed to judge integrity of IVDs. Results: The fibrin hydrogel is able to keep the silk seal in place throughout the 14 days of in organ culture under all conditions. Additionally, cell activity showed optimistic results and we could not confirm negative effects of the repaired discs regarding overexpression of inflammation markers. Conclusions: The genipin-enhanced fibrin hydrogel in combination with the silk fleece- membrane composite seems to be a promising approach for IVD repair. Currently we assess the capability of GDF-6 incorporated in our silk composites on human mesenchymal stem cells and later on in organ culture. References 1. Clarke LE, McConnell JC, Sherratt MJ, Derby B, Richardson SM, Hoyland JA. Growth differentiation factor 6 and transforming growth factor-beta differentially mediate mesenchymal stem cell differentiation, composition and micromechanical properties of nucleus pulposus constructs. Arthritis Res Ther 2014, Mar 12;16(2):R67. 2. Chan SC, Gantenbein-Ritter B. Preparation of intact bovine tail intervertebral discs for organ culture. J Vis Exp 2012, Feb 2;60(60):e3490. Acknowledgements. This work is funded by the Gebert Rüf Foundation, project number GRS-028/13.

Protrusio acetabuli: joint loading with severe pincer impingement and its theoretical implications for surgical therapy

Severe pincer impingement (acetabular protrusio) is an established cause of hip pain and osteoarthritis. The proposed underlying pathomechanism is a dynamic pathological contact of the prominent acetabular rim with the femoral head-neck junction. However, this cannot explain the classically described medial osteoarthritis in these hips. We therefore asked: (1) Does an overload exist in the medial aspect of the protrusio joint? and (2) What is the influence of three contemporary joint-preserving procedures on load distribution in protrusio hips? In vivo force and motion data for walking and standing to sitting were applied to six 3D finite element models (normal, dysplasia, protrusio, acetabular rim trimming, acetabular reorientation, and combined reorientation/rim trimming). Compared with dysplasia, the protrusio joint resulted in opposite patterns of von Mises stress and contact pressure during walking. In protrusio hips, we found an overload at the medial margin of the lunate surface (54% higher than normal). Isolated rim trimming further increased the medial overload (up to 28% higher than protrusio), whereas acetabular reorientation with/without rim trimming reduced stresses by up to 25%. Our results can be used as an adjunct for surgical decision making in the treatment of acetabular protrusio.

The impact of the position effect on the factorial structure of the Culture Fair Test (CFT)

The Culture Fair Test (CFT) is a psychometric test of fluid intelligence consisting of four subtests; Series, Classification, Matrices, and Topographies. The four subtests are only moderately intercorrelated, doubting the notion that they assess the same construct (i.e., fluid intelligence). As an explanation of these low correlations, we investigated the position effect. This effect is assumed to reflect implicit learning during testing. By applying fixed-links modeling to analyze the CFT data of 206 participants, we identified position effects as latent variables in the subtests; Classification, Matrices, and Topographies. These position effects were disentangled from a second set of latent variables representing fluid intelligence inherent in the four subtests. After this separation of position effect and basic fluid intelligence, the latent variables representing basic fluid intelligence in the subtests Series, Matrices, and Topographies could be combined to one common latent variable which was highly correlated with fluid intelligence derived from the subtest Classification (r=.72). Correlations between the three latent variables representing the position effects in the Classification, Matrices, and Topographies subtests ranged from r=.38 to r=.59. The results indicate that all four CFT subtests measure the same construct (i.e., fluid intelligence) but that the position effect confounds the factorial structure

A new combined endpoint using U-statistic in analysis in clinical trials

Common endpoints can be divided into two categories. One is dichotomous endpoints which take only fixed values (most of the time two values). The other is continuous endpoints which can be any real number between two specified values. Choices of primary endpoints are critical in clinical trials. If we only use dichotomous endpoints, the power could be underestimated. If only continuous endpoints are chosen, we may not obtain expected sample size due to occurrence of some significant clinical events. Combined endpoints are used in clinical trials to give additional power. However, current combined endpoints or composite endpoints in cardiovascular disease clinical trials or most clinical trials are endpoints that combine either dichotomous endpoints (total mortality + total hospitalization), or continuous endpoints (risk score). Our present work applied U-statistic to combine one dichotomous endpoint and one continuous endpoint, which has three different assessments and to calculate the sample size and test the hypothesis to see if there is any treatment effect. It is especially useful when some patients cannot provide the most precise measurement due to medical contraindication or some personal reasons. Results show that this method has greater power then the analysis using continuous endpoints alone. ^

An evaluation of sleep hypnotic and stimulant effect on human performance using a computerized psychological test battery

This study evaluated the administration-time-dependent effects of a stimulant (Dexedrine 5-mg), a sleep-inducer (Halcion 0.25-mg) and placebo (control) on human performance. The investigation was conducted on 12 diurnally active (0700-2300) male adults (23-38 yrs) using a double-blind, randomized sixway-crossover three-treatment, two-timepoint (0830 vs 2030) design. Performance tests were conducted hourly during sleepless 13-hour studies using a computer generated, controlled and scored multi-task cognitive performance assessment battery (PAB) developed at the Walter Reed Army Institute of Research. Specific tests were Simple and Choice Reaction Time, Serial Addition/Subtraction, Spatial Orientation, Logical Reasoning, Time Estimation, Response Timing and the Stanford Sleepiness Scale. The major index of performance was "Throughput", a combined measure of speed and accuracy.^ For the Placebo condition, Single and Group Cosinor Analysis documented circadian rhythms in cognitive performance for the majority of tests, both for individuals and for the group. Performance was best around 1830-2030 and most variable around 0530-0700 when sleepiness was greatest (0300).^ Morning Dexedrine dosing marginally enhanced performance an average of 3% with reference to the corresponding in time control level. Dexedrine AM also increased alertness by 10% over the AM control. Dexedrine PM failed to improve performance with reference to the corresponding PM control baseline. With regard to AM and PM Dexedrine administrations, AM performance was 6% better with subjects 25% more alert.^ Morning Halcion administration caused a 7% performance decrement and 16% increase in sleepiness and a 13% decrement and 10% increase in sleepiness when administered in the evening compared to corresponding in time control data. Performance was 9% worse and sleepiness 24% greater after evening versus morning Halcion administration.^ These results suggest that for evening Halcion dosing, the overnight sleep deprivation occurring in coincidence with the nadir in performance due to circadian rhythmicity together with the CNS depressant effects combine to produce performance degradation. For Dexedrine, morning administration resulted in only marginal performance enhancement; Dexedrine in the evening was less effective, suggesting the 5-mg dose level may be too low to counteract the partial sleep deprivation and nocturnal nadir in performance. ^

Geotechnical properties of shelf sdiments from the Prydz Bay

This paper presents a geotechnical characterization of the glacigenic sediments in Prydz Bay, East Antarctica, based on the shipboard physical properties data obtained during Leg 119, combined with results of land-based analyses of 24 whole-round core samples. Main emphasis is placed on the land-based studies, which included oedometer consolidation tests, triaxial and simple shear tests for undrained shear strength, permeability tests in oedometer and triaxial cell, Atterberg limits, and grain-size analyses. The bulk of the tested sediments comprise overconsolidated diamictites of a relatively uniform lithology. The overconsolidation results from a combination of glacial loading and sediment overburden subsequently removed by extensive glacial erosion of the shelf. This leads to downhole profiles of physical properties that have been observed not to change as a function of the thickness of present overburden. A number of fluctuations in the parameters shows a relatively systematic trend and most likely results from changes in the proximity to the ice sheet grounding line in response to variations in the glacial regime. Very low permeabilities mainly result from high preconsolidation stresses (Pc'). Pc' values up to 10,000 kPa were estimated from the oedometer tests, and empirical estimates based on undrained shear strengths (up to 2500 kPa) indicate that the oedometer results are conservative. The diamictites generally classify as inactive, of low to medium plasticity, and they consolidate with little deformation, even when subjected to great stresses. This is the first report of geotechnical data from deep boreholes on the Antarctic continental shelf, but material of similar character can also be expected in other areas around the Antarctic.

Compression and expansion index and void ratio of samples from Lomonosov Ridge and Yermak Plateau

With the coupled use of multibeam swath bathymetry, high-resolution subbottom profiling and sediment coring from icebreakers in the Arctic Ocean, there is a growing awareness of the prevalence of Quaternary ice-grounding events on many of the topographic highs found in present water depths of <1000 m. In some regions, such as the Lomonosov Ridge and Yermak Plateau, overconsolidated sediments sampled through either drilling or coring are found beneath seismically imaged unconformities of glacigenic origin. However, there exists no comprehensive analysis of the geotechnical properties of these sediments, or how their inferred stress state may be related to different glacigenic processes or types of ice-loading. Here we combine geophysical, stratigraphic and geotechnical measurements from the Lomonosov Ridge and Yermak Plateau and discuss the glacial geological implications of overconsolidated sediments. The degree of overconsolidation, determined from measurements of porosity and shear strength, is shown to result from consolidation and/or deformation below grounded ice and, with the exception of a single region on the Lomonosov Ridge, cannot be explained by erosion of overlying sediments. We demonstrate that the amount and depth of porosity loss associated with a middle Quaternary (~ 790-950 thousand years ago - ka) grounding on the Yermak Plateau is compatible with sediment consolidation under an ice sheet or ice rise. Conversely, geotechnical properties of sediments from beneath late Quaternary ice-groundings in both regions, independently dated to Marine Isotope Stage (MIS) 6, indicate a more transient event commensurate with a passing tabular iceberg calved from an ice shelf.

Stress tests of ODP Site 131-808 sediments

Sediments undergoing accretion in trench-forearc systems are subjected to conditions of large lateral thrusting. This stress regime controls the mechanism of faulting as well as the yield and strength properties of the sediment. Understanding them is therefore crucial for the construction of quantitative models of sediment dynamics in convergent margin settings. For this purpose triaxial and oedometer tests were performed on six whole-round core samples recovered from Site 808 from depths between 173 and 705 mbsf. Samples from five depth intervals were subjected to a triaxial test program that was primarily designed to define yield and strength behavior. Test specimens were cut parallel and normal to the core axis. Additional five oedometer tests with similarly prepared specimens were performed on samples from four depth intervals to evaluate the directional state and degree of sediment compaction. Test results show that the degree of sediment compaction is higher than expected from overburden. This overcompaction increases with depth. A well-developed mechanical anisotropy is evident in all samples tested, regardless of their depth and lithology. Values of yield limit, stiffness, and shear strength are up to 40% higher in the horizontal direction compared to the vertical direction. In addition the test data demonstrate that the axis of the volumetric yield loci have rotated into extensional stress field. This verifies that the mechanical state of sediment in the accretionary wedge is controlled by in-situ stress conditions of extensional nature. The coefficients of lateral stress inferred suggest that the extensional stress regime becomes increasingly effective with depth.

Impact of changing carbonate chemistry, temperature, and salinity on growth and test degradation of the benthic foraminifer Ammonia aomoriensis

The present study investigated the combined effects of ocean acidification, temperature, and salinity on growth and test degradation of Ammonia aomoriensis. This species is one of the dominant benthic foraminifera in near-coastal habitats of the southwestern Baltic Sea that can be particularly sensitive to changes in seawater carbonate chemistry. To assess potential responses to ocean acidification and climate change, we performed a fully crossed experiment involving three temperatures (8, 13, and 18°C), three salinities (15, 20, and 25) and four pCO2 levels (566, 1195, 2108, and 3843 µatm) for six weeks. Our results highlight a sensitive response of A. aomoriensis to undersaturated seawater with respect to calcite. The specimens continued to grow and increase their test diameter in treatments with pCO2 <1200 µatm, when Omega calc >1. Growth rates declined when pCO2 exceeded 1200 µatm (Omega calc <1). A significant reduction in test diameter and number of tests due to dissolution was observed below a critical Omega calc of 0.5. Elevated temperature (18°C) led to increased Omega calc, larger test diameter, and lower test degradation. Maximal growth was observed at 18°C. No significant relationship was observed between salinity and test growth. Lowered and undersaturated Omega calc, which results from increasing pCO2 in bottom waters, may cause a significant future decline of the population density of A. aomoriensis in its natural environment. At the same time, this effect might be partially compensated by temperature rise due to global warming.

Experiment: Combined effects of CO2, temperature, irradiance and time on the physiological performance of Chondrus crispus (Rhodophyta)

In natural environments, marine biotas are exposed to a variety of simultaneously acting abiotic factors. Among these, temperature, irradiance and CO2 availability are major factors influencing the physiological performance of marine macroalgae. To test whether elevated levels of CO2 may remediate the otherwise reduced performance of uncalcified seaweeds under the influence of other stressful abiotic factors, we performed multifactorial experiments with the red alga Chondrus crispus from Helgoland (North Sea) with two levels of CO2, temperature and irradiance: low and high pCO2 levels were tested in combination with either (1) optimal and low irradiances or (2) optimal and sub-lethal high temperatures for growth. Performance of C. crispus was evaluated as biomass increase and relative growth rates (RGR), gross photosynthesis and pigment content. Acclimations of growth and photosynthesis were measured after 4 and 8 days. Acclimation time was crucial for elucidating single or combined CO2 effects on growth and photosynthesis. Signifi- cant CO2 effects became evident only in combination with either elevated temperature or reduced irradiance. Growth and photosynthesis had divergent patterns: RGR and biomass significantly increased only under a combination of high pCO2 and elevated temperature; gross photosynthesis was significantly reduced under high pCO2 conditions at low irradiance. Pigment content varied in response to irradiance and temperature, but was independent of pCO2.