Cervical spine injuries: A whole-body musculoskeletal model for the analysis of spinal loading

This is the final version of the article. Available from Public Library of Science via the DOI in this record.Cervical spine trauma from sport or traffic collisions can have devastating consequences for individuals and a high societal cost. The precise mechanisms of such injuries are still unknown as investigation is hampered by the difficulty in experimentally replicating the conditions under which these injuries occur. We harness the benefits of computer simulation to report on the creation and validation of i) a generic musculoskeletal model (MASI) for the analyses of cervical spine loading in healthy subjects, and ii) a population-specific version of the model (Rugby Model), for investigating cervical spine injury mechanisms during rugby activities. The musculoskeletal models were created in OpenSim, and validated against in vivo data of a healthy subject and a rugby player performing neck and upper limb movements. The novel aspects of the Rugby Model comprise i) population-specific inertial properties and muscle parameters representing rugby forward players, and ii) a custom scapula-clavicular joint that allows the application of multiple external loads. We confirm the utility of the developed generic and population-specific models via verification steps and validation of kinematics, joint moments and neuromuscular activations during rugby scrummaging and neck functional movements, which achieve results comparable with in vivoand in vitrodata. The Rugby Model was validated and used for the first time to provide insight into anatomical loading and cervical spine injury mechanisms related to rugby, whilst the MASI introduces a new computational tool to allow investigation of spinal injuries arising from other sporting activities, transport, and ergonomic applications. The models used in this study are freely available at simtk.org and allow to integrate in silico analyses with experimental approaches in injury prevention.Funding: This project is funded by the Rugby Football Union (RFU) Injured Players Foundation. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Language components for modular DSLs using traits

Recent advances in tooling and modern programming languages have progressively brought back the practice of developing domain-specific languages as a means to improve software development. Consequently, the problem of making composition between languages easier by emphasizing code reuse and componentized programming is a topic of increasing interest in research. In fact, it is not uncommon for different languages to share common features, and, because in the same project different DSLs may coexist to model concepts from different problem areas, it is interesting to study ways to develop modular, extensible languages. Earlier work has shown that traits can be used to modularize the semantics of a language implementation; a lot of attention is often spent on embedded DSLs; even when external DSLs are discussed, the main focus is on modularizing the semantics. In this paper we will show a complete trait-based approach to modularize not only the semantics but also the syntax of external DSLs, thereby simplifying extension and therefore evolution of a language implementation. We show the benefits of implementing these techniques using the Scala programming language

Red blood cell precursor mass as an independent determinant of serum erythropoietin level.

Serum erythropoietin (sEpo) concentration is primarily related to the rate of renal production and, under the stimulus of hypoxia, increases exponentially as hemoglobin (Hb) decreases. Additional factors, however, appear to influence sEpo, and in this work, we performed studies to evaluate the role of the red blood cell precursor mass. We first compared the relationship of sEpo with Hb in patients with low versus high erythroid activity. The first group included 27 patients with erythroid aplasia or hypoplasia having serum transferrin receptor (sTfR) levels 10 mg/L (erythroid activity > 2 times normal). There was no difference between the two groups with respect to Hb (8.3 +/- 1.6 v 8.0 +/- 1.3 g/dL, P > .05), but sEpo levels were notably higher in patients with low erythroid activity (1,601 +/- 1,542 v 235 +/- 143 mU/mL, P < . 001). In fact, multivariate analysis of variance (ANOVA) showed that, at any given Hb level, sEpo was higher in patients with low erythroid activity (P < .0001). Twenty patients undergoing allogeneic or autologous bone marrow transplantation (BMT) were then investigated. A marked increase in sEpo was seen in all cases at the time of marrow aplasia, disproportionately high when compared with the small decrease in Hb level. Sequential studies were also performed in five patients with iron deficiency anemia undergoing intravenous (IV) iron therapy. Within 24 to 72 hours after starting iron treatment, marked decreases in sEpo (up to one log magnitude) were found before any change in Hb level. Similar observations were made in patients with megaloblastic anemia and in a case of pure red blood cell aplasia. These findings point to an inverse relationship between red blood cell precursor mass and sEpo: at any given Hb level, the higher the number of red blood cell precursors, the lower the sEpo concentration. The most likely explanation for this is that sEpo levels are regulated not only by the rate of renal production, but also by the rate of utilization by erythroid cells

Musculoskeletal modelling of the human cervical spine for the investigation of injury mechanisms during axial impacts

This is the final version. Available from Public Library of Science via the DOI in this record.All relevant data are available at Figshare [https://figshare.com/projects/SILVESTROS_PLOS_ONE_SUPPORTING_DOCUMENTS/58280] and musculoskeletal models and relevant project information is available on the OpenSim SimTK repository [https://simtk.org/projects/csibath].Head collisions in sport can result in catastrophic injuries to the cervical spine. Musculoskeletal modelling can help analyse the relationship between motion, external forces and internal loads that lead to injury. However, impact specific musculoskeletal models are lacking as current viscoelastic values used to describe cervical spine joint dynamics have been obtained from unrepresentative quasi-static or static experiments. The aim of this study was to develop and validate a cervical spine musculoskeletal model for use in axial impacts. Cervical spine specimens (C2-C6) were tested under measured sub-catastrophic loads and the resulting 3D motion of the vertebrae was measured. Specimen specific musculoskeletal models were then created and used to estimate the axial and shear viscoelastic (stiffness and damping) properties of the joints through an optimisation algorithm that minimised tracking errors between measured and simulated kinematics. A five-fold cross validation and a Monte Carlo sensitivity analysis were conducted to assess the performance of the newly estimated parameters. The impact-specific parameters were integrated in a population specific musculoskeletal model and used to assess cervical spine loads measured from Rugby union impacts compared to available models. Results of the optimisation showed a larger increase of axial joint stiffness compared to axial damping and shear viscoelastic parameters for all models. The sensitivity analysis revealed that lower values of axial stiffness and shear damping reduced the models performance considerably compared to other degrees of freedom. The impact-specific parameters integrated in the population specific model estimated more appropriate joint displacements for axial head impacts compared to available models and are therefore more suited for injury mechanism analysis.Rugby Football Union (RFU) Injured Players Foundatio

Bioactive glasses functionalized with polyphenols: in vitro interactions with healthy and cancerous osteoblast cells

Bioactive glasses are widely studied as biomaterials for bone contact applications. In this research work, the opportunity to modify the surface of a bioactive glass with polyphenols (gallic acid, and natural polyphenols extracted from red grape skin and green tea leaves) has been investigated in order to induce a selective anti-tumor activity in vitro. The presence of surface grafted molecules has been optically proved by fluorescence microscopy exploiting their autofluorescence. Direct and indirect cytotoxicity assays have been performed with human bone osteosarcoma cells (U2OS) and human fetal pre-osteoblasts (hFOB), as well as the quantification of oxygen and nitrogen reactive species (RONS) engendered from cells in response to the materials. Finally, the DNA damage of U2OS cells upon contact with the bioactive glass has been evaluated in order to verify any selective cytotoxic activity of functionalized materials against cancer cells. Results showed a selective cytotoxic activity of functionalized bioactive glasses toward osteosarcoma cells that was particularly evident when cells were cultivated directly onto glasses surface. Moreover, the presence of grafted polyphenols increased the RONS production and induced a permanent DNA damage on the U2SOS cells while they promote a certain anti-inflammatory action toward hFOB. These preliminary results suggest polyphenols grafted bioactive glasses as promising material for bone substitution in cancer treatment

Bioactive materials: In vitro investigation of different mechanisms of hydroxyapatite precipitation

Abstract Bioactive materials, able to induce hydroxyapatite precipitation in contact with body fluids, are of great interest for their bone bonding capacity. . The aim of this paper is to compare bioactive materials with different surface features to verify the mechanisms of action and the relationship with kinetics and type of precipitated hydroxyapatite over time. Four different surface treatments for Ti/Ti6Al4V alloy and a bioactive glass were selected and a different mechanism of bioactivity is supposed for each of them. Apart from the conventional techniques (FESEM, XPS and EDX), less common characterizations (zeta potential measurements on solid surfaces and FTIR chemical imaging) were applied. The results suggest that the OH groups on the surface have several effects: the total number of the OH groups mainly affects hydrophilicity of surfaces, while the isoelectric points, surface charge and ions attraction mainly depend on OH acidic/basic strength. Kinetics of hydroxyapatite precipitation is faster when it involves a mechanism of ion exchange while it is slower when it is due to electrostatic effects . The electrostatic effect cooperates with ion exchange and it speeds up kinetics of hydroxyapatite precipitation. Different bioactive surfaces are able to differently induce precipitation of type A and B of hydroxyapatite, as well as different degrees of crystallinity and carbonation. Statement of significance The bone is made of a ceramic phase (a specific type of hydroxyapatite), a network of collagen fibers and the biological tissue. A strong bond of an orthopedic or dental implant with the bone is achieved by bioactive materials where precipitation and growth of hydroxyapatite occurs on the implant surface starting from the ions in the physiological fluids. Several bioactive materials are already known and used, but their mechanism of action is not completely known and the type of precipitated hydroxyapatite not fully investigated. In this work, bioactive titanium and bioglass surfaces are compared through conventional and innovative methodologies. Different mechanisms of bioactivity are identified, with different kinetics and the materials are able to induce precipitation of different types of hydroxyapatite, with different degree of crystallinity and carbonation