Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study

BACKGROUND AND OBJECTIVE

The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%-50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.

PATIENTS AND METHODS

Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).

RESULTS

A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69).

CONCLUSIONS

In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.

Predicting Wrist Joint Angles from the Kinematics of the Arm: Application to the Control of Upper Limb Prostheses

Automation of wrist rotations in upper limb prostheses allows simplification of the human-machine interface, reducing the user's mental load and avoiding compensatory movements. This study explored the possibility of predicting wrist rotations in pick-and-place tasks based on kinematic information from the other arm joints. To do this, the position and orientation of the hand, forearm, arm, and back were recorded from five subjects during transport of a cylindrical and a spherical object between four different locations on a vertical shelf. The rotation angles in the arm joints were obtained from the records and used to train feed-forward neural networks (FFNNs) and time-delay neural networks (TDNNs) in order to predict wrist rotations (flexion/extension, abduction/adduction, and pronation/supination) based on the angles at the elbow and shoulder. Correlation coefficients between actual and predicted angles of 0.88 for the FFNN and 0.94 for the TDNN were obtained. These correlations improved when object information was added to the network or when it was trained separately for each object (0.94 for the FFNN, 0.96 for the TDNN). Similarly, it improved when the network was trained specifically for each subject. These results suggest that it would be feasible to reduce compensatory movements in prosthetic hands for specific tasks by using motorized wrists and automating their rotation based on kinematic information obtained with sensors appropriately positioned in the prosthesis and the subject's body.

Influence of Cross-Section and Pitch on the Mechanical Response of NiTi Endodontic Files under Bending and Torsional Conditions—A Finite Element Analysis

In this article, the effects of cross-section and pitch on the mechanical response of NiTi endodontic files is studied by means of finite element analyses. The study was conducted over a set of eight endodontic rotary files, whose geometry was obtained from combinations of two cross-sections(square and triangular) and four pitches. Each file was subjected to bending and torsional analyses, simulating the testing conditions indicated in the ISO 3630 Standard, in order to assess their stiffness and mechanical strength. The results indicate that endodontic files with a square cross-section have double the stiffness of those with triangular cross-sections, both in terms of bending and torsion. For both loading modes, endodontic files with a triangular cross-section can undergo larger deformations before overload failure than those with a square cross-section: up to 20% more in bending and 40% in torsion. Moreover, under equivalent boundary conditions, endodontic files with triangular cross-sections present a higher fatigue life than those with square cross-sections: up to more than 300% higher for small pitches. The effect of pitch on the stiffness and strength of the file is smaller than that of the cross-section shape, but smaller pitches could be beneficial when using a triangularcross-section, as they increase the bending flexibility, fatigue life, and torsion stiffness. These results suggest a clinical recommendation for the use of files with a triangular-shaped cross-section and a small pitch in order to minimize ledging and maximize fatigue life. Finally, in this study, we reveal the sensitivity of the orientation of files with respect to the bending direction, which must be taken into account when designing, reporting, and interpreting test results under such loading conditions.

Fatigue Analysis of NiTi Rotary Endodontic Files through Finite Element Simulation: Effect of Root Canal Geometry on Fatigue Life

This article describes a numerical procedure for estimating the fatigue life of NiTi endodontic rotary files. An enhanced finite element model reproducing the interaction of the endodontic file rotating inside the root canal was developed, which includes important phenomena that allowed increasing the degree of realism of the simulation. A method based on the critical plane approach was proposed for extracting significant strain results from finite element analysis, which were used in combination with the Coffin-Manson relation to predict the fatigue life of the NiTi rotary files. The proposed procedure is illustrated with several numerical examples in which different combinations of endodontic rotary files and root canal geometries were investigated. By using these analyses, the effect of the radius of curvature and the angle of curvature of the root canal on the fatigue life of the rotary files was analysed. The results confirm the significant influence of the root canal geometry on the fatigue life of the NiTi rotary files and reveal the higher importance of the radius of curvature with respect to the angle of curvature of the root canal.

Counselling toward reducing alcohol use, knowledge about its morbidity and personal consumption among students of medical and dental courses in north-western Spain

Background

Alcohol use disorder (AUD) is directly linked to high-risk consumption. Healthcare students have a crucial role to play in its prevention and management. The aim of this study is to analyse alcohol consumption, as well as to consider the knowledge and attitudes regarding morbidity, and the stage of change when providing assistance to quit AUD.

Material and Methods

A cross-sectional study was conducted among Dentistry and Medical students using specific and validated questionnaires in an anonymous and voluntary way. Initially, 925 students were invited to participate, of them 500 were reached.

Results

Among them 85.9% suffered from AUD of whom 75% were women (p<0.001), and it was considered that the female gender constituted an independent risk factor (OR=2.63, CI 95% 1.55-4.45, p<0.001). The majority of the participants did not achieve the pass mark, nonetheless, the results showed improved levels of knowledge among participants in the latter years of their studies (p<0.001). Dental students demonstrated greater shortcomings in terms of their knowledge of general pathology, whereas the medical students’ knowledge of oral pathologies proved worse (p<0.001). Most of students believed that identifying cases of AUD-affected patients falls within their competence, nonetheless, they believed that they do not have the necessary competencies. Among participants 58.2% were in a stage of change regarding AUD attitudes.

Conclusions

The majority of respondents presented AUD. In general, the participants’ knowledge about alcohol was low. Reviewing the syllabuses and evaluating the implementation of gender-differentiated training programmes in both degrees would be considered necessary.

Key words:Alcohol use disorder, healthcare students, addiction, health literacy, behaviours.

Association between xerostomia, oral and general health, and obesity in adults. A cross-sectional pilot study

BACKGROUND

The objective of this study was to analyse the association between oral and general health variables and obesity indicators with the sensation of dry mouth or xerostomia as evaluated on the Xerostomia Inventory (XI).

MATERIAL AND METHODS

A total of 354 randomly selected subjects participated in this cross-sectional pilot study and completed an anonymous questionnaire. Anthropometric, clinical, and xerostomic variables were evaluated. Kruskal-Wallis, ANOVA and Bonferroni test were used for multiple comparisons. ROC curves and multinomial logistic regression were used to determine the (OR) risk of xerostomia.

RESULTS

A total of 30.7 % of respondents reported xerostomia based on XI. The dry mouth question, the XI taken as a "gold standard", showed a diagnostic sensitivity of 70.37 %, and a specificity of 83.27 % (AUC=0.768, p<0.001). Logistical regression showed the highest xerostomia OR was associated to patients with bad self-perceived health, 6.31 (CI 95% 2.89-13.80, p<0.001). In the model adjusted for tooth mobility, bone or respiratory diseases, and the consumption of anxiolytics and antidepressants, the OR was 3.46 (CI 95% 1.47-8.18, p=0.005).

CONCLUSIONS

a high prevalence of xerostomia was found in this cross-sectional pilot study, which was significantly more frequent in women, and increased with age. Xerostomia was associated to several systemic diseases, psychological conditions, and oral functional disorders such as tooth mobility. These preliminary results can serve as the basis for developing guidelines for the application of innovative measures designed to improve the quality of life of individuals with xerostomia.

Dataset of Tactile Signatures of the Human Right Hand in Twenty-One Activities of Daily Living Using a High Spatial Resolution Pressure Sensor

Successful grasping with multi-fingered prosthetic or robotic hands remains a challenge to be solved for the effective use of these hands in unstructured environments. To this end, currently available tactile sensors need to improve their sensitivity, robustness, and spatial resolution, but a better knowledge of the distribution of contact forces in the human hand in grasping tasks is also necessary. The human tactile signatures can inform models for an efficient control of the artificial hands. In this study we present and analyze a dataset of tactile signatures of the human hand in twenty-one representative activities of daily living, obtained using a commercial high spatial resolution pressure sensor. The experiments were repeated for twenty-two subjects. The whole dataset includes more than one hundred million pressure data. The effect of the task and the subject on the grip force and the contribution to this grip force made by the different hand regions were analyzed. We also propose a method to effectively synchronize the measurements from different subjects and a method to represent the tactile signature of each task, highlighting the hand regions mainly involved in the task. The correlations between hand regions and between different tasks were also analyzed.

Grasping Ability and Motion Synergies in Affordable Tendon-Driven Prosthetic Hands Controlled by Able-Bodied Subjects

Affordable 3D-printed tendon-driven prosthetic hands are a rising trend because of their availability and easy customization. Nevertheless, comparative studies about the functionality of this kind of prostheses are lacking. The tradeoff between the number of actuators and the grasping ability of prosthetic hands is a relevant issue in their design. The analysis of synergies among fingers is a common method used to reduce dimensionality without any significant loss of dexterity. Therefore, the purpose of this study is to assess the functionality and motion synergies of different tendon-driven hands using an able-bodied adaptor. The use of this adaptor to control the hands by means of the fingers of healthy subjects makes it possible to take advantage of the human brain control while obtaining the synergies directly from the artificial hand. Four artificial hands (IMMA, Limbitless, Dextrus v2.0, InMoov) were confronted with the Anthropomorphic Hand Assessment Protocol, quantifying functionality and human-like grasping. Three subjects performed the tests by means of a specially designed able-bodied adaptor that allows each tendon to be controlled by a different human finger. The tendon motions were registered, and correlation and principal component analyses were used to obtain the motion synergies. The grasping ability of the analyzed hands ranged between 48 and 57% with respect to that of the human hand, with the IMMA hand obtaining the highest score. The effect of the subject on the grasping ability score was found to be non-significant. For all the hands, the highest tendon-pair synergies were obtained for pairs of long fingers and were greater for adjacent fingers. The principal component analysis showed that, for all the hands, two principal components explained close to or more than 80% of the variance. Several factors, such as the friction coefficient of the hand contact surfaces, limitations on the underactuation, and impairments for a correct thumb opposition need to be improved in this type of prostheses to increase their grasping stability. The principal components obtained in this study provide useful information for the design of transmission or control systems to underactuate these hands.

Anthropomorphism Index of Mobility for Artificial Hands

The increasing development of anthropomorphic artificial hands makes necessary quick metrics that analyze their anthropomorphism. In this study, a human grasp experiment on the most important grasp types was undertaken in order to obtain an Anthropomorphism Index of Mobility (AIM) for artificial hands. The AIM evaluates the topology of the whole hand, joints and degrees of freedom (DoFs), and the possibility to control these DoFs independently. It uses a set of weighting factors, obtained from analysis of human grasping, depending on the relevance of the different groups of DoFs of the hand. The computation of the index is straightforward, making it a useful tool for analyzing new artificial hands in early stages of the design process and for grading human-likeness of existing artificial hands. Thirteen artificial hands, both prosthetic and robotic, were evaluated and compared using the AIM, highlighting the reasons behind their differences. The AIM was also compared with other indexes in the literature with more cumbersome computation, ranking equally different artificial hands. As the index was primarily proposed for prosthetic hands, normally used as nondominant hands in unilateral amputees, the grasp types selected for the human grasp experiment were the most relevant for the human nondominant hand to reinforce bimanual grasping in activities of daily living. However, it was shown that the effect of using the grasping information from the dominant hand is small, indicating that the index is also valid for evaluating the artificial hand as dominant and so being valid for bilateral amputees or robotic hands.

Is mortality in elderly septic patients as high as expected? Long-term mortality in a surgical sample cohort

PURPOSE

To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival.

MATERIALS AND METHODS

A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records.

RESULTS

A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction.

CONCLUSIONS

The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.

First evidence of an extensive Acheulean large cutting tool accumulation in Europe from Porto Maior (Galicia, Spain)

We describe a European Acheulean site characterised by an extensive accumulation of large cutting tools (LCT). This type of Lower Paleolithic assemblage, with dense LCT accumulations, has only been found on the African continent and in the Near East until now. The identification of a site with large accumulations of LCTs favours the hypothesis of an African origin for the Acheulean of Southwest Europe. The lithic tool-bearing deposits date back to 293–205 thousand years ago. Our chronological findings confirm temporal overlap between sites with clear “African” Acheulean affinities and Early Middle Paleolithic sites found elsewhere in the region. These complex technological patterns could be consistent with the potential coexistence of different human species in south-western Europe during the Middle Pleistocene.

System for the experimental evaluation of anthropomorphic hands. Application to a new 3D-printed prosthetic hand prototype

In the present study, we propose a new actuation device and protocol for testing the grasping performance of low-cost 3D-printed hand prototypes. The actuation device is connected to the forearm of a healthy user and allows him to use his thumb and fingers to control any prototype moved by up to six tendons attached to this device. The protocol includes grasping actions on 24 different objects using eight typical grasp types to obtain a grasping ability score and information about the coordination of motion among the fingers. This study also presents a new design for a low-cost 3D-printed prosthetic hand, called the IMMA hand. Preliminary tests were performed with the IMMA hand and the actuation device on two subjects, using the protocol, to assess the validity of the device for the experimental evaluation of hand prototypes in early design stages. The analysis of the results of these tests shows that the coordination of motions among fingers is quite similar for both subjects, indicating a similar control of the artificial hand. Index and ring finger motions are highly correlated in over half of the grasp actions performed for both subjects.

Grip force and force sharing in two different manipulation tasks with bottles

Grip force and force sharing during two activities of daily living were analysed experimentally in 10 right-handed subjects. Four different bottles, filled to two different levels, were manipulated for two tasks: transporting and pouring. Each test subject's hand was instrumented with eight thin wearable force sensors. The grip force and force sharing were significantly different for each bottle model. Increasing the filling level resulted in an increase in grip force, but the ratio of grip force to load force was higher for lighter loads. The task influenced the force sharing but not the mean grip force. The contributions of the thumb and ring finger were higher in the pouring task, whereas the contributions of the palm and the index finger were higher in the transport task. Mean force sharing among fingers was 30% for index, 29% for middle, 22% for ring and 19% for little finger. Practitioner Summary: We analysed grip force and force sharing in two manipulation tasks with bottles: transporting and pouring. The objective was to understand the effects of the bottle features, filling level and task on the contribution of different areas of the hand to the grip force. Force sharing was different for each task and the bottles features affected to both grip force and force sharing.

Hand Posture Prediction Using Neural Networks within a Biomechanical Model

This paper proposes the use of artificial neural networks (ANNs) in the framework of a biomechanical hand model for grasping. ANNs enhance the model capabilities as they substitute estimated data for the experimental inputs required by the grasping algorithm used. These inputs are the tentative grasping posture and the most open posture during grasping. As a consequence, more realistic grasping postures are predicted by the grasping algorithm, along with the contact information required by the dynamic biomechanical model (contact points and normals). Several neural network architectures are tested and compared in terms of prediction errors, leading to encouraging results. The performance of the overall proposal is also shown through simulation, where a grasping experiment is replicated and compared to the real grasping data collected by a data glove device.

Using kinematic reduction for studying grasping postures. An application to power and precision grasp of cylinders

The kinematic analysis of human grasping is challenging because of the high number of degrees of freedom involved. The use of principal component and factorial analyses is proposed in the present study to reduce the hand kinematics dimensionality in the analysis of posture for ergonomic purposes, allowing for a comprehensive study without losing accuracy while also enabling velocity and acceleration analyses to be performed. A laboratory study was designed to analyse the effect of weight and diameter in the grasping posture for cylinders. This study measured the hand posture from six subjects when transporting cylinders of different weights and diameters with precision and power grasps. The hand posture was measured using a Vicon(®) motion-tracking system, and the principal component analysis was applied to reduce the kinematics dimensionality. Different ANOVAs were performed on the reduced kinematic variables to check the effect of weight and diameter of the cylinders, as well as that of the subject. The results show that the original twenty-three degrees of freedom of the hand were reduced to five, which were identified as digit arching, closeness, palmar arching, finger adduction and thumb opposition. Both cylinder diameter and weight significantly affected the precision grasping posture: diameter affects closeness, palmar arching and opposition, while weight affects digit arching, palmar arching and closeness. The power-grasping posture was mainly affected by the cylinder diameter, through digit arching, closeness and opposition. The grasping posture was largely affected by the subject factor and this effect couldn't be attributed only to hand size. In conclusion, this kinematic reduction allowed identifying the effect of the diameter and weight of the cylinders in a comprehensive way, being diameter more important than weight.

The Origin of The Acheulean: The 1.7 Million-Year-Old Site of FLK West, Olduvai Gorge (Tanzania)

The appearance of the Acheulean is one of the hallmarks of human evolution. It represents the emergence of a complex behavior, expressed in the recurrent manufacture of large-sized tools, with standardized forms, implying more advance forethought and planning by hominins than those required by the precedent Oldowan technology. The earliest known evidence of this technology dates back to c. 1.7 Ma. and is limited to two sites (Kokiselei [Kenya] and Konso [Ethiopia]), both of which lack functionally-associated fauna. The functionality of these earliest Acheulean assemblages remains unknown. Here we present the discovery of another early Acheulean site also dating to c. 1.7 Ma from Olduvai Gorge. This site provides evidence of the earliest steps in developing the Acheulean technology and is the oldest Acheulean site in which stone tools occur spatially and functionally associated with the exploitation of fauna. Simple and elaborate large-cutting tools (LCT) and bifacial handaxes co-exist at FLK West, showing that complex cognition was present from the earliest stages of the Acheulean. Here we provide a detailed technological study and evidence of the use of these tools on the butchery and consumption of fauna, probably by early Homo erectus sensu lato.

An introductory study of common grasps used by adults during performance of activities of daily living

This paper presents the results of a descriptive survey on human grasps. Sixty-four videos were selected to represent tasks performed in the main areas of activities of daily living (ADL) (personal care, meal preparation, eating, housekeeping, etc.). All the participants were right-handed. Elementary grasps were identified for each hand, and the grasp type (from a 9-type classification), the hands involved, and the duration were registered for each case. The results show that the most commonly used grasps are: pinch, non-prehensile, cylindrical, lateral pinch and lumbrical. The presence of these grasps in the areas of ADL is, however, very different (e.g., pinch is widely used in food preparation and very little in driving). Some grasps were used more frequently with one hand or when both hands were used simultaneously (e.g., special pinch was hardly used by the left hand). Knowing the grasp types most frequently used in ADL is essential to be able to assess grasp rehabilitation processes or hand prostheses development.

Validity of a simple videogrammetric method to measure the movement of all hand segments for clinical purposes

Hand movement measurement is important in clinical, ergonomics and biomechanical fields. Videogrammetric techniques allow the measurement of hand movement without interfering with the natural hand behaviour. However, an accurate measurement of the hand movement requires the use of a high number of markers, which limits its applicability for the clinical practice (60 markers would be needed for hand and wrist). In this work, a simple method that uses a reduced number of markers (29), based on a simplified kinematic model of the hand, is proposed and evaluated. A set of experiments have been performed to evaluate the errors associated with the kinematic simplification, together with the evaluation of its accuracy, repeatability and reproducibility. The global error attributed to the kinematic simplification was 6.68°. The method has small errors in repeatability and reproducibility (3.43° and 4.23°, respectively) and shows no statistically significant difference with the use of electronic goniometers. The relevance of the work lies in the ability of measuring all degrees of freedom of the hand with a reduced number of markers without interfering with the natural hand behaviour, which makes it suitable for its use in clinical applications, as well as for ergonomic and biomechanical purposes.

Stiffness map of the grasping contact areas of the human hand

The elasticity and damping of the soft tissues of the hand contribute to dexterity while grasping and also help to stabilise the objects in manipulation tasks. Although some previous works have studied the force-displacement response of the fingertips, the responses in all other regions of the hand that usually participate in grasping have not been analysed to date. In this work we performed experimental measurements in 20 subjects to obtain a stiffness map of the different grasping contact areas of the human hand. A force-displacement apparatus was used to simultaneously measure force and displacement at 39 different points on the hand at six levels of force ranging from 1N to 6N. A non-linear force-displacement response was found for all points, with stiffness increasing with the amount of force applied. Mean stiffness for the different points and force levels was within the range from 0.2N/mm to 7.7N/mm. However, the stiffness range and variation with level of force were found to be different from point to point. A total of 13 regions with similar stiffness behaviours were identified. The stiffness in the fingertips increased linearly with the amount of force applied, while in the palm it remained more constant for the range of forces considered. It is hypothesised that the differences in the stiffness behaviour from one region to another allow these regions to play different roles during grasping.

Mechanical performance of endodontic restorations with prefabricated posts: sensitivity analysis of parameters with a 3D finite element model

Many studies have investigated the effect of different parameters of the endodontically restored tooth on its final strength, using in vitro tests and model simulations. However, the differences in the experimental set-up or modelling conditions and the limited number of parameters studied in each case prevent us from obtaining clear conclusions about the relative importance of each parameter. In this study, a validated 3D biomechanical model of the restored tooth was used for an exhaustive sensitivity analysis. The individual influence of 20 different parameters on the mechanical performance of an endodontic restoration with prefabricated posts was studied. The results bring up the remarkable importance of the loading angle on the final restoration strength. Flexural loads are more critical than compressive or tensile loads. Young's modulus of the post and its length and diameter are the most influential parameters for strength, whereas other parameters such as ferrule geometry or core and crown characteristics are less significant.

State of the art and review on the treatment technologies of water reverse osmosis concentrates

The growing demand for fresh water is partially satisfied by desalination plants that increasingly use membrane technologies and among them reverse osmosis to produce purified water. Operating with water recoveries from 35% to 85% RO plants generate huge volumes of concentrates containing all the retained compounds that are commonly discharged to water bodies and constitute a potentially serious threat to marine ecosystems; therefore there is an urgent need for environmentally friendly management options of RO brines. This paper gives an overview on the potential treatments to overcome the environmental problems associated to the direct discharge of RO concentrates. The treatment options have been classified according to the source of RO concentrates and the maturity of the technologies. For the sake of clarity three different sources of RO concentrates are differentiated i) desalination plants, ii) tertiary processes in WWTP, and iii) mining industries. Starting with traditional treatments such as evaporation and crystallization other technologies that have emerged in last years to reduce the volume of the concentrate before disposal and with the objective of achieving zero liquid discharge and recovery of valuable compounds from these effluents are also reviewed. Most of these emerging technologies have been developed at laboratory or pilot plant scale (see Table 1). With regard to RO concentrates from WWTP, the manuscript addresses recent studies that are mainly focused on reducing the organic pollutant load through the application of innovative advanced oxidation technologies. Finally, works that report the treatment of RO concentrates from industrial sources are analyzed as well.

Premolars restored with posts of different materials: fatigue analysis

Previous works studied the effect of the material and the dimensions of the post on the biomechanical performance (fracture strength and stress distribution) of restored teeth, under static loads. The aim of this work was to study the effect of the post material (glass fibre and stainless steel) on restored teeth, which have the final crown, under dynamic conditions. The use of a biomechanical model, including a fatigue analysis from FEA, is presented as a powerful method to study the effect of the material of the intraradicular post. The inclusion of the fatigue analysis allows for a more realistic study that takes into account the dynamic nature of masticatory forces. At the same time, the results obtained are easier to interpret by both dentists and mechanical engineers. No differences were found, with the load and number of cycles considered, between glass fibre and stainless steel as material for the intraradicular post used in premolars restorations.

Experimental strength of restorations with fibre posts at different stages, with and without using a simulated ligament

The aim of this study was to analyse the strength and failure mode of teeth restored with fibre posts under retention and flexural-compressive loads at different stages of the restoration and to analyse whether including a simulated ligament in the experimental setup has any effect on the strength or the failure mode. Thirty human maxillary central incisors were distributed in three different groups to be restored with simulation of different restoration stages (1: only post, 2: post and core, 3: post-core and crown), using Rebilda fibre posts. The specimens were inserted in resin blocks and loaded by means of a universal testing machine until failure under tension (stage 1) and 50º flexion (stages 2-3). Half the specimens in each group were restored using a simulated ligament between root dentine and resin block and the other half did not use this element. Failure in stage 1 always occurred at the post-dentine interface, with a mean failure load of 191·2 N. Failure in stage 2 was located mainly in the core or coronal dentine (mean failure load of 505·9 N). Failure in stage 3 was observed in the coronal dentine (mean failure load 397·4 N). Failure loads registered were greater than expected masticatory loads. Fracture modes were mostly reparable, thus indicating that this post is clinically valid at the different stages of restoration studied. The inclusion of the simulated ligament in the experimental system did not show a statistically significant effect on the failure load or the failure mode.

Interpreting finite element results for brittle materials in endodontic restorations

BACKGROUND

Finite element simulation has been used in last years for analysing the biomechanical performance of post-core restorations in endodontics, but results of these simulations have been interpreted in most of the works using von Mises stress criterion. However, the validity of this failure criterion for brittle materials, which are present in these restorations, is questionable. The objective of the paper is to analyse how finite element results for brittle materials of endodontic restorations should be interpreted to obtain correct conclusions about the possible failure in the restoration.

METHODS

Different failure criteria (Von Mises, Rankine, Coulomb-Mohr, Modified Mohr and Christensen) and material strength data (diametral tensile strength and flexural strength) were considered in the study. Three finite element models (FEM) were developed to simulate an endodontic restoration and two typical material tests: diametral tensile test and flexural test.

RESULTS

Results showed that the Christensen criterion predicts similar results as the Von Mises criterion for ductile components, while it predicts similar results to all other criteria for brittle components. The different criteria predict different failure points for the diametral tensile test, all of them under multi-axial stress states. All criteria except Von Mises predict failure for flexural test at the same point of the specimen, with this point under uniaxial tensile stress.

CONCLUSIONS

From the results it is concluded that the Christensen criterion is recommended for FEM result interpretation in endodontic restorations and that the flexural test is recommended to estimate tensile strength instead of the diametral tensile test.

Influence of material and diameter of pre-fabricated posts on maxillary central incisors restored with crown

Numerous research works have studied the effect of post-design parameters on the mechanical behaviour of restored teeth without reaching any clear conclusions. Previous works by the authors ascertained the effect of material and post-dimensions for non-crowned restored teeth. The aim of this work was to study the effect of post-material and diameter for crowned teeth. First, an experimental fracture strength test was performed on eighteen extracted human maxillary central incisors. Teeth were decoronated, treated endodontically and restored (nine with glass fibre posts and nine with stainless steel posts). Several post-diameters were used. The final crown restoration was carried out using a reinforced glass-ceramic material. Failure loads were recorded and results were compared using the one-way anova. Secondly, the finite element technique was used to model the restored teeth and to compare the estimated stress distributions. The addition of the crown did not affect the strength of the restoration to any significant extent and post-diameter did not influence the biomechanical performance of either of the post-systems. The crown acts as a protector, thus eliminating the influence of the post-diameter that was found previously when using stainless steel posts, but it does not completely rule out the possibility of a root fracture. Significantly, lower failure loads were found experimentally for teeth restored with stainless steel posts. The stress distributions predicted by the model corroborated these findings and allowed the authors to propose the use of glass fibre posts as a more robust restorative technique.

A modified elastic foundation contact model for application in 3D models of the prosthetic knee

Different models have been used in the literature for the simulation of surface contact in biomechanical knee models. However, there is a lack of systematic comparisons of these models applied to the simulation of a common case, which will provide relevant information about their accuracy and suitability for application in models of the implanted knee. In this work a comparison of the Hertz model (HM), the elastic foundation model (EFM) and the finite element model (FEM) for the simulation of the elastic contact in a 3D model of the prosthetic knee is presented. From the results of this comparison it is found that although the nature of the EFM offers advantages when compared with that of the HM for its application to realistic prosthetic surfaces, and when compared with the FEM in CPU time, its predictions can differ from FEM in some circumstances. These differences are considerable if the comparison is performed for prescribed displacements, although they are less important for prescribed loads. To solve these problems a new modified elastic foundation model (mEFM) is proposed that maintains basically the simplicity of the original model while producing much more accurate results. In this paper it is shown that this new mEFM calculates pressure distribution and contact area with accuracy and short computation times for toroidal contacting surfaces. Although further work is needed to confirm its validity for more complex geometries the mEFM is envisaged as a good option for application in 3D knee models to predict prosthetic knee performance.

Influenza virus infection causes specific degradation of the largest subunit of cellular RNA polymerase II

It has been described that influenza virus polymerase associates with RNA polymerase II (RNAP II). To gain information about the role of this interaction, we explored if changes in RNAP II occur during infection. Here we show that influenza virus causes the specific degradation of the hypophosphorylated form of the largest subunit of RNAP II without affecting the accumulation of its hyperphosphorylated forms. This effect is independent of the viral strain and the origin of the cells used. Analysis of synthesized mRNAs in isolated nuclei of infected cells indicated that transcription decreases concomitantly with RNAP II degradation. Moreover, this degradation correlated with the onset of viral transcription and replication. The ubiquitin-mediated proteasome pathway is not involved in virally induced RNAP II proteolysis. The expression of viral polymerase from its cloned cDNAs was sufficient to cause the degradation. Since the PA polymerase subunit has proteolytic activity, we tested its participation in the process. A recombinant virus that encodes a PA point mutant with decreased proteolytic activity and that has defects in replication delayed the effect, suggesting that PA's contribution to RNAP II degradation occurs during infection.

Influence of prefabricated post dimensions on restored maxillary central incisors

The aim of this study was to test the following hypothesis: biomechanical performance (fracture strength and stress distribution) of restored teeth is less sensitive to post diameter and post length when using glass fibre posts than when using stainless steel posts. First, an experimental fracture strength test was performed on 80 extracted human maxillary central incisors. Teeth were decoronated, treated endodontically and restored (40 with glass fibre posts and 40 with stainless steel posts), and the length and diameter of the posts varied uniformly. Failure loads were recorded and results were compared using an ancova analysis. Secondly, the finite element technique was used to develop a model of the restored tooth. The post diameter had a significant effect on the biomechanical performance of teeth restored with stainless steel posts. Lower failure loads were found as post diameter increased. However, the post diameter of those teeth restored with glass fibre posts, and the post length for both post systems under consideration, did not affect the biomechanical performance of restored teeth to a significant degree. The stress distributions predicted by the developed model corroborated these findings, confirmed the assumed hypothesis, and permitted the proposal of the use of glass fibre posts to achieve a restorative technique that is less sensitive to post dimensions, and thus more robust.

An Early Pleistocene hominin mandible from Atapuerca-TD6, Spain

We present a mandible recovered in 2003 from the Aurora Stratum of the TD6 level of the Gran Dolina site (Sierra de Atapuerca, northern Spain). The specimen, catalogued as ATD6-96, adds to the hominin sample recovered from this site in 1994-1996, and assigned to Homo antecessor. ATD6-96 is the left half of a gracile mandible belonging to a probably female adult individual with premolars and molars in place. This mandible shows a primitive structural pattern shared with all African and Asian Homo species. However, it is small and exhibits a remarkable gracility, a trait shared only with the Early and Middle Pleistocene Chinese hominins. Furthermore, none of the mandibular features considered apomorphic in the European Middle and Early Upper Pleistocene hominin lineage are present in ATD6-96. This evidence reinforces the taxonomic identity of H. antecessor and is consistent with the hypothesis of a close relationship between this species and Homo sapiens.

Optimum tool handle diameter for a cylinder grip

The ideal diameter for a tool handle for males and females has been determined using an existing biomechanical model of the hand validated in previous works. The model estimates a 33-mm optimum diameter tool handle for the general population (males and females). When the optimum diameter for a tool handle is selected, the muscles exert the minimum force needed to hold the tool and perform gripping activities. Optimal handle design reduces the force required for gripping a tool, protects the underlying joint structures, and reduces the risk of developing cumulative trauma associated with repetitive task requiring high grip forces and awkward postures. This article provides a design parameter for optimal tool diameter to aid the therapist in the selection of assistive devices, built-up handles, or for the fabrication of a tool handle.

Description and Validation of a Non-Invasive Technique to Measure the Posture of All Hand Segments

The aim of this work is to describe and validate a technique for measuring the posture of all the segments of the hand in a non-invasive way. The technique uses digital photographic images to reconstruct 3-D location of markers drawn on the skin. The markers are defined to obtain joint rotation angles with physiological meaning. Different experiments have been developed in order to analyze the accuracy and repeatability of the angle measurements. Although the placement of markers does not require any special care, the errors due to their location are lower than 2.6 deg in all cases, thus assuring the repeatability of the technique.

A 3D biomechanical model of the hand for power grip

A three-dimensional scalable biomechanical model of the four fingers of the hand to evaluate power grip is proposed. The model has been validated by means of reproducing an experiment in which the subjects exerted the maximal voluntary grasping force over cylinders of different diameters. The model is used to simulate the cylinder grip for two hand sizes and for five different handle diameters. The reduction of the muscle forces using different handle diameters has been studied. The model can be applied to the design and evaluation of handles for power grip and to the study of power grasp for normal and abnormal hands.

A 3-D dynamic model of human finger for studying free movements

The purpose of this work is to develop a 3D inverse dynamic model of the human finger for estimating the muscular forces involved during free finger movements. A review of the existing 3D models of the fingers is presented, and an alternative one is proposed. The validity of the model has been proved by means of two simulations: free flexion-extension motion of all joints, and free metacarpophalangeal (MCP) adduction motion. The simulation shows the need for a dynamic model including inertial effects when studying fast movements and the relevance of modelling passive forces generated by the structures studying free movements, such as the force exerted by the muscles when they are stretched and the passive action of the ligaments over the MCP joint in order to reproduce the muscular force pattern during the simulation of the free MCP abduction-adduction movements.

On the age of the hominid fossils at the Sima de los Huesos, Sierra de Atapuerca, Spain: paleomagnetic evidence

We report new paleomagnetic data for the Middle Pleistocene hominid-bearing strata in the Sima de los Huesos, North Spain. Sediments (brown muds with human and bear fossils and the underlying sterile clayey and sandy unit) preserve both normal and reversed magnetic components. The sterile unit has exclusively reversed magnetization, dating back to the Matuyama Chron, and thus is Lower Pleistocene in age. The overlying fossiliferous muds have a dominant normal magnetization that overprints a partially resolved reversed magnetization. These data are compatible with one of the reversal events that occurred during the Brunhes Chron. Combined with the existing U-series dates and evidence from the macro- and microfauna, these paleomagnetic results suggest an age of the hominid fossils between 325 to 205 ka, whereas the underlying sand and silts are older than 780 ka.

Magnetochronology and stratigraphy at Gran Dolina section, Atapuerca (Burgos, Spain)

The Atapuerca Site (Burgos, N. Spain) is an extensive archaeological site which has yielded numerous human fossil remains. The Gran Dolina section, one of the open-air excavations and subject of this study, consists of a sedimentary infilling of 18 m thickness in a gallery originated by karstification of the host Cretaceous limestones. In this paper we present new stratigraphic and paleomagnetic evidence for the age and the sedimentary environment of the karst infilling where the archaeological site is located. Paleomagnetic dating places the hominids (Aurora stratum) in the Matuyama reversed Chron, hence before 780 ka. We also report evidence for a short normal polarity event at the bottom of the section that we speculate as being Jaramillo or Kamikatsura. The early and well-constrained date of the Atapuerca archaeological site, its location in the cul-de-sac we know as Europe, its stratigraphic context, the abundant fossil remains and the stone tool industry make it one of the most important localities for the question of the earliest human occupation in Europe.

Paleomagnetic age for hominid fossils at Atapuerca archaeological site, Spain

A paleomagnetic investigation at the Gran Dolina site excavation (Atapuerca, Spain) shows that the sediments containing the recently discovered human occupation were deposited more than 780,000 years ago, near the time of the Matuyama-Brunhes boundary. Forty-one oriented samples were obtained from 22 sites along an 18-meter section of the Gran Dolina karst filling. The lower 16 sites displayed reversed-polarity magnetizations whereas the upper six sites were normal. The reversal spans the hominid finds at stratigraphic level TD6 (the Aurora stratum), and these hominid fossils are therefore the oldest in southern Europe.