The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study.

BACKGROUND: In patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused. OBJECTIVES: This study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN. METHODS: In this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample T-test for (normally distributed) and the Mann-Whitney U test (non-normally distributed) were used. RESULTS: The subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion. CONCLUSIONS: This study presented that decreasing range of motion at lower limbs' joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.

Biomechanical analysis of the effect of mesenchymal stem cells on mandibular distraction osteogenesis.

BACKGROUND: The purpose of this study was to investigate the effects of bone marrow-derived stem cells on consolidation period by using a new biomechanical testing method on sheep mandible model. METHODS: Eight sheep underwent bilateral mandibular osteotomies. After latency period, bone distraction was activated. Mesenchymal stem cells were transplanted into the gap of the left mandibular distracted callus on the first day of consolidation period. The sheep were then randomly divided into 2 groups (group A = 4, group B = 4). Group A and group B animals were killed on the third and sixth weeks of consolidation, respectively. Fracture pattern and localization, bone regeneration ratio and density, and stress distribution of 16 distracted hemimandibles were evaluated by computed tomography and biomechanical analysis. RESULTS: Two different fracture patterns were observed in the 2 groups. The left halves of mandibles exhibited horizontal fracture out of the distraction zone, and the cross-sectional area was compact bone [H (-) C], whereas the fracture patterns of control sides were oblique, which passed through the distraction zone with a propensity of trabecular bone [O (+) T]. Stress distribution at the critical cross-section of distraction region was not different in halves of mandibles. However, bone regeneration ratios and regenerated bone densities were significantly higher in left sides (P < 0.05). CONCLUSIONS: Transplantation of mesenchymal stem cells promotes maturity of the distracted callus. The new experimental model, which allowed to test the mandible as a system by simulating in vivo loading conditions, revealed differences in the mechanical behavior of the halves of mandible.

Correlation dimension estimates of human postural sway.

Human postural sway during quiet standing demonstrates a complex structured dynamics, which has been studied by applying numerous methods, such as linear system identification methods, stochastic analysis, and nonlinear system dynamics tools. Although each of the methods applied revealed some particular features of the sway data none of them have succeeded to present a global picture of the quiet stance dynamics, which probably has both stochastic and deterministic properties. In this study we have started applying ergodic theory of dynamical systems to explore statistical characteristic of the sway dynamics observed in successive trials of a subject, different subjects in an age group, and finally different age groups constituted by children, adults, and elderly subjects. Five successive 180-s long trials were performed by each of 28 subjects in four age groups at quiet stance with eyes open. Stationary and ergodic signal characteristics of five successive center of pressure time series collected from a subject in antero-posterior direction (CoPx) were examined. 97% of the trials were found to be stationary by applying Run Test while children and elderly groups demonstrated significant nonstationary behavior. On the other hand 13 out of 24 subjects were found to be nonergodic. We expected to observe differences in complexity of CoPx dynamics due to aging (Farmer, Ott, & Yorke, 1983). However linear metrics such as standard deviation and Fourier spectra of CoPx signals did not show differences due to the age groups. Correlation dimension (Dk) estimates of stationary CoPx signals being an invariant measure of nonlinear system dynamics were computed by using the average displacement method (Eckmann & Ruelle, 1985). Postural dynamics was expanded in m-dimensional space through CoPx signal by introducing optimum time delays, τcritical. 112 out of 136 stationary CoPx signals for 24 stationary subjects converged to Dk estimates. Average of Dk estimates for children and adult groups was 3.67±0.28, whereas mean of Dk estimates for elderly subjects was 4.12±0.59. Nonlinear metrics of postural sway (τcritical, msaturated, and Dk estimates) showed significant differences with respect to the age groups. Dk estimates computed from ergodic subjects' CoPx sway trajectories revealed that human quiet standing demonstrates multiple degree of freedom dynamics having a fractal structure with a considerable level of noise embedded in the signal whose characteristics is determined individually for each subject. Furthermore by using ergodic theory of complex systems, we have been able to show that the ability to independently control multiple degrees of freedom has been affected by aging.

In vitro investigation and biomechanical modeling of the effects of PLF-68 on osteoarthritis in a three-dimensional model.

In this study, it was hypothesized that Pluronic F-68 (PLF-68) increases matrix synthesis of osteoarthritis (OA) chondrocytes in addition to its well-documented cell survival effect. To test this hypothesis, rat articular chondrocytes were embedded in agarose discs and were exposed to 5-azacytidine (Aza-C) to induce OA-like alterations. Chondrocytes were then treated with PLF-68 (8 and 12 mg/ml) for 10 days. Aza-C-exposed and PLF-68-untreated chondrocytes and Aza-C-unexposed and PLF-68-untreated chondrocytes were used as negative and positive control groups, respectively. Dynamic hydrostatic pressure (max 0.2 MPa, 0.1 Hz) was applied to discs for 30 min/day (5 days/week). Cell viability, collagen and proteoglycan deposition in discs were determined. Unconfined compression stress relaxation tests were performed to determine peak stress and material parameters of discs--namely spring constants (k (1) and k (2)), damping coefficient (η), instantaneous modulus (E (0)) and relaxed modulus (E (∞)) using Kelvin model to evaluate the functional coherence of the matrix. PLF-68 treatment significantly increased the collagen deposition in discs and viability of OA-like chondrocytes. A dose-dependent increase was also observed for elastic stiffness parameters (k (1), k (2), E (0) and E (∞)). Same positive effect of PLF-68 was not observed for proteoglycan deposition. However, dose-dependent increase in η suggests that PLF-68 treatment resulted with the deposition of functional matrix. This is the first study which reports that PLF-68 has also positive effect on collagen synthesis of OA cells. As a conclusion, our results suggest that PLF-68 has a potential for recovery from OA-like alterations, which should be further analyzed.

Biomechanical analysis of the rigid fixation of zygoma fractures: an experimental study.

In this experimental study, the goal was to test the sufficiency of actual fixation plates in zygomatic complex fractures and the efficiency of a modified plate at the zygomaticofrontal suture in a suitable model, which was designed for biomechanical study. To address this issue, a zygomatic fracture model produced by using a cadaveric cranium was simulated and the fractures were fixed by the actual and modified fixation materials. The force simulating masseter muscle pull was applied with the Lloyd material testing apparatus, and the rotation of the zygoma was determined using displacement transducers. In this study, there were three different experimental groups. Although miniplates at the zygomaticomaxillary buttress and microplates at the infraorbital rim were used in all three groups, three different plates (miniplate, microplate, and modified plate) were used at the frontozygomatic suture in these groups. Rotational displacement of the zygoma with the effects of simulated masseter muscle force was determined. According to the results obtained, microplates are not effective in stabilizing the frontozygomatic suture when the masseter muscle forces are within physiological range. Although miniplates stabilize zygomatic complex fractures, it was shown that modified microplates, which have no ondulation along the plate border, have a higher resistance to rotation than that of the conventional plates. The rotation angle at the instant of fracture with microplates was 4.59 degrees, and that with miniplates was 1.26 degrees. The maximum rotation angle with modified microplates was 0.32 degrees. Modified microplates designed for the fixation of fractures in the zygomatico-orbital region have been shown to be suitable in a well-designed experimental model and might be appropriate for clinical use.