Transmission rear seal leak on 2004 Nissan Titan

About how much it cost to repair a rear seal leak?

2 answers
cost of repair for rear seal leak for ford explorer 4x4 eddie bower edition
04 Titans have this problem, its almost always a indication of impending differential failure....RARELY its just a bad seal on 04 - early 05 titans. Dealer will probably say its a vent issue.BULL SH$%!!! As a auto tech of 15 years and titan owner I've seen more bad rear titan differentials then I care to. NISSAN NEEDS A RECALL.
Leakage happens when bearings start to fail and allow gear set and thus axles move around more the allowable . In turn putting excessive loading and heat on components. Common to see spider gears with enough clearance between teeth to throw a wrench through it. If it leaks oil at rear axle, axle shafts must be R&R'd. To do so differential needs to be opened up..
AND SHOULD BE INSPECTED FOR PREMATURE WEAR. Nissan doesn't rebuild differentials for liability reasons. New differential is a UPDATED UNIT (if that doesn't screem nissan is aware of this problem, when the play blind and deaf to it) Also. upadated gear lube spec 75W-140 SYNTHETIC LUBE ONLY! MOST fail around 50-60k miles. Also front differentials fail around same mileage and same wear. In my. professional opinion its due to insufficient grade gear lube installed at factory and if serviced at dealer following Nissan's spec lube at service intervals. CAUSING. EXCESSIVE HEAT AND PREMATURE WEAR. Hence the new updated differential with. "heat dissipating" aluminum cover and 75-140 synthetic lube. Its a $2800 repair. depending on your local dealerships labor rate. Front differential $1300


1741-7015-9-661741-7015 Review
Bone regeneration: current concepts and future directions
 DimitriouRozaliarozaliadimitriou@yahoo.co.uk JonesElenamsjej@leeds.ac.uk McGonagleDennisd.g.mcgonagle@leeds.ac.uk GiannoudisVPeterpgiannoudi@aol.com

Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK

UK Leeds NIHR Biomedical Research Unit, Leeds Institute of Molecular Medicine, Beckett Street, Leeds, LS9 7TF, UK

Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds and Chapel Allerton Hospital, Chapeltown Road, Leeds, UK

BMC Medicine 1741-7015 2011 9 1 66 http://www.biomedcentral.com/1741-7015/9/66 10.1186/1741-7015-9-6621627784

Bone possesses the intrinsic capacity for regeneration as part of the repair process in response to injury, as well as during skeletal development or continuous remodelling throughout adult life 1 2 . Bone regeneration is comprised of a well-orchestrated series of biological events of bone induction and conduction, involving a number of cell types and intracellular and extracellular molecular-signalling pathways, with a definable temporal and spatial sequence, in an effort to optimise skeletal repair and restore skeletal function 2 3 . In the clinical setting, the most common form of bone regeneration is fracture healing, during which the pathway of normal fetal skeletogenesis, including intramembranous and endochondral ossification, is recapitulated 4 . Unlike in other tissues, the majority of bony injuries (fractures) heal without the formation of scar tissue, and bone is regenerated with its pre-existing properties largely restored, and with the newly formed bone being eventually indistinguishable from the adjacent uninjured bone 2 . However, there are cases of fracture healing in which bone regeneration is impaired, with, for example, up to 13% of fractures occurring in the tibia being associated with delayed union or fracture non-union 5 . In addition, there are other conditions in orthopaedic surgery and in oral and maxillofacial surgery in which bone regeneration is required in large quantity (beyond the normal potential for self-healing), such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis and osteoporosis.

Current clinical approaches to enhance bone regeneration

For all the aforementioned cases in which the normal process of bone regeneration is either impaired or simply insufficient, there are currently a number of treatment methods available in the surgeon's armamentarium, which can be used either alone or in combination for the enhancement or management of these complex clinical situations, which can often be recalcitrant to treatment, representing a medical and socioeconomic challenge. Standard approaches widely used in clinical practice to stimulate or augment bone regeneration include distraction osteogenesis and bone transport 6 7 , and the use of a number of different bone-grafting methods, such as autologous bone grafts, allografts, and bone-graft substitutes or growth factors 8 9 . An alternative method for bone regeneration and reconstruction of long-bone defects is a two-stage procedure, known as the Masquelet technique. It is based on the concept of a "biological" membrane, which is induced after application of a cement spacer at the first stage and acts as a 'chamber' for the insertion of non-vascularised autograft at the second stage 10 . There are even non-invasive methods of biophysical stimulation, such as low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic fields (PEMF) 11 12 13 , which are used as adjuncts to enhance bone regeneration.

During distraction osteogenesis and bone transport, bone regeneration is induced between the gradually distracted osseous surfaces. A variety of methods are currently used to treat bone loss or limb-length discrepancies and deformities, including external fixators and the Ilizarov technique 6 7 , combined unreamed intramedullary nails with external monorail distraction devices 14 , or intramedullary lengthening devices 15 . However, these methods are technically demanding and have several disadvantages, including associated complications, requirement for lengthy treatment for both the distraction (1 mm per day) and the consolidation period (usually twice the distraction phase), and effects on the patient's psychology and well-being 6 7 .

Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of orthopaedic and maxillofacial procedures, with autologous bone being considered as the 'gold standard' bone-grafting material, as it combines all properties required in a bone-graft material: osteoinduction (bone morphogenetic proteins (BMPs) and other growth factors), osteogenesis (osteoprogenitor cells) and osteoconduction (scaffold) 16 . It can also be harvested as a tricortical graft for structural support 16 , or as a vascularised bone graft for restoration of large bone defects 17 or avascular necrosis 18 . A variety of sites can be used for bone-graft harvesting, with the anterior and posterior iliac crests of the pelvis being the commonly used donor sites. Recently, with the development of a new reaming system, the reamer-irrigator-aspirator (RIA), initially developed to minimise the adverse effects of reaming during nailing of long-bone fractures, the intramedullary canal of long bones has been used as an alternative harvesting site, providing a large volume of autologous bone graft 19 . Furthermore, because it is the patient's own tissue, autologous bone is histocompatible and non-immunogenic, reducing to a minimum the likelihood of immunoreactions and transmission of infections. Nevertheless, harvesting requires an additional surgical procedure, with well-documented complications and discomfort for the patient, and has the additional disadvantages of quantity restrictions and substantial costs 20 21 22 .

An alternative is allogeneic bone grafting, obtained from human cadavers or living donors, which bypasses the problems associated with harvesting and quantity of graft material. Allogeneic bone is available in many preparations, including demineralised bone matrix (DBM), morcellised and cancellous chips, corticocancellous and cortical grafts, and osteochondral and whole-bone segments, depending on the recipient site requirements. Their biological properties vary, but overall, they possess reduced osteoinductive properties and no cellular component, because donor grafts are devitalised via irradiation or freeze-drying processing 23 . There are issues of immunogenicity and rejection reactions, possibility of infection transmission, and cost 8 23 .

Bone-graft substitutes have also been developed as alternatives to autologous or allogeneic bone grafts. They consist of scaffolds made of synthetic or natural biomaterials that promote the migration, proliferation and differentiation of bone cells for bone regeneration. A wide range of biomaterials and synthetic bone substitutes are currently used as scaffolds, including collagen, hydroxyapatite (HA), β-tricalcium phosphate (β-TCP) and calcium-phosphate cements, and glass ceramics 8 23 , and the research into this field is ongoing. Especially for reconstruction of large bone defects, for which there is a need for a substantial structural scaffold, an alternative to massive cortical auto- or allografts is the use of cylindrical metallic or titanium mesh cages as a scaffold combined with cancellous bone allograft, DBM or autologous bone 24 25 .

Limitations of current strategies to enhance bone regeneration

Most of the current strategies for bone regeneration exhibit relatively satisfactory results. However, there are associated drawbacks and limitations to their use and availability, and even controversial reports about their efficacy and cost-effectiveness. Furthermore, at present there are no heterologous or synthetic bone substitutes available that have superior or even the same biological or mechanical properties compared with bone. Therefore, there is a necessity to develop novel treatments as alternatives or adjuncts to the standard methods used for bone regeneration, in an effort to overcome these limitations, which has been a goal for many decades. Even back in the 1950s, Professor Sir Charnley, a pioneer British orthopaedic surgeon, stated that 'practically all classical operations of surgery have now been explored, and unless some revolutionary discovery is made which will put the control of osteogenesis in the surgeon's power, no great advance is likely to come from modification of their detail' 26 .

Since then, our understanding of bone regeneration at the cellular and molecular level has advanced enormously, and is still ongoing. New methods for studying this process, such as quantitative three-dimensional microcomputed tomography analyses, finite element modelling, and nanotechnology have been developed to further evaluate the mechanical properties of bone regenerate at the microscopic level. In addition, advances made in cellular and molecular biology have allowed detailed histological analyses, in vitro and in vivo characterisation of bone-forming cells, identification of transcriptional and translational profiles of the genes and proteins involved in the process of bone regeneration and fracture repair, and development of transgenic animals to explore the role of a number of genes expressed during bone repair, and their temporal and tissue-specific expression patterns 27 . With the ongoing research in all related fields, novel therapies have been used as adjuncts or alternatives to traditional bone-regeneration methods. Nevertheless, the basic concept for managing all clinical situations requiring bone regeneration, particularly the complex and recalcitrant cases, remains the same, and must be applied. Treatment strategies should aim to address all (or those that require enhancement) prerequisites for optimal bone healing, including osteoconductive matrices, osteoinductive factors, osteogenic cells and mechanical stability, following the 'diamond concept' suggested for fracture healing (Figure 1) 28 .

Figure 1

Male patient 19 years of age with infected non-union after intramedullary nailing of an open tibial fracture

Male patient 19 years of age with infected non-union after intramedullary nailing of an open tibial fracture. (A). Anteroposterior (AP) and lateral X-rays of the tibia illustrating osteolysis (white arrow) secondary to infection. The patient underwent removal of the nail, extensive debridement and a two-staged reconstruction of the bone defect, using the induced membrane technique for bone regeneration (the Masquelet technique). (B) Intraoperative pictures showing: (1) a 60 mm defect of the tibia (black arrow) at the second stage of the procedure; (2) adequate mechanical stability was provided with internal fixation (locking plate) bridging the defect, while the length was maintained (black arrow); (3) maximum biological stimulation was provided using autologous bone graft harvested from the femoral canal (black arrow, right), bone-marrow mesenchymal stem cells (broken arrow, left) and the osteoinductive factor bone morphogenetic protein-7 (centre); (4) the graft was placed to fill the bone defect (black arrow). (C) Intraoperative fluoroscopic images showing the bone defect after fixation. (D) Postoperative AP and lateral X-rays at 3 months, showing the evolution of the bone regeneration process with satisfactory incorporation and mineralisation of the graft (photographs courtesy of PVG).

BMPs and other growth factors

With improved understanding of fracture healing and bone regeneration at the molecular level 29 , a number of key molecules that regulate this complex physiological process have been identified, and are already in clinical use or under investigation to enhance bone repair.

Of these molecules, BMPs have been the most extensively studied, as they are potent osteoinductive factors. They induce the mitogenesis of mesenchymal stem cells (MSCs) and other osteoprogenitors, and their differentiation towards osteoblasts. Since the discovery of BMPs, a number of experimental and clinical trials have supported the safety and efficacy of their use as osteoinductive bone-graft substitutes for bone regeneration. With the use of recombinant DNA technology, BMP-2 and BMP-7 have been licensed for clinical use since 2002 and 2001 respectively 30 . These two molecules have been used in a variety of clinical conditions including non-union, open fractures, joint fusions, aseptic bone necrosis and critical bone defects 9 . Extensive research is ongoing to develop injectable formulations for minimally invasive application, and/or novel carriers for prolonged and targeted local delivery 31 .

Other growth factors besides BMPs that have been implicated during bone regeneration, with different functions in terms of cell proliferation, chemotaxis and angiogenesis, are also being investigated or are currently being used to augment bone repair 32 33 , including platelet-derived growth factor, transforming growth factor-β, insulin-like growth factor-1, vascular endothelial growth factor and fibroblast growth factor, among others 29 . These have been used either alone or in combinations in a number of in vitro and in vivo studies, with controversial results 32 33 . One current approach to enhance bone regeneration and soft-tissue healing by local application of growth factors is the use of platelet-rich plasma, a volume of the plasma fraction of autologous blood with platelet concentrations above baseline, which is rich in many of the aforementioned molecules 34 .

'Orthobiologics' and the overall concept to stimulate the local 'biology' by applying growth factors (especially BMPs, because these are the most potent osteoinductive molecules) could be advantageous for bone regeneration or even for acceleration of normal bone healing to reduce the length of fracture treatment. Their clinical use, either alone or combined with bone grafts, is constantly increasing. However, there are several issues about their use, including safety (because of the supraphysiological concentrations of growth factors needed to obtain the desired osteoinductive effects), the high cost of treatment, and more importantly, the potential for ectopic bone formation 35 .

Currently BMPs are also being used in bone-tissue engineering, but several issues need to be further examined, such as optimum dosage and provision of a sustained, biologically appropriate concentration at the site of bone regeneration, and the use of a 'cocktail' of other growth factors that have shown significant promising results in preclinical and early clinical investigation 32 or even the use of inhibitory molecules in an effort to mimic the endogenous 'normal' growth-factor production. Nanoparticle technology seems to be a promising approach for optimum growth-factor delivery in the future of bone-tissue engineering 36 . Nevertheless, owing to gaps in the current understanding of these factors, it has not been possible to reproduce in vivo bone regeneration in the laboratory.

An adequate supply of cells (MSCs and osteoprogenitors) is important for efficient bone regeneration. The current approach of delivering osteogenic cells directly to the regeneration site includes use of bone-marrow aspirate from the iliac crest, which also contains growth factors. It is a minimally invasive procedure to enhance bone repair, and produces satisfactory results 37 . However, the concentration and quality of MSCs may vary significantly, depending on the individual (especially in older people) 38 39 , the aspiration sites and techniques used 39 , and whether further concentration of the bone marrow has been performed 37 , as bone-marrow aspiration concentrate (BMAC) is considered to be an effective product to augment bone grafting and support bone regeneration 40 41 . Overall, however, there are significant ongoing issues with quality control with respect to delivering the requisite number of MSCs/osteoprogenitors to effect adequate repair responses 40 .

Issues of quantity and alternative sources of MSCs are being extensively investigated. Novel approaches in terms of cell harvesting, in vitro expansion and subsequent implantation are promising 42 43 44 , because in vitro expansion can generate a large number of progenitor cells. However, such techniques add substantial cost and risks (such as contamination with bacteria or viruses), may reduce the proliferative capacity of the cells and are time-consuming requiring two-stage surgery 45 . This strategy is already applied for cartilage regeneration 46 . Alternative sources of cells, which are less invasive, such as peripheral blood 47 and mesenchymal progenitor cells from fat 48 , muscle, or even traumatised muscle tissue after debridement 49 , are also under extensive research. However, the utility of fat-derived MSCs for bone-regeneration applications is debatable, with some studies showing them to be inferior to bone-marrow-derived MSCs in animal models 50 51 , and the evidence for a clinically relevant or meaningful population of circulating MSCs also remains very contentious 52 .

It is fair to say that the role of MSCs in fracture repair is still in its infancy, largely due to a lack of studies into the biology of MSCs in vivo in the fracture environment. This to a large extent relates to the historical perceived rarity of 'in vivo MSCs' and also to a lack of knowledge about in vivo phenotypes. The in vivo phenotype of bone-marrow MSCs has been recently reported 53 and, even more recently, it has been shown that this population was actually fairly abundant in vivo in normal and pathological bone 54 . This knowledge opens up novel approaches for the characterisation and molecular profiling of MSCs in vivo in the fracture environment. This could be used to ultimately improve outcomes of fracture non-union based on the biology of these key MSC reparative cells.

Scaffolds and bone substitutes

Although they lack osteoinductive or osteogenic properties, synthetic bone substitutes and biomaterials are already widely used in clinical practice for osteoconduction. DBM and collagen are biomaterials, used mainly as bone-graft extenders, as they provide minimal structural support 8 . A large number of synthetic bone substitutes are currently available, such as HA, β-TCP and calcium-phosphate cements, and glass ceramics 8 23 . These are being used as adjuncts or alternatives to autologous bone grafts, as they promote the migration, proliferation and differentiation of bone cells for bone regeneration. Especially for regeneration of large bone defects, where the requirements for grafting material are substantial, these synthetics can be used in combination with autologous bone graft, growth factors or cells 8 . Furthermore, there are also non-biological osteoconductive substrates, such as fabricated biocompatible metals (for example, porous tantalum) that offer the potential for absolute control of the final structure without any immunogenicity 8 .

Research is ongoing to improve the mechanical properties and biocompatibility of scaffolds, to promote osteoblast adhesion, growth and differentiation, and t0 allow vascular ingrowth and bone-tissue formation. Improved biodegradable and bioactive three-dimensional porous scaffolds 55 are being investigated, as well as novel approaches using nanotechnology, such as magnetic biohybrid porous scaffolds acting as a crosslinking agent for collagen for bone regeneration guided by an external magnetic field 56 , or injectable scaffolds for easier application 57 .

Tissue engineering

The tissue-engineering approach is a promising strategy added in the field of bone regenerative medicine, which aims to generate new, cell-driven, functional tissues, rather than just to implant non-living scaffolds 58 . This alternative treatment of conditions requiring bone regeneration could overcome the limitations of current therapies, by combining the principles of orthopaedic surgery with knowledge from biology, physics, materials science and engineering, and its clinical application offers great potential 58 59 . In essence, bone-tissue engineering combines progenitor cells, such as MSCs (native or expanded) or mature cells (for osteogenesis) seeded in biocompatible scaffolds and ideally in three-dimensional tissue-like structures (for osteoconduction and vascular ingrowth), with appropriate growth factors (for osteoinduction), in order to generate and maintain bone 60 . The need for such improved composite grafts is obvious, especially for the management of large bone defects, for which the requirements for grafting material are substantial 8 . At present, composite grafts that are available include bone synthetic or bioabsorbable scaffolds seeded with bone-marrow aspirate or growth factors (BMPs), providing a competitive alternative to autologous bone graft 8 .

Several major technical advances have been achieved in the field of bone-tissue engineering during the past decade, especially with the increased understanding of bone healing at the molecular and cellular level, allowing the conduction of numerous animal studies and of the first pilot clinical studies using tissue-engineered constructs for local bone regeneration. To date, seven human studies have been conducted using culture-expanded, non-genetically modified MSCs for regeneration of bone defects: two studies reporting on long bones and five on maxillofacial conditions 61 . Even though they are rather heterogeneous studies and it is difficult to draw conclusive evidence from them, bone apposition by the grafted MSCs was seen, but it was not sufficient to bridge large bone defects. Furthermore, the tissue-engineering approach has been used to accelerate the fracture-healing process or to augment the bone-prosthesis interface and prevent aseptic loosening in total joint arthroplasty, with promising results regarding its efficacy and safety 62 63 .

Recently, an animal study has shown the potential for prefabrication of vascularised bioartificial bone grafts in vivo using β-TCP scaffolds intraoperatively filled with autogenous bone marrow for cell loading, and implanted into the latissimus dorsi muscle for potential application at a later stage for segmental bone reconstruction, introducing the principles of bone transplantation with minimal donor-site morbidity and no quantity restrictions 64 .

Overall, bone-tissue engineering is in its infancy, and there are many issues of efficacy, safety and cost to be addressed before general clinical application can be achieved. Cultured-expanded cells may have mutations or epigenetic changes that could confer a tumour-forming potential 44 . However, in vitro and in vivo evidence suggests that the risk of tumour formation is minimal 65 . No cases of tumour transformation were reported in 41 patients (45 joints) after autologous bone-marrow-derived MSC transplantation for cartilage repair, who were followed for up to 11 years and 5 months 46 . Another important issue is the difficulty of achieving an effective and high-density cell population within three-dimensional biodegradable scaffolds 66 . Consequently, numerous bioreactor technologies have been investigated, and many others should be developed 67 . Their degradation properties should also preserve the health of local tissues and the continuous remodelling of bone 44 . Three-dimensional porous scaffolds with specific architectures at the nano, micro and macro scale for optimum surface porosity and chemistry, which enhance cellular attachment, migration, proliferation and differentiation, are undergoing a continuous evaluation process.

Gene therapy

Another promising method of growth-factor delivery in the field of bone-tissue engineering is the application of gene therapy 68 69 . This involves the transfer of genetic material into the genome of the target cell, allowing expression of bioactive factors from the cells themselves for a prolonged time. Gene transfer can be performed using a viral (transfection) or a non-viral (transduction) vector, and by either an in vivo or ex vivo gene-transfer strategy. With the in vivo method, which is technically relatively easier, the genetic material is transferred directly into the host; however, there are safety concerns with this approach. The indirect ex vivo technique requires the collection of cells by tissue harvest, and their genetic modification in vitro before transfer back into the host. Although technically more demanding, it is a safer method, allowing testing of the cells for any abnormal behaviour before reimplantation, and selection of those with the highest gene expression 69 .

Besides the issues of cost, efficacy and biological safety that need to be answered before this strategy of genetic manipulation is applied in humans, delivery of growth factors, particularly BMPs, using gene therapy for bone regeneration has already produced promising results in animal studies 70 71 .

Mechanical stability and the role of mechanical stimulation in bone regeneration

In addition to the intrinsic potential of bone to regenerate and to the aforementioned methods used to enhance bone regeneration, adequate mechanical stability by various means of stabilisation and use of fixation devices is also an important element for optimal bone repair, especially in challenging cases involving large bone defects or impaired bone healing. The mechanical environment constitutes the fourth factor of the 'diamond concept' of fracture healing, along with osteoconductive scaffolds, growth factors and osteogenic cells, interacting during the repair process 28 .

During bone regeneration, intermediate tissues, such as fibrous connective tissue, cartilage and woven bone, precede final bone formation, providing initial mechanical stability and a scaffold for tissue differentiation. The mechanical loading affects the regeneration process, with different stress distribution favouring or inhibiting differentiation of particular tissue phenotypes 72 . High shear strain and fluid flows are thought to stimulate formation of fibrous connective tissue, whereas lower levels stimulate formation of cartilage, and even lower levels favour ossification 72 .

The interfragmentary strain concept of Perren has been used to describe the different patterns of bone repair (primary or secondary fracture healing), suggesting that the strain that causes healthy bone to fail is the upper limit that can be tolerated for the regenerating tissue 73 . Since then, extensive research on this field has further refined the effects of mechanical stability and mechanical stimulation on bone regeneration and fracture healing 74 . Numerous in vivo studies have shown contradictory results regarding the contribution of strain and mechanical stimulation, in terms of compression or distraction, in bone formation during fracture healing. In early fracture healing, mechanical stimulation seems to enhance callus formation, but the amount of callus formation does not correspond to stiffness 74 . During the initial stages of bone healing, a less rigid mechanical environment resulted in a prolonged chondral bone regeneration phase, whereas the process of intramembranous ossification appeared to be independent of mechanical stability 75 . By contrast, a more rigid mechanical environment resulted in a smaller callus and a reduced fibrous-tissue component 76 . For later stages of bone regeneration, lower mechanical stability was found to inhibit callus bridging and stiffness 74 . Finally, in vitro studies have also shown the role of the mechanical environment on different cell types involved in bone regeneration. It has been demonstrated using cell-culture systems that the different cellular responses in terms of proliferation and differentiation after mechanical stimulation depend on the strain magnitude and the cell phenotype 74 .

Mechanical stability is also important for local vascularisation and angiogenesis during bone regeneration. In an in vivo study, it was shown that smaller interfragmentary movements led to the formation of a greater number of vessels within the callus, particularly in areas close to the periosteum, compared with larger movements 77 , whereas increased interfragmentary shear was associated with reduced vascularisation with a higher amount of fibrous-tissue formation and a lower percentage of mineralised bone during early bone healing 78 .

Finally, the presence of a mechanically stable environment throughout the bone-regeneration process is also essential when additional methods are being used to enhance bone repair 28 79 . Optimal instrumentation with minimal disruption of the local blood supply is required to supplement and protect the mechanical properties of the implanted grafts or scaffolds to allow incorporation, vascularisation and subsequent remodelling 79 .

Systemic enhancement of bone regeneration

As an alternative to local augmentation of the bone-regeneration process, the use of systemic agents, including growth hormone (GH) 80 and parathyroid hormone (PTH) 81 is also under extensive research. Current evidence suggests a positive role for GH in fracture healing, but there are issues about its safety profile and optimal dose, when systemically administered to enhance bone repair 80 . There are also numerous animal studies and clinical trials showing that intermittent PTH administration induces both cancellous and cortical bone regeneration, enhances bone mass, and increases mechanical bone strength and bone-mineral density, with a relatively satisfactory safety profile 81 82 . Currently, two PTH analogues, PTH 1-34 (or teriparitide) and PTH 1-84, are already used in clinical practice as anabolic agents for the treatment of osteoporosis 81 83 , and research is being carried out into their off-label use as bone-forming agents in complex conditions requiring enhancement of bone repair, such as complicated fractures and non-unions.

In addition to the anabolic agents for bone regeneration, current antiresorptive therapies that are already in clinical use for the management of osteoporosis could be used to increase bone-mineral density during bone regeneration and remodelling by reducing bone resorption. Biphosphonates, known to reduce the recruitment and activity of osteoclasts and increase their apoptosis, and strontium ranelate, known to inhibit bone resorption and stimulate bone formation, could be beneficial adjuncts to bone repair by altering bone turnover 84 . In addition, a new pharmaceutical agent called denosumab, which is a fully human monoclonal antibody designed to target receptor activator of nuclear factor-κB ligand (RANKL), a protein that selectively inhibits osteoclastogenesis, might not only decrease bone turnover and increase bone-mineral density in osteoporosis, but also indirectly improve bone regeneration in other conditions requiring enhancement 85 .

Recently, another signalling pathway, the Wnt pathway, was found to play a role in bone regeneration 86 . Impaired Wnt signalling is associated with osteogenic pathologies, such as osteoporosis and osteopenia. Thus, novel strategies that systemically induce the Wnt signalling pathway or inhibit its antagonists, such as sclerostin, can improve bone regeneration. However, there are concerns about carcinogenesis 87 .

Another approach for systemic enhancement of bone regeneration is the use of agonists of the prostaglandin receptors EP2 and EP4, which were found to be skeletally anabolic at cortical and cancellous sites. Promising results have been seen in animal models, without adverse effects, and therefore these receptors may represent novel anabolic agents for the treatment of osteoporosis and for augmentation of bone healing 27 .

Finally, new treatments for systemic augmentation of bone regeneration may come to light while researchers are trying to elucidate the alterations seen at the cellular and molecular level in conditions with increased bone formation capacity. Fibrodysplasia ossificans progressiva, a rare genetic disorder, is an example of how an abnormal metabolic condition can be viewed as evidence for systemic regeneration of large amounts of bone secondary to alterations within the BMP signalling pathway 88 , and may indicate unique treatment potentials.

There are several clinical conditions that require enhancement of bone regeneration either locally or systemically, and various methods are currently used to augment or accelerate bone repair, depending on the healing potential and the specific requirements of each case. Knowledge of bone biology has vastly expanded with the increased understanding at the molecular level, resulting in development of many new treatment methods, with many others (or improvements to current ones) anticipated in the years to come. However, there are still gaps; in particular, there is still surprisingly little information available about the cellular basis for MSC-mediated fracture repair and bone regeneration in vivo in humans. Further understanding in this area could be the key to an improved and integrated strategy for skeletal repair.

In the future, control of bone regeneration with strategies that mimic the normal cascade of bone formation will offer successful management of conditions requiring enhancement of bone regeneration, and reduce their morbidity and cost in the long term. Research is ongoing within all relevant fields, and it is hoped that many bone-disease processes secondary to trauma, bone resection due to ablative surgery, ageing, and metabolic or genetic skeletal disorders will be successfully treated with novel bone-regeneration protocols that may address both local and systemic enhancement to optimise outcome.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

RD contributed to the literature review and writing. EJ, DMcG and PVG contributed to the writing of specific sections of the manuscript within their main scientific interest, and critically revised the manuscript for important intellectual content. All authors read and have given final approval of the final manuscript.

Bone injury, healing and grafting
BatesPRamachandranMBasic Orthopaedic Sciences. The Stanmore GuideLondon: Hodder ArnoldRamachandran M2007123134
The cell and molecular biology of fracture healing
EinhornTAClin Orthop Relat Res1998355SupplS7219917622
Differential temporal expression of members of the transforming growth factor beta superfamily during murine fracture healing
ChoTJGerstenfeldLCEinhornTAJ Bone Miner Res20021751352010.1359/jbmr.2002.17.3.51311874242
Does adult fracture repair recapitulate embryonic skeletal formation?
FergusonCAlpernEMiclauTHelmsJAMech Dev199987576610.1016/S0925-4773(99)00142-210495271
Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures
AudigéLGriffinDBhandariMKellamJRüediTPClin Orthop Relat Res200543822123216131895
Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method
AronsonJJ Bone Joint Surg Am1997798124312589278087
Management of segmental defects by the Ilizarov intercalary bone transport method
GreenSAJacksonJMWallDMMarinowHIshkanianJClin Orthop Relat Re.1992280136142
Bone substitutes: an update
GiannoudisPVDinopoulosHTsiridisEInjury200536Suppl 3S202716188545
Bone morphogenetic proteins in musculoskeletal medicine
GiannoudisPVEinhornTAInjury200940Suppl 3S1320082783
The concept of induced membrane for reconstruction of long bone defects
MasqueletACBegueTOrthop Clin North Am2010411273710.1016/j.ocl.2009.07.01119931050
The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis
BusseJWBhandariMKulkarniAVTunksECMAJ200216644374419935211873920
Improved healing response in delayed unions of the tibia with low-intensity pulsed ultrasound: results of a randomized sham-controlled trial
SchoferMDBlockJEAignerJSchmelzABMC Musculoskelet Disord20101122910.1186/1471-2474-11-229295898620932272
Low-intensity pulsed ultrasound and pulsed electromagnetic field in the treatment of tibial fractures: a systematic review
WalkerNADenegarCRPreischeJJ Athl Train2007424530535214008018174942
The monorail method for segment bone transport
RaschkeMOedekovenGFickeJClaudiBFInjury199324Suppl 2S54618188331
The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia
ColeJDJustinDKasparisTDeVlughtDKnoblochCInjury200132Suppl 412913911223044
Bone graft materials. An overview of the basic science
BauerTWMuschlerGFClin Orthop Relat Res2000371102710693546
Long bone reconstruction with vascularized bone grafts
PedersonWCPersonDWOrthop Clin North Am2007381233510.1016/j.ocl.2006.10.00617145292
Femoral head osteonecrosis: Why choose free vascularized fibula grafting
KorompiliasAVBerisAELykissasMGKostas-AgnantisIPSoucacosPNMicrosurgery2010
Surgical techniques: how I do it? The reamer/irrigator/aspirator (RIA) system
GiannoudisPVTzioupisCGreenJInjury200940111231123610.1016/j.injury.2009.07.07019783249
Comparison of anterior and posterior iliac crest bone graft in terms of harvest-site morbidity and functional outcomes
AhlmannEPatzakisMRoidisNShepherdLHoltomPJ Bone Joint Surg Am200284571672010.1302/0301-620X.84B5.1257112004011
Physical and monetary costs associated with autogenous bone graft harvesting
St JohnTAVaccaroARSahAPSchaeferMBertaSCAlbertTHilibrandAAm J Orthop2003321182312580346
Morbidity at bone graft donor sites
YoungerEMChapmanMWJ Orthop Trauma19893319219510.1097/00005131-198909000-000022809818
Bone-grafting and bone-graft substitutes
FinkemeierCGJ Bone Joint Surg Am200284345446411886919
Is an impacted morselized graft in a cage an alternative for reconstructing segmental diaphyseal defects?
BullensPHBart SchreuderHWde Waal MalefijtMCVerdonschotNBumaPClin Orthop Relat Res2009467378379110.1007/s11999-008-0686-5263545119142693
Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage
OstermannPAHaaseNRübberdtAWichMEkkernkampAJ Orthop Trauma200216859760110.1097/00005131-200209000-0001012352570UristMRO'ConnorBTBurwellRGBone Graft Derivatives and SubstitutesOxford: Butterworth-Heinemann Ltd1994
The control of fracture healing and its therapeutic targeting: improving upon nature
KomatsuDEWardenSJJ Cell Biochem2010109230231119950200
Fracture healing: the diamond concept
GiannoudisPVEinhornTAMarshDInjury200738Suppl 4S3618224731
Current concepts of molecular aspects of bone healing
DimitriouRTsiridisEGiannoudisPVInjury200536121392140410.1016/j.injury.2005.07.01916102764
Medical devices. [<url>http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/default.htm</url>]
Food and Drug Administration
Formulations and delivery vehicles for bone morphogenetic proteins: latest advances and future directions
BlokhuisTJInjury200940Suppl 3S81120082796
Growth factors: beyond bone morphogenetic proteins
NauthAGiannoudisPVEinhornTAHankensonKDFriedlaenderGELiRSchemitschEHJ Orthop Trauma201024954354610.1097/BOT.0b013e3181ec483320736791
The role of growth factors and related agents in accelerating fracture healing
SimpsonAHMillsLNobleBJ Bone Joint Surg Br200688670170510.1302/0301-620X.88B6.1752416720758
The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature
AlsousouJThompsonMHulleyPNobleAWillettKJ Bone Joint Surg Br200991898799610.1302/0301-620X.91B8.2254619651823
Bone morphogenetic proteins in orthopaedic trauma surgery
ArgintarEEdwardsSDelahayJInjury2010
Composite glycidyl methacrylated dextran (Dex-GMA)/gelatin nanoparticles for localized protein delivery
ChenFMMaZWDongGYWuZFActa Pharmacol Sin200930448549310.1038/aps.2009.1519305420
Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today
PountosIGeorgouliTKontakisGGiannoudisPVInt Orthop201034131210.1007/s00264-009-0892-0289926019844709
Age-related osteogenic potential of mesenchymal stromal stem cells from human vertebral bone marrow
D'IppolitoGSchillerPCRicordiCRoosBAHowardGAJ Bone Miner Res19991471115112210.1359/jbmr.1999.14.7.111510404011
Effect of age and sampling site on the chondro-osteogenic potential of rabbit marrow-derived mesenchymal progenitor cells
HuibregtseBAJohnstoneBGoldbergVMCaplanAIJ Orthop Res2000181182410.1002/jor.110018010410716274
Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells
HernigouPPoignardABeaujeanFRouardHJ Bone Joint Surg Am20058771430143710.2106/JBJS.D.0221515995108
Bridging the gap: bone marrow aspiration concentrate reduces autologous bone grafting in osseous defects
JägerMHertenMFochtmannUFischerJHernigouPZilkensCHendrichCKrauspeRJ Orthop Res201129217318010.1002/jor.2123020740672
Ex vivo enrichment of mesenchymal cell progenitors by fibroblast growth factor 2
BianchiGBanfiAMastrogiacomoMNotaroRLuzzattoLCanceddaRQuartoRExp Cell Res200328719810510.1016/S0014-4827(03)00138-112799186
Marrow-isolated adult multilineage inducible (MIAMI) cells, a unique population of postnatal young and old human cells with extensive expansion and differentiation potential
D'IppolitoGDiabiraSHowardGAMeneiPRoosBASchillerPCJ Cell Sci2004117142971298110.1242/jcs.0110315173316
Cellular strategies for enhancement of fracture repair
PattersonTEKumagaiKGriffithLMuschlerGFJ Bone Joint Surg Am200890Suppl 111111918676945
The relevance of mesenchymal stem cells in vivo for future orthopaedic strategies aimed at fracture repair
McGonagleDEnglishAJonesEACurr Orthop200721426226710.1016/j.cuor.2007.07.004
Safety of autologous bone marrow-derived mesenchymal stem cell transplantation for cartilage repair in 41 patients with 45 joints followed for up to 11 years and 5 months
WakitaniSOkabeTHoribeSMitsuokaTSaitoMKoyamaTNawataMTenshoKKatoHUematsuKKurodaRKurosakaMYoshiyaSHattoriKOhgushiHJ Tissue Eng Regen Med20115214615010.1002/term.29920603892
Therapeutic potential of vasculogenesis and osteogenesis promoted by peripheral blood CD34-positive cells for functional bone healing
MatsumotoTKawamotoAKurodaRIshikawaMMifuneYIwasakiHMiwaMHoriiMHayashiSOyamadaANishimuraHMurasawaSDoitaMKurosakaMAsaharaTAm J Pathol20061691440145710.2353/ajpath.2006.060064169884417003498
Multilineage cells from human adipose tissue: implications for cell-based therapies
ZukPAZhuMMizunoHHuangJFutrellJWKatzAJBenhaimPLorenzHPHedrickMHTissue Eng20017221122810.1089/10763270130006285911304456
Mesenchymal progenitor cells derived from traumatized human muscle
JacksonWMAragonABDjouadFSongYKoehlerSMNestiLJTuanRSJ Tissue Eng Regen Med20093212913810.1002/term.149281416119170141
Do adipose tissue-derived mesenchymal stem cells have the same osteogenic and chondrogenic potential as bone marrow-derived cells?
ImGIShinYWLeeKBOsteoarthritis Cartilage2005131084585310.1016/j.joca.2005.05.00516129630
Comparison of mesenchymal stem cells from bone marrow and adipose tissue for bone regeneration in a critical size defect of the sheep tibia and the influence of platelet-rich plasma
NiemeyerPFechnerKMilzSRichterWSuedkampNPMehlhornATPearceSKastenPBiomaterials201031133572352910.1016/j.biomaterials.2010.01.08520153047
Human bone marrow mesenchymal stem cells in vivo
JonesEMcGonagleDRheumatology (Oxford)2008472126131
Isolation and characterization of bone marrow multipotential mesenchymal progenitor cells
JonesEAKinseySEEnglishAJonesRAStraszynskiLMeredithDMMarkhamAFJackAEmeryPMcGonagleDArthritis Rheum200246123349336010.1002/art.1069612483742
Large-scale extraction and characterization of CD271+ multipotential stromal cells from trabecular bone in health and osteoarthritis: implications for bone regeneration strategies based on uncultured or minimally cultured multipotential stromal cells
JonesEEnglishAChurchmanSMKouroupisDBoxallSAKinseySGiannoudisPGEmeryPMcGonagleDArthritis Rheum20106271944195420222109
A novel collagen/hydroxyapatite/poly(lactide-co-ε-caprolactone) biodegradable and bioactive 3D porous scaffold for bone regeneration
AkkouchAZhangZRouabhiaMJ Biomed Mater Res A201196A69370410.1002/jbm.a.33033
A conceptually new type of bio-hybrid scaffold for bone regeneration
TampieriALandiEValentiniFSandriMD'AlessandroTDediuVMarcacciMNanotechnology201122101510410.1088/0957-4484/22/1/01510421135464
Injectable nanocrystalline hydroxyapatite paste for bone substitution: in vivo analysis of biocompatibility and vascularization
LaschkeMWWittKPohlemannTMengerMDJ Biomed Mater Res B Appl Biomater200782249450517279565
Bone tissue engineering: state of the art and future trends
SalgadoAJCoutinhoOPReisRLMacromol Biosci20044874376510.1002/mabi.20040002615468269
Bone tissue engineering: hope vs hype
RoseFROreffoROBiochem Biophys Res Commun20022921710.1006/bbrc.2002.651911890663
Mesenchymal stem cells and their future in bone repair
JonesEAYangXBInt J Adv Rheumatol2005331521
Clinical application of human mesenchymal stromal cells for bone tissue engineering
ChatterjeaAMeijerGvan BlitterswijkCde BoerJStem Cells Int20102010215625298937921113294
A multi-center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast (Ossron) injection to treat fractures
KimSJShinYWYangKHKimSBYooMJHanSKImSAWonYDSungYBJeonTSChangCHJangJDLeeSBKimHCLeeSYBMC Musculoskelet Disord2009102010.1186/1471-2474-10-20265645519216734
Tissue engineered ceramic artificial joint--ex vivo osteogenic differentiation of patient mesenchymal cells on total ankle joints for treatment of osteoarthritis
OhgushiHKotobukiNFunaokaHMachidaHHiroseMTanakaYTakakuraYBiomaterials200526224654466110.1016/j.biomaterials.2004.11.05515722135
Prefabrication of vascularized bioartificial bone grafts in vivo for segmental mandibular reconstruction: experimental pilot study in sheep and first clinical application
KokemuellerHSpalthoffSNolffMTavassolFEssigHStuehmerCBormannKHRückerMGellrichNCInt J Oral Maxillofac Surg201039437938710.1016/j.ijom.2010.01.01020167453
Clinical-grade production of human mesenchymal stromal cells: occurrence of aneuploidy without transformation
TarteKGaillardJLatailladeJJFouillardLBeckerMMossafaHTchirkovARouardHHenryCSplingardMDulongJMonnierDGourmelonPGorinNCSensebéLSociété Française de Greffe de Moelle et Thérapie CellulaireBlood201011581549155310.1182/blood-2009-05-21990720032501
Conditions affecting cell seeding onto three-dimensional scaffolds for cellular-based biodegradable implants
WeinandCXuJWPerettiGMBonassarLJGillTJJ Biomed Mater Res B Appl Biomater2009911808719388093
Repair of large osteochondral defects with allogeneic cartilaginous aggregates formed from bone marrow-derived cells using RWV bioreactor
YoshiokaTMishimaHOhyabuYSakaiSAkaogiHIshiiTKojimaHTanakaJOchiaiNUemuraTJ Orthop Res200725101291129810.1002/jor.2042617549704
Mesenchymal stem cells and gene therapy
CaplanAIClin Orthop Relat Res2000379SupplS677011039754
Orthopaedic application of gene therapy
ChenYJ Orthop Sci2001619920710.1007/s00776010007211484110
Bone morphogenetic proteins and tissue engineering: future directions
CaloriGMDonatiDDi BellaCTagliabueLInjury200940Suppl 3S677620082795
Combination of bone tissue engineering and BMP-2 gene transfection promotes bone healing in osteoporotic rats
TangYTangWLinYLongJWangHLiuLTianWCell Biol Int20083291150115710.1016/j.cellbi.2008.06.00518638562
A mechano-regulation model for tissue differentiation during fracture healing: analysis of gap size and loading
LacroixDPrendergastPJJ Biomech20023591163117110.1016/S0021-9290(02)00086-612163306
Physical and biological aspects of fracture healing with special reference to internal fixation
PerrenSMClin Orthop Relat Res1979138175196376198
Effect of mechanical stability on fracture healing--an update
JagodzinskiMKrettekCInjury200738Suppl1S31018224731
Instability prolongs the chondral phase during bone healing in sheep
EpariDRSchellHBailHJDudaGNBone200638686487010.1016/j.bone.2005.10.02316359937
The course of bone healing is influenced by the initial shear fixation stability
SchellHEpariDRKassiJPBragullaHBailHJDudaGNJ Orthop Res20052351022102810.1016/j.orthres.2005.03.00515878254
The effect of mechanical stability on local vascularization and tissue differentiation in callus healing
ClaesLEckert-HübnerKAugatPJ Orthop Res20022051099110510.1016/S0736-0266(02)00044-X12382978
Initial vascularization and tissue differentiation are influenced by fixation stability
LienauJSchellHDudaGNSeebeckPMuchowSBailHJJ Orthop Res200523363964510.1016/j.orthres.2004.09.00615885486
Bone scaffolds: The role of mechanical stability and instrumentation
BabisGCSoucacosPNInjury200536SupplS38S4416291322
Growth hormone: does it have a therapeutic role in fracture healing?
TranGTPagkalosJTsiridisENarvaniAAHeliotisMMantalarisATsiridisEExpert Opin Investig Drugs200918788791110.1517/1354378090289306919480608
Parathyroid hormone as an anabolic skeletal therapy
RubinMRBilezikianJPDrugs200565172481249810.2165/00003495-200565170-0000516296873
The safety and efficacy of parathyroid hormone (PTH) as a biological response modifier for the enhancement of bone regeneration
TzioupisCCGiannoudisPVCurr Drug Saf20061218920310.2174/15748860677693057118690930
PTH analogues and osteoporotic fractures
VerhaarHJLemsWFExpert Opin Biol Ther20101091387139410.1517/14712598.2010.50687020629581
European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO): European guidance for the diagnosis and management of osteoporosis in postmenopausal women
KanisJABurletNCooperCDelmasPDReginsterJYBorgstromFRizzoliROsteoporos Int200819439942810.1007/s00198-008-0560-z261396818266020
The role and efficacy of denosumab in the treatment of osteoporosis: an update
CharopoulosIOrmeSGiannoudisPVExpert Opin Drug Saf2011
Wnt pathway, an essential role in bone regeneration
ChenYAlmanBAJ Cell Biochem2009106335336210.1002/jcb.2202019127541
The therapeutic potential of the Wnt signaling pathway in bone disorders
WagnerERZhuGZhangBQLuoQShiQHuangEGaoYGaoJLKimSHRastegarFYangKHeBCChenLZuoGWBiYSuYLuoJLuoXHuangJDengZLReidRRLuuHHHaydonRCHeTCCurr Mol Pharmacol201141142510.2174/187446721110401001420825362
Mutations of the noggin (NOG) and of the activin A type I receptor (ACVR1) genes in a series of twenty-seven French fibrodysplasia ossificans progressiva (FOP) patients
LucotteGHouzetAHubansCLagardeJPLenoirGGenet Couns2009201536219400542

Pre-publication history


Public Release:  Climate change projected to drive species northward

New study predicts eastern Pacific species shifting poleward 30 km per decade

NOAA Fisheries West Coast Region

The study suggests that shifting species will likely move into the habitats of other marine life to the north, especially in the Gulf of Alaska and Bering Sea. Some will simultaneously disappear from areas at the southern end of their ranges, especially off Oregon and California.

"As the climate warms, the species will follow the conditions they're adapted to," said Richard Brodeur, a NOAA Fisheries senior scientist at the Northwest Fisheries Science Center's Newport Research Station and coauthor of the study. "We're going to see more interactions between species and there will be winners and losers that we cannot foresee."

The study, led by William Cheung of the University of British Columbia, estimated changes in the distribution of 28 near-surface fish species commonly collected by research surveys in the northeast Pacific Ocean. The researchers used established global climate models to project how the distribution of the fish would shift by 2050 as greenhouse gases warm the atmosphere and, in turn, the ocean surface.

Brodeur cautioned that like any models, climate models carry uncertainty. While they provide a glimpse of the most likely changes in global climate, they may be less accurate when estimating more fine-scale, local changes.

"Nothing is certain," he said, "but we think we have a picture of the most likely changes."

Some species shifts are already being documented as West Coast waters are warming: predatory Humboldt squid from Central and South America have invaded the West Coast of North America in recent years, albacore have shifted to more northerly waters and eulachon have disappeared from warming waters at the southern end of their range.

"Thinking more broadly, this re-shuffling of marine species across the whole biological community may lead to declines in the beneficial functions of marine and coastal ecosystems," said Tom Okey, a Pew Fellow in Marine Conservation at the University of Victoria and a coauthor of the study. "These declines may occur much more rapidly and in more surprising ways than our expected changes in species alone."

The study anticipates warm-water species such as thresher sharks and chub mackerel becoming more prominent in the Gulf of Alaska and off British Columbia. Some predators such as sea lions and seabirds, which rear their young in fixed rookeries or colonies, may find the fish they usually prey on moving beyond predators' usual foraging ranges.

"If their prey moves farther north, they either have to travel farther and expend more energy to get to them, or find something else to eat," Brodeur said. "It's the same thing for fishermen. If it gets warmer, the fish they depend on are going to move up north and that means more travel time and more fuel will be needed to follow them, or else they may need to switch to different target species. It may not happen right away but we are likely to see that kind of a trend."

El Nino years, when tropical influences temporarily warm the eastern Pacific, offer a preview of what to expect as the climate warms.

Shifts in marine communities may be most pronounced in high-latitude regions such as the Gulf of Alaska and Bering Sea, which the study identifies as "hotspots" of change. Cold-water species such as salmon and capelin have narrower temperature preferences than warmer water species, making them more sensitive to ocean warming and likely to respond more quickly.

An intrusion of warm-water species into cooler areas could lead to significant changes in marine communities and ecosystems. The diversity of northern fish communities, now often dominated by a few very prolific species such as walleye pollock, may increase as southern species enter the region, leading to new food web and species interactions.


View Single Post
Old 08-22-2012, 09:44 AM   #11
Rebecca Ednie
Insane Embellisher
Join Date: Jul 2005
Location: Mount Albert, near Toronto, Ontario Canada
Posts: 792

I use a cheap light box with white fabric draped inside set up with large construction lights. They are very yellow so I always set my white balance to tungsten (light bulb symbol) and also colour correct them later as well. I'd recommend day light bulb lamps if you can.

I stand my cards up and try to photograph them head on meaning as straight in front as possible. So my angle is lower for a side fold card than for a top fold one. This prevents distortion of the lines. I love seeing other peoples cards taken at an angle, for some reason that doesn't work for me unless I am photographing the details.

I recommend macro mode on a POS camera or a fast (low max aperture like 1.8 or 2.4) macro lens for a DSLR camera. If you have a DSLR, setting your aperture makes a huge difference in how your picture looks. If you normally shoot in auto, try out aperture priority mode! It lets you control the ISO and aperture but figures out the rest. Low numbers like 1.8, 3.5 etc will give you that tight focus on your focal point with the rest of the card's focus blurring away from that center point. If you set it up at 4+, you will start getting more of the card in focus. All of this depends on how far away you are too as the further back, the more of the card is in focus and vice versa. These are just the settings I've used. I use small numbers for details and larger ones for the whole card and even higher numbers for photographing a 3-D project or a group of cards like 8.0. If you have a card with very dimensional bellies on it, treat it like a 3-D project if you want it all in focus. This principle works with groups of people too. Use higher apertures for larger groups to get everyone in focus.

If you find you photos are blurry, especially at higher aperture numbers, use a mini tripod and self timer to take your pictures. The camera is compensating for low light caused by a small aperture (large numbers reflect a small size opening to let light through) by opening the camera's shutter for longer. Any hand shake is recorded as blur where with a faster shutter, there isn't time for the camera to record that movement because it isn't open long enough.

A too small aperture can also cause blurriness. Look carefully at your photo. Is anything in focus? Even a tiny element? Perhaps the rest is blurry because you have too much of that artistic blurriness (called bokeh) where the focus is tight on one element then fades out around that. Your tight focus area may be smaller than you want or in the wrong place. A damaged lens can also cause this but if some photos are ok but others aren't, that clearly isn't the problem.

If you like to add props to your photos, you can use the principles above to determine where to place them based on whether you want them in focus or not. The further away you place them, to the side or back to front, the more blurry they will appear!
Rebecca Ednie
Live Well, Laugh often, Love much
Rebecca Ednie is offline
Reply With Quote


Skip to content

About the Chorus

The Yale Slavic Chorus is a performance group comprised of women from a variety of cultural and academic backgrounds who share a common passion for Slavic music. The Chorus sings a diverse repertoire that spans the traditions of Bulgaria, Russia, Ukraine, and Georgia, among others. Though many members of the Chorus are not native speakers of Slavic languages, the Yale Slavic Chorus works extensively with native folk musicians and vocalists to practice accurate pronunciation and style.

Although primarily an undergraduate group, the Slavs, as we are affectionately known around Yale’s campus, also include other members of the Yale community. The Slavic Chorus has always been dedicated to maintaining musical vigor and excellence, seeking to empower women through song.

Recent Press:

The Slavs in the Republic of Georgia!

A Brief History

The Chorus was founded in 1969, the first year of undergraduate co-education at Yale, and was the first all-women’s group on Campus.  It was originally conducted by William Robbins, Jr., then a music major in Yale College and a member of the all-male Yale Russian Chorus. In 2015, the Chorus celebrated our 45th anniversary with a reunion concert that drew alumnae from all across the globe.

Our Method and Music

We are an entirely student-run, student-directed ensemble. We transcribe and arrange much of our own music, but are always looking for new songs to sing. We also learn much of our music via an oral tradition and by listening to original source recordings. During our performances, we strive to maintain the original mode of presentation, which often includes dissonant harmonies, unusual rhythms, and distinctive vocal qualities which make Slavic and Eastern European music unique and exciting. We have also begun incorporating more traditional folk dances into our performances.

Amanda Crego-Emley and Charlotte Finegold

Athena Wheaton and Claire Gottsegen


Pages Menu
Categories Menu

Most recent articles

Flower Remedies

Flower remedies are said to use the vibrational essence of flowers to balance the negative emotions that make us more vulnerable to disease. They provide a simple, natural method of establishing personal equilibrium and harmony.

Reflexology is a natural therapy that treats health problems or potential problems through massage of the feet, and sometimes the hands.

Reiki is a form of therapy that uses hands-on, no-touch, and visualisation techniques to improve the flow of life energy throughout the body. The word ‘Reiki’ is Japanese and literally means ‘universal life energy’.

Emotional Freedom Techniques

Emotional Freedom Techniques, or EFT (often known as Tapping ), is a healing approach that rebalances the body’s energy system, and has been shown to be especially effective treating unresolved emotional issues.

Rather than being a single therapy, naturopathy can more accurately be described as a combination of natural therapies, including nutrition therapy, dietary supplements, hydrotherapy, and lifestyle coaching. The approaches used vary, depending on the unique needs of the individual client.


Travel Experts Alliance

When you travel the world in search of authenticity, culture and tradition, you come to expect a certain standard of excellence from those you choose to guide you through the experience. When a professional exceeds that standard, they attain a new level of distinction. Each of the individuals below are specialists in their region of the world: they have garnered multiple nominations and awards for the quality of their work and the level of their commitment to the preservation of the Earth, her people and resources. They have contributed long hours, sweat, and the uniqueness of their particular creative processes to ensure that your journey exceeds your expectations, allows the region they operate within to retain its cultural significance, and keeps the impact on the local environment minimal. When you choose from among the Travel Experts Alliance, know that the trip of a lifetime they propose will truly be an exceptional adventure.

Jalsa Urubshurow

Nomadic Expeditions

Specializing in Mongolia

A pioneer in environmental conservation through for-profit sustainable tourism initiatives, Jalsa Urubshurow’s story began in 1952 when his parents immigrated to the US after a seemingly endless search for safe haven from Stalinist persecution in Russia. Born on the other side of the world from his ancestral heritage, Jalsa grew up speaking Mongolian and listening to the legends his father recited to him. Jalsa fought his way toward a hugely successful career as a carpenter, founding a framing business in 1989 which grew into one of the nation’s leading framing contractors. The company was eventually awarded the National Housing Quality Award, the highest honor given to any trade contractor.

One year after the establishment of his framing business, Mongolia transitioned to democracy, and Jalsa’s dream of visiting his father’s homeland became a reality. During his first exploration of Mongolia’s astounding beauty, the nation’s first democratically elected Prime Minister, His Excellency Dash Byambasuren, recruited him to advise on expanding accessibility to Western travelers. Jalsa eagerly took up the challenge, and Nomadic Expeditions became a full-fledged operation in 1992.

Two decades later, Nomadic Expeditions has become the premier tour operator for the region and a strong force within the sustainable tourism sector. From introducing this unique type of travel as an alternative source of income to the country’s infrastructure to creating and maintaining the Three Camel Lodge, the Gobi Desert’s only luxury eco-lodge focused on the preservation of the region and its inhabitants, the company has seen significant growth in the areas it calls home. As an operation Nomadic Expeditions has garnered multiple awards over the years, including National Geographic Adventure’s Best Adventure Travel Companies on Earth in 2009 and Jalsa himself as Condé Nast Traveler’s only Top Travel Specialist for Mongolia for six consecutive seasons (2008-2013). The company continues to grow and expand, adding several trips a year to new and exciting destinations.

Jalsa’s continued exploration of Mongolia, especially now through the eyes of his son, have brought him great joy and an enduring desire to engage others personally in initiating and developing sustainable practices wherever they travel. A co-founder of the North America-Mongolia Business Council (NAMBC), a non-profit organization comprised of the CEOs of American and Canadian corporations active in Mongolia, Jalsa and his colleagues are dedicated to expanding bilateral economic, investment and trade relations between Mongolia and North America. He has also previously served on the board for the Bodhi Tree Foundation, and continues to support numerous charities and nonprofits around the world.

Cherri Briggs

Explore, Inc.

Specializing in Africa

Cherri is a member of the Explorer’s Club, a meeting point for explorers and scientists worldwide. Her passion for exploration was best exemplified in the expedition she organized and led in 2003, which was the first descent of Mozambique’s 450-mile Lugenda River. When not in Africa she operates from Explore headquarters in Steamboat Springs Colorado.

Mei Zhang

Specializing in China

Today, WildChina is an award-winning tour operator that creates bespoke trips highlighted by rich personal interactions and superior access to experts and venues. Travel to China goes beyond a glimpse of the Great Wall, the Forbidden City, and the Terracotta Warriors. It’s about understanding what you see. A skyscraper surrounded by a multitude of cranes is an opportunity to learn about the vast differences in the lives of the migrant worker who is operating the crane and the young couple who will soon live in the skyscraper. Travel to a remote corner of one of China’s provinces is having the chance to share a cup of tea with a local Yi shaman in his home, and listen to his stories of learning the centuries-old practice from his father.

Andrea Ross

Journeys Within

Specializing in Cambodia

March 6, 2011: LA Times article “Beyond Angkor, Cambodia, a Khmer kingdom emerges from the jungle

Sanjay Saxena

Destination Himalaya

Specializing in India

Sanjay’s deep, insider’s knowledge of his homeland together with his talent for creating unique itineraries to traditional and remote destinations, make him one of the travel world’s top-ranking India and Tibet specialists. For 11 consecutive years (2003 – 2013), he has received Conde Nast’s “Top Travel Specialist” award for his exemplary work in South Asia, specifically India, Tibet, Nepal and Sri Lanka. Under his leadership Destination Himalaya has also been chosen by National Geographic Adventure for one of the “Best Outfitters on Earth” Award.


By Amanda Deering

Amanda Deering is an undergraduate student at UCLA pursuing a degree in Psychology. She has been working at C.A.R.D. as a Research Assistant since summer of 2010. Before C.A.R.D., Amanda first learned about Autism Spectrum Disorders at the UCSB Koegel Autism Center. Outside of C.A.R.D., she is an aspiring photographer and works as a DJ on UCLA radio.

What is ABA? Natural Environment Training

The goal of any ABA therapist is to help improve the life of the child they work with and their family using the principles of behavior analysis. By using NET, these real life applications are addressed. Throughout this past month I have learned that as you get to know a child better, you are more equipped for NET because you know what generalized skills the child could really use and are able to use reinforcers that you understand are the child’s favorite to create these effective changes and improvements in their life. Such skills as answering the phone when it rings, asking for the child’s favorite movie when they want to watch it, and responding appropriately to a sibling make life for the child and the family a whole lot easier.

What is ABA? Discrete Trial Training

What is ABA? Part 1

Some Thoughts on Emotional Communication in Asperger’s Syndrome

People with AS also understand emotions differently. While a typical person can quickly perceive sadness, anger, and happiness, some with AS find these emotions more difficult to comprehend. The identification of emotions may take longer, making communication more difficult. But in no way does this difference exclude them from feeling emotion.

Perfect Movie Experience for Children with Autism

‘Star Wars’, ‘Back to the Future’, and ‘Wizard of Oz’ were a few of my favorite movies as a kid. There is no avoiding the fact that these movies are best watched at the theater. There is something about watching a movie on a big screen, with great sound effects and being able to share this experience with a crowd that make you feel you are part of the movie.

Therapy for Autism with Dogs

Ernie Els, Making a Difference in the Autism Community with Golf

Yoga: The New Autism Therapy

Do What You Love and Love What You Do

iPads. The New Behavior Therapist?

When I first saw the iPad, I must admit, I thought it was a completely unnecessary and awkward-looking device. It wasn’t until I heard how helpful it was for children with autism and other communication disorders that I understood how useful this technology could be. This makes complete sense, too; the iPad, which is simple enough for children to use, is also very appealing to the young ones who love to feel ‘adult’ by using new technology.


1. hikari-shimoda-01

    Manga Mondays ~ Hikari Shimoda

  2. harumi-yamaguchi-01

    Fashion Fridays ~ Harumi Yamaguchi

    Harumi Yamaguchi is a seminal Japanese artist, whose illustrations evoked female equality in an era of great political and social reforms. When she embarked on her career, in the early 1970s, Yamaguchi was the only eminent illustrator working with the airbrush medium.

  3. loundraw-01

    Manga Mondays ~ loundraw

  4. keiko-takemiya-01

    Manga Mondays ~ Keiko Takemiya

    If you follow the Illustrator’s Lounge on Facebook or Twitter, you may have seen us mention the latest exhibition being held at the House of Illustration, Shojo Manga: The World of Japanese Girls’ Comics. Shojo is manga aimed at a teenage female readership (shojo literally means “young woman”). Shojo Manga will be the first major exhibition of the genre in the UK. So, I thought I would take this opportunity to look at one of the pioneers of shojo and a highlight of the exhibition, Keiko Takemiya.

  5. tomioka-jiro-01

    Manga Mondays ~ Tomioka Jiro

    Tomioka Jiro is an illustrator from Japan. He has worked on covers for multiple Japanese magazines, including Tokyo Ziggrat, Touch, and Frontier. He has collaborated with several Vocaloid producers, including takamatt, YM, and effe.

  6. hajime-isayama-01

    Manga Mondays ~ Hajime Isayama

    Hajime Isayama is the Japanese manga artist of Shingeki no Kyojin (Attack on Titan). The series has become a phenomenal commercial success. As of July 2015, the manga has 52.5 million copies in circulation. Its popularity was spurred on with the release of the anime adaptation of the same name.


      "I can see that there's something over there and I know it's a chair, because I've sat in it," said Hamilton, giving her companion a pat as he sat by her side. "He's the best pair of eyes in the world."

      "He was the first wheelchair guide trained in the west," Hamilton said.

      "I'm happy for him because he's truly recognized for all he's accomplished."

      "No, the cats do not become jealous of him because of the awards or the honors," laughed Hamilton.

      A third inductee is Hunter, a German short-haired pointer who helped save a woman's life. The Veterinary Medical Association said he was recognized posthumously, as he was recently euthanized because of an advanced medical condition.


WORLD TO END MAY 2011 claims an organisation called eBibleFellowship. From their tract titled Judgment Day we learn that; “On May 21st, Judgment Day will begin and the rapture (the taking up into heaven of God’s elect people) will occur at the end of the 23-year great tribulation. On October 21st the world will be destroyed by fire (7000 years from the flood; 13,023 years from creation).” Link: eBibleFellowship

ED. COM. As we make no apologies for being a Christian creationist site, who firmly believe Jesus is the Creator God of Genesis as well as Saviour and Lord of the Gospels, we do get asked about end times, so here’s our final comment on eBible’s claim. When Jesus’ disciples asked Him about the end of the world He told them what kinds of things would happen before the end comes and what it will be like, but He clearly stated (see Matthew 24: 36) that only the Father in Heaven knows when the end will come. No human beings or angels, i.e. no created beings including the folk at eBible know the day or hour. Therefore WE PREDICT the world will NOT end on either 21st May or 21st October 2011, and we look forward with interest to what eBible will say on 22nd October 2011. Until then check out our other Creation Research predictions in our Predictions File. (Ref. eschatology, time, prophecy)

UNIVERSE IS RUN DOWN AND COMING TO ITS END according to reports in ScienceDaily 27 Jan 2010 and ABC News in Science 8 Oct 2010. Chas Egan and Charles Lineweaver from the Australian National University (ANU) Research School of Astronomy and Astrophysics have calculated the entropy of the universe and decided the universe is 30 times more run down than previously thought. Egan explained: "The universe started out in a low entropy state and, in accordance with the second law of thermodynamics, the entropy has been increasing ever since. This is important because the amount of energy available to life in the universe, including terrestrial life, depends on the entropy of the universe. We'd like to know how much energy will be available to life forms anywhere in the universe, and where this energy is. The first step in this procedure was to determine the entropy of the universe. That is what we did. The next step in the research is to work out how close the universe is to maximum entropy, how much entropy is being produced and how much time is left before the universe and all life in it dies in the inevitable heat death." In the meantime a team of physicists led by Raphael Bousso from the University of California, Berkeley, claim there is "a 50-50 chance of the universe ending in the next 3.7 billion years." However, Lineweaver of ANU is not impressed. He claims they are simply imposing a catastrophe for statistical reasons to fit a cosmology model of multiple universes popping in and out of existence like bubbles in boiling water.
Links: ScienceDaily ABC

ED. COM. The increase in entropy, or running down of the universe is a reminder that as time goes on things in the real world actually go from complex and organised to chaotic and disorganised. Despite the false claims that energy can come to places like earth and therefore increase available energy and therefore order, the real result is still the opposite of evolution. The One who made the universe, the Lord Jesus Christ, tells us the universe is coming to an end, and it will end with a heat death, but not the kind of slow dissipation of energy physicists mean by "heat death". The Apostle Peter tells us the earth will be destroyed by a massive fire, when everything is burnt up and the universe will disappear with a great noise. (2 Peter 3:4-10) Thus, the Big Bang theory has the explosion in the wrong place - the big bang will occur at the end, not the beginning of the universe. Jesus also said that Heaven and Earth will pass away but His word would not. Therefore, rather than trying to calculate when the universe will end, people should be preparing to live in the New Heavens and Earth that will replace the current run down universe by submitting themselves to Christ the Creator and Saviour. (Ref. astronomy, physics, thermodynamics)


Inca Civilization

Machu Picchu

Fascinating culture and Inca heritage of this beautiful country

Lake Titicaca

Animals of Peru

Home » Featured, Lake Titicaca, Travel and Places, Visit Peru

Lake Titicaca

Submitted by |
Lake Titicaca, surrounded by glaciers

Lake Titicaca  Peru  is located in the department of Puno bordering Bolivia in the Andes Mountains, its surface is evenly distributed between Bolivia and Peru. The lake is surrounded by Andean mountain ridges and slopes varying in altitude between 4,000 and 4,200 meters or 13,100 and 13,800 feet above sea level. The lake itself is located on a high plateau ranging from 3,657 to 4,000 meters or 11,200 to 13,100 feet above sea level. Lake Titicaca is known for the deep blue beauty of its water.

At this altitude temperatures average less than 15C or 59F all year round and it remains constant throughout the year. Temperatures do not drop at night or in winter as much as in other places at similar altitudes.

Lake Titicaca is divided into two sub-basins, the larger one is Lago Grande and the smaller is Lago Pequeño. Both lakes are connected by the Strait of Tiquina. The bright luminescent sunlight permeates the highland Altiplano making it feel spiritual and magical. It is necessary to bring sun block as the sunlight is very intense in high altitude and the rays bounding off the lake can cause severe sunburn.  About 25 rivers deposit their water in the lake but only one, the Desaguadero River drains it, 95% or the incoming water lost through evaporation.

To the local population the lake has mystical properties as it is surrounded by fertile land in the otherwise dry and windswept Altiplano. The Inca Civilization considered the lake as a sacred place.

Lake Titicaca History

Deep blue water of Lake Titicaca

According to one of the legends of the origin of the Incas, the first Inca Manco Capac and his wife Mama Ocllo emerged from the depths of Lake Titicaca on the sacred rock on Isla Del Sol to look for a place to build an empire. Lake Titicaca was a sacred lake to the Incas.

Lake Titicaca was the cradle for Peru’s ancient civilizations. The Puraka culture settled in this fertile land around 200BC and a millennium later the Tiwuanaku culture emerged and spread throughout the Altiplano and into Bolivia. Warlike tribes like the Aymaras and the Collas emerged only to be absorbed by the Incas. It was the Inca civilization that unified the many cultures and spread into this land forming the Inca Empire. The current local population is the Uros people who have populated this territory for hundreds of years, they come from the Aymara and the Quechua populations and they speak the ancient language of Aymara.

It is believed that the name Titicaca means “Rock Puma” derived from the Aymara language titi: wild cat and karka: rock. Legend tells that titis used to live on the rocky islands of the lake and that they swam from the islands to the mainland in search of food. Nowadays the titi cat or the Andean cat is the most endangered cat species in the Americas.

Legend of the lost city

Divers from “Atahualpa 2000” expedition by Akakor Geographical Exploring. BBC News

Ever since the Inca civilization inhabited this area, the lake has drawn fascination and according to local population is has mythic, almost sacred powers. Stories of Inca treasures lost by the Spanish and an underwater city have attracted many expeditions. In 1968 French explorer Jacques Cousteau undertook a one and a half month underwater exploration. The expedition did not find the lost city but brought out animal varieties not found anywhere else in the world.

Related Information about Lake Titicaca

Lake Titicaca Facts

Lake Titicaca is the highest navigable lake in the world. It is the largest lake in South America in terms of volume.

Lake Titicaca Islands

Local indigenous people, the Uros, have settled in the shores of the lake for thousands of years but they also live on the islands. They live on about 40 manmade floating islands.

Puno Peru

Puno is located in the Altiplano of Peru, surrounded by the Andean mountain range.

The origin of the Incas

There are two legends explaining the origin of the Incas, the legend of Lake Titicaca and the Ayar Brothers.

Back to Home page

Tags: , , , ,

No Comment »

2 Pingbacks »


Distance Between Elkhart, KS and Lamar, CO

How many miles? 123 Miles / 199 Km

How many times? 2 hours 8 mins

Distance, Gas Consumption and Emission Notes

Distance from Elkhart, KS to Lamar, CO is 123Miles or 199 Km. You can get this distance about 2 hours 8 mins. If you want to planning travel with plane for 85 Miles or 137 Km, You can get this distance about 40 mins .

A car with an average MPG will needs 5.69 gallons of gas to get the route between these points.

The estimated cost of gas to get between Elkhart, KS and Lamar, CO is $12.92.

During the route, an average car will release 111.48 pounds of CO2 to the atmosphere. Your carbon footprint is 0.91 pounds of CO2 per mile.

* Average US MPG used for calculations is 21.6 MPG.
* Coordinates of Elkhart, KS is 37.0080784, -101.8900393 and coordinates of Lamar, CO is 38.0870787, -102.6207387


Camellias – Close planting

Q: I recently purchased several camellias. Each of the camellias seemed to have two trunks. I investigated and was able to separate the tangled roots into two plants. Is it OK to have them planted so close together?

A: This is common nursery practice. In order to make sure that they have at least one strong plant in a pot, the nursery folks will stick two cuttings in it. Sometimes one dies but often both form roots and grow well. I saw a ‘Yuletide’ camellia last week that had three rooted cuttings in it. There’s no harm in having the plants grow close together. There’s also no harm in separating them, carefully, so you have multiple plants.


Call Now For A FREE Consultation

(727) 451-6900

No Recovery No Fee Promise

Can an Auto Accident Cause a Chiari Malformation?

A Chiari malformation also commonly referred to as cerebellar ectopia or Arnold Chiari malformation. is a head injury long thought to be only congenital in nature. However, several recent studies have shown a correlation between a traumatic episode (i.e., auto accident) and symptomatic chiari. In other words, a Chiari malformation can be asymptomatic for an indefinite period of time. In fact, most individuals with a Chiari malformation have no idea.

What is a Chiari Malformation?

A Chiari I malformation is a structural defect in the cerebellum, the part of the brain that controls balance. Normally, the cerebellum and parts of the brain stem sit in an indented space at the lower rear of the skull, above the foramen magnum. When part of the cerebellum is located below the foramen magnum, it is called a Chiari malformation or tonsillar ectopia. Chiari malformations may develop when the bony space is smaller than normal, causing the cerebellum and brain stem to be pushed downward into the foramen magnum and into the upper spinal canal. The resulting pressure on the cerebellum and brain stem may affect functions controlled by these areas and block the flow of cerebrospinal fluid – the clear liquid that surrounds and cushions the brain and spinal cord – to and from the brain.

Chiari Malformation Symptoms

The symptoms most often associated with Chiari I malformations include occipital headache, neck pain, upper extremity numbness, paresthesias (“pins and needles”) and weakness. In some cases there can also be lower extremity weakness and signs of cerebellar dysfunction.

Can a Chiari Malformation be Caused by Trauma

In recent years, increased research about the causes of Chiari I malformations has produced some interesting results. Initially, Chiari malformation was thought to be an exclusively congenital issue that was caused by structural defects in the brain and spinal cord that occur during fetal development. However, recent research has revealed that Chiari malformations can also be related to trauma, especially whiplash.

Several studies have suggested that a previously undetected Chiari I malformation can be symptomatically awakened as a result of trauma caused during a motor vehicle crash. While these studies determined that head or neck trauma is capable of “triggering” symptoms relating to Chiari I malformations, in a 2010 study, Michael D. Freeman and number of other experts set out to determine an even more intriguing question: could motor vehicle crash trauma actually be the sole cause of a Chiari I malformation? The answer is that it’s definitely possible.

Chiari Malformation Following an Auto Accident

Regardless of whether or not crash trauma triggers pre-existing asymptomatic Chiari I malformation or actually causes it, research indicates that symptoms of Chiari I malformations are substantially more prevalent in whiplash-injured patients. The important takeaway from this is that if you suffer head or neck trauma in an accident, especially whiplash, you may develop symptoms resulting from a Chiari I malformation. In a whiplash mechanism accident, the head moves violently forward then backwards. This is known as an acceleration deceleration mechanism injury. During such an episode the cerebellar tonsils can pass through the opening at the bottom of the skull (known as the foramen magnum) and pass into the upper part of the neck. In a seminal study published in the Journal of Brain Surgery written by Professor Michael Freeman and Dr. Ezriel Kornel, a correlation between acceleration/deceleration injuries and symptomatic chiari was found after reviewing 1200 cervical MRI films. 1 The study illustrates that a pre-existing congenital Chiari often becomes symptomatic following a motor vehicle collision. Disruption of the CSF results in symptoms including dizziness and disorientation.

We have been retained on a number of Chiari malformation cases including several referred by other law firms.  Insurance carriers often rely on outdated science depicting such injuries to be congenital and will assert that trauma played no role in the pathology. However, we focus only on the symptoms and the lack thereof of symptomatology related to Chiari pre-dating an accident. In other cases we focus on an exacerbation or aggravation of a pre-exiting injury wherein it can be illustrated that the symptoms were dramatically altered as a result of a traumatic episode.

In any event, Chiari cases are rarely if ever resolved in pre-suit. A claimant is generally left, with only one potential recourse; which is filing a lawsuit. In our experience, Chiari cases are heavily laden with expert testimony and we often retain a Radiologist, Neurosurgeon and Epidemiologist to illustrate the significance of this injury and the likelihood of our client presenting with such symptoms absent a traumatic event. Symptomatic Chiari is a very serious condition that often will not resolve absent surgical intervention, which generally consists of a craniotomy. A craniotomy is an extremely invasive procedure with a number of associated risks. Due to the long term prognosis of individuals with symptomatic Chiari, we must account for the need for potential future surgical intervention.


Photography Tours

China is a great allure for many travelers from its picturesque natural views and special landscapes to cultural treasures. For photographers or shutterbugs, China offers an amazing array of subjects such as Great Wall, Guilin mountains and rivers, wild west of Sichuan, Giant Pandas, ancient towns, mysterious Tibet, ethnic flavor in southwest, etc. Besides these regular and must-see destinations, China photography tours also takes you to the urban crush to shoot a side of China which is rarely seen by most travelers. So take your camera equipment and come with us to capture the beautiful image of natural and ancient China.


Blackberry-Blueberry Tart W/Cornmeal Crust

Total Time
Prep 15 mins
Cook 20 mins

Ingredients Nutrition

  1. Preheat the oven to 350 degrees Farenheit.
  2. To make the crust: In a medium bowl, whisk together the flour, cornmeal, baking powder and salt. Set aside. In a medium bowl, mix the butter and 1/2 cup sugar together until smooth. Incorporate the eggs and extracts and beat until combined. Gradually cream together with the flour mixture and mix until the dough comes together. Separate 1/3 of the dough and set aside.
  3. Butter a 9 inch pan and press the remaining dough into the pan evenly. Roll and cut the separated dough and set aside. Freeze all of the dugh for approx 30 minutes until firm.
  4. Meanwhile, to make the filling: In a medium bowl, mix togetherthe vinegar, cornstarch, and sugar and add in the berries. Stir until the berries are fully coated and set aside until needed.
  5. Assembling/making the Pie: Pour the filling evenly into the chilled pie crust and top with the rolled out dough. Sprinkle lightly with granulated sugar and turn the oven up to 375. Place the pie on the middle rack and bake at 375 for 25 minutes, until the crust is golden. Serve cold and refridgerate for up to a week.


The deal was announced Monday.

Upton batted .237 with 18 homers, 38 doubles, 62 RBIs and 42 steals in 154 games with the AL East champions last season. He is the only player in the major leagues with at least 100 doubles and 100 steals over the past three seasons.

The 27-year-old center fielder lost in arbitration last year, when he was awarded $3 million rather than his request for $3.3 million. He and Carl Crawford then became the first teammates in major league history to have 60-plus extra-base hits and 40-plus steals in the same season.

Crawford left last month for a $142 million, seven-year contract with Boston.


Abilene City Council: Lease with Frontier, Texas! renewed, ACU land rezoned

ABILENE, Texas - The Abilene City Council voted to renew its 10-year lease agreement with Frontier, Texas!

This means the museum will continue to maintain the facility and the city will be responsible for the landscaping.

Frontier, Texas! just celebrated its 10th anniversary.

The tourist attraction has seen 370,000 visitors since it first opened its doors.

Also Thursday, the council voted to rezone land just north of Abilene Christian University, located at the northwest corner of Ambler Ave. and ACU Drive.

The university wants to use this land to build overflow parking lots for its new athletic facilities.

Members of a nearby neighborhood homeowner's association expressed their concerns at Thursday's council meeting.

They said they're worried about not having a buffer zone between their homes and the school.

They said they're also concerned about potential street closures, as it would impede the way they get in and out of their neighborhood.

ACU has requested to abandon ACU Drive north of Ambler Ave and Margaret St., as well as the adjacent alleys.

Mayor Norm Archibald said this proposal would allow ACU to combine areas currently separated by ACU Drive.

That motion passed, but with with some stipulations.

The council proposed a solid, 7-foot fence with no access would be built to separate the neighborhood from the school property.

Recent Headlines

Local Mugshots


Precious time

Precious time While we all have busy lives, we should better appreciate the moments we have with God

It’s Time to ...

What is the purpose of time?

What is the purpose of time?

Does every moment count?

Does every moment count? Whether we are wasting time or using it wisely depends on our individual vocation

Arriving Late To Mass An uncorrectable habit?

Stickball and iceboxes

Stickball and iceboxes Reminiscences of days gone by shows us that time passes, life goes on and winter will come

Free webcast

Most Popular

Former Satanist becomes Catholic leader, teacher
The inconsistencies of ‘Je suis Charlie’
Anglo-Lutheran Catholics?
Catholic population steady, despite Pew report
An argument: Retreat toward engagement