Real-time visual feedback can cue changes in grip force during electric hand tool operation.

Objectives. Grip force applied during repetitive hand tool use varies amongst individuals and some apply more force than necessary. Augmented feedback may help modify grip force to reduce the risk of developing cumulative trauma disorders but has been scarcely investigated during electric hand tool operation. This study evaluated the feasibility of using real-time visual feedback to modify grip force and forearm electromyography (EMG) during electric hand tool operation. A secondary objective was to evaluate the effect of hand and tool orientation on any effects of visual feedback. Methods. Grip force and forearm muscle EMG were recorded as participants fastened bolts at three locations (low, high and overhead) using an electric pistol-grip nut-runner, without and with visual feedback. Results. Feedback decreased grip force (36.1% decrease; p < 0.001) and EMG of three wrist flexor muscles (22.8-33.0%; p < 0.008). Grip force and EMG also differed between fastening locations, but there were no interactions with condition (baseline and feedback; p > 0.266), suggesting that visual feedback can modify grip force across varying hand and tool orientations. Conclusion. Visual feedback can successfully modify grip force during hand tool operation. However, further investigation is needed to understand how to appropriately implement visual feedback during hand tool operation.

Computational study of extrinsic factors affecting ACL strain during single-leg jump landing.

BACKGROUND: Non-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain. METHODS: 3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen's ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants. RESULTS: The maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05). CONCLUSIONS: Soft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.

Characterizing In-Situ Metatarsal Fracture Risk During Simulated Workplace Impact Loading.

Metatarsal fractures represent the most common traumatic foot injury; however, metatarsal fracture thresholds remain poorly characterized, which affects performance targets for protective footwear. This experimental study investigated impact energies, forces, and deformations to characterize metatarsal fracture risk for simulated in situ workplace impact loading. A drop tower setup conforming to ASTM specifications for testing impact resistance of metatarsal protective footwear applied a target impact load (22-55 J) to 10 cadaveric feet. Prior to impact, each foot was axially loaded through the tibia with a specimen-specific bodyweight load to replicate a natural weight-bearing stance. Successive iterations of impact tests were performed until a fracture was observed with X-ray imaging. Descriptive statistics were computed for force, deformation, and impact energy. Correlational analysis was conducted on donor age, BMI, deformation, force, and impact energy. A survival analysis was used to generate injury risk curves (IRC) using impact energy and force. All 10 specimens fractured with the second metatarsal being the most common fracture location. The mean peak energy, force, and deformation during fracture were 46.6 J, 4640 N, 28.9 mm, respectively. Survival analyses revealed a 50% fracture probability was associated with 35.8 J and 3562 N of impact. Foot deformation was not significantly correlated (p = 0.47) with impact force, thus deformation is not recommended to predict metatarsal fracture risk. The results from this study can be used to improve test standards for metatarsal protection, provide performance targets for protective footwear developers, and demonstrate a methodological framework for future metatarsal fracture research.

Biomechanical Comparison of 3 Medial Patellofemoral Complex Reconstruction Techniques Shows Medial Overconstraint but No Significant Difference in Patella Lateralization and Contact Pressure.

PURPOSE: The purpose of this study was to investigate biomechanical differences of medial patellofemoral ligament (MPFL) reconstruction, medial quadriceps tendon femoral ligament (MQTFL) reconstruction, and a combination of these techniques to restore lateral patellar constraint and contact pressures. METHODS: Eight fresh frozen cadaver knees were mounted to a custom jig with physiological quadriceps tendon loading. Flexion angles and contact pressure (CP) were dynamically measured using Tekscan® pressure sensors and Polhemus® Liberty 6 degree of freedom (6DOF) positioning sensors in the following conditions: 1) intact 2) MPFL and MQTFL deficient, 3) MPFL reconstructed, 4) Combined MPFL + MQTFL reconstructed, and 5) MQTFL reconstructed. Lateral patellar translation was tested using horizontally directed 30 N force applied at 30° of knee flexion. The knees were flexed in dynamic fashion, and CP values were recorded for 10°, 20°, 30°, 50°, 70°, and 90° degrees of flexion. Group differences were assessed with ANOVA's followed by pairwise comparisons with Bonferroni correction. RESULTS: MPFL (P = .002) and combined MPFL/MQTFL (P = .034) reconstruction significantly reduced patellar lateralization from +19.28% (9.78%, 28.78%) in the deficient condition to -17.57% (-27.84%, -7.29%) and -15.56% (-33.61%, 2.30%), respectively. MPFL reconstruction was most restrictive and MQTFL reconstruction the least -7.29% (-22.01%, 7.45%). No significant differences were found between the three reconstruction techniques. Differences in CP between the three reconstruction techniques were not significant (<.02 MPa) at all flexion angles. CONCLUSION: The present study found no significant difference for patellar lateralization and patellofemoral CP between MPFL, combined MPFL/MQTFL, and MQTFL reconstruction. All 3 techniques resulted in stronger lateral patellar constraint compared to the native state, while the MQTFL reconstruction emulated the intact state the closest. CLINICAL RELEVANCE: Various surgical techniques for medial patellofemoral complex reconstruction can restore patellar stability with similar patellofemoral articular pressures.

In-Situ Fracture Tolerance of the Metatarsals During Quasi-Static Compressive Loading of the Human Foot.

Accidental foot injuries including metatarsal fractures commonly result from compressive loading. The ability of personal protective equipment to prevent these traumatic injuries depends on the understanding of metatarsal fracture tolerance. However, the in situ fracture tolerance of the metatarsals under direct compressive loading to the foot's dorsal surface remains unexplored, even though the metatarsals are the most commonly fractured bones in the foot. The goal of this study was to quantify the in situ fracture tolerance of the metatarsals under simulated quasi-static compressive loading. Fresh-frozen cadaveric feet (n = 10) were mounted into a testing apparatus to replicate a natural stance and loaded at the midmetatarsals with a cylindrical bar to simulate a crushing-type injury. A 900 N compressive force was initially applied, followed by 225 N successive load increments. Specimens were examined using X-ray imaging between load increments to assess for the presence of metatarsal fractures. Descriptive statistics were conducted for metatarsal fracture force and deformation. Pearson correlation tests were used to quantify the correlation between fracture force with age and body mass index (BMI). The force and deformation at fracture were 1861 ± 642 N (mean ± standard deviation) and 22.6 ± 3.4 mm, respectively. Fracture force was correlated with donor BMI (r = 0.90). Every fractured specimen experienced a transverse fracture in the second metatarsal. New biomechanical data from this study further quantify the metatarsal fracture risk under compressive loading and will help to improve the development and testing of improved personal protective equipment for the foot to avoid catastrophic injury.

The effects of pistol grip power tools on median nerve pressure and tendon strains.

Objectives. Tendonitis and carpal tunnel syndrome are common cumulative trauma disorders that can occur with repetitive usage of pistol grip power tools. The role of reaction torque resulting in a forceful rotary displacement of the tool handle, as well as the role of applied grip force, is not clear in the development of these disorders. This study aimed to quantify the flexor tendon strains and median nerve pressure during a typical power tool operation securing a threaded fastener. Methods. Six fresh-frozen cadaver arms were made to grip a replica pistol grip power tool using static weights to apply muscle forces. A 5-Nm torque was applied to the replica power tool. The median nerve pressure and strains in the flexor digitorum profundus and superficialis tendons were measured using a catheter and strain gauges, at three wrist flexion angles. Results. The peak tendon strains were between 1.5 and 2% and were predominantly due to the grip force more than the transmitted torque. Median nerve pressure significantly increased with the wrist flexed versus extended. Conclusion. The results indicate that the contribution of the grip force to the tendon strain and median nerve pressure was greater than the contribution from the reaction torque.

Isolating In-Situ Grip and Push Force Distribution from Hand-Handle Contact Pressure with an Industrial Electric Nutrunner.

OBJECTIVES: Grip force during hand tool operation is the primary contributor to tendon strain and related wrist injuries, whereas push force is a contributor to shoulder injuries. However, both cannot be directly measured using a single measurement instrument. The objective of this research was to develop and test an algorithm to isolate the grip and push force distributions from in-situ hand-handle pressure measurements and to quantify their distributions among industrial workers using an electric nutrunner. METHODS: Experienced automobile assembly line workers used an industrial nutrunner to tighten fasteners at various locations and postures. The pressure applied by the hand on the tool handle was measured dynamically using pressure sensors mounted on the handle. An algorithm was developed to compute the push force applied to the handle of an electric pistol-grip nutrunner based on recorded pressure measurements. An optimization problem was solved to find the contribution of each measured pressure to the actual pushing force of the tool. Finally, the grip force was determined from the difference between the measured pressure and the calculated pushing pressure. RESULTS: The grip force and push force were successfully isolated and there was no correlation between the two forces. The computed grip force increased from low to high fastener locations, whereas the push force significantly increased during overhead fastening. A significant difference across the participants' computed grip forces was observed. The grip force distribution showed that its contribution to total hand force was larger than other definitions in the literature. CONCLUSIONS: The developed algorithm can aid in better understanding the risk of injury associated with different tasks through the notion of grip and push force distribution. This was shown to be important as even workers with considerable power tool experience applied significantly more grip and push force than other participants, all of whom successfully completed each task. Moreover, the fact that both forces were uncorrelated shows the need for extracting them independently.

Prognostic determinants of locally advanced buccal mucosa cancer: Do we need to relook the current staging criteria?

OBJECTIVES: Current guidelines advocate non-surgical treatment for T4b buccal mucosa carcinoma with surgery preferred in other stages. We investigated oncologic outcomes of this cohort in comparison with T4a cohort, treated by similar multi-modality approach of primary surgery followed by adjuvant treatment and identified prognostic determinants of survival. MATERIALS AND METHODS: Oncologic outcome of prospectively accrued 282 patients with cT4a and cT4b buccal mucosa squamous cell carcinoma were evaluated for overall survival (OS) and disease free survival (DFS) at 2 years of the whole cohort and for the subgroups of T4a and T4b patients. Multivariate Cox proportional hazards regression analysis was performed to identify prognostic determinants. RESULTS: Of 277 eligible patients treated and followed for a median period of 21 months, the OS was comparable between T4a and T4b as 64% vs 58%, (p = 0.354). The DFS between the two subgroups was 64% vs 61%, (p = 0.316). Although there was 47% pathologic down staging from the clinical stage, there was no significant difference in oncologic outcome between pT4a and pT4b (OS, 57% vs 58% for T4a and T4b, p = 0.687; DFS, 58% vs 60% for T4a and T4b, p = 0.776). On multivariate analysis, extra capsular spread (p = 0.042), lateral pterygoid muscle involvement (p = 0.035) and defaulting adjuvant treatment (p < 0.001) were independent predictors of outcome for the T4b cohort when other factors were controlled. CONCLUSIONS: Primary surgery followed by adjuvant chemo-radiotherapy offers comparable results in selected T4b gingiva and buccal mucosal cancer, suggesting the need to relook the staging criteria for oral cavity cancer.

The effect of unloader knee braces on medial meniscal strain.

BACKGROUND:: A medial meniscal tear is a common knee injury, especially following an anterior cruciate ligament injury. Decreasing the compressive force on the medial meniscus during dynamic activities using an unloader knee brace could reduce meniscal strain, effectively reducing injury risk and/or severity. OBJECTIVES:: To investigate the efficacy of two unloader knee braces on medial meniscus strain during dynamic activities in intact & deficient anterior cruciate ligament states. STUDY DESIGN:: Combined in vivo/in vitro study. METHODS:: In vivo knee kinematics and muscle force profiles from a healthy individual performing single/doubleleg squats and walking motions were simulated on 10 cadaveric specimens using a dynamic knee simulator system. Simulations were performed on knees in unbraced and braced scenarios, with and without the anterior cruciate ligament. Anterior and posterior medial meniscal strains were measured. RESULTS:: Two different braces each showed a significant reduction in the posteromedial meniscal strain ( p ⩽ 0.01) in an intact anterior cruciate ligament state. Neither brace mirrored this result for the anteromedial strain ( p > 0.05). In the deficient anterior cruciate ligament state, the braces had no significant effect on strain ( p > 0.05). CONCLUSION:: Two unloader knee braces effectively reduced strain in the medial meniscus with an intact anterior cruciate ligament during dynamic activities. Neither brace made a significant reduction in strain for anterior cruciate ligament-deficient knees. CLINICAL RELEVANCE: Unloader knee braces could be used to reduce the medial meniscus strain following meniscal surgery and during rehabilitation in patients with an isolated medial meniscus injury. However, these braces cannot be recommended for this purpose in patients with an anterior cruciate ligament deficiency.

The Effects of Filter Cutoff Frequency on Musculoskeletal Simulations of High-Impact Movements.

Estimation of muscle forces through musculoskeletal simulation is important in understanding human movement and injury. Unmatched filter frequencies used to low-pass filter marker and force platform data can create artifacts during inverse dynamics analysis, but their effects on muscle force calculations are unknown. The objective of this study was to determine the effects of filter cutoff frequency on simulation parameters and magnitudes of lower-extremity muscle and resultant joint contact forces during a high-impact maneuver. Eight participants performed a single-leg jump landing. Kinematics was captured with a 3D motion capture system, and ground reaction forces were recorded with a force platform. The marker and force platform data were filtered using 2 matched filter frequencies (10-10 Hz and 15-15 Hz) and 2 unmatched filter frequencies (10-50 Hz and 15-50 Hz). Musculoskeletal simulations using computed muscle control were performed in OpenSim. The results revealed significantly higher peak quadriceps (13%), hamstrings (48%), and gastrocnemius forces (69%) in the unmatched (10-50 Hz and 15-50 Hz) conditions than in the matched (10-10 Hz and 15-15 Hz) conditions (P < .05). Resultant joint contact forces and reserve (nonphysiologic) moments were similarly larger in the unmatched filter categories (P < .05). This study demonstrated that artifacts created from filtering with unmatched filter cutoffs result in altered muscle forces and dynamics that are not physiologic.

Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain.

PURPOSE: The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities. METHODS: A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions. RESULTS: The brace lowered peak and average meniscal strain in ACL deficient knees (P < 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (P < 0.05). CONCLUSIONS: This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees. LEVEL OF EVIDENCE: II.

Cysteinyl leukotriene receptor 1 facilitates tumorigenesis in a mouse model of colitis-associated colon cancer.

Cysteinyl leukotriene receptor 1 (CysLT1R) has been shown to be up-regulated in the adenocarcinomas of colorectal cancer patients, which is associated with a poor prognosis. In a spontaneous model of colon cancer, CysLT1R disruption was associated with a reduced tumor burden in double-mutant female mice (ApcMin/+/Cysltr1-/-) compared to ApcMin/+ littermates. In the current study, we utilized a genetic approach to investigate the effect of CysLT1R in the induced azoxymethane/dextran sulfate sodium (AOM/DSS) model of colitis-associated colon cancer. We found that AOM/DSS female mice with a global disruption of the Cysltr1 gene (Cysltr1-/-) had a higher relative body weight, a more normal weight/length colon ratio and smaller-sized colonic polyps compared to AOM/DSS wild-type counterparts. The Cysltr1-/- colonic polyps exhibited low-grade dysplasia, while wild-type polyps had an adenoma-like phenotype. The Cysltr1-/- colonic polyps exhibited significant decreases in nuclear ß-catenin and COX-2 protein expression, while the normal crypts surrounding the polyps exhibited increased Mucin 2 expression. Furthermore, Cysltr1-/- mice exhibited an overall reduction in inflammation, with a significant decrease in proinflammatory cytokines, polyp 5-LOX expression and infiltration of CD45 leukocytes and F4/80 macrophages. In conclusion, the present genetic approach in an AOM/DSS model further supports an important role for CysLT1R in colon tumorigenesis.

Perforator Peroneal Artery Flap for Tongue Reconstruction.

INTRODUCTION: Reconstruction has evolved long way from primary closure to flaps. As time evolved, better understanding of vascularity of flap has led to the development of innovative reconstructive techniques. These flaps can be raised from various parts of the body for reconstruction and have shown least donor site morbidity. We use one such peroneal artery perforator flap for tongue reconstruction with advantage of thin pliable flap, minimal donor site morbidity and hidden scar. MATERIALS AND METHODS: Our patient 57yrs old lady underwent wide local excision with selective neck dissection. Perforators are marked about 10 and 15 cm inferiorly from the fibular head using hand held Doppler. Leg is positioned in such a way to give better exposure during dissection of the flap and flap is harvested under a tourniquet with pressure kept 350 mm Hg. The perforator is kept at the eccentric location, so as to gain length of the pedicle. Skin incison is placed over the peroneal muscle and deepened unto the deep facia, then the dissection is continued over the muscle and the perforator arising from the lateral septum. The proximal perforator about 10 cm from the fibular head is a constant perforator and bigger one, which is traced up to the peroneal vessel. We could get a 6 cm of pedicle length. Finally the flap is islanded on this perforator and the pedicle is ligated and flap harvested. Anastamosis was done to the ipsilateral side to facial vessels. The donor site is closed primarily and in the upper half one can harvest 5 cm width flap without requiring a skin graft along with a length of 8 to 12 cm. DISCUSSION: Various local and free flap has been used for reconstruction of partial tongue defects with its obvious donor site problems, like less pliable skin and not so adequate tissue from local flaps and sacrificing a important artery as in radial forearm flap serves as the work horse in reconstruction of partial tongue defects, Concept of super microsurgery was popularized by Japanese in 1980s and the concept of angiosome proposed by Taylor paved the way for development of new flaps. True perforator flaps are those where the source vessel is left undisturbed and overlying skin flap is raised. Yoshimura proposed cutaneous flap could be raised from peroneal artery (Br J Plast Surg 42:715-718, 1989). Wolff et al. (Plast Reconstr Surg 113:107-113, 2004) first used perforator based peroneal artery flap for oral reconstruction. Location of perforators vary, hence pre operative localisation can be done by ultrasound doppler, CT angio or MR angiography. Disadvantages over radial flap include varying anatomic location of perforators, need for imaging and difficult dissection of delicate vessels through muscles and hence a learning curve. Our patient had an arterial thrombus within few hours post-operatively which was successfully salvaged with immediate re-exploration and re-anastomosis of artery. Post-operative healing was uneventful and donor site was closed primarily without the need for graft. CONCLUSIONS: Perforator peroneal flap serves as a useful armamentarium for reconstruction of moderate size defects of tongue, buccal mucosa and floor of mouth with advantages of thin pliable flap, minimal donor site morbidity and hidden scar.

Bi-paddled radial forearm free flap in the reconstruction of bilateral buccal mucosal defects-a case series.

Oral submucous fibrosis is a commonly encountered clinical problem in the Indian subcontinent. Treatment with surgery and reconstruction with appropriate flap, followed by vigorous physiotherapy is the ideal management. We report three advanced cases that were successfully managed and rehabilitated with bi-paddled radial forearm free flaps. Mean preoperative mouth opening was 3 mm, and mean postoperative mouth opening was found to be 27 mm after 18 months of follow-up. Thus, instead of two flaps, use of a single-donor-site, bi-paddled radial forearm free flap, is recommended for the reconstruction of bilateral buccal defects resulting from oral submucous fibrosis release.

The eicosanoids leukotriene D4 and prostaglandin E2 promote the tumorigenicity of colon cancer-initiating cells in a xenograft mouse model.

BACKGROUND: Colorectal cancer is one of the most common types of cancers worldwide. Recent studies have identified cancer-initiating cells (CICs) as a subgroup of replication-competent cells in the development of colorectal cancer. Although it is understood that an inflammation-rich tumor microenvironment presumably supports CIC functions, the contributory factors are not very well defined. The present study advances our understanding of the role of the eicosanoids leukotriene D4 (LTD4) and prostaglandin E2 (PGE2) in the tumorigenic ability of CICs and investigates the consequential changes occurring in the tumor environment that might support tumor growth. METHODS: In this study we used human HCT-116 colon cancer ALDH(+) cells in a nude mouse xenograft model. Protein expression and immune cell was determined in tumor-dispersed cells by flow cytometry and in tumor sections by immunohistochemistry. mRNA expressions were quantified using RT-q-PCR and plasma cytokine levels by Multiplex ELISA. RESULTS: We observed that LTD4 and PGE2 treatment augmented CIC-induced tumor growth. LTD4-and PGE2-treated xenograft tumors revealed a robust increase in ALDH and Dclk1 protein expression, coupled with activated ß-catenin signaling and COX-2 up-regulation. Furthermore, LTD4 or PGE2 accentuated the accumulation of CD45 expressing cells within xenograft tumors. Further analysis revealed that these infiltrating immune cells consisted of neutrophils (LY6G) and M2 type macrophages (CD206(+)). In addition, LTD4 and PGE2 treatment significantly elevated the plasma levels of cysteinyl leukotrienes and PGE2, as well as levels of IL-1ß, IL-2, IL-6, TNF-α and CXCL1/KC/GRO. In addition, increased mRNA expression of IL-1ß, IL-6 and IL-10 were detected in tumors from mice that had been treated with LTD4 or PGE2. CONCLUSION: Our data suggest that both LTD4 and PGE2 promote CICs in initiating tumor growth by allowing modifications in the tumor environment. Our data indicate that new therapeutic strategies targeting eicosanoids, specifically LTD4 and PGE2, could be tested for better therapeutic management of colon cancer.

Cysteinyl leukotriene 1 receptor influences intestinal polyp incidence in a gender-specific manner in the ApcMin/+ mouse model.

There is emerging literature emphasizing the role of inflammatory eicosanoids, including prostaglandins and leukotrienes, in cancer development. Increased expression of both the cysteinyl leukotriene receptor 1 (CysLTR1) and the enzyme responsible for the production of leukotrienes, 5-lipoxygenase, is associated with poor prognosis in patients with colorectal adenocarcinomas. Apc mutation is an early event in the development of sporadic and hereditary (familial adenomatous polyposis) colorectal cancer. We utilized the Apc(Min/+) mouse model of familial adenomatous polyposis/sporadic colorectal cancer to investigate the role of CysLTR1 in intestinal tumorigenesis by crossing Apc(Min/+) mice with mice lacking the Cysltr1 gene. We could observe a reduced tumor burden in the small intestine of double-mutant female (Cysltr1 (-/-) Apc (Min/+) ) but not double-mutant male mice, compared with gender-matched single-mutant (Cysltr1 (+/+) Apc (Min/+) ) mice. This reduction was in a Cysltr1-dependent manner, female double-mutant mice having significantly reduced tumor formation compared with control littermates. The female double-mutant phenotype was accompanied with decreased systemic inflammation, as evidenced by significantly reduced serum levels of prostaglandin E2 and CysLTs, as well as increased CD3(+)CD8(+) T-cell tumor infiltration. Furthermore, the reduced formation of polyps in double-mutant (Cysltr1 (-/-) Apc (Min/+) ) female mice could in part be explained by the cytotoxic action of CD3(+)CD8(+) T cells in the polyp and reduced nuclear accumulation of ß-catenin in the epithelium of small intestinal polyps. Our results stress the important role that CysLTR1 plays in colorectal cancer and its potential as a therapeutic target in cancer therapy.

Effect of sagittal plane mechanics on ACL strain during jump landing.

The relationships between non-contact anterior cruciate ligament injuries and the underlying biomechanics are still unclear, despite large quantities of academic research. The purpose of this research was to study anterior cruciate ligament strain during jump landing by investigating its correlation with sagittal plane kinetic/kinematic parameters and by creating an empirical model to estimate the maximum strain. Whole-body kinematics and ground reaction forces were measured from seven subjects performing single leg jump landing and were used to drive a musculoskeletal model that estimated lower limb muscle forces. These muscle forces and kinematics were then applied on five instrumented cadaver knees using a dynamic knee simulator system. Correlation analysis revealed that higher ground reaction force, lower hip flexion angle and higher hip extension moment among others were correlated with higher peak strain (p < 0.05). Multivariate regression analyses revealed that intrinsic anatomic factors account for most of the variance in strain. Among the extrinsic variables, hip and trunk flexion angles significantly contributed to the strain. The empirical relationship developed in this study could be used to predict the relative strain between jumps of a participant and may be beneficial in developing training programs designed to reduce an athlete's risk of injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1636-1644, 2016.

Can a knee brace reduce the strain in the anterior cruciate ligament? A study using combined in vivo/in vitro method.

BACKGROUND AND AIM: It is unknown whether prophylactic knee braces can reduce the strain in the anterior cruciate ligament during dynamic activities. TECHNIQUE: An athlete, who had characteristics of high anterior cruciate ligament injury risk, was chosen. A motion capture system (Optotrak Certus; Northern Digital, Waterloo, ON, Canada) was used to record dynamic trials during drop-landing activity of this subject with and without the knee brace being worn. A musculoskeletal model was used to estimate the muscle forces during this activity. A dynamic knee simulator then applied kinematics and muscle forces on a cadaver knee with and without the brace mounted on it. The anterior cruciate ligament strain was measured. DISCUSSION: The peak strain in the anterior cruciate ligament was substantially lower for the braced (7%) versus unbraced (20%) conditions. Functional knee braces could decrease the strain in the anterior cruciate ligament during dynamic activities in a high-risk subject. However, the reduction seems to be a result of altered muscle firing pattern due to the brace. CLINICAL RELEVANCE: Prophylactic knee brace could reduce the strain in the anterior cruciate ligament of high-risk subjects during drop-landing through altered muscle firing pattern associated with brace wear. This could help reduce the anterior cruciate ligament injury risk.

High rotation rate behavior of cervical spine segments in flexion and extension.

Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2-C3 to C7-T1 were dissected from eight donors and were tested to 10 deg of rotation at 1 and 500 deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p < 0.05) of increased stiffness at the higher rotation rate above 4 deg of rotation in flexion and at 8 deg and 10 deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data.