Cell viability in intervertebral disc under various nutritional and dynamic loading conditions: 3d finite element analysis

In this study, a new cell density model was developed and incorporated into the formulation of the mechano-electrochemical mixture theory to investigate the effects of deprivation of nutrition supply at boundary source, degeneration, and dynamic loading on the cell viability of intervertebral disc (IVD) using finite element methods. The deprivation of nutrition supply at boundary source was simulated by reduction in nutrition level at CEP and AF boundaries. Cases with 100%, 75%, 60%, 50% and 30% of normal nutrition level at both CEP and AF boundaries were modeled. Unconfined axial sinusoidal dynamic compressions with different combinations of amplitude (u=10%± 2.5%, ± 5%) and frequency (f=1, 10, 20 cycle/day) were applied. Degenerated IVD was modeled with altered material properties. Cell density decreased substantially with reduction of nutrition level at boundaries. Cell death was initiated primarily near the NP-AF interface on the mid-plane. Dynamic loading did not result in a change in the cell density in non-degenerated IVD, since glucose levels did not fall below the minimum value for cell survival; in degenerated IVDs, we found that increasing frequency and amplitude both resulted in higher cell density, because dynamic compression facilitates the diffusion of nutrients and thus increases the nutrition level around IVD cells. The novel computational model can be used to quantitatively predict both when and where cells start to die within the IVD under various kinds of nutritional and mechanical conditions.

Nutrient transport in human annulus fibrosus is affected by compressive strain and anisotropy

The avascular intervertebral disc (IVD) receives nutrition via transport from surrounding vasculature; poor nutrition is believed to be a main cause of disc degeneration. In this study, we investigated the effects of mechanical deformation and anisotropy on the transport of two important nutrients--oxygen and glucose--in human annulus fibrosus (AF). The diffusivities of oxygen and glucose were measured under three levels of uniaxial confined compression--0, 10, and 20%--and in three directions--axial, circumferential, and radial. The glucose partition coefficient was also measured at three compression levels. Results for glucose and oxygen diffusivity in AF ranged from 4.46 × 10(-7) to 9.77 × 10(-6) cm(2)/s and were comparable to previous studies; the glucose partition coefficient ranged from 0.71 to 0.82 and was also similar to previous results. Transport properties were found to decrease with increasing deformation, likely caused by fluid exudation during tissue compression and reduction in pore size. Furthermore, diffusivity in the radial direction was lower than in the axial or circumferential directions, indicating that nutrient transport in human AF is anisotropic. This behavior is likely a consequence of the layered structure and unique collagen architecture of AF tissue. These findings are important for better understanding nutritional supply in IVD and related disc degeneration.

3D finite element analysis of nutrient distributions and cell viability in the intervertebral disc: effects of deformation and degeneration

The intervertebral disc (IVD) receives important nutrients, such as glucose, from surrounding blood vessels. Poor nutritional supply is believed to play a key role in disc degeneration. Several investigators have presented finite element models of the IVD to investigate disc nutrition; however, none has predicted nutrient levels and cell viability in the disc with a realistic 3D geometry and tissue properties coupled to mechanical deformation. Understanding how degeneration and loading affect nutrition and cell viability is necessary for elucidating the mechanisms of disc degeneration and low back pain. The objective of this study was to analyze the effects of disc degeneration and static deformation on glucose distributions and cell viability in the IVD using finite element analysis. A realistic 3D finite element model of the IVD was developed based on mechano-electrochemical mixture theory. In the model, the cellular metabolic activities and viability were related to nutrient concentrations, and transport properties of nutrients were dependent on tissue deformation. The effects of disc degeneration and mechanical compression on glucose concentrations and cell density distributions in the IVD were investigated. To examine effects of disc degeneration, tissue properties were altered to reflect those of degenerated tissue, including reduced water content, fixed charge density, height, and endplate permeability. Two mechanical loading conditions were also investigated: a reference (undeformed) case and a 10% static deformation case. In general, nutrient levels decreased moving away from the nutritional supply at the disc periphery. Minimum glucose levels were at the interface between the nucleus and annulus regions of the disc. Deformation caused a 6.2% decrease in the minimum glucose concentration in the normal IVD, while degeneration resulted in an 80% decrease. Although cell density was not affected in the undeformed normal disc, there was a decrease in cell viability in the degenerated case, in which averaged cell density fell 11% compared with the normal case. This effect was further exacerbated by deformation of the degenerated IVD. Both deformation and disc degeneration altered the glucose distribution in the IVD. For the degenerated case, glucose levels fell below levels necessary for maintaining cell viability, and cell density decreased. This study provides important insight into nutrition-related mechanisms of disc degeneration. Moreover, our model may serve as a powerful tool in the development of new treatments for low back pain.

Effect of endplate calcification and mechanical deformation on the distribution of glucose in intervertebral disc: a 3D finite element study

The intervertebral disc (IVD) is avascular, receiving nutrition from surrounding vasculature. Theoretical modelling can supplement experimental results to understand nutrition to IVD more clearly. A new, 3D finite element model of the IVD was developed to investigate effects of endplate calcification and mechanical deformation on glucose distributions in IVD. The model included anatomical disc geometry, non-linear coupling of cellular metabolism with pH and oxygen concentration and strain-dependent properties of the extracellular matrix. Calcification was simulated by reducing endplate permeability (∼79%). Mechanical loading was applied based on in vivo disc deformation during the transition from supine to standing positions. Three static strain conditions were considered: supine, standing and weight-bearing standing. Minimum glucose concentrations decreased 45% with endplate calcification, whereas disc deformation led to a 4.8-63% decrease, depending on the endplate condition (i.e. normal vs. calcified). Furthermore, calcification more strongly affected glucose concentrations in the nucleus compared to the annulus fibrous region. This study provides important insight into nutrient distributions in IVD under mechanical deformation.

Relationship between solute transport properties and tissue morphology in human annulus fibrosus

Poor nutritional supply to the intervertebral disc is believed to be an important factor leading to disc degeneration. However, little is known regarding nutritional transport in human annulus fibrosus (AF) and its relation to tissue morphology. We hypothesized that solute diffusivity in human AF is anisotropic and inhomogeneous, and that transport behaviors are associated with tissue composition and structure. To test these hypotheses, we measured the direction-dependent diffusivity of a fluorescent molecule (fluorescein, 332 Da) in three regions of AF using a fluorescence recovery after photobleaching (FRAP) technique, and associated transport results to the regional variation in water content and collagen architecture in the tissue. Diffusivity in AF was anisotropic, with higher values in the axial direction than in the radial direction for all regions investigated. The values of the diffusion coefficient ranged from 0.38 +/- 0.25 x 10(-6) cm(2)/s (radial diffusivity in outer AF) to 2.68 +/- 0.84 x 10(-6) cm(2)/s (axial diffusivity in inner AF). In both directions, diffusivity decreased moving from inner to outer AF. Tissue structure was investigated using both scanning electron microscopy and environmental scanning electron microscopy. A unique arrangement of microtubes was found in human AF. Furthermore, we also found that the density of these microtubes varied moving from inner to outer AF. A similar trend of regional variation was found for water content, with the highest value also measured in inner AF. Therefore, we concluded that a relationship exists among the anisotropic and inhomogeneous diffusion in human AF and the structure and composition of the tissue.

Strain-dependent oxygen diffusivity in bovine annulus fibrosus

The intervertebral disk (IVD) is the largest avascular structure in the human body. Transport of small molecules in IVD is mainly through diffusion from the endplates and the peripheral blood vessels surrounding IVD. Studies have investigated the structure, chemical components, and water content in IVD, but to our knowledge no study has investigated the effect of mechanical loading on oxygen transport in IVD. The objective of this study was to determine the strain-dependent behavior of oxygen diffusivity in IVD tissue. A one-dimensional steady-state diffusion experiment was designed and performed to determine the oxygen diffusivity in bovine annulus fibrosus (AF). The oxygen diffusivity was calculated using equation derived from Fick's law. A total of 20 AF specimens (d=6 mm, h approximately 0.5 mm) from bovine coccygeal IVD were used to determine oxygen diffusivity at three levels of compressive strain. The average oxygen diffusivity (mean+/-SD) of bovine AF in the axial direction was 1.43+/-0.242 x 10(-5) cm(2)/s (n=20) at 4.68+/-1.67% compressive strain level, 1.05+/-0.282 x 10(-5) cm(2)/s (n=20) at 14.2+/-1.50% strain level, and 7.71+/-1.63 x 10(-6) cm(2)/s (n=20) at 23.7+/-1.34% strain level. There was a significant decrease in oxygen diffusivity with increasing level of compressive strain (ANOVA, p<0.05). Oxygen diffusivity of bovine AF in the axial direction has been determined. The mechanical loading has a significant effect on oxygen transport in IVD tissues. This study is important in understanding nutritional transport in IVD tissues and related disk degeneration.

A conductivity approach to measuring fixed charge density in intervertebral disc tissue

A new method for measuring the fixed charge density (FCD) in intervertebral disc (IVD) tissues employing a two-point electrical conductivity approach was developed. In this technique, the tissue is first confined and equilibrated in a potassium chloride (KCl) solution, and the tissue conductivity is then measured. This is then repeated with a second concentration of KCl solution. The FCD can be determined from the conductivity measurements. Using this method, the FCD values of bovine annulus fibrosus (AF) and nucleus pulposus (NP) tissues were determined to be 0.060 +/- 0.027 mEq/g wet tissue and 0.19 +/- 0.039 mEq/g wet tissue, respectively. The FCD of AF was significantly lower than that of NP tissue, similar to results in the literature for human IVD tissues. In order to verify the accuracy of the new method, the glycosaminoglycan (GAG) contents of the tissues were measured and used to estimate the tissue FCD. A strong correlation (R (2) = 0.84-0.87) was found to exist between FCD values measured and those estimated from GAG contents, indicating that the conductivity approach is a reliable technique for measuring the FCD of IVD tissues.

Effect of mechanical loading on electrical conductivity in human intervertebral disk

The intervertebral disk (IVD), characterized as a charged, hydrated soft tissue, is the largest avascular structure in the body. Mechanical loading to the disk results in electromechanical transduction phenomenon as well as altered transport properties. Electrical conductivity is a material property of tissue depending on ion concentrations and diffusivities, which are in turn functions of tissue composition and structure. The aim of this study was to investigate the effect of mechanical loading on electrical behavior in human IVD tissues. We hypothesized that electrical conductivity in human IVD is strain-dependent, due to change in tissue composition caused by compression, and inhomogeneous, due to tissue structure and composition. We also hypothesized that conductivity in human annulus fibrosus (AF) is anisotropic, due to the layered structure of the tissue. Three lumbar IVDs were harvested from three human spines. From each disk, four AF specimens were prepared in each of the three principal directions (axial, circumferential, and radial), and four axial nucleus pulposus (NP) specimens were prepared. Conductivity was determined using a four-wire sense-current method and a custom-designed apparatus by measuring the resistance across the sample. Resistance measurements were taken at three levels of compression (0%, 10%, and 20%). Scanning electron microscopy (SEM) images of the human AF tissue were obtained in order to correlate tissue structure with conductivity results. Increasing compressive strain significantly decreased conductivity for all groups (p<0.05, analysis of variance (ANOVA)). Additionally, specimen orientation significantly affected electrical conductivity in the AF tissue, with conductivity in the radial direction being significantly lower than that in the axial or circumferential directions at all levels of compressive strain (p<0.05, ANOVA). Finally, conductivity in the NP tissue was significantly higher than that in the AF tissue (p<0.05, ANOVA). SEM images of the AF tissues showed evidence of microtubes orientated in the axial and circumferential directions, but not in the radial direction. This may suggest a relationship between tissue morphology and the anisotropic behavior of conductivity in the AF. The results of this investigation demonstrate that electrical conductivity in human IVD is strain-dependent and inhomogeneous, and that conductivity in the human AF tissue is anisotropic (i.e., direction-dependent). This anisotropic behavior is correlated with tissue structure shown in SEM images. This study provides important information regarding the effects of mechanical loading on solute transport and electrical behavior in IVD tissues.

Effects of low glucose concentrations on oxygen consumption rates of intervertebral disc cells

STUDY DESIGN

Investigation of the effects of low glucose concentrations on the oxygen consumption rates of intervertebral disc cells.

OBJECTIVES

To determine the oxygen consumption rate of porcine anulus fibrosus (AF) cells at different glucose concentrations and to examine the differences in the oxygen consumption rate between AF and nucleus pulposus (NP) cells at different glucose levels.

SUMMARY OF BACKGROUND DATA

Poor nutrient supply has been suggested as a potential mechanism for degeneration of the intervertebral disc (IVD). Distribution of nutrients in the IVD is strongly dependent on transport properties of the tissue and cellular metabolic rates. Previous studies have shown dependence of oxygen consumption rate of IVD cells on oxygen tension, pH levels, and glucose levels outside the physiologic range. However, the oxygen consumption rate of AF cells at in vivo glucose levels has not been investigated.

METHODS

IVD cells were isolated from the outer AF and NP of 4- to 5-month-old porcine lumbar discs. The changes in oxygen tension were recorded when cells were cultured in sealed metabolism chamber. The oxygen consumption rate of cells was determined by theoretical curve fitting using the Michaelis-Menten equation.

RESULTS

The outer AF cells cultured in high glucose medium (25 mmol/L) exhibited the lowest oxygen consumption rate, whereas no significant differences in oxygen consumption rates were found among outer AF cells cultured at physiologic glucose levels (i.e., 1 mmol/L, 2.5 mmol/L, 5 mmol/L). The oxygen consumption rate of NP cells was significantly greater than that of outer AF cells.

CONCLUSION

Since the oxygen consumption rates determined in this study are comparable to the findings in the literature, this study has developed a new alternative method for determining oxygen consumption rate. The oxygen consumption rates of IVD cells reported in this study will be valuable for theoretically predicting local oxygen concentrations in IVD, which can provide a better understanding of transport of oxygen in the discs.

Pre-operative localization of breast microcalcification using high-frequency ultrasound

AIM

To determine whether high-frequency ultrasound (US) can be used to reliably localize breast microcalcification preoperatively in the absence of any associated mass lesion or distortion.

PATIENTS AND METHODS

Seventeen patients, found to have microcalcification at mammography, the majority screen detected, were studied using high-frequency (10 or 13 MHz) US to visualize the calcified particles. The approximate site of the microcalcifications was first determined from the mammograms. Once the calcifications had been localized, the skin overlying the site was marked with an indelible marker and the depth of the calcifications recorded for the surgeon. Successful excision of microcalcifications was confirmed with postbiopsy specimen X-ray.

RESULTS

Fifteen of the 17 patients (88%) underwent successful removal of the microcalcifications. The mean microcalcification cluster size was 160 mm with a mean number of calcifications of 20 at a mean depth of 15 mm. The mean size of the individual calcifications was 0.29 mm.

CONCLUSION

Our results show that high-frequency US is an effective non-invasive method of identifying and localizing breast microcalcification, and can be used as an alternative to hook wire stereotaxic localization in the majority of patients.

Characterization of cadherins expressed by murine thymocytes

Thymocytes develop in close apposition to the stromal cells of the thymus. The ontogeny of thymocytes is dependent on intimate interactions between these cells and the stromal cells. The molecular mechanisms involved in regulating thymocyte-stromal cell interactions remain to be clearly defined. In this study, we utilized a polymerase chain reaction strategy to identify members of the cadherin family of cell adhesion molecules that are expressed by CD4+ CD8+ thymocytes, the major cell type in the thymus. One classical cadherin (E-cadherin), three atypical cadherins (OB-cadherin) K-cadherin, and cadherin-8), and two novel cadherins (T1-cadherin and T2-cadherin) were found to be expressed by the CD4+ CD8+ thymocytes. The discovery that these cells display multiple cadherins opens a new area of investigation concerning the adhesive mechanisms involved in modulating thymocyte-stromal cell interactions. We speculate that cadherins will prove to play an essential role in the ontogeny of thymocytes.

Quality and interpretation of operative cholangiography in a district general hospital

The quality and interpretation of operative cholangiography were assessed in 128 patients undergoing cholecystectomy. The quality of each cholangiogram was assessed by calculating a cholangiogram score according to the anatomical structure visualized. Out of a maximum possible score of 5, 26% of cholangiograms achieved a score of less than or equal to 3 and were considered as technical failures. The sensitivity, specificity and negative predictive values regarding the surgeon's interpretation of the cholangiograms were high and compared well with the radiologist's assessment. However, the positive predictive value for the surgeon's assessment of the cholangiograms was 74% compared with 95% for the radiologist (P less than 0.02). Improvement in cholangiography can only be achieved by greater attention to detail and perseverance. After an adequate examination, the only criteria for common bile duct exploration should be the presence of filling defect(s).

A waiting time survey in general practice

Keeping patients waiting unnecessarily can be a cause of stress for both patient and doctor. Waiting time is a tangible aspect of your practice that patients will use to judge you, even more than your knowledge and skill. Determine your own actual waiting time, and see if you 'measure up'.

Small business, cash budgets and general practice

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

Nutritional myopathy in goats

A nutritional myopathy in unweaned fibre goats aged 2 to 4 mths is described in 3 flocks from the tablelands of New South Wales. Clinically affected animals were illthrifty and in circulatory failure prior to being found dead. At necropsy, there was pronounced ascites, pulmonary congestion and marked mottling of the liver. Chalky white streaks and patches were obvious in the myocardium, particularly in the right ventricular wall. Skeletal muscles varied from grossly normal to generally pale. Histologically, the myocardium exhibited areas of severe acute myonecrosis with mineralisation and adjoining areas of phagocytosis and fibrosis. In 2 of 3 flocks, some skeletal muscles showed a mild subacute myopathy. Marked hepatic congestion extended to periacinar haemorrhage and necrosis in some areas. Dietary imbalances of selenium, vitamin E and polyunsatured fatty acids were probable factors in the pathogenesis of the condition.

How to assess the business performance of your practice

The objective of this article is to provide motivation and practical guidance to those general practitioners who wish to assess the performance of their practice in the business and financial sense, but who believe that they lack the necessary training and resources.

BCG emulsion immunotherapy of equine sarcoid

Of 61 horses with sarcoids treated with intralesional injection of a double emulsion incorporating inactivated bacillus Calmette Guérin organisms, 36 (59 per cent) showed complete regression and 11 (18 per cent) showed partial regression. The majority of cases required only one treatment. Not all sarcoids were responsive to this therapy; those not responding were usually large or on horses with multiple sarcoids.

Oral toxicity of a bloom of the Cyanobacterium microcystis Aeruginosa administered to mice over periods up to 1 year

Cyanobacterial blooms in lakes have been reported causing livestock deaths and liver injury to human populations. In this study bloom material consisting of Microcystis aeruginosa was collected from a farm water storage after the death of sheep drinking from it. The cyanobacterial cells were lysed and a cell-free extract was provided to mice at a series of dilutions as their only source of drinking water. Mice of both sexes, with controls, were killed at intervals up to 1 yr of administration. Autopsies, histopathological examination, and analyses of plasma lactate dehydrogenase and alanine aminotransferase were carried out. Increased mortality was observed, particularly among males, together with chronic active liver injury and elevated alanine aminotransferase in blood. In control mice and those receiving lower concentrations of extract, hepatic amyloidosis with neutrophil infiltration, and bronchopneumonia, were seen with increasing age. The bronchopneumonia appeared earlier among mice receiving cyanobacterial extract. Four tumors were seen in 71 mice receiving a high concentration of extract for up to 1 yr, none in 150 mice receiving lower concentrations, and 2 in 73 control mice. No effects on male or female fertility, embryonic mortality, neonatal viability, or skeletal development were observed, but 7 out of 73 neonatal mice born to parents given cyanobacterial extract showed reduced brain size. No cases were seen in controls. We conclude that the major toxicity exhibited is liver injury. Further attention is needed for evaluation of carcinogenicity and embryonic damage.

Toxicity of the cyanobacterium Nodularia spumigena Mertens

The bloom forming cyanobacterium (blue-green alga) Nodularia spumigena produced a peptide hepatotoxin with an LD50 of 70 micrograms/kg i.p. in mice. The livers of lethally poisoned mice were haemorrhagic and enlarged, the weight doubling to about 10% of total body weight. Histologically there was centrilobular to midzonal disruption and lysis of hepatocytes resulting in haemorrhage and formation of blood lakes. Death occurred approximately 1 hr after i.p. injection. By 30 min significant increases had occurred in the plasma levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase and glucose paralleling degeneration and necrosis of centrilobular hepatocytes. In vitro the toxin caused rapid dose-dependent deformation of freshly isolated rat hepatocytes, which was accompanied by the activation of phosphorylase a; 125 ng/ml of toxin being sufficient to cause these changes in 10(6) cells. This work demonstrates that, both in vivo and in vitro, Nodularia toxin shares many similarities in its action to the well characterized peptide toxins of another cyanobacterium, Microcystis aeruginosa.

Toxicity to mice and sheep of a bloom of the cyanobacterium (blue-green alga) Anabaena circinalis

A bloom of Anabaena circinalis shown to be lethal to mice (i.p. LD50 17.0 +/- 0.6 mg/kg) was tested for lethal potency when given orally to mice and intraruminally and intraperitoneally to sheep. The lethal oral dose in mice was at least 170 times the parenteral dose. The bloom was lethal when given i.p. to sheep but lethality was not observed when given intraruminally in doses up to 1710 mg/kg, equivalent to drinking 8.5 litres of thick algal bloom, a volume far in excess of that likely to be consumed naturally. In vivo testing of lethal potency by i.p. inoculation of mice is therefore an unreliable method for judging potential oral toxicity in livestock of blooms of Anabaena.

Kikuyu poisoning of cattle in New South Wales and its relationship to pasture fungi on kikuyu grass (Pennisetum clandestinum)

In the late summer and autumn of 1980 kikuyu poisoning of cattle was diagnosed on 9 farms in New South Wales resulting in 213 deaths among 1370 cattle at risk. Clinical, autopsy and histopathological findings are described and are consistent with those previously recorded. Kikuyu grass samples from 5 paddocks in which deaths were occurring were examined for the presence of fungi. Myrothecium spp were not present. Fusarium semitectum, F. moniliforme var subglutinans, Penicillium spp and a Phoma sp were the most common fungi isolated but with the exception of F. semitectum were not consistently present. F. semitectum was present in adjacent kikuyu grass paddocks in which deaths were not occurring. Two of the farms had army caterpillar (Mythimna convecta) infestations. Army caterpillar faeces present in these paddocks did not contain Myrothecium spp; the fungi present reflected the population present on the kikuyu grass. These findings do not suggest a mycotic cause for kikuyu poisoning.

Lethal potency and tissue distribution of 125I-labelled toxic peptides from the blue-green alga Microcystis aeruginosa

Toxic heptapeptides from a water bloom of the cyanobacterium Microcystis aeruginosa were purified by HPLC. The unoxidised fraction was iodinated with 125I plus 127I by the lactoperoxidase/H2O2 method, further purified by HPLC, and the non-iodinated and three iodinated fractions administered i.p. to male mice. All iodinated fractions were toxic, with symptoms and pathological lesions of the liver identical with those caused by non-iodinated peptide. Radioactivity was concentrated in the liver of mice at death.