When local phytotherapies meet biomedicine. Cross-sectional study of knowledge and intercultural practices against malaria in Eastern French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies. AIM OF THE STUDY: The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). RESULTS: A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%. CONCLUSIONS: This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.

Development and validation of a behavioural video coding scheme for detecting mental workload in manual assembly.

Manual assembly in the future Industry 4.0 workplace will put high demands on operators' cognitive processing. The development of mental workload (MWL) measures therefore looms large. Physiological gauges such as electroencephalography (EEG) show promising possibilities, but still lack sufficient reliability when applied in the field. This study presents an alternative measure with a substantial ecological validity. First, we developed a behavioural video coding scheme identifying 11 assembly behaviours potentially revealing MWL being too high. Subsequently, we explored its validity by analysing videos of 24 participants performing a high and a low complexity assembly. Results showed that five of the behaviours identified, such as freezing and the amount of part rotations, significantly differed in occurrence and/or duration between the two conditions. The study hereby proposes a novel and naturalistic method that could help practitioners to map and redesign critical assembly phases, and researchers to enrich validation of MWL-measures through measurement triangulation. Practitioner summary: Current physiological mental workload (MWL) measures still lack sufficient reliability when applied in the field. Therefore, we identified several observable assembly behaviours that could reveal MWL being too high. The results propose a method to map MWL by observing specific assembly behaviours such as freezing and rotating parts. Abbreviations: MWL: mental workload; EEG: electroencephalography; fNIRS: functional near infrared spectroscopy; AOI: area of interest; SMI: SensoMotoric Instruments, ETG: Eye-Tracking Glasses; FPS: frames per second; BORIS: Behavioral Observation Research Interactive Software; IRR: inter-rater reliability; SWAT: Subjective Workload Assessment Technique; NASA-TLX: National Aeronautics and Space Administration Task Load Index; EL: emotional load; DSSQ: Dundee Stress State Questionnaire; PHL: physical load; SBO: Strategisch Basis Onderzoek.

Asymptomatic Plasmodium falciparum and vivax infection in the neighborhood of Blondin, Saint-Georges-de-l'Oyapock District, French Guiana.

Optimized elimination strategies are needed to control transmission of malaria. As part of an elimination campaign, active detection of asymptomatic Plasmodium carriers by highly sensitive methods is deemed necessary. Asymptomatic carriage leads to complex scientific, ethical, and operational issues regarding individual or collective detection and treatment. To address this issue, a crosssectional study was carried out in French Guiana to determine the prevalence of asymptomatic Plasmodium carriage during an inter-epidemic season in the whole population of a neighborhood of Saint-Georges-de-l'Oyapock, along the Brazilian border. Fifty-eight participants out of 63 residents were screened. The median age was 23.3 years (range: 2 months-72 years), with a male/female sex-ratio of 0.56. The majority of the participants (74%, N = 43/58) reported a history of malaria, 12% (N = 7/58) during the past 12 months. All rapid diagnostic tests for malaria were negative. Among the 58 participants, malaria prevalence detected by nested-PCR (Polymerase Chain Reaction) was 3.6% (N = 2/56). Two asymptomatic carriers of Plasmodium were identified: one child with Plasmodium vivax and one adult with Plasmodium falciparum. These two carriers were treated and did not develop malaria within the eight months following the diagnosis. This study confirmed the presence of asymptomatic parasitaemias outside hyperendemic areas. However, the benefits of such an active detection and patient treatment to eliminate malaria in French Guiana need to be evaluated at a larger scale.

Differential Interaction of the Staphylococcal Toxins Panton-Valentine Leukocidin and γ-Hemolysin CB with Human C5a Receptors.

Staphylococcus aureus is well adapted to the human host. Evasion of the host phagocyte response is critical for successful infection. The staphylococcal bicomponent pore-forming toxins Panton-Valentine leukocidin LukSF-PV (PVL) and γ-hemolysin CB (HlgCB) target human phagocytes through interaction with the complement receptors C5aR1 and C5aR2. Currently, the apparent redundancy of both toxins cannot be adequately addressed in experimental models of infection because mice are resistant to PVL and HlgCB. The molecular basis for species specificity of the two toxins in animal models is not completely understood. We show that PVL and HlgCB feature distinct activity toward neutrophils of different mammalian species, where activity of PVL is found to be restricted to fewer species than that of HlgCB. Overexpression of various mammalian C5a receptors in HEK cells confirms that cytotoxicity toward neutrophils is driven by species-specific interactions of the toxins with C5aR1. By taking advantage of the species-specific engagement of the toxins with their receptors, we demonstrate that PVL and HlgCB differentially interact with human C5aR1 and C5aR2. In addition, binding studies illustrate that different parts of the receptor are involved in the initial binding of the toxin and the subsequent formation of lytic pores. These findings allow a better understanding of the molecular mechanism of pore formation. Finally, we show that the toxicity of PVL, but not of HlgCB, is neutralized by various C5aR1 antagonists. This study offers directions for the development of improved preclinical models for infection, as well as for the design of drugs antagonizing leukocidin toxicity.

Material optimization of femoral component of total hip prosthesis using fiber reinforced polymeric composites.

In this report an integrated approach to the three-dimensional material optimization of femoral components of hip prostheses is described. The effectiveness of using reinforced fiber composites for the material optimization of hip implants has been demonstrated and general guidelines on some material design aspects of total hip replacement (THR), in terms of fiber volume fraction and fiber orientation angles, are provided. A modular program was developed to interface the optimization routine with the finite element code. In this study two cases of cemented and non-cemented THR were investigated. In both cases perfectly bonded interfaces were assumed. Two objective functions were defined based on interface failure criteria and bone adaptive remodeling to avoid interface disruption and to reduce the risk of bone loss. The overall results demonstrated the effectiveness of the technique, which can provide meaningful insights into the fiber-reinforced composite material design of orthopaedic implants.

Anterior-inferior capsular shift of the shoulder: a biomechanical comparison of glenoid-based versus humeral-based shift strategies.

This study compared the biomechanical effects of an anterior-inferior capsular shift based at the humeral side with one on the glenoid side of the joint on resultant multidirectional glenohumeral translation and rotation. Nine matched pairs of fresh cadaveric shoulders were placed in a testing apparatus that constrained 3 rotations but allowed simultaneous free translation of the humeral head with respect to the glenoid. The right and left shoulders of each of the matched pairs were randomized to undergo either a glenoid-based or humeral-based anterior capsular shift. The shoulders were tested vented and following the capsular shift procedure. Translational testing was performed at 0 degrees, 45 degrees, and 90 degrees of glenohumeral elevation with the humerus in neutral rotation, 30 degrees internal rotation, and 30 degrees external rotation. Sequential loads of 30 N in anterior, posterior, and inferior directions were applied while maintaining a 22-N joint compressive load. The maximum arc of internal and external rotation after application of a 1-newton-meter moment was determined for the vented specimens and then after the capsular shift procedure. Both shift strategies resulted in significant limitation of anterior, posterior, and inferior translation in all of the tested positions. No significant differences were noted between the 2 shift strategies with respect to restriction of translation in the anterior or inferior directions. The glenoid-based shift caused a significantly greater decrease in posterior translation at 45 degrees and 90 degrees of abduction. With respect to rotation, the glenoid-based shift exerted significantly greater restriction on external rotation than the humeral-based shift. This study supports the use of either a humeral-based or glenoid-based shift to control multidirectional glenohumeral instability. Greater reduction in external rotation was demonstrated after the glenoid-based shift. Specific differences demonstrated in translation control for humeral-based versus glenoid-based capsular shift procedures may be useful in tailoring a procedure for specific instability patterns.

Machine vision photogrammetry: a technique for measurement of microstructural strain in cortical bone.

Understanding local microstructural deformations and strains in cortical bone may lead to a better understanding of cortical bone damage development, fracture, and remodeling. Traditional experimental techniques for measuring deformation and strain do not allow characterization of these quantities at the microstructural level in cortical bone. This study describes a technique based on digital stereoimaging used to measure the microstructural strain fields in cortical bone. The technique allows the measurement of material surface displacements and strains by comparing images acquired from a specimen at two distinct stress states. The accuracy of the system is investigated by analyzing an undeformed image set; the test image is identical to the reference image but translated by a known pixel amount. An increase in the correlation sub-image train parameter results in an increase in displacement measurement accuracy from 0.049 to 0.012 pixels. Errors in strain calculated from the measured displacement field were between 39 and 564 microstrain depending upon the sub-image train size and applied image displacement. The presence of a microcrack in cortical bone results in local strain at the crack tip reaching 0.030 (30,000 microstrain) and 0.010 (10,000 microstrain) near osteocyte lacunae. It is expected that the use of this technique will allow a greater understanding of bone strength and fracture as well as bone mechanotransduction.

Activation of endogenous thrombin receptors causes clustering and sensitization of epidermal growth factor receptors of swiss 3T3 cells without transactivation.

The G protein-coupled thrombin receptor can induce cellular responses in some systems by transactivating the epidermal growth factor (EGF) receptor. This is in part due to the stimulation of ectoproteases that generate EGF receptor ligands. We show here that this cannot account for the stimulation of proliferation or migration by thrombin of Swiss 3T3 cells. Thrombin has no direct effect on the activation state of the EGF receptor or of its downstream effectors. However, thrombin induces the subcellular clustering of the EGF receptor at filamentous actin-containing structures at the leading edge and actin arcs of migrating cells in association with other signaling molecules, including Shc and phospholipase Cgamma1. In these thrombin-primed cells, the subsequent migratory response to EGF is potentiated. Thrombin did not potentiate the EGF-stimulated EGF receptor phosphorylation. Thus, in Swiss 3T3 cells the G protein-coupled thrombin receptor can potentiate the EGF tyrosine kinase receptor response when activated by EGF, and this appears to be due to the subcellular concentration of the receptor with downstream effectors and not to the overall ability of EGF to induce receptor transphosphorylation. Thus, the EGF receptor subcellular localization which is altered by thrombin appears to be an important determinant of the efficacy of downstream EGF receptor signaling in cell migration.

The flightless I protein colocalizes with actin- and microtubule-based structures in motile Swiss 3T3 fibroblasts: evidence for the involvement of PI 3-kinase and Ras-related small GTPases.

The flightless I protein contains an actin-binding domain with homology to the gelsolin family and is likely to be involved in actin cytoskeletal rearrangements. It has been suggested that this protein is involved in linking the cytoskeletal network with signal transduction pathways. We have developed antibodies directed toward the leucine rich repeat and gelsolin-like domains of the human and mouse homologues of flightless I that specifically recognize expressed and endogenous forms of the protein. We have also constructed a flightless I-enhanced green fluorescent fusion vector and used this to examine the localization of the expressed protein in Swiss 3T3 fibroblasts. The flightless I protein localizes predominantly to the nucleus and translocates to the cytoplasm following serum stimulation. In cells stimulated to migrate, the flightless I protein colocalizes with beta-tubulin- and actin-based structures. Members of the small GTPase family, also implicated in cytoskeletal control, were found to colocalize with flightless I in migrating Swiss 3T3 fibroblasts. LY294002, a specific inhibitor of PI 3-kinase, inhibits the translocation of flightless I to actin-based structures. Our results suggest that PI 3-kinase and the small GTPases, Ras, RhoA and Cdc42 may be part of a common functional pathway involved in Fliih-mediated cytoskeletal regulation. Functionally, we suggest that flightless I may act to prepare actin filaments or provide factors required for cytoskeletal rearrangements necessary for cell migration and/or adhesion.

Effects of loading conditions and objective function on three-dimensional shape optimization of femoral components of hip endoprostheses.

A numerical procedure was implemented for the three-dimensional (3D) shape optimization of the femoral component in total hip replacement. An algorithm was developed for defining the component geometry in terms of longitudinal and cross-sectional shape variables. The 3D design model was combined with a 3D finite element analysis and a numerical optimization procedure. An idealized femoral geometry and perfectly bonded interfaces were used for cemented and uncemented implants. The design objective was to smooth some measure of the stresses along the local interface. The effects of two different load conditions and several different objective functions were examined. A common initial implant design was used for all cases. The general trend in all design optimization was to produce a somewhat bulky implant with a rectangular cross-section. The outcome was more strongly affected by loading condition than the choice of objective function. The use of a strain energy density criterion as the objective function proved to be the most effective in reducing all equivalent stress criteria.

Insulin induces epidermal growth factor (EGF) receptor clustering and potentiates EGF-stimulated DNA synthesis in swiss 3T3 cells: a mechanism for costimulation in mitogenic synergy.

In many cellular systems, activation with more than one ligand can produce a cellular response that is greater than the sum of the individual responses to the ligands. This synergy is sometimes referred to as coactivation. In Swiss 3T3 fibroblasts, activation of the epidermal growth factor (EGF) receptor produces a weak induction of DNA synthesis. Insulin has no stimulatory effect on this response. However, in combination, EGF and insulin synergize to cause a large induction of S phase. The underlying cellular biochemistry of this effect has been examined. The data indicate that phospholipase C activation is a major component of agonist-induced DNA synthesis. In contrast, activation of p70 S6 kinase by single agonists was inversely related to their ability to stimulate DNA synthesis. Therefore, it was examined whether stimulation of Swiss 3T3 cells with insulin causes changes in the subcellular distribution of EGF receptors and phospholipase Cgamma1 that could potentially explain the observed synergy or costimulation. It was found that insulin effectively induced the accumulation of EGF receptors on the actin arc of cells without activation of the EGF receptor. In contrast, EGF, when added for several hours, did not cause accumulation of the EGF receptor at this site. However, both EGF and insulin stimulated the accumulation of phospholipase Cgamma1 at the actin arc, which was coincident with the EGF receptor in the case of insulin- stimulated cells. Therefore, it is suggested that the insulin-induced coclustering of the EGF receptor with phospholipase Cgamma1 at the actin arc may allow for greater efficiency of signal transduction, resulting in the synergy observed for these two hormones in stimulation of DNA synthesis.

The flightless I protein localizes to actin-based structures during embryonic development.

The product of the flightless I gene is predicted to provide a link between molecules of an as yet unidentified signal transduction pathway and the actin cytoskeleton. Previous work has shown that weak and severe mutations of the flightless I locus in Drosophila melanogaster cause disruption in the indirect flight muscles and in embryonic cellularization events, respectively, indicative of a regulatory role for the flightless I protein in cytoskeletal rearrangements. A C-terminal domain within flightless I with significant homology to the gelsolin-like family of actin-binding proteins has been identified, but evidence of a direct interaction between endogenous flightless I and actin remains to be shown. In the present study, chick, mouse and Drosophila melanogaster embryos have been examined and the localization of flightless I investigated in relation to the actin cytoskeleton. It is shown that flightless I localization is coincident with actin-rich regions in parasympathetic neurons harvested from chicks, in mouse blastocysts and in structures associated with cellularization in Drosophila melanogaster.

The effects of processing and low dose irradiation on cortical bone grafts.

The authors studied the effects of standard processing and preprocessing low dose gamma irradiation (1.5 Mrad) on the strength and incorporation of syngeneic and allogeneic cortical bone grafts. Bilateral femoral middiaphyseal 8-mm segmental defects in 120 male Fisher rats were stabilized with internal fixation. Each defect received one of six types of grafts: fresh syngeneic, processed syngeneic, irradiated processed syngeneic, fresh allogeneic, processed allogeneic, and irradiated processed allogeneic grafts. Graft processing included soaking in 70% ethanol and deep freezing for preservation. Irradiation was performed by 60Co source immediately before processing. Grafts were evaluated by histologic analysis, histomorphometric analysis, and biomechanical testing at 4 and 6 months after surgery. Graft treatment, either processing or irradiation processing, did not affect consistently or significantly the incorporation of syngeneic or allogeneic grafts. Graft allogenicity was the major determinant of the revascularization and the histologic pattern of graft incorporation. Processed and irradiated processed allogeneic grafts gained compressive strength with time and were as strong as syngeneic grafts at 6 months. Biomechanical and histologic data from this study suggest that standard processing and preprocessing low dose irradiation do not compromise the natural course of allogeneic cortical bone graft incorporation.

The molecules of memory.

Identifying the key components in the molecular mechanisms of learning and memory is a highly complex process. Here we look at some specific experimental research that has contributed to our knowledge of molecular memory.

A damage model for nonlinear tensile behavior of cortical bone.

To describe the time-dependent nonlinear tensile behavior observed in experimental studies of cortical bone, a damage model was developed using two internal state variables (ISV's). One ISV is a damage parameter that represents the loss of stiffness. A rule for the evolution of this ISV was defined based on previously observed creep behavior. The second ISV represents the inelastic strain due to viscosity and internal friction. The model was tested by simulating experiments in tensile and bending loading. Using average values from previous creep studies for parameters in the damage evolution rule, the model tended to underestimate the maximum nonlinear strains and to overestimate the nonlinear strain accumulated after load reversal in the tensile test simulations. Varying the parameters for the individual tests produced excellent fits to the experimental data. Similarly, the model simulations of the bending tests could produce excellent fits to the experimental data. The results demonstrate that the 2-ISV model combining damage (stiffness loss) with slip and viscous behavior could capture the nonlinear tensile behavior of cortical bone in axial and bending loading.

Biomechanical issues in bone transplantation.

Because the biomechanical competence of the graft is a central issue, many research studies of bone grafts include a biomechanical component. The biomechanical evaluation serves as a bottom-line measure of the experimental outcome in which some measure of mechanical performance is compared among treatment groups. This article considers the biomechanics of grafts in the context of this experimental work and focuses on three issues: (1) the interplay between biology and biomechanics of grafts, (2) the effects of treatment choices on biomechanical properties, and (3) model factors that may influence biomechanical performance.

The role of the lamellar interface during torsional yielding of human cortical bone.

Fragility fractures are a result of alterations in bone quantity, tissue properties, applied loads, or a combination of these factors. The current study addresses the contribution of cortical bone tissue properties to skeletal fragility by characterizing the shear damage accumulation processes which occur during torsional yielding in normal bone. Samples of human femoral cortical bone were loaded in torsion and damaged at a post-yield twist level. The number of microcracks within osteons, interstitial tissue, and along cement lines were assessed using basic fuchsin staining. Damage density measures (number of cracks/mm2) were correlated with stiffness degradation and changes in relaxation. Damaged samples exhibited a wide variation in total microcrack density, ranging from 1.1 to 43.3 cracks/mm2 with a mean density of 19.7 +/- 9.8 cracks/mm2. Lamellar interface cracks comprised more than 75% of the total damage, indicating that the lamellar interface is weak in shear and is a principal site of shear damage accumulation. Damage density was positively correlated with secant stiffness degradation, but only explained 22% of the variability in degradation. In contrast, damage density was uncorrelated with the changes in relaxation, indicating that a simple crack counting measure such as microcrack density was not an appropriate measure of relaxation degradation. Finally, a nonuniform microcrack density distribution was observed, suggesting that internal shear stresses were redistributed within the torsion samples during post-yield loading. The results suggested that the lamellar interface in human cortical bone plays an important role in torsional yielding by keeping cracks physically isolated from each other and delaying microcrack coalescence in order to postpone the inevitable formation of the fatal crack.

Inelastic strain accumulation in cortical bone during rapid transient tensile loading.

An experimental study examined the tensile stress-strain behavior of cortical bone during rapid load cycles to high strain amplitudes. Machined bovine and human cortical bone samples were subjected to loading cycles at a nominal load/unload rate of +/- 420 MPa/s. Loads were reversed at pre selected strain levels such that load cycles were typically completed in 0.5-0.7 seconds. Axial strain behavior demonstrated considerable nonlinearity in the first load cycle, while transverse strain behavior was essentially linear. For the human bone 29.1 percent (S.D. = 4.7 percent), and for the bovine bone 35.1 percent (S.D. = 10.8 percent) of the maximum nonlinear strain accumulated after load reversal, where nonlinear strain was defined as the difference between total strain and strain corresponding to linear elastic behavior. Average residual axial strain on unloading was 35.4 percent (S.D. = 1.2 percent) for human bone and 35.1 percent (S.D. = 2.9 percent) of maximum nonlinear strain. Corresponding significant volumetric strains and residual volumetric strains were found. The results support the conclusions that the nonlinear stress-strain behavior observed during creep loading also occurs during transient loading at physiological rates. The volume increases suggest that damage accumulation, i.e., new internal surfaces and voids, plays a major role in this behavior. The residual volume increases and associated disruptions in the internal structure of bone provide a potential stimulus for a biological repair response.

Osseointegration of surface-blasted implants made of titanium alloy and cobalt-chromium alloy in a rabbit intramedullary model.

The purpose of this study was to compare the osseointegration of surface-blasted Ti6A14V and CoCr implants in vivo. Ti6A14V and CoCr rods blasted with 710 microm A12O3 particles were bilaterally press-fit into the medullary space of distal femora of 24 rabbits. Evaluation was made radiographically, histologically, histomorphometrically (3, 6, and 12 weeks after implantation), and mechanically (12 weeks). Both Ti6A14V and CoCr implants demonstrated good biocompatibility radiographically and histologically. Toluidine blue-stained sections revealed an osteoconductive effect of the blasted surface, and fluorochrome labeling analysis showed active bone formation at the bone-implant interface at as late as 12 weeks for both specimens. CoCr showed significantly lower interfacial shear strength than Ti6A14V although the bone contact area with the implant surface was comparable and no intervening soft tissue at the bone-implant interface could be seen for either implant by scanning electron microscopy backscatter analysis. Unmineralized tissue (cartilage and osteoid) was observed more frequently on the CoCr surface than on the Ti6A14V surface. These data show less osseointegration of CoCr implants with this blasted surface for this short period, possibly due to a slight difference in surface roughness and some negative effects of CoCr on bone attachment.

A kinematic study of the cervical spine before and after segmental arthrodesis.

STUDY DESIGN: The acute kinematic consequence of segmental arthrodesis in the cervical spine on the remaining open motion segments was studied in a cadaveric model. OBJECTIVES: To evaluate the distribution of motion across unfused cervical motion segments after a segmental arthrodesis. The applied load was determined as a function of arthrodesis length and level by using a fixed range of motion for the cervical spine (C2-T1). SUMMARY OF BACKGROUND DATA: An increased incidence of degenerative disease may exist at the levels immediately adjacent to a cervical arthrodesis as a result of alteration in biomechanical behavior at these levels. METHODS: One-, two-, and three-level fusions were simulated in multilevel ligamentous human cervical spines. Specimens were tested nondestructively through a 30 degrees range of sagittal plane rotation. Motion was recorded using three-dimensional stereophotogrammetry. Sagittal plane rotation of each motion segment in the fusion models was compared with the corresponding rotation in the unfused specimen. RESULTS: In the C2-C4 fusion, the increase in motion at C5-C6 was statistically less (P < 0.05) than the increase at C7-T1. In the C2-C5 fusion, the increase in motion at C5-C6 was statistically less (P < 0.05) than the increases at C6-C7 and C7-T1. For each of the five other fusion types tested, no statistical differences existed between the increases in sagittal rotation at any of the open motion segments. The bending moment necessary to produce 30 degrees of sagittal rotation increased nonlinearly as the number of motion segments fused increased. CONCLUSIONS: Under what was considered a realistic loading paradigm, sagittal plane rotation was not increased disproportionately at the motion segments immediately adjacent to a segmental arthrodesis in the cervical spine. The nonlinear rise in applied bending moment to achieve constant displacement was characteristic of the behavior of the ligaments and intervertebral discs throughout the spine as they underwent increasing deformation.