Predicting cervico-thoraco-lumbar vertebra positions from cutaneous markers: Combining local frame and postural predictors improves robustness to posture

Predictions of vertebra positions from external data are required in many fields like motion analysis or for clinical applications. Existing predictions mainly cover the thoraco-lumbar spine, in one posture. The objective of this study was to develop a method offering robust vertebra position predictions in different postures for the whole spine, in the sagittal plane. EOS radiographs were taken in three postures: slouched, erect, and subject's usual sitting posture, using 21 healthy participants pre-equipped with opaque cutaneous markers. Local curvilinear Frenet frames were built on a spline fitted to spinous processes' cutaneous markers. Vertebra positions were expressed as polar coordinates in these frames, defining an angle (α) and distance (d). Multilinear regressions were fitted to explain α and d from anthropometric predictors and predictors presumed to be linked to spinal posture, the predictors' effects being considered both locally and remotely. Anthropometric predictors were the main predictors for d distances, and postural predictors for α angles, with postural predictors still showing a marked influence on d distances for the cervical spine. Vertebra positions were then predicted by cross-validation. The average RMSE on vertebra positions was 11.0 ± 3.7 mm across the entire spine, 13.4 ± 4.1 mm across the cervical spine and 10.1 ± 3.1 mm across the thoraco-lumbar spine for all participants and postures, performances similar to previous models designed for a single posture. Our simple geometrical and statistical model thus appears promising for predicting vertebra positions from external data in several spinal postures and for the whole spine.

Subject-specific model-derived kinematics of the shoulder based on skin markers during arm abduction up to 180° - assessment of 4 gleno-humeral joint models

Accuracy of shoulder kinematics predicted by multi-body kinematics optimisation depend on the joint models used. This study assesses the influence of four different subject-specific gleno-humeral joint models within multi-body kinematics optimisation: a 6-degree-of-freedom joint (i.e. single-body kinematics optimisation), a sphere-on-sphere joint (with two spheres of different radii) and a spherical joint with or without penalised translation. To drive these models, the 3D coordinates of 12 skin markers of 6 subjects performing static arm abduction poses up to 180° were used. The reference data was obtained using biplane X-rays from which 3D bone reconstructions were generated: scapula and humerus were 3D reconstructed by fitting a template model made of geometrical primitives on the two bones' X-rays. Without any motion capture system, the recording of the skin markers was performed at the very same time than the X-rays with radiopaque markers. The gleno-humeral displacements and angles, and scapula-thoracic angles were computed. The gleno-humeral sphere-on-sphere joint provided slightly better results than the spherical joint with or without penalised translation, but considerably better gleno-humeral displacements than the 6-DoF joint. Considering that it can easily be personalised from medical images, this sphere-on-sphere model seems promising for shoulder multi-body kinematics optimisation.

Closed-loop multibody kinematic optimization coupled with double calibration improves scapular kinematic estimates in asymptomatic population

Non-invasive methods still need to better estimate scapular kinematics because of soft tissue artifact issue. This study aimed to develop and assess new procedures to estimate scapular kinematics by combining closed kinematic chain optimization and double calibration. Sixteen healthy volunteers performed static postures mimicking analytical and daily living movements. Scapulo-thoracic angles were computed either with a scapula locator (Ref), or with a closed-loop multibody kinematic optimization (Ell) or with double calibration involving linear (DClin), exponential (DCexp) or logarithmic (DClog) correction. Double calibration corrections enforced scapulo-thoracic angles to be the same than those measured with Ref at the end of the movement performed. DClin and DClog significantly (p < 0.01) reduced scapulo-thoracic misorientation for at least the second third of the movement with averaged improvement ranging from 9° to 32°. Moreover, for arm elevation in the sagittal plane, internal rotations and mimicking hair combing, the beneficial effect of DClin and DClog propagates up to half of the movement. To conclude, when a kinematic chain is required, coupling double calibration (using either linear or logarithmic correction), to a closed-loop multibody kinematic optimization is an efficient and fast method in regard with improvement in scapular kinematic estimates in healthy population.

Influence of glenohumeral joint muscle insertion on moment arms using a finite element model

Accurate muscle geometry is essential to estimate moment arms in musculoskeletal models. Given the complex interactions between shoulder structures, we hypothesized that finite element (FE) modelling is suitable to obtain physiological muscle trajectory. A FE glenohumeral joint model was developed based on medical imaging. Moment arms were computed and compared to literature and MRI-based estimation. Our FE model produces moment arms consistent with the literature and with MRI data (max 17 mm differences). The inferior and superior fibres of a same muscle can have opposite action; predictions of moment arms are sensitive to muscle insertion (up to 20 mm variation).

Human shoulder response to side impacts: a finite element study

This study aimed at developing a shoulder finite element (FE) model able to simulate the dynamic behaviour and to predict injuries in case of side impacts. This model is an updated version of the initial Human Model for Safety (HUMOS) FE model of the human body. Simulations performed with the model have been compared to experimental results of side impact tests conducted previously at INRETS. The shoulder model response under lateral impact appears to be in good agreement with experimental data such as impact force and shoulder deflections for different impact speeds and impact directions. These results seem promising for future applications such as shoulder injury prediction in simulated car crashes.

OKT 3 reaction in a renal transplant patient

In this case, the intended patient outcomes were achieved. Nursing was clearly able to take a very proactive role in providing the necessary emergency patient care to prevent further patient compromise. Once the immediate physiologic danger of respiratory decompensation was treated, nursing moved on to intervene in the less-serious complications associated with OKT 3 reaction to assure maximal patient comfort. Finally, patient teaching was done both to assess the learning needs associated with the OKT 3 reaction, as well as to prepare the patient and family for administration of additional doses of OKT 3. These nursing actions resulted in a very favorable outcome for both the patient and family.

Protection of uninfected human bone marrow cells in long-term culture from G418 toxicity after retroviral-mediated transfer of the NEOr gene

The long-term effect of retroviral-mediated gene transfer into human hematopoietic cells in vitro was studied in bone marrow culture. Two retroviral vectors (pN2 or pZIP NEO) were used to transfer the gene coding for neomycin phosphotransferase, which confers neomycin resistance, as a dominant selectable marker. Following infection, bone marrow cells of multiple hematopoietic lineages displayed resistance for the duration of the cultures (greater than 80 days) to normally cytotoxic doses of the neomycin analog G418. However, upon DNA analysis of cells surviving in G418, the NEOr (neomycin resistance) gene was not detected under conditions where single copy genes could readily be seen, despite the presence of NEOr RNA sequences. In order to investigate this observation further, infected and uninfected cells were separated by a filter, and cultured in the same medium containing G418. The uninfected cells continued to survive in the presence of normally toxic concentrations of G418. Medium alone from infected cells was able to protect uninfected cells the same way. Efficiency of transfer of this and perhaps other selectable marker genes to cells in the long-term culture system may consequently be overestimated if survival of cells alone is quantitated. These results indicate that long-term cultures are a useful in vitro model for the study of retroviral-mediated gene transfer to human hematopoietic cells.