Validation of a Biomechanical Injury and Disease Assessment Platform Applying an Inertial-Based Biosensor and Axis Vector Computation.

Inertial kinetics and kinematics have substantial influences on human biomechanical function. A new algorithm for Inertial Measurement Unit (IMU)-based motion tracking is presented in this work. The primary aims of this paper are to combine recent developments in improved biosensor technology with mainstream motion-tracking hardware to measure the overall performance of human movement based on joint axis-angle representations of limb rotation. This work describes an alternative approach to representing three-dimensional rotations using a normalized vector around which an identified joint angle defines the overall rotation, rather than a traditional Euler angle approach. Furthermore, IMUs allow for the direct measurement of joint angular velocities, offering the opportunity to increase the accuracy of instantaneous axis of rotation estimations. Although the axis-angle representation requires vector quotient algebra (quaternions) to define rotation, this approach may be preferred for many graphics, vision, and virtual reality software applications. The analytical method was validated with laboratory data gathered from an infant dummy leg's flexion and extension knee movements and applied to a living subject's upper limb movement. The results showed that the novel approach could reasonably handle a simple case and provide a detailed analysis of axis-angle migration. The described algorithm could play a notable role in the biomechanical analysis of human joints and offers a harbinger of IMU-based biosensors that may detect pathological patterns of joint disease and injury.

A stochastic model validated with human test data causally associating target vehicle Delta V, occupant cervicocranial biomechanics, and injury during rear-impact crashes.

Even at low to moderate-speeds, rear-end motor vehicle crashes have been strongly associated with occupant cervicocranial biomechanics that lead to head and neck injury. In this paper, we present the development of an analytic mechanics model of occupant head and neck motion as associated with modeled target vehicle Delta V during rear-end vehicular crashes. The inclusion of stochastic mechanical input variables further developed the model beyond the deterministic framework by reflecting aspects of the random nature of real-world crashes and the resulting injuries. This approach led to the characterization of 1000 crash simulations, quantifying Delta V and the resulting probabilistic occupant biomechanics. The model was validated through the direct comparison with 86 published human subject crash tests. Overall, the model slightly underestimated by -2.6% the magnitude of peak head accelerations identified in the literature. The utility of the model allows a forensic biomechanical investigator to customize some of the fundamental input crash parameters and appropriately explore the resulting vehicular mechanics and their direct influence on injury biomechanics.

A temporospatial histomorphometric analysis of bone density adjacent to acid-etched self-tapping dental implants with an external hexagon connection in the female baboon.

OBJECTIVE: To characterize osseointegration as the percent of bone-implant contact (%BIC) along the surface (0.0 mm) as well as at surface profiles 0.5 mm and 1.0 mm lateral to the implant, determining any differences between early occlusally loaded and non-loaded implants. MATERIAL AND METHODS: In ten adult female baboons, 120 dental implants were randomly placed in opposing mandibular and maxillary locations. Eighty sites had two groups of healing (no load) of either 1 (n = 40) or 2 (n = 40) months leading to 3 months of functional loading. These sites received full acid-etched surface implants. The 40 control implants represented healing only periods (no load) for 1 (n = 10), 2 (n = 10), 4 (n = 10), and 5 (n = 10) months. These implants were of a vertically split surface texture design (acid-etched and machined). Block sections and photomicrographs were obtained. Blinded histometric analyses determined the %BIC via a superimposed template. RESULTS: The unloaded groups (1, 2, and 4 months) had higher %BIC compared to the 5-month group (p < 0.0001). The loaded groups exhibited mean bone densities of 59.2% and 55.5% (1-month healing at 0.5 mm and 1.0 mm, respectively) and 61.0% and 57.1% (2-month healing at 0.5 mm and 1.0 mm, respectively) with no significant difference between healing time (p = 0.4118). CONCLUSION: There was a lateral increase in %BIC in the loaded compared to unloaded groups. CLINICAL RELEVANCE: The decrease in bone densities at the 5-month unloaded group suggests that there is a critical earlier time period when dental implants should be placed into functional load.

Application of flexural and membrane stress analysis to distinguish tensile and compressive moduli of biologic materials.

Three-point bending is often used during the mechanical determination of tissue material properties. When taken to failure, the test samples often experience high deformations. The objective of this study was to present beam and plate theories as analytical tools for determining tensile and compressive elastic moduli during the transition from flexure to membrane stress states. Samples of cartilage, a highly flexible connective tissue having differing tensile and compressive moduli, were tested. Three-point bending tests were conducted on auricular (ear) and costal (rib) cartilage harvested from pigs. The influence of span length variation and Poisson's ratio assumptions were statistically assessed. Tensile elastic moduli of the ear (3.886 MPa) and rib (6.131 MPa) were derived from high-deformation bending tests. The functional assessment described here can be applied as a design input approach for tissue reconstruction and tissue engineering, considering both hard and soft tissue applications.

Affordance-Based Surgical Design Methods Considering Biomechanical Artifacts.

Surgical design in personalized medicine is often based on native anatomy, which may not accurately reflect the interaction between native musculoskeletal tissues and biomechanical artifacts. To overcome this problem, researchers have developed alternative methods based on affordance-based design. The design process can be viewed in terms of action possibilities provided by the (biological) environment. Here, we use the affordance-based approach to address possibilities for action offered by biomechanical artifacts. In anterior crucial ligament (ACL) reconstruction, the design goal is to avoid ligament impingement while optimizing the placement of the tibial tunnel. Although in the current rationale for tibial tunnel placement roof impingement is minimized to avoid a negative affordance, we show that tibial tunnel placement can rather aim to constrain the target bounds with respect to a positive affordance. We describe the steps for identifying the measurable invariants and provide a mathematical framework for the surgery affordances within the knee.

Crestal bone loss due to abutment manipulation and an internal silver deposition implant design in a canine model.

OBJECTIVE: The study aimed to evaluate the effect of internal silver coating as a countermeasure to crestal bone loss around implants with or without multiple abutment disconnections/reconnections. MATERIALS AND METHODS: Following tooth extraction, 48 implants with connected healing abutments (24 implants internally coated with elemental silver) were placed in the mandible of eight beagle dogs. Two months after implant surgery one side of the mandible was randomly assigned to four abutment manipulations (disconnection/reconnection) on a weekly basis. At 4 months postoperative, biopsies were obtained and prepared for histomorphometric analysis. RESULTS: Healing abutment manipulation increased crestal bone remodeling when compared to no abutment manipulation (1.28 mm versus 0.92 mm, respectively), although the difference was not statistically significant (p = 0.0836). Overall, an internal silver coating did not provide a statistically sufficient implant treatment characteristic as a countermeasure to crestal bone loss (p = 0.7801). CONCLUSIONS: These findings indicate that the controlled variables explored here (abutment manipulation/internal silver coating) have a limited effect on initial crestal bone loss. CLINICAL RELEVANCE: Abutment manipulation during prosthetic work does not seem to harm the peri-implant soft and hard tissues.

A Deterministic Model of Human Motion Based on Algebraic Techniques and a Sensor Network to Simulate Shoulder Kinematics.

Limiting the quantitative characterization of ambulatory mobility to only the two-dimensional sagittal plane through the investigation of key kinematic parameters, may still inform scientists and bioengineers of critical elements of joint locomotion. This paper presents the initial validation of a deterministic biomechanical gait model that was derived from an inverse kinematic analysis of three-dimensional upper extremity movement. Algebraic methods were applied to generate shoulder flexion and extension angles during a single gait cycle during normal walking. The direct kinematic measurements from a motion capture system were analyzed and compared to the predicted measurements from the algebraic model for eight healthy, human subjects. The predicted results over all subjects varied from the actual joint angle measurements with a nominal amount of mean error (23%), while correlations were quite strong (mean R2 = 0.97). These findings indicate the potential value of deterministic modeling with algebraic techniques as an alternative to existing methods.

The Influence of Vitamin D Metabolism on Gene Expression, Matrix Production and Mineralization During Osteoprecursor Cell-Based Bone Development.

BACKGROUND: Multipotential precursor cell lines derived from human bone marrow, capable of differentiating into cartilage or bone, may provide a useful tissue development model for studying the regulation and metabolism of putative growth and differentiation factors necessary for tissue regeneration. In mammals, the process of bone development depends on the proliferation and differentiation of osteoblast lineage cells, and the subsequent synthesis and mineralization of bone extracellular matrix (ECM). Vitamin D metabolites play a pivotal role in bone and mineral homeostasis, and are positive factors on bone development. Recently, it was demonstrated that a human-derived engineered osteoblast precursor cell line (OPC1), derived from human bone marrow, can metabolize the parental precursor vitamin D3 (vitaD3) to the active steroid 1α,25-dihydroxyvitamin D3 (1,25OH2D3), and elicit an osteogenic response that results in the decrease in proliferation and increase in ECM synthesis during early bone development. The aim in this study is to characterize gene expression, matrix production and mineralization within a bone development model. METHODS: We investigated whether vitaD3 influences bone ECM mineralization in the same manner as 1,25OH2D3 in confluent cultures of OPC1s. In addition, we explored the influence of vitamin D metabolites, in combination with other commonly used osteogenic factors, ascorbic acid, ß-glycerophosphate, dexamethasone (dex) and recombinant human bone morphogenetic protein-2 (rhBMP-2) on the osteoinduction of OPC1. RESULTS: It was demonstrated that OPC1 expresses the mRNA for the enzymatic equipment necessary to convert vitaD3 to 1,25OH2D3, as well as the mRNA expression of the catabolic enzyme known to regulate the concentration of active 1,25OH2D3. It was also demonstrated that mRNA expression for the vitamin D receptor (VDR) was influenced by both vitaD3 and 1,25OH2D3. Differential results using vitamin D metabolites in combination with ascorbic acid, ß-glycerophosphate, dex and/or rhBMP-2 were observed in alkaline phosphatase (ALP) activity and calcium deposition, and mRNA expression of procollagen type I (proColI), osteocalcin (OC) and osteopontin (OP). CONCLUSIONS: Overall it was demonstrated that vitamin D in combination with osteogenic factors influences the temporal bone development sequence in a positive manner.

Biomechanical Analysis of Concealed Pack Load Influences on Terrorist Gait Signatures Derived from Gröbner Basis Theory.

This project examines kinematic gait parameters as forensic predictors of the influence associated with individuals carrying concealed weighted packs up to 20% of their body weight. An initial inverse dynamics approach combined with computational algebra provided lower limb joint angles during the stance phase of gait as measured from 12 human subjects during normal walking. The following paper describes the additional biomechanical analysis of the joint angle data to produce kinetic and kinematic parameters further characterizing human motion. Results include the rotational velocities and accelerations of the hip, knee, and ankle as well as inertial moments and kinetic energies produced at these joints. The reported findings indicate a non-statistically significant influence of concealed pack load, body mass index, and gender on joint kinetics (p>0.05). Ratios of loaded to unloaded kinematics, however, identified some statistical influence on gait (p<0.05). On-going studies are examining an additional subject cohort with greater pack loads in an effort to identify alterations in gait signatures as a counter-terrorism approach.

Novel computational approaches characterizing knee physiotherapy.

A knee joint's longevity depends on the proper integration of structural components in an axial alignment. If just one of the components is abnormally off-axis, the biomechanical system fails, resulting in arthritis. The complexity of various failures in the knee joint has led orthopedic surgeons to select total knee replacement as a primary treatment. In many cases, this means sacrificing much of an otherwise normal joint. Here, we review novel computational approaches to describe knee physiotherapy by introducing a new dimension of foot loading to the knee axis alignment producing an improved functional status of the patient. New physiotherapeutic applications are then possible by aligning foot loading with the functional axis of the knee joint during the treatment of patients with osteoarthritis.

The relationship between vehicle roof crush and head, neck and spine injury in rollover crashes.

BACKGROUND: It is well established that rollover crashes are associated with a higher risk of serious injury and death than other types of crashes. Some of the most serious injuries that can result from a rollover crash are those to the head, neck and spine. The mechanism of injury to these body parts in a rollover is a matter of dispute in the literature. Some authors have concluded that the magnitude of vehicle roof deformation or vertical roof crush resulting from a rollover crash is not causally associated with head and neck injury severity, while others offer support for a causal association between roof crush and the degree of injury. A better understanding of the cause of serious injuries resulting from rollover crashes is important for improving injury prevention. METHODS: This study utilized data from the National Automotive Sampling System--Crashworthiness Data System (NASS-CDS) for the years 1997 through 2007. Both cross-sectional and matched case-control designs along with a new composite injury metric termed the Head, Neck and Spine New Injury Severity Score (HNS-NISS) were used to analyze these data. RESULTS: The cross-sectional analysis demonstrated a 64% (95% CI: 26-114%) increase in the odds of a life-threatening injury as estimated by the HNS-NISS with every 10 cm of increased roof crush. The results of the matched case-control analysis demonstrated a 44% (95% CI: 8-91%) increase in the odds of sustaining any injury to the head, neck or spine with every 10 cm increase in roof crush. CONCLUSION: These results lend statistical support to a causal association between roof crush and head, neck and spine injury severity. Though they do not constitute definitive proof, they do contradict previously published theories suggesting that roof deformation is unrelated to such injuries.

Tracking Knee Joint Functional Axes through Tikhonov Filtering and Plucker Coordinates.

Researchers have reported several compensation methods to estimate bone and joint position from a cluster of skin-mounted markers as influenced by Soft Tissue Artifacts (STA). Tikhonov Regularization Filtering (TRF) as a means to estimate Instantaneous Screw Axes (ISA) was introduced here as a means to reduce the displacement of a rigid body to its simplest geometric form. Recent studies have suggested that the ISA of the knee, i.e., Knee Functional Axes (KFA), might be closely connected to the estimation of constraint forces such as those due to medial and lateral connective tissues. The estimations of ISAs were known to be highly sensitive to noisy data, which may be mathematically ill-posed, requiring smoothing such as that conducted by regularization. The main contribution in this work was to establish the reciprocal connection between the KFA and Ground Reaction Forces (GRF) as a means to estimate joint constraint forces. Presented results compare the computational performance with published kinetic and kinematic joint data generated from an instrumented total knee replacement. Implications of these preliminary findings with respect to dynamic alignment as a functional anatomic metric are discussed.

The stationary configuration of the knee.

BACKGROUND: Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear. METHODS: We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion. These components include the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments and cartilage contact surfaces in the medial and lateral compartments. Their influence on the bony rotation about the instantaneous screw axis is governed by restraining forces along the constraints explored using the principle of reciprocity. RESULTS: Published kinetic and kinematic joint data (American Society of Mechanical Engineers Grand Challenge Competition to Predict In Vivo Knee Loads) are applied to define knee joint function for verification using an available instrumented knee data set. We found that the line of the ground reaction force (GRF) vector is very close to the axis of the knee joint. It aligns the knee joint with the GRF such that the reaction torques are eliminated. The reaction to the GRF will then be carried by the structural components of the knee instead. CONCLUSIONS: The use of this reciprocal system introduces a new dimension of foot loading to the knee axis alignment. This insight shows that locating knee functional axes is equivalent to the static alignment measurement. This method can be used for the optimal design of braces and orthoses for conservative treatment of knee osteoarthritis.

An Informational Algorithm as the Basis for Perception-Action Control of the Instantaneous Axes of the Knee.

Traditional locomotion studies emphasize an optimization of the desired movement trajectories while ignoring sensory feedback. We propose an information based theory that locomotion is neither triggered nor commanded but controlled. The basis for this control is the information derived from perceiving oneself in the world. Control therefore lies in the human-environment system. In order to test this hypothesis, we derived a mathematical foundation characterizing the energy that is required to perform a rotational twist, with small amplitude, of the instantaneous axes of the knee (IAK). We have found that the joint's perception of the ground reaction force may be replaced by the co-perception of muscle activation with appropriate intensities. This approach generated an accurate comparison with known joint forces and appears appropriate in so far as predicting the effect on the knee when it is free to twist about the IAK.

Extrahepatic 25-Hydroxylation of Vitamin D3 in an Engineered Osteoblast Precursor Cell Line Exploring the Influence on Cellular Proliferation and Matrix Maturation during Bone Development.

Osteoblastic precursors experience distinct stages during differentiation and bone development, which include proliferation, extracellular matrix (ECM) maturation, and ECM mineralization. It is well known that vitamin D plays a large role in the regulation of bone mineralization and homeostasis via the endocrine system. The activation of vitamin D requires two sequential hydroxylation steps, first in the kidney and then in the liver, in order to carry out its role in calcium homeostasis. Recent research has demonstrated that human-derived mesenchymal stem cells (MSCs) and osteoblasts can metabolize the immediate vitamin D precursor 25-dihydroxyvitamin D3 (25OHD3) to the active steroid lα,25-dihydroxyvitamin D3 (1,25OH2D3) and elicit an osteogenic response. However, reports of extrahepatic metabolism of vitamin D3, the parental vitamin D precursor, have been limited. In this study, we investigated whether osteoblast precursors have the capacity to convert vitamin D3 to 1,25OH2D3 and examined the potential of vitamin D3 to induce 1,25OH2D3 associated biological activities in osteoblast precursors. It was demonstrated that the engineered osteoblast precursor derived from human marrow (OPC1) is capable of metabolizing vitamin D3 to 1,25OH2D3 in a dose-dependent manner. It was also demonstrated that administration of vitamin D3 leads to the increase in alkaline phosphatase (ALP) activity associated with osteoblast ECM maturation and calcium deposits and a decrease in cellular proliferation in both osteoblast precursor cell lines 0PC1 andOMC3T3-E1. These findings provide a two-dimensional culture foundation for future three-dimensional engineered tissue studies using the OPC1 cell line.

Efferent Copy and Corollary Discharge Motor Control Behavior Associated with a Hopping Activity.

Hoppers respond not only to stimuli from the ground surfaces but also to cues generated by their own behaviors. This leads to desensitization because although the afferent and reafferent signals have distinct causes, they are carried by the same sensory channels. From a behavioral viewpoint, it may be necessary to distinguish between signals from the two causes especially when monitoring changes in the external environment separate from those due to self-movement. We were able to separate afferent sensory stimuli from self-generated, reafferent signals using an action-oriented perception system and dynamic programming approach. This effort addressed the question of how the nerve system selects which particular degree of freedom (DOF) to cancel reafferent input. We have proposed an internal one-DOF model characterizing the motor control system during hopping, allowing the generation of an estimated ground reaction signal to drive natural shock absorption of the leg.

Forensic epidemiologic and biomechanical analysis of a pelvic cavity blowout injury associated with ejection from a personal watercraft (jet-ski).

Jet-propelled personal watercraft (PWC) or jet-skis have become increasingly popular. The means of propulsion of PWC, which is a jet of water forced out of small nozzle at the rear of the craft, combined with a high risk of falling off of the seat and into close proximity with the water jet stream, raise the potential for a unique type of injury mechanism. The most serious injuries associated with PWC falls are those that occur when the perineum passes in close proximity to the jet nozzle and the high-pressure water stream enters the vaginal or rectal orifice. We describe the forensic investigation into a case of an anovaginal "blowout" injury in a passenger who was ejected from the rear seat position of a PWC and subsequently suffered life-threatening injuries to the pelvic organs. The investigation included a biomechanical analysis of the injury mechanism, a summary of prior published reports of internal pelvic injuries resulting from PWC falls as well as other water sports and activities, and a comparison of the severity of the injuries resulting from differing mechanisms using the New Injury Severity Score (NISS). The mean (± standard deviation [SD]) NISS values for reported PWC injuries [not including the NISS of 38 in this case study] were 11.2 (± 9.5), while the mean value for reported water-skiing falls was half that of the PWC group at 5.6 (± 5.2). It was concluded that the analyzed injuries were unique to a PWC ejection versus other previously described non-PWC-associated water sport injuries. It is recommended that PWC manufacturers help consumers understand the potential risks to passengers with highly visible warnings and reduce injury risk with revised seat design, and/or passenger seat "deadman" switches.

Plasma levels of polychlorinated biphenyls, non-Hodgkin lymphoma, and causation.

Polychlorinated biphenyls (PCBs) are synthetic chlorinated hydrocarbons that have extensively polluted the environment and bioaccumulated in the food chain. PCBs have been deemed to be probable carcinogens by the Environmental Protection Agency, and exposure to high levels of PCBs has been consistently linked to increased risk of non-Hodgkin lymphoma (NHL). In the present article we present a forensic epidemiologic evaluation of the causal relationship between NHL and elevated PCB levels via application of the Bradford-Hill criteria. Included in the evaluation is a meta-analysis of the results of previously published case-control studies in order to assess the strength of association between NHL and PCBs, resulting in an odds ratio in which the lowest percentile PCB concentration (quartile, quintile, or tertile) has been compared with the highest percentile concentration in the study groups. The weight-adjusted odds ratio for all PCB congeners was 1.43 with a 95% confidence interval of 1.31 to 1.55, indicating a statistically significant causal association with NHL. Because of the lack of an unexposed comparison group, a rationale for the use of a less than 2.0 relative risk causal contribution threshold is presented herein, including an ecologic analysis of NHL incidence and PCB accumulation (as measured by sales volume) over time. The overall results presented here indicate a strong general causal association between NHL and PCB exposure.

A reciprocal connection factor for assessing knee-joint function.

In the knee joint, interactions between instantaneous kinetics and kinematics associated with ligamentous and articular tissues are not fully understood. These structures may be represented by the instantaneous screw axis ($) (ISA) and static force vectors ($'). Geometric changes to the joint structure affecting motion have not been fully explained, especially after surgical reconstruction and replacement procedures. The ISA offers a joint-characterisation approach, which is dependent on the combined forces of ligaments, articular contacts and muscles. The standard four-bar linkage model in the sagittal plane demonstrates that the normal contact force and the lines of action of the cruciate ligaments always intersect at the centre of rotation of the joint. A kinematic knee model in which the articular surfaces in the lateral and medial compartments as well as the isometric fascicles in the engaged ligaments may be represented as five constraints in a one-degree-of-freedom parallel spatial mechanism. This study provides a theoretical foundation to elucidate the role of each of these elements in the control of the ISA. A recourse to the principle of virtual work explained through d'Alembert's principle for reducing a dynamics problem to an instantaneous static scenario allows screws to be applied to the biomechanics of human motion. The principle of reciprocity links these approaches together to explain the transmitting load between the tibia and the femur as well as the relative motion within the knee joint. A principal clinical implication of this study is the introduction of the reciprocal connection factor to evaluate knee kinematics and kinetics in one simple term, allowing the quantitative assessment of the outcome of knee-joint treatment and rehabilitation methods.

Assessing specific causation of mesothelioma following exposure to chrysotile asbestos-containing brake dust.

BACKGROUND: The question of whether chrysotile asbestos-containing brake dust can plausibly serve as a cause of mesothelioma in an exposed individual has become a matter of heated debate in the medical literature despite multiple international, federal, and state governmental agencies acknowledging a causal association. OBJECTIVES: We describe and provide an analysis of various industry and academic perspectives contributing to the debate. METHODS: A framework is presented for evaluating the general and specific causal relationship between brake dust exposure and mesothelioma utilizing the principles of forensic epidemiology, and by applying the Bradford-Hill criteria. RESULTS AND CONCLUSIONS: We conclude that there is a "net" of evidence favoring a causal relationship between brake dust-associated chrysotile exposure and mesothelioma. The industry-sponsored position that there is insufficient evidence to support a contiguous "chain" of causation is specious from both a methodologic and evidentiary perspective. Finally, we suggest a semiquantitative approach for the evaluation of individual causation in putative cases of mesothelioma with a history of significant brake dust exposure.