The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: a single-centre, retrospective analysis.

Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID-19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID-19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co-oximetry on arterial blood gas analysis (SaO2 ) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (Sp O2 ). Bias was calculated as the mean difference between SaO2 and Sp O2 measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO2 and Sp O2 measurements. Bias (limits of agreement) between SaO2 and Sp O2 measurements was 0.05% (-2.21-2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79-2.35), -0.33% (-2.47-2.35) and -0.75% (-3.47-1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID-19 pneumonitis, Sp O2 measurements showed a level of agreement with SaO2 values that was in line with previous work, and this was not affected by patient ethnicity.

Epilepsy and Pregnancy: For healthy pregnancies and happy outcomes. Suggestions for service improvements from the Multispecialty UK Epilepsy Mortality Group.

Between 2009 and 2012 there were 26 epilepsy-related deaths in the UK of women who were pregnant or in the first post-partum year. The number of pregnancy-related deaths in women with epilepsy (WWE) has been increasing. Expert assessment suggests that most epilepsy-related deaths in pregnancy were preventable and attributable to poor seizure control. While prevention of seizures during pregnancy is important, a balance must be struck between seizure control and the teratogenic potential of antiepileptic drugs (AEDs). A range of professional guidance on the management of epilepsy in pregnancy has previously been issued, but little attention has been paid to how optimal care can be delivered to WWE by a range of healthcare professionals. We summarise the findings of a multidisciplinary meeting with representation from a wide group of professional bodies. This focussed on the implementation of optimal pregnancy epilepsy care aiming to reduce mortality of epilepsy in mothers and reduce morbidity in babies exposed to AEDs in utero. We identify in particular -What stage to intervene - Golden Moments of opportunities for improving outcomes -Which Key Groups have a role in making change -When - 2020 vision of what these improvements aim to achieve. -How to monitor the success in this field We believe that the service improvement ideas developed for the UK may provide a template for similar initiatives in other countries.

A health impact assessment of the 2014 Commonwealth Games in Glasgow.

OBJECTIVE: To influence the planning of the 2014 Commonwealth Games such that the positive impacts are maximized and the negative impacts are mitigated. STUDY DESIGN: Participatory health impact assessment (HIA). METHODS: A participatory HIA was performed using standard World Health Organization methods. A scoping event was held to involve decision makers in the process and to identify the key areas for consideration. A large community engagement exercise and a systematic review were conducted as part of the evidence-gathering phase. The results of the HIA were reported to the key decision makers involved in the Glasgow City Council legacy strategy. RESULTS: The likely net health impact of hosting the Commonwealth Games was uncertain. It was suggested that the main mechanisms through which impacts were likely to be felt were: the economy; civic pride; engagement in decision making; the provision of new infrastructure; and participation in cultural events. A series of recommendations was produced in order to maximize positive health benefits and mitigate negative impacts. CONCLUSIONS: HIA is a useful tool for engaging communities and decision makers in the public health agenda. HIAs of major multi-sport events are limited by a lack of quality evidence and the inability to predict impacts reliably.

Photocatalytic oxidation of 2,4,6-trichlorophenol in water using a cocurrent downflow contactor reactor (CDCR).

The heterogeneous photocatalytic oxidation of aqueous solutions of 2,4,6-trichlorophenol (2,4,6-TCP) as a model pollutant in industrial wastewater has been carried out in a pilot scale cocurrent downflow contactor reactor (CDCR). The reactions were carried out in the presence of Ultra-Violet radiation, O(2) and TiO(2) photocatalyst (VP Aeroperl P25/20). The TiO(2) was characterized by Dynamic Vapour Sorption (DVS) technique giving specific surface area and surface energy of 46.06 m(2)g(-1) and 80.12 mJ m(-2), respectively. The CDC reactor was fitted with an internally and vertically mounted 1.0 kW or 2.0 kW UV lamp. The reactions were carried out at 50 degrees C and 1 bar, with the reactor being operated in closed loop recycle mode and suspended photocatalyst being re-circulated. The CDC reactor, a device of very high mass transfer efficiency giving unusually large gas hold-up of approximately 50%, was operated with oxygen mass transfer and dissolution in the zone above the UV lamp (high mass transfer zone) and along and around the UV lamp housing (reaction zone). Under optimized reaction conditions, 100% conversion of 2,4,6-TCP was achieved in 180 min using 15 dm(3) solutions with initial concentration of 120 mg dm(-3). A combination of TiO(2) photocatalyst, UV irradiation and oxidant was observed to give the most rapid photodegradation and photomineralization of the 2,4,6-TCP in comparison with irradiation only. Using the 1 kW or 2 kW UV lamps, conversion of 100 mg dm(-3) of 2,4,6-TCP after 30 min was 62.51% and 90.71%, respectively, with initial reaction rates of 1.33 x 10(-5) and 4.22 x 10(-5) mol min(-1), respectively, and rate constants 0.0046 and 0.29 min(-1), respectively.

Biological responses to the chemical recovery of acidified fresh waters in the UK.

We report biological changes at several UK Acid Waters Monitoring Network lakes and streams that are spatially consistent with the recovery of water chemistry induced by reductions in acid deposition. These include trends toward more acid-sensitive epilithic diatom and macroinvertebrate assemblages, an increasing proportional abundance of macroinvertebrate predators, an increasing occurrence of acid-sensitive aquatic macrophyte species, and the recent appearance of juvenile (<1 year old) brown trout in some of the more acidic flowing waters. Changes are often shown to be directly linked to annual variations in acidity. Although indicative of biological improvement in response to improving water chemistry, "recovery" in most cases is modest and very gradual. While specific ecological recovery endpoints are uncertain, it is likely that physical and biotic interactions are influencing the rate of recovery of certain groups of organisms at particular sites.

Upregulation of activating transcription factor 3 (ATF3) by intrinsic CNS neurons regenerating axons into peripheral nerve grafts.

The expression of the transcription factor ATF3 in the brain was examined by immunohistochemistry during axonal regeneration induced by the implantation of pieces of peripheral nerve into the thalamus of adult rats. After 3 days, ATF3 immunoreactivity was present in many cells within approximately 500 mum of the graft. In addition, ATF3-positive cell nuclei were found in the thalamic reticular nucleus (TRN) and medial geniculate nuclear complex (MGN), from which most regenerating axons originate. CNS cells with ATF3-positive nuclei were predominantly neurons and did not show signs of apoptosis. The number of ATF3-positive cells had declined by 7 days and further by 1 month after grafting when most ATF3-positive cells were found in the TRN and MGN. 14 days or more after grafting, some ATF3-positive nuclei were distorted and may have been apoptotic. In some experiments of 1 month duration, neurons which had regenerated axons to the distal ends of grafts were retrogradely labeled with DiAsp. ATF3-positive neurons in these animals were located in regions of the TRN and MGN containing retrogradely labeled neurons and the great majority were also labeled with DiAsp. SCG10 and c-Jun were found in neurons in the same regions as retrogradely labeled and ATF3-positive cells. Thus, ATF3 is transiently upregulated by injured CNS neurons, but prolonged expression is part of the pattern of gene expression associated with axonal regeneration. The co-expression of ATF3 with c-jun suggests that interactions between these transcription factors may be important for controlling the program of gene expression necessary for regeneration.

Common antiepileptic drugs in pregnancy in women with epilepsy.

BACKGROUND: The potential adverse effects of antiepileptic drug (AED) exposure in pregnancy have been well recognised but the relative risks of specific antiepileptic drug exposures remain poorly understood. OBJECTIVES: To assess the adverse effects of commonly used antiepileptic drugs on maternal and fetal outcomes in pregnancy in women with epilepsy. Comparison of outcomes following specific antiepileptic drug exposures in utero to unexposed pregnancies in the general population or women with epilepsy are described. The current manuscript reports the first phase of this review which focuses upon neurodevelopmental outcomes in children exposed to antiepileptic drugs in utero. SEARCH STRATEGY: We searched MEDLINE, Pharmline, EMBASE, Reprotox and TERIS from 1966 to December 2003. Review articles and conference abstracts were also hand searched. SELECTION CRITERIA: All randomized controlled trials, prospective cohorts of children of pregnant women with and without epilepsy and case control studies (cases: developmental delay or impaired cognitive outcome, control: normal development) were included. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed using an adapted version of the Newcastle-Ottawa Scale. The wide variety of outcome measures and methodological approaches made meta-analysis difficult and a descriptive analysis of the results is presented. MAIN RESULTS: PART A 1b - DEVELOPMENTAL OUTCOMES: The majority of studies were of limited quality. There was little evidence about which specific drugs carry more risk than others to the development of children exposed in utero. The results between studies are conflicting and while most failed to find a significant detrimental outcome with in utero exposure to monotherapy with carbamazepine, phenytoin or phenobarbitone, this should be interpreted cautiously. There were very few studies of exposure to sodium valproate. Polytherapy exposure in utero was more commonly associated with poorer outcomes, as was exposure to any AEDs when analysis did not take into account type of AED. The latter may reflect the large proportion of children included in these studies who were in fact exposed to polytherapy. REVIEWERS' CONCLUSIONS: PART A 1b - DEVELOPMENTAL OUTCOMES: Based on the best current available evidence it would seem advisable for women to continue medication during pregnancy using monotherapy at the lowest dose required to achieve seizure control. Polytherapy would seem best avoided where possible. More population based studies adequately powered to examine the effects of in utero exposure to specific monotherapies which are used in everyday practice are required.

The role of the clinical nurse specialist in epilepsy. A national survey.

PURPOSE: To review and describe the key roles of the UK clinical nurse specialist in epilepsy (CNSE), and to identify the specialist nurses' contribution to care through an exploration of CNSE's perceptions of their roles. METHOD: Using the Delphi technique [Applied Project Design and Analysis, 3rd ed., Churchill Livingstone, London, 2000, p. 243] a national survey of all known UK CNSEs was completed. One hundred and thirty questionnaires identifying nine key hypotheses central to the role of the CNSE were distributed and 76 valid questionnaires returned. RESULTS: The response rate was 63% and was geographically representative of the UK population of CNSEs. CNSEs were employed in a range of hospital and community settings with differing patient groups. Seventy-two percent of respondents held higher academic nursing qualifications but only 36% had previous epilepsy or neurology experience. Thirty percent of respondents had been employed in the role of CNSE for more than 5 years and 84% were employed as a G or H grade nurse. Only 39% of CNSEs held nurse-led clinics and of those 32% were responsible for all decisions made during their clinic. Furthermore, 40% of CNSEs saw new patients who had not previously been reviewed by one of the medical team. The level of responsibility for drug management was mainly at a monitoring and advisory level but a small number of CNSEs held much greater responsibility. The responses to the nine hypotheses were compared using cross tabulations. CONCLUSION: The findings of the study and the review of the CNSE in the UK revealed that the key roles of the CNSE were difficult to define. Yet, the respondents identified that there were common core features central to their contribution to care as specialist nurses.

NG2 proteoglycan expression in the peripheral nervous system: upregulation following injury and comparison with CNS lesions.

The chondroitin sulphate proteoglycan NG2 blocks neurite outgrowth in vitro and thus may be able to inhibit axonal regeneration in the CNS. We have used immunohistochemistry to compare the expression of NG2 in the PNS, where axons regenerate, and the spinal cord, where regeneration fails. NG2 is expressed by satellite cells in dorsal root ganglia (DRG) and in the perineurium and endoneurium of intact sciatic nerves of adult rats. Endoneurial NG2-positive cells were S100-negative. Injury to dorsal roots, ventral rami or sciatic nerves had no effect on NG2 expression in DRG but sciatic nerve section or crush caused an upregulation of NG2 in the damaged nerve. Strongly NG2-positive cells in damaged nerves were S100-negative. The proximal stump of severed nerves was capped by dense NG2, which surrounded bundles of regenerating axons. The distal stump, into which axons regenerated, also contained many NG2-positive/S100-negative cells. Immunoelectron microscopy revealed that most NG2-positive cells in distal stumps had perineurial or fibroblast-like morphologies, with NG2 being concentrated at the poles of the cells in regions exhibiting microvillus-like protrusions or caveolae. Compression and partial transection injuries to the spinal cord also caused an upregulation of NG2, and NG2-positive cells and processes invaded the lesion sites. Transganglionically labelled ascending dorsal column fibres, stimulated to sprout by a conditioning sciatic nerve injury, ended in the borders of lesions among many NG2-positive processes. Thus, NG2 upregulation is a feature of the response to injury in peripheral nerves and in the spinal cord, but it does not appear to limit regeneration in the sciatic nerve.

End-stage renal disease in Indo-Asians in the North-West of England.

BACKGROUND: The incidence of end-stage renal disease (ESRD) in England is increasing. There is a higher incidence of ESRD in British Indo-Asians than in the White population. AIM: To determine to what degree the increasing demand for renal replacement therapy in the UK is due to Indo-Asian patients. To study the presentation to renal services of Indo-Asian patients with ESRD and report any inequalities in initial treatment of Indo-Asian patients with ESRD compared to their White counterparts. DESIGN: Prospective, inception cohort study. METHODS: Consecutive adult patients with ESRD who started renal replacement therapy between 1 April 2000 and 31 December 2001 in all 14 renal units serving an area from North Cheshire to South Cumbria, including Greater Manchester and Lancashire, were recruited and interviewed. RESULTS: Of the 578 patients, 9.5% were Indo-Asian. The annual acceptance rate for renal replacement therapy was 342 per million population in Indo-Asians, compared with 91 per million population in the White population ( p < 0.001). Indo-Asian patients with ESRD were younger (median age 51 years vs. 60 yrs, p = 0.006) and more socially deprived (81% vs. 36.5% in the 5th Carstairs quintile, p < 0.001). A greater proportion of Indo-Asian patients with ESRD presented late to specialist renal services (31% vs. 19%, p = 0.03). Once adjusting for their younger age, atherosclerotic renovascular disease and/or hypertensive nephropathy was more prevalent in Indo-Asian patients (OR 4.9; p = 0.03). There was no difference in the initial mode of maintenance dialysis or the perception of choice the patients felt they had, based on their ethnicity. DISCUSSION: There is a silent epidemic of ESRD in Indo-Asian patients in the North-West, possibly vascular in aetiology, in which specialist intervention is late. This suggests that Indo-Asian patients should be prioritized for early intervention strategies to reduce the burden of ESRD.

Correlation between putative inhibitory molecules at the dorsal root entry zone and failure of dorsal root axonal regeneration.

The molecular mechanisms involved in preventing regenerating dorsal root axons from entering the spinal cord at the dorsal root entry zone (DREZ) are obscure. We used immunohistochemistry, in situ hybridization, and electron microscopy to study axonal regeneration after dorsal rhizotomy in adult rats and its relationship to cellular changes and the distribution of putative growth inhibitory molecules in this region. Astrocyte processes, ending as bulb-shaped expansions, grew up to 700 microm into the basal lamina tubes of injured roots, where regenerating axons were also present. Some of these axons approached or reached the DREZ but grew no further; others turned back toward the ganglion, suggesting the presence of repulsive cues in or near the DREZ. Tenascin-C mRNA and protein and CSPG stub immunoreactivity were strongly upregulated in the roots after rhizotomy, but were only weakly expressed in the DREZ. Tenascin-R immunoreactivity was confined to CNS tissue, and unaffected by rhizotomy. Large, rounded GFAP-negative, NG2-immunoreactive cells, a few of which were OX42 positive, were found in the DREZ following rhizotomy. Astrocyte processes projecting into the roots were tenascin-R and NG2 negative. Hence, only NG2-expressing cells and tenascin-R were appropriately situated to inhibit regeneration through the DREZ.

Tenascin-C expression and axonal sprouting following injury to the spinal dorsal columns in the adult rat.

We have examined the expression and distribution of the extracellular matrix molecule tenascin-C in and around lesions of the thoracic dorsal columns in adult rats 3 days to 8 weeks after injury, using in situ hybridization, immunofluorescence, electron microscopy and immunoelectron microscopy. Numerous tenascin-C mRNA+ cells were present in and around the lesion at 3 days; fewer were present at 14 days and almost none 30 days after injury. Most tenascin-C mRNA+ cells in the spinal cord around the lesion were GFAP+, but most of those within the lesion were not, suggesting that tenascin-C is produced in the injured spinal cord by a subpopulation of astrocytes and by other cells that invade the lesion; these cells may include meningeal cells, macrophages, and Schwann cells. From 3 to 30 days after injury, heavy tenascin-C immunoreactivity was present at the lesion site (especially transections), and there was lighter immunoreactivity around the lesion and in the degenerating dorsal column. The heaviest immunoreactivity was associated with collagen fibrils in areas of expanded extracellular space and with basal laminae (covering Schwann cells and some astrocytes) but tenascin-C was also found close to the surfaces of some OX-42 + macrophages/microglia, leptomeningeal cells, and capillaries. Neurofilament (NF)+ axons grew into the highly tenascin-C-immunoreactive lesion sites, indicating that tenascin-C does not prevent axonal growth into these areas. However, such axons were not coated with tenascin-C except where directly exposed to the extracellular space.

Comparisons of the thermodynamic properties of three nickel-titanium orthodontic archwires.

The unique memory property of thermodynamic wire is only partially understood. It is believed to result from the wire's inherent capability to markedly alter its atomic bonding forces as a function of temperature. This shape recovery phenomenon may be the result of a transition in crystal structure that occurs by deformation and cooling. When the transition is reversed, by heating, the structure reverts to its original form and abrupt property changes occur. The purpose of this study was to determine the transition temperature ranges (TTR) of three commercially available thermodynamic archwires and to determine the rate of recovery of the wires when bent to a uniform shape. A jig was constructed to hold the wires and was suspended in a water bath within a plexiglass box. The temperature of the water bath was gradually increased. A program was written to acquire a single video frame from a running video tape and then allow the operator to graphically overlay the position of each wire specimen. The results indicate that the TTRs for the three commercially available thermodynamic wires are of similar magnitudes (x = 6.7 degrees C, 6.2 degrees C and 6.7 degrees C). The greatest differences were in the standard deviations (1.3 degrees C, 2.2 degrees C and 3.7 degrees C) which may be a function of manufacturing during alloying of the wire and/or its heat treatment.

Loads in the spinal structures during lifting: development of a three-dimensional comprehensive biomechanical model.

Epidemiological studies have shown that loads imposed on the human spine during daily living play a significant role in the onset of low back pain. The loads applied to the lumbar spine are shared by a number of structures: muscles; posterior elements, including facets and ligaments; and the disc of a ligamentous motion segment. In vivo, it is not practical to determine forces in these structures using experimental techniques. Biomechanical models, based on an optimization technique of electromyographic activities of the trunk muscles, have been proposed to predict forces in the load transmitting structures. The mathematical models reported in the literature are based on information collected from a wide variety of sources, of which the subject that takes part in the experiment is only one. The present study describes techniques developed in our laboratory to collect from the subjects themselves all the data needed for the formulation of a biomechanical model. The results demonstrated that back lifting with 0 N (no load), 90 N, and 180 N in the hands created maximum external flexion moments respectively of 109.6 Nm, 137.9 Nm, and 161.7 Nm, at the L3-4 disc level. The corresponding external axial compression forces on the disc were 469.5 N, 511.8 N, and 601.5 N. The predicted disc compression varied from 3.4 to 5.0 times the body weight. In comparison to the static lifting mode, the dynamic lifting task caused an increase in the disc compression force ranging from 15.8% to 39.4% depending on the load being lifted (e.g., 3256 N for the dynamic mode vs. 2516 N for the static mode when the subject lifted 90 N). The salient features of the entire protocol developed by the authors and the need for further improvements are also presented.

A method for the fatigue testing of pedicle screw fixation devices.

Spinal devices/instrumentation are used to augment the stability of a decompressed spinal segment during surgery. Like any other mechanical component, the device can fail. A standard in vitro test protocol, was developed to determine load vs number of cycles to failure curve for a pedicle screw-plate/rod type spinal device. The protocol based on the use of an 'artificial spine' model, is clinically relevant. The protocol was used to characterize the load-carrying capacities and failure modes of a specific pedicle screw-rod type fixation device to demonstrate its appropriateness. The devices (Kaneda) were tested in the quasi-static as well as fatigue bending modes. In the bending fatigue mode, the devices failed at loads significantly smaller than the corresponding quasi-static failure load magnitude (806 N). The device exhibited an endurance limit in the fatigue bending mode. The device is not likely to exhibit failure if subjected to cyclic loads which cause less than 380 N axial compression (and an accompanying bending moment relative to the device of less than 13.57 Nm). The failures observed in specimens subjected to the fatigue tests ranged from complete to partial breakage of the paraspinal rods as opposed to failure due to permanent deformation (yielding) of the rods in the quasi-static bending test specimens. The protocol developed can be used for any other screw-plate/rod type spinal instrumentation. The use of a standard protocol by researchers would enable a comparison of various devices currently available in the market. Such comparative data would be useful for the scientific community, and agencies such as the FDA and ASTM.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of stress-induced porosity due to conventional and a modified spinal fixation device.

A hypothesis that device-related osteopenia can be reduced by decreasing the rigidity of a fixation device was tested through a canine study. Polymer washers were interposed between the integral nut and plate of the variable spinal plating (VSP) system to reduce its rigidity. A solid fusion was observed 6 months postoperatively in all of the animals using VSP or modified systems. The stabilized segment using both systems showed similar load-displacement behaviors immediately after surgery and 6 months postoperatively. Although not significant, 5.6 and 1.8% decreases in volumetric density of mineralized bone were found in the stabilized segments due to VSP and modified systems, respectively. The modified system also increased bone growth around screws. The new concept of using polymer washers, to decrease rigidity of the fixation device over time, may reduce device-related osteopenia.

Dynamic response of the occipito-atlanto-axial (C0-C1-C2) complex in right axial rotation.

The torque-angular deformation in right axial rotation until failure of the ligamentous occipito-atlanto-axial complex subjected to variable loading rate (dynamic) axial torque was characterized using a biaxial MTS system. A special fixture and gear box that permitted right axial rotation of the specimen until failure without imposing any additional constraints were used to obtain the data. The specimens were divided into three groups and tested until failure at three different dynamic loading rates: 50, 100, and 400 degrees/s. A previous study by the authors provided data for quasi-static (4 degrees/s) loading conditions. The torque versus rotation curves can be divided into two straight regions and two transition zones. The plots clearly indicated that at loading rates higher than 4 degrees/s, the specimens became stiffer in the region of steadily increasing resistance prior to failure. The increase in stiffness was maximum at 100 degrees/s. The stiffness decreased somewhat at 400 degrees/s in comparison with 100 degrees/s, but this decrease was not significant. The resulting torque-right axial rotation curves were also examined to estimate the magnitude of maximum resistance (torque) and the corresponding angular rotation value. The average maximum resistance torque increased from 13.6 Nm at 4 degrees/s to 27.8 Nm at 100 degrees/s. The corresponding right angular rotation data (65-78 degrees), however, did not show any significant variation with loading rate. Posttest dissection of the specimens indicated that the type of injury observed was related to the rate of axial loading imposed on a specimen during testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation.

Internal fixation with instrumentation often accompanies surgical fusion to augment spinal stability, provide temporary fixation while the surgical fusion mass unites, and enhance postoperative mobilization of a patient. Some surgeons, however, feel that the existing plate-screw designs are too rigid and are the primary cause of "iatrogenic" adverse effects clinically observed. A three-part study, involving in vitro experimental protocol, analytical finite-element-based models, and an in vivo canine investigation, was undertaken to study the role of decreasing rigidity of a device on the biomechanical response of the stabilized segments. Two alternatives--the use of one variable screw placement (Steffee plate [unilateral, 1VSP model]) as opposed to two VSP plates (bilateral, 2VSP model) and two VSP plates with polymer washers placed in between the integral nut and plate (2MVSP model)--were considered for achieving a reduction in the rigidity of the conventional VSP system. The load-displacement data obtained from the in vitro experiments and the stress distributions within the stabilized and intact models predicted by the finite-element models revealed that the unilateral VSP system is less rigid and is likely to reduce stress shielding of the vertebral bodies compared with the 2VSP model. The undesirable effects associated with the use of the 1VSP plate system are the presence of coupled motions due to the inherent asymmetry and the likely inability to provide enough rigidity for decompression procedures requiring a complete excision of the disc. The use of two MVSP plates overcomes these deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)