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Park H, Klishko AN, Oh K, Zhang C, Grenga G, Herrin KR, Dalton JF, Kistenberg RS, Lemay MA, Pitkin M, DeWeerth SP, Prilutsky BI. Electrical Stimulation of Distal Tibial Nerve During Stance Phase of Walking May Reverse Effects of Unilateral Paw Pad Anesthesia in the Cat. Motor Control 2023; 27:71-95. [PMID: 36316008 PMCID: PMC9772080 DOI: 10.1123/mc.2022-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022]
Abstract
Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the cat could be reduced/reversed by electrical stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve during stance. Several split-belt conditions were investigated in four adult female cats. In addition, we investigated the effects of similar distal tibial nerve stimulation on overground walking of one male cat that had a transtibial, bone-anchored prosthesis for 29 months and, thus, had no cutaneous/proprioceptive feedback from the foot. In all treadmill conditions, cats walked with intact cutaneous feedback (control), with right fore- and hindpaw pads anesthetized by lidocaine injections, and with a combination of anesthesia and electrical stimulation of the ipsilateral distal tibial nerve during the stance phase at 1.2× threshold of afferent activation. Electrical stimulation of the distal tibial nerve during the stance phase of walking with anesthetized ipsilateral paw pads reversed or significantly reduced the effects of paw pad anesthesia on several kinematic variables, including lateral center of mass shift, cycle and swing durations, and duty factor. We also found that stimulation of the residual distal tibial nerve in the prosthetic hindlimb often had different effects on kinematics compared with stimulation of the intact hindlimb with paw anesthetized. We suggest that stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve provides functionally meaningful motion-dependent sensory feedback, and stimulation responses depend on limb conditions.
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Affiliation(s)
- Hangue Park
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
- Department of Electrical & Computer Engineering, Texas A&M University, College Station, TX,USA
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon,South Korea
| | - Alexander N Klishko
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
| | - Kyunggeune Oh
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
- Department of Neuroscience and Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, Baltimore, MD,USA
| | - Celina Zhang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
| | - Gina Grenga
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
| | - Kinsey R Herrin
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA,USA
| | | | - Robert S Kistenberg
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
| | | | - Mark Pitkin
- Tufts University School of Medicine, Boston, MA,USA
- Poly-Orth International, Sharon, MA,USA
| | - Stephen P DeWeerth
- School of Electrical and Computer Engineering and Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA,USA
- Departments of Bioengineering and of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA,USA
| | - Boris I Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA,USA
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Mendonça A, Braga V, Fernandes T, Oliveira G, Beraldo G. Fixed bilateral endo-exo prostheses in feline femur - case report. ARQ BRAS MED VET ZOO 2023. [DOI: 10.1590/1678-4162-12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
ABSTRACT The use of endo-exo prosthesis is an alternative to improve the quality of life of amputees, allowing correct distribution of body weight, reducing skin problems and pain related to the implant, and reducing lameness. The aim of this paper is to report the use of a fixed bilateral endo-exo femur prostheses in a cat with amputation prior to treatment. The endoprostheses were made with titanium and the exoprostheses were made with 3D printing technology. A longitudinal craniolateral surgical approach was used and the skin incision was made over the knee-joint, then fascia lata incision, followed by biceps femoris and vastus lateralis muscles retraction, incision through the joint capsule to expose the tibiofemoral joint, disarticulation, and tibia and fibula removal. Afterwards, a femoral leveling osteotomy and insertion of the implant in the medullary canal were performed, being attached in the cis and trans cortical bone. The patient was evaluated in the immediate post-operative and periodically thereafter, showing satisfactory results, without macroscopic signs of rejection, wound dehiscence or infection, fracture, or injury of limbs, and presented adapted walking. Furthermore, it was observed the return to common behaviors for the species.
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Affiliation(s)
| | - V.A.A. Braga
- Universidade Federal Rural de Pernambuco, Brazil
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3
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Xu D, Zhou H, Zhang Q, Baker JS, Ugbolue UC, Radak Z, Ma X, Gusztav F, Wang M, Gu Y. A new method proposed to explore the feline's paw bones of contributing most to landing pattern recognition when landed under different constraints. Front Vet Sci 2022; 9:1011357. [PMID: 36299631 PMCID: PMC9589501 DOI: 10.3389/fvets.2022.1011357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022] Open
Abstract
Felines are generally acknowledged to have natural athletic ability, especially in jumping and landing. The adage “felines have nine lives” seems applicable when we consider its ability to land safely from heights. Traditional post-processing of finite element analysis (FEA) is usually based on stress distribution trend and maximum stress values, which is often related to the smoothness and morphological characteristics of the finite element model and cannot be used to comprehensively and deeply explore the mechanical mechanism of the bone. Machine learning methods that focus on feature pattern variable analysis have been gradually applied in the field of biomechanics. Therefore, this study investigated the cat forelimb biomechanical characteristics when landing from different heights using FEA and feature engineering techniques for post-processing of FEA. The results suggested that the stress distribution feature of the second, fourth metacarpal, the second, third proximal phalanx are the features that contribute most to landing pattern recognition when cats landed under different constraints. With increments in landing altitude, the variations in landing pattern differences may be a response of the cat's forelimb by adjusting the musculoskeletal structure to reduce the risk of injury with a more optimal landing strategy. The combination of feature engineering techniques can effectively identify the bone's features that contribute most to pattern recognition under different constraints, which is conducive to the grasp of the optimal feature that can reveal intrinsic properties in the field of biomechanics.
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Affiliation(s)
- Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China,Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary,Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China,School of Health and Life Sciences, University of the West of Scotland, Scotland, United Kingdom
| | - Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Ukadike C. Ugbolue
- School of Health and Life Sciences, University of the West of Scotland, Scotland, United Kingdom
| | - Zsolt Radak
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Fekete Gusztav
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary,Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Meizi Wang
- Faculty of Sports Science, Ningbo University, Ningbo, China,Faculty of Health and Safety, Óbuda University, Budapest, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China,*Correspondence: Yaodong Gu
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Rosen S, Duerr FM, Elam LH. Prospective evaluation of complications associated with orthosis and prosthesis use in canine patients. Front Vet Sci 2022; 9:892662. [PMID: 35967994 PMCID: PMC9372342 DOI: 10.3389/fvets.2022.892662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe use of orthoses and prostheses is expanding in veterinary medicine. However, research evaluating the efficacy and complications of these devices in veterinary patients is limited. The primary objective of this study was to prospectively determine the complications and outcomes associated with custom orthosis and prosthesis use in the canine patient.Materials and MethodsThis was a prospective, clinical trial that followed patients for 12 months following device fitting. Owner-perceived complications, clinical metrology instruments, and objective gait analysis were used as outcome measures at various time points. The patients were grouped into the following four major categories: Patients with a carpal orthosis, patients with a stifle orthosis, patients with a tarsal orthosis, and patients with a prosthetic device.ResultsForty-three patients were included in the study. Thirty-nine out of 43 patients (91%) experienced at least one complication, with 7/7 (100%) prosthesis patients experiencing at least one complication. At least one skin complication was reported for the following patient groups during the first 3 months of use: 8/14 (58%) stifle orthoses, 9/10 (90%) carpal orthoses, 6/10 (60%) tarsal orthoses, and 4/7 (58%) prostheses. Patient non-acceptance of the device was identified in 2/15 (14%) stifle orthoses, 1/10 (10%) tarsal orthoses, and 4/7 (55%) prostheses. One out of 15 (7%) stifle orthoses, 4/10 (40%) carpal orthoses, 4/10 (40%) tarsal orthoses, and 1/7 (15%) prostheses experienced mechanical device problems necessitating repair. The majority of patients with carpal and stifle orthoses showed improvement on objective gait analysis in percent body weight distribution of the affected limb between baseline and the most recent follow-up without the device donned: 83% (n = 6) of patients with carpal orthoses, 100% (n = 11) of patients with stifle orthoses. None of the patients with tarsal orthoses showed a similar improvement (0%; n = 4).Discussion and conclusionThree major complications associated with canine orthosis and prosthesis use were identified in this study as follows: Skin complications (abrasions, loss of hair, and sores), mechanical device problems, and patient non-acceptance of the device. Owners should be notified of these potential complications prior to pursuing orthoses or prostheses as a potential treatment option. Although clinical improvement was noted in the majority of patients with stifle and carpal pathology, given the lack of a control group, it is unknown how much of this improvement can be attributed to the orthoses.
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Hall P, Stubbs C, Anderson DE, Greenacre C, Crouch DL. Rabbit hindlimb kinematics and ground contact kinetics during the stance phase of gait. PeerJ 2022; 10:e13611. [PMID: 35734635 PMCID: PMC9208372 DOI: 10.7717/peerj.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/29/2022] [Indexed: 01/17/2023] Open
Abstract
Though the rabbit is a common animal model in musculoskeletal research, there are very limited data reported on healthy rabbit biomechanics. Our objective was to quantify the normative hindlimb biomechanics (kinematics and kinetics) of six New Zealand White rabbits (three male, three female) during the stance phase of gait. We measured biomechanics by synchronously recording sagittal plane motion and ground contact pressure using a video camera and pressure-sensitive mat, respectively. Both foot angle (i.e., angle between foot and ground) and ankle angle curves were unimodal. The maximum ankle dorsiflexion angle was 66.4 ± 13.4° (mean ± standard deviation across rabbits) and occurred at 38% stance, while the maximum ankle plantarflexion angle was 137.2 ± 4.8° at toe-off (neutral ankle angle = 90 degrees). Minimum and maximum foot angles were 17.2 ± 6.3° at 10% stance and 123.3 ± 3.6° at toe-off, respectively. The maximum peak plantar pressure and plantar contact area were 21.7 ± 4.6% BW/cm2 and 7.4 ± 0.8 cm2 respectively. The maximum net vertical ground reaction force and vertical impulse, averaged across rabbits, were 44.0 ± 10.6% BW and 10.9 ± 3.7% BW∙s, respectively. Stance duration (0.40 ± 0.15 s) was statistically significantly correlated (p < 0.05) with vertical impulse (Spearman's ρ = 0.76), minimum foot angle (ρ = -0.58), plantar contact length (ρ = 0.52), maximum foot angle (ρ = 0.41), and minimum foot angle (ρ = -0.30). Our study confirmed that rabbits exhibit a digitigrade gait pattern during locomotion. Future studies can reference our data to quantify the extent to which clinical interventions affect rabbit biomechanics.
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Affiliation(s)
- Patrick Hall
- Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, Knoxville, Tennessee, United States
| | - Caleb Stubbs
- Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, Knoxville, Tennessee, United States
| | - David E. Anderson
- Department of Large Animal Clinical Sciences, University of Tennessee - Knoxville, Knoxville, Tennessee, United States
| | - Cheryl Greenacre
- Department of Small Animal Clinical Sciences, University of Tennessee - Knoxville, Knoxville, Tennessee, United States
| | - Dustin L. Crouch
- Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee - Knoxville, Knoxville, Tennessee, United States
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6
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Pitkin M, Cassidy C, Shevtsov MA, Jarrell JR, Park H, Farrell BJ, Dalton JF, Childers WL, Kistenberg RS, Oh K, Klishko AN, Prilutsky BI. Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface. Mil Med 2021; 186:688-695. [PMID: 33499499 PMCID: PMC7832823 DOI: 10.1093/milmed/usaa445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/04/2020] [Accepted: 11/16/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The three major unresolved problems in bone-anchored limb prosthetics are stable, infection-free integration of skin with a percutaneous bone implant, robust skeletal fixation between the implant and host bone, and a secure interface of sensory nerves and muscles with a prosthesis for the intuitive bidirectional prosthetic control. Here we review results of our completed work and report on recent progress. MATERIALS AND METHODS Eight female adult cats received skin- and bone-integrated pylon (SBIP) and eight male adult cats received SBIP-peripheral neural interface (PNI) pylon into the right distal tibia. The latter pylons provided PNI for connection between a powered sensing transtibial prosthesis and electrodes in residual soleus muscle and on residual distal tibial nerve. If signs of infection were absent 28-70 days after implantation, cats started wearing a passive prosthesis. We recorded and analyzed full-body mechanics of level and slope locomotion in five cats with passive prostheses and in one cat with a powered sensing prosthesis. We also performed histological analyses of tissue integration with the implants in nine cats. Four pigs received SBIPs into the left hindlimb and two pigs-into the left forelimb. We recorded vertical ground reaction forces before amputation and following osseointegration. We also conducted pullout postmortem tests on the implanted pylons. One pig received in dorsum the modified SBIPs with and without silver coating. RESULTS Six cats from the SBIP groups had implant for 70 days. One cat developed infection and did not receive prosthesis. Five cats had pylon for 148 to 183 days, showed substantial loading of the prosthesis during locomotion (40.4% below presurgery control), and demonstrated deep ingrowth of skin and bone tissue into SBIP (over 60%). Seven of eight cats from the SBIP-PNI group demonstrated poor pylon integration without clinical signs of infection. One cat had prosthesis for 824 days (27 months). The use of the bidirectionally controlled prosthesis by this animal during level walking demonstrated increased vertical loading to nearly normal values, although the propulsion force was significantly reduced. From the study on pigs, it was found that symmetry in loading between the intact and prosthetic limbs during locomotion was 80 ± 5.5%. Skin-implant interface was infection-free, but developed a stoma, probably because of the high mobility of the skin and soft tissues in the pig's thigh. Dorsal implantation resulted in the infection-free deep ingrowth of skin into the SBIP implants. CONCLUSIONS Cats with SBIP (n = 5) and SBIP-PNI (n = 1) pylons developed a sound interface with the residuum skin and bone and demonstrated substantial loading of prosthetic limb during locomotion. One animal with SBIP developed infection and seven cats with SBIP-PNI demonstrated poor bone integration without signs of infection. Future studies of the SBIP-PNI should focus on reliability of integration with the residuum. Ongoing study with pigs requires decreasing the extra mobility of skin and soft tissues until the skin seal is developed within the SBIP implant.
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Affiliation(s)
- Mark Pitkin
- Poly-Orth International, Sharon, MA, 02067, USA
| | | | - Maxim A Shevtsov
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences, Laboratory of Biomedical Nanotechnologies, Petersburg, 194064, Russia
- Department of Biotechnology, First Pavlov State Medical University of St. Petersburg, Petersburg, 197022, Russia
| | - Joshua R Jarrell
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Hangue Park
- Department of Electrical & Computer Engineering. Texas A&M University, College Station, TX, 77843, USA
| | - Brad J Farrell
- Department of Physical Therapy, Georgia State University, Atlanta, GA, 30302, USA
| | - John F Dalton
- Georgia Hand, Shoulder & Elbow, Atlanta, GA, 30309, USA
| | - W Lee Childers
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio, Ft. Sam Houston, TX, 78234, USA
| | - Robert S Kistenberg
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Kyunggeune Oh
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Alexander N Klishko
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Boris I Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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7
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Shevtsov M, Gavrilov D, Yudintceva N, Zemtsova E, Arbenin A, Smirnov V, Voronkina I, Adamova P, Blinova M, Mikhailova N, Galibin O, Akkaoui M, Pitkin M. Protecting the skin-implant interface with transcutaneous silver-coated skin-and-bone-integrated pylon in pig and rabbit dorsum models. J Biomed Mater Res B Appl Biomater 2020; 109:584-595. [PMID: 32935912 DOI: 10.1002/jbm.b.34725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Implant-associated soft tissue infections at the skin-implant interface represent the most frequent complications in reconstructive surgery and lead to implant failures and revisions. Titanium implants with deep porosity, called skin-and-bone-integrated-pylons (SBIP), allow for skin ingrowth in the morphologically natural direction, thus restoring a reliable dermal barrier and reducing the risk of infection. Silver coating of the SBIP implant surface using physical vapor deposition technique offers the possibility of preventing biofilm formation and exerting a direct antimicrobial effect during the wound healing phase. In vivo studies employing pig and rabbit dorsum models for assessment of skin ingrowth into the pores of the pylon demonstrated the safety of transcutaneous implantation of the SBIP system. No postoperative complications were reported at the end of the follow-up period of 6 months. Histological analysis proved skin ingrowth in the minipig model without signs of silver toxicity. Analysis of silver release (using energy dispersive X-ray spectroscopy) in the model of intramedullary-inserted silver-coated SBIP in New Zealand rabbits demonstrated trace amounts of silver after 3 months of in-bone implantation. In conclusion, selected temporary silver coating of the SBIP implant surface is powerful at preventing the periprosthetic infections without imparing skin ingrowth and can be considered for clinical application.
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Affiliation(s)
- Maxim Shevtsov
- Department of Radiation Immuno-Oncology, Center for Translational Cancer Research Technische Universität München (TranslaTUM), Klinikum Rechts der Isar, Munich, Germany.,Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia.,Department of Pediatric Neurosurgery, Almazov National Medical Research Centre, Russian Polenov Neurosurgical Institute, St. Petersburg, Russia.,Laboratory of Biomedical Cell Technologies, Far Eastern Federal University, Vladivostok, Russia
| | - Dmitriy Gavrilov
- Federal State Budgetary Institution "Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht" of the Ministry of Labour and Social Protection of the Russian Federation, St. Petersburg, Russia
| | - Natalia Yudintceva
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Elena Zemtsova
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Andrei Arbenin
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Vladimir Smirnov
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | | | - Polina Adamova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - Miralda Blinova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Nataliya Mikhailova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Oleg Galibin
- Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia
| | | | - Mark Pitkin
- Tufts University, Boston, Massachusetts, USA.,Poly-Orth International, Sharon, Massachusetts, USA
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8
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Jeyapalina S, Colombo JS, Beck JP, Agarwal JP, Schmidt LA, Bachus KN. Epidermal growth factor receptor genes are overexpressed within the periprosthetic soft-tissue around percutaneous devices: A pilot study. J Biomed Mater Res B Appl Biomater 2019; 108:527-537. [PMID: 31074946 DOI: 10.1002/jbm.b.34409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022]
Abstract
Epidermal downgrowth around percutaneous devices produce sinus tracts, which then accumulate bacteria becoming foci of infection. This mode to failure is epidermal-centric, and is accelerated by changes in the chemokines and cytokines of the underlying periprosthetic granulation tissue (GT). In order to more fully comprehend the mechanism of downgrowth, in this 28-day study, percutaneous devices were placed in 10 Zucker diabetic fatty rats; 5 animals were induced with diabetes mellitus II (DM II) prior to the surgery and 5 animals served as a healthy, nondiabetic cohort. At necropsy, periprosthetic tissues were harvested, and underwent histological and polymerase chain reaction (PCR) studies. After isolating GTs from the surrounding tissue and extracting ribonucleic acids, PCR array and quantitative-PCR (qPCR) analyses were carried-out. The PCR array for 84 key wound-healing associated genes showed a five-fold or greater change in 31 genes in the GTs of healthy animals compared to uninjured healthy typical skin tissues. Eighteen genes were overexpressed and these included epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR). Thirteen genes were underexpressed. When GTs of DM II animals were compared to healthy animals, there were 8 genes overexpressed and 25 genes underexpressed; under expressed genes included EGF and EGFR. The qPCR and immunohistochemistry data further validated these observations. Pathway analysis of genes up-regulated 15-fold or more indicated two, EGFR and interleukin-10, centric clustering effects. It was concluded that EGFR could be a key player in exacerbating the epidermal downgrowth, and might be an effective target for preventing downgrowth.
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Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - John S Colombo
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,The School of Dentistry, University of Utah School of Medicine, Salt Lake City, Utah
| | - James P Beck
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Linda A Schmidt
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kent N Bachus
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
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9
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Jarrell JR, Farrell BJ, Kistenberg RS, Dalton JF, Pitkin M, Prilutsky BI. Kinetics of individual limbs during level and slope walking with a unilateral transtibial bone-anchored prosthesis in the cat. J Biomech 2018; 76:74-83. [PMID: 29861094 PMCID: PMC6062466 DOI: 10.1016/j.jbiomech.2018.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/21/2018] [Accepted: 05/13/2018] [Indexed: 12/29/2022]
Abstract
Ongoing animal preclinical studies on transcutaneous bone-anchored prostheses have aimed to improve biomechanics of prosthetic locomotion in people with limb loss. It is much less common to translate successful developments in human biomechanics and prosthetic research to veterinary medicine to treat animals with limb loss. Current standard of care in veterinary medicine is amputation of the whole limb if a distal segment cannot be salvaged. Bone-anchored transcutaneous prostheses, developed for people with limb loss, could be beneficial for veterinary practice. The aim of this study was to examined if and how cats utilize the limb with a bone-anchored passive transtibial prosthesis during level and slope walking. Four cats were implanted with a porous titanium implant into the right distal tibia. Ground reaction forces and full-body kinematics were recorded during level and slope (±50%) walking before and 4-6 months after implantation and prosthesis attachment. The duty factor of the prosthetic limb exceeded zero in all cats and slope conditions (p < 0.05) and was in the range of 45.0-60.6%. Thus, cats utilized the prosthetic leg for locomotion instead of walking on three legs. Ground reaction forces, power and work of the prosthetic limb were reduced compared to intact locomotion, whereas those of the contralateral hind- and forelimbs increased (p < 0.05). This asymmetry was likely caused by insufficient energy generation for propulsion by the prosthetic leg, as no signs of pain or discomfort were observed in the animals. We concluded that cats could utilize a unilateral bone-anchored transtibial prosthesis for quadrupedal level and slope locomotion.
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Affiliation(s)
- Joshua R Jarrell
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Brad J Farrell
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Robert S Kistenberg
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Mark Pitkin
- Tufts University School of Medicine, Boston, MA, USA; Poly-Orth International, Sharon, MA, USA
| | - Boris I Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA.
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10
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Park H, Islam MS, Grover MA, Klishko AN, Prilutsky BI, DeWeerth SP. A Prototype of a Neural, Powered, Transtibial Prosthesis for the Cat: Benchtop Characterization. Front Neurosci 2018; 12:471. [PMID: 30057524 PMCID: PMC6053514 DOI: 10.3389/fnins.2018.00471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 06/21/2018] [Indexed: 01/11/2023] Open
Abstract
We developed a prototype of a neural, powered, transtibial prosthesis for the use in a feline model of prosthetic gait. The prosthesis was designed for attachment to a percutaneous porous titanium implant integrated with bone, skin, and residual nerves and muscles. In the benchtop testing, the prosthesis was fixed in a testing rig and subjected to rhythmic vertical displacements and interactions with the ground at a cadence corresponding to cat walking. Several prosthesis functions were evaluated. They included sensing ground contact, control of transitions between the finite states of prosthesis loading, and a closed-loop modulation of the linear actuator gain in each loading cycle. The prosthetic design parameters (prosthesis length = 55 mm, mass = 63 g, peak extension moment = 1 Nm) corresponded closely to those of the cat foot-ankle with distal shank and the peak ankle extension moment during level walking. The linear actuator operated the prosthetic ankle joint using inputs emulating myoelectric activity of residual muscles. The linear actuator gain was modulated in each cycle to minimize the difference between the peak of ground reaction forces (GRF) recorded by a ground force sensor and a target force value. The benchtop test results demonstrated a close agreement between the GRF peaks and patterns produced by the prosthesis and by cats during level walking.
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Affiliation(s)
- Hangue Park
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States.,Biomechanics and Motor Control Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Muhammad S Islam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Martha A Grover
- School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Alexander N Klishko
- Biomechanics and Motor Control Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Boris I Prilutsky
- Biomechanics and Motor Control Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Stephen P DeWeerth
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States.,P.C. Rossin College of Engineering and Applied Science, Lehigh University, Bethlehem, PA, United States
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11
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Shevtsov MA, Yudintceva NM, Blinova MI, Voronkina IV, Suslov DN, Galibin OV, Gavrilov DV, Akkaoui M, Raykhtsaum G, Albul AV, Pitkin E, Pitkin M. Evaluation of the temporary effect of physical vapor deposition silver coating on resistance to infection in transdermal skin and bone integrated pylon with deep porosity. J Biomed Mater Res B Appl Biomater 2018; 107:169-177. [PMID: 29573163 DOI: 10.1002/jbm.b.34108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
Abstract
Periprosthetic infection via skin-implant interface is a leading cause of failures and revisions in direct skeletal attachment of limb prostheses. Implants with deep porosity fabricated with skin and bone integrated pylons (SBIP) technology allow for skin ingrowth through the implant's structure creating natural barrier against infection. However, until the skin cells remodel in all pores of the implant, additional care is required to prevent from entering bacteria to the still nonoccupied pores. Temporary silver coating was evaluated in this work as a means to provide protection from infection immediately after implantation followed by dissolution of silver layer in few weeks. A sputtering coating with 1 µm thickness was selected to be sufficient for fighting infection until the deep ingrowth of skin in the porous structure of the pylon is completed. In vitro study showed less bacterial (Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa) growth on silver coated tablets compared to the control group. Analysis of cellular density of MG-63 cells, fibroblasts, and mesenchymal stem cells (MSCs) showed that silver coating did not inhibit the cell growth on the implants and did not affect cellular functional activity. The in vivo study did not show any postoperative complications during the 6-month observation period in the model of above-knee amputation in rabbits when SBIP implants, either silver-coated or untreated were inserted into the bone residuum. Three-phase scintigraphy demonstrated angiogenesis in the pores of the pylons. The findings suggest that a silver coating with well-chosen specifications can increase the safety of porous implants for direct skeletal attachment. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 169-177, 2019.
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Affiliation(s)
- Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Technical University of Munich, Munich, Germany.,Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia.,Polenov Russian Scientific Research Institute of Neurosurgery, St. Petersburg, Russia
| | - Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Miralda I Blinova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Irina V Voronkina
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Dmitriy N Suslov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Oleg V Galibin
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dmitriy V Gavrilov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - Andrey V Albul
- Veterinary Clinic "Neurology, Traumatology and Intensive Therapy of Doctor Sotnikov V.V.,", St. Petersburg, Russia
| | - Emil Pitkin
- Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Pitkin
- Poly-Orth International, Sharon, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
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