David J. Nuckley
Other affiliations: University of Washington
Bio: David J. Nuckley is an academic researcher from University of Minnesota. The author has contributed to research in topics: Intervertebral disc & Poison control. The author has an hindex of 22, co-authored 76 publications receiving 1338 citations. Previous affiliations of David J. Nuckley include University of Washington.
Papers published on a yearly basis
TL;DR: The proximal and distal tibial divisions of the superficial MCL, POL, and deep MCL produced loads of clinical importance and will assist in reconstruction graft choices, fixation method choices, and overall operative treatment of medial knee injury.
Abstract: Background: The structural properties of the individual components of the superficial medial collateral ligament (MCL), deep MCL, and posterior oblique ligament (POL) have not been studied in isolation. To define the necessary strength requirements for an anatomical medial knee reconstruction, knowledge of these structural properties is necessary.Hypothesis: The components of the superficial MCL, POL, and deep MCL have significantly different structural properties.Study Design: Controlled laboratory study.Methods: This study used 20 fresh-frozen nonpaired cadaveric knee specimens with a mean age of 54 years (range, 27 to 68 years). These knees provided 8 samples for each tested medial knee structure, which was individually isolated and loaded to failure at 20 mm per minute. Specifically tested were the superficial MCL with intact femoral and detached proximal tibial attachments, the superficial MCL with intact femoral and detached distal tibial attachments, the central arm of the POL, and the isolated dee...
TL;DR: Evidence indicates that conservative intervention for hallux valgus provides relief from symptoms but does not reverse deformity, and theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity.
Abstract: Hallux valgus is a progressive foot deformity characterized by a lateral deviation of the hallux with corresponding medial deviation of the first metatarsal. Late-stage changes may render the hallux painful and without functional utility, leading to impaired gait. Various environmental, genetic, and anatomical predispositions have been suggested, but the exact cause of hallux valgus is unknown. Evidence indicates that conservative intervention for hallux valgus provides relief from symptoms but does not reverse deformity. Part 1 of this perspective article reviews the literature describing the anatomy, pathomechanics, and etiology of hallux valgus. Part 2 expands on the biomechanical initiators of hallux valgus attributed to the first metatarsal. Theory is advanced that collapse of the arch with vertical orientation (tilt) of the first metatarsal axis initiates deformity. To counteract the progression of hallux valgus, we use theory to discuss a possible mechanism by which foot orthoses can bolster the arch and reorient the first metatarsal axis horizontally.
•03 Apr 2009
TL;DR: In this article, a clinical sensing glove system to quantify force, shear, hardness, etc., measured in manual therapies is disclosed, where a sensor undergoes micro-bending, macro bending, evanescent coupling, change in resonance, a change in polarization, and change in phase modulation, in response to pressure/force applied.
Abstract: A clinical sensing glove system to quantify force, shear, hardness, etc., measured in manual therapies is disclosed. A sensor is disposed in a clinical glove. The sensor undergoes micro-bending, macro-bending, evanescent coupling, a change in resonance, a change in polarization, a change in phase modulation, in response to pressure/force applied. The amount of micro-bending, macro-bending, evanescent coupling, change in resonance, change in polarization, and/or change in phase modulation is proportional to the intensity of the pressure/force. A clinician can quantitatively determine the amount of pressure, force, shear, hardness, rotation, etc., applied.
TL;DR: Routine MRI sequences are not adequate in detecting early changes in degeneration and fails to correlate with pain or improve patient stratification, so quantitative T2* mapping is a sensitive quantitative method capable of detecting changes associated with disc degeneration.
Abstract: Study Design. Experimental correlation study design to quantify features of disc health, including signal intensity and distinction between the annulus fibrosus and nucleus pulposus, with T2* magnetic resonance imaging (MRI) and correlate with the functional mechanics in corresponding motion segments. Objective. Establish the relationship between disc health assessed by quantitative T2* MRI and functional lumbar mechanics. Summary of Background Data. Degeneration leads to altered biochemistry in the disc, affecting the mechanical competence. Clinical routine MRI sequences are not adequate in detecting early changes in degeneration and fails to correlate with pain or improve patient stratification. Quantitative T2* relaxation time mapping probes biochemical features and may offer more sensitivity in assessing disc degeneration. Methods. Cadaveric lumbar spines were imaged using quantitative T2* mapping, as well as conventional T2-weighted MRI sequences. Discs were graded by the Pfirrmann scale, and features of disc health, including signal intensity (T2* intensity area) and distinction between the annulus fibrosus and nucleus pulposus (transition zone slope), were quantified by T2*. Each motion segment was subjected to pure moment bending to determine range of motion (ROM), neutral zone (NZ), and bending stiffness. Results. T2* intensity area and transition zone slope were significantly correlated with flexion ROM (P = 0.015; P = 0.002), ratio of NZ/ROM (P = 0.010; P = 0.028), and stiffness (P = 0.044; P = 0.026), as well as lateral bending NZ/ROM (P = 0.005; P = 0.010) and stiffness (P = 0.022; P = 0.029). T2* intensity area was also correlated with lateral bending ROM (P = 0.023). Pfirrmann grade was only correlated with lateral bending NZ/ROM (P = 0.001) and stiffness (P = 0.007). Conclusion. T2* mapping is a sensitive quantitative method capable of detecting changes associated with disc degeneration. Features of disc health quantified with T2* predicted altered functional mechanics of the lumbar spine better than traditional Pfirrmann grading. This new methodology and analysis technique may enhance the assessment of degeneration and enable greater patient stratification for therapeutic strategies. Conclusion. Level of Evidence: N/A
TL;DR: The range of neural space integrity associated with simulated physiologic motion of the lower cervical spine in an experimental setting is defined and may be useful in comparing neural space changes in pathologic conditions and may enhance refinement of neurologic injury prevention strategies.
Abstract: Study Design. An experimental investigation of intervertebral foramen and spinal canal neural space integrity was performed throughout physiologic range of motion of the lower cervical spine in intact human cadaver specimens. Objective. To investigate cervical positions that might place the neural tissues of the spine in heightened risk of injury. To meet this objective the following hypotheses were tested: 1) spinal canal integrity varies with specific normal range of motion positions of the lower cervical spine, and 2) intervertebral foramen integrity is dependent on and unique for different physiologic positions of the lower cervical spine. Summary of Background Data. Cervical spine injuries are frequently associated with compressive damage to neurologic tissues and consequently poor clinical out-comes. Neurologic injury typically occurs from disc, ligementous, or bony occlusion of the spinal canal and intervertebral foraminal spaces dynamically during an injury event or with abnormal alignment and position after the injury event. Prior studies have shown pressure and geometric changes in cervical spine neural spaces in certain cervical spine positions. However, to the authors' knowledge, this is the first research effort aimed at elucidating the integrity of the cervical spine neural spaces through-out the normal physiologic range of motion. Methods. The authors instrumented 17 fresh-frozen unembaimed cadaveric human cervical spines (C3-C7) with specially designed intervertebral foramen occlusion transducers and a spinal canal occlusion transducer. The specimens were loaded with pure bending moments to produce simulated physiologic motions of the lower cervical spine. The resulting occlusion profiles for the intervertebral foramen and spinal canal were recorded along with the 6-degree of freedom position of the cervical spine. Because these occlusion measurements describe the ability of the spine to preserve the space for the neural structures, the authors define this neuroprotective role of the vertebral column as neural space integrity. Results. The range of motion developed experimentally in this study compared well with published reports of normal cervical motion. Thus, subsequent changes in neural space integrity may be regarded as resulting from normal human cervical spine motion. No significant change in the spinal canal space was detected for any physiologic motion: however, intervertebral foramen integrity was significantly altered in extension, ipsilateral bending, combined ipsilateral bending and extension, and combined contraiateral bending with extension when compared with intact upright neutral position Conclusions. This study defines the range of neural space integrity associated with simulated physiologic motion of the lower cervical spine in an experimental setting. This information may be useful in comparing neural space changes in pathologic conditions and may enhance refinement of neurologic injury prevention strategies.
TL;DR: One in three adults aged over 65 in England have difficulty understanding basic health‐related information, suggests a study in the BMJ, and the Patients Association said patients should help draft information leaflets so they are "relevant and clear".
Abstract: One in three adults aged over 65 in England have difficulty understanding basic health‐related information, suggests a study in the BMJ. They are more than twice as likely to die within five years as adults with no literacy problems, it was found. The University College London study tested nearly 8,000 adults on their understanding of aspirin instructions. The Patients Association said patients should help draft information leaflets so they are \"relevant and clear\". BMJ The Royal College of Nursing (RCN) has published 'Persistent challenges to providing quality care: An RCN report on the views and experiences of frontline nursing staff in care homes in England'. The report found that care homes are struggling to provide high quality care for residents with complex medical conditions, against a backdrop of a severe funding, equipment and staff shortages. The report identifies a lack of training for staff, inappropriate admissions and extreme pressure on the workforce leading to poor staff morale. The RCN says that getting health and social funding right is crucial for the sustainability of the social care system and the NHS. NHS Improvement have published 'Accurate diagnosis for suspected COPD'. This document covers diagnosis, tests and assessment of severity and impact. Through an early and quality assured diagnosis, a more comprehensive assessment of severity, effective proactive disease management and evidence based treatment interventions, lives will be saved and the burden on the resources of the NHS will be reduced. The webpages include information about a good patient pathway, evidence, guidance, top tips, service models, case studies etc
TL;DR: It is argued that mechanics and biology are interconnected and amplify each other and the proposed disease model explains the comparable efficacy of very different animal models of disc degeneration, but also helps to consider the consequences of therapeutic interventions, either at the cellular, material or mechanical level.
TL;DR: This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.
Abstract: Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.
TL;DR: A wide-ranging look at basic and advanced biostatistical concepts and methods in a format calibrated to individual interests and levels of proficiency can be found in this paper, where the authors examine the design of medical studies, descriptive statistics, and introductory ideas of probability theory and statistical inference.
Abstract: This versatile reference provides a wide-ranging look at basic and advanced biostatistical concepts and methods in a format calibrated to individual interests and levels of proficiency. Written with an eye toward the use of computer applications, the book examines the design of medical studies, descriptive statistics, and introductory ideas of probability theory and statistical inference; explores more advanced statistical methods; and illustrates important current uses of biostatistics.