Biomechanical evaluation of a low profile, anchored cervical interbody spacer device in the setting of progressive flexion-distraction injury of the cervical spine

Introduction

Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity.

Methods

Thirteen human cadaveric subaxial cervical spines (C3–C7) were tested at C5–C6 in flexion–extension, lateral bending and axial rotation in the load-control mode under ±1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5–C6.

Results

The anchored spacer device with locked screw configuration significantly reduced C5–C6 flexion–extension (FE) motion from 14.8 ± 4.2 to 3.9 ± 1.8°, lateral bending (LB) from 10.3 ± 2.0 to 1.6 ± 0.8, and axial rotation (AR) from 11.0 ± 2.4 to 2.5 ± 0.8 compared with intact under (p < 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5–C6 FE motion from 10.7 ± 1.7 to 5.5 ± 2.5°, LB from 8.3 ± 1.4 to 2.7 ± 1.0, and AR from 8.8 ± 2.7 to 4.6 ± 1.3 compared with intact (p < 0.01). The ROM of the C5–C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 ± 2.1 in FE, 2.0 ± 1.1 in LB, and 3.3 ± 1.4 in AR. Conversely, the ROM of the C5–C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 ± 4.5 in FE, 5.0 ± 1.6 in LB, and 9.5 ± 4.6 in AR.

Conclusions

The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion–distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries.     

Relationships between brain and body temperature,clinical and imaging outcomes after ischemic stroke

Pyrexia soon after stroke is associated with severe stroke and poor functional outcome. Few studies have assessed brain temperature after stroke in patients, so little is known of its associations with body temperature, stroke severity, or outcome. We measured temperatures in ischemic and normal-appearing brain using ¹H-magnetic resonance spectroscopy and its correlations with body (tympanic) temperature measured four-hourly, infarct growth by 5 days, early neurologic (National Institute of Health Stroke Scale, NIHSS) and late functional outcome (death or dependency). Among 40 patients (mean age 73 years, median NIHSS 7, imaged at median 17 hours), temperature in ischemic brain was higher than in normal-appearing brain on admission (38.6°C-core, 37.9°C-contralateral hemisphere, P=0.03) but both were equally elevated by 5 days; both were higher than tympanic temperature. Ischemic lesion temperature was not associated with NIHSS or 3-month functional outcome; in contrast, higher contralateral normal-appearing brain temperature was associated with worse NIHSS, infarct expansion and poor functional outcome, similar to associations for tympanic temperature. We conclude that brain temperature is higher than body temperature; that elevated temperature in ischemic brain reflects a local tissue response to ischemia, whereas pyrexia reflects the systemic response to stroke, occurs later, and is associated with adverse outcomes.     

Nonlinear model predictive control based on constraint transformation

The paper presents a constraint transformation approach for nonlinear model predictive control (MPC) subject to a class of state and control constraints. The approach uses a two‐stage transformation technique to incorporate the constraints into a new unconstrained MPC formulation with new variables. As part of the stability analysis, the relationship of the new unconstrained MPC scheme to an interior penalty formulation in the original variables is discussed. The approach is combined with an unconstrained gradient method that allows for computing the single MPC iterations in a real‐time manner. The applicability of the approach, for example, to fast mechatronic systems, is demonstrated by numerical as well as experimental results. Copyright © 2015 John Wiley & Sons, Ltd.     

Systemic absorption of nicotine following acute secondhand exposure to electronic cigarette aerosol in a realistic social setting

Evidence suggests exposure of nicotine-containing e-cigarette aerosol to nonusers leads to systemic absorption of nicotine. However, no studies have examined acute secondhand exposures that occur in public settings. Here, we measured the serum, saliva and urine of nonusers pre- and post-exposure to nicotine via e-cigarette aerosol. Secondarily, we recorded factors affecting the exposure.Six nonusers of nicotine-containing products were exposed to secondhand aerosol from ad libitum e-cigarette use by three e-cigarette users for 2?h during two separate sessions (disposables, tank-style). Pre-exposure (baseline) and post-exposure peak levels (Cmax) of cotinine were measured in nonusers’ serum, saliva, and urine over a 6-hour follow-up, plus a saliva sample the following morning. We also measured solution consumption, nicotine concentration, and pH, along with use behavior.Baseline cotinine levels were higher than typical for the US population (median serum session one?=?0.089?ng/ml; session two?=?0.052?ng/ml). Systemic absorption of nicotine occurred in nonusers with baselines indicative of no/low tobacco exposure, but not in nonusers with elevated baselines. Median changes in cotinine for disposable exposure were 0.007?ng/ml serum, 0.033?ng/ml saliva, and 0.316?ng/mg creatinine in urine. For tank-style exposure they were 0.041?ng/ml serum, 0.060?ng/ml saliva, and 0.948?ng/mg creatinine in urine. Finally, we measured substantial differences in solution nicotine concentrations, pH, use behavior and consumption.Our data show that although exposures may vary considerably, nonusers can systemically absorb nicotine following acute exposure to secondhand e-cigarette aerosol. This can particularly affect sensitive subpopulations, such as children and women of reproductive age.     

Experimental Study of Tensile Properties of Styrene–Butadiene–Styrene Modified Asphalt Binders

The requirements imposed on road pavements are ever increasing nowadays, necessitating the improvement of the properties of paving materials. The most commonly used paving materials include bituminous mixtures that are composed of aggregate grains bound by a bituminous binder. The properties of bitumens can be improved by modification with polymers. Among the copolymers used for modifying bitumens, styrene–butadiene–styrene, a thermoplastic elastomer, is the most commonly used. This article presents the results of tests conducted on bitumens modified with two types of styrene–butadiene–styrene copolymer (linear and radial). Two bitumen types of different penetration grades (35/50 and 160/220) were used in the experiments. The content of styrene–butadiene–styrene added to the bitumen varied between 1% and 6%. The results of the force ductility test showed that cohesion energy can be used for qualitative evaluation of the efficiency of modification of bitumen with styrene–butadiene–styrene copolymer. The determined values of the cohesion energy were subjected to the original analysis taking into account the three characteristic elongation zones of the tested binders. The performed analyses made it possible to find a parameter whose values correlate significantly with the content of styrene–butadiene–styrene copolymer in the modified bitumen. With smaller amounts of added modifier (approximately 2%), slightly better effects were obtained in the case of linear copolymer styrene–butadiene–styrene and for larger amounts of modifier (5–6%) radial copolymer styrene–butadiene–styrene was found to be more effective. This is confirmed by the changes in the binder structure, as indicated by the penetration index (PI).