Hip Joint Angles and Moments during Stair Ascent Using Neural Networks and Wearable Sensors

End-stage hip joint osteoarthritis treatment, known as total hip arthroplasty (THA), improves satisfaction, life quality, and activities of daily living (ADL) function. Postoperatively, evaluating how patients move (i.e., their kinematics/kinetics) during ADL often requires visits to clinics or specialized biomechanics laboratories. Prior work in our lab and others have leveraged wearables and machine learning approaches such as artificial neural networks (ANNs) to quantify hip angles/moments during simple ADL such as walking. Although level-ground ambulation is necessary for patient satisfaction and post-THA function, other tasks such as stair ascent may be more critical for improvement. This study utilized wearable sensors/ANNs to quantify sagittal/frontal plane angles and moments of the hip joint during stair ascent from 17 healthy subjects. Shin/thigh-mounted inertial measurement units and force insole data were inputted to an ANN (2 hidden layers, 10 total nodes). These results were compared to gold-standard optical motion capture and force-measuring insoles. The wearable-ANN approach performed well, achieving rRMSE = 17.7% and R² = 0.77 (sagittal angle/moment: rRMSE = 17.7 ± 1.2%/14.1 ± 0.80%, R² = 0.80 ± 0.02/0.77 ± 0.02; frontal angle/moment: rRMSE = 26.4 ± 1.4%/12.7 ± 1.1%, R² = 0.59 ± 0.02/0.93 ± 0.01). While we only evaluated healthy subjects herein, this approach is simple and human-centered and could provide portable technology for quantifying patient hip biomechanics in future investigations.

Developing a method for quantifying hip joint angles and moments during walking using neural networks and wearables

Quantifying hip angles/moments during gait is critical for improving hip pathology diagnostic and treatment methods. Recent work has validated approaches combining wearables with artificial neural networks (ANNs) for cheaper, portable hip joint angle/moment computation. This study developed a Wearable-ANN approach for calculating hip joint angles/moments during walking in the sagittal/frontal planes with data from 17 healthy subjects, leveraging one shin-mounted inertial measurement unit (IMU) and a force-measuring insole for data capture. Compared to the benchmark approach, a two hidden layer ANN (n = 5 nodes per layer) achieved an average rRMSE = 15% and R²=0.85 across outputs, subjects and training rounds.

Effect of head size and rotation on taper corrosion in a hip simulator

AIMS

This study investigates head-neck taper corrosion with varying head size in a novel hip simulator instrumented to measure corrosion related electrical activity under torsional loads.

METHODS

In all, six 28 mm and six 36 mm titanium stem-cobalt chrome head pairs with polyethylene sockets were tested in a novel instrumented hip simulator. Samples were tested using simulated gait data with incremental increasing loads to determine corrosion onset load and electrochemical activity. Half of each head size group were then cycled with simulated gait and the other half with gait compression only. Damage was measured by area and maximum linear wear depth.

RESULTS

Overall, 36 mm heads had lower corrosion onset load (p = 0.009) and change in open circuit potential (OCP) during simulated gait with (p = 0.006) and without joint movement (p = 0.004). Discontinuing gait's joint movement decreased corrosion currents (p = 0.042); however, wear testing showed no significant effect of joint movement on taper damage. In addition, 36 mm heads had greater corrosion area (p = 0.050), but no significant difference was found for maximum linear wear depth (p = 0.155).

CONCLUSION

Larger heads are more susceptible to taper corrosion; however, not due to frictional torque as hypothesized. An alternative hypothesis of taper flexural rigidity differential is proposed. Further studies are necessary to investigate the clinical significance and underlying mechanism of this finding. Cite this article: Bone Jt Open 2021;2(11):1004-1016.

In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study

BACKGROUND

Modular dual-mobility (MDM) total hip arthroplasty (THA) implants have an additional metal-metal interface between the metal liner and outer metal shell that poses a risk of corrosion. The purpose of this study is to evaluate retrieved MDM liners to evaluate qualitative and quantitative damage and corrosion patterns at this interface.

METHODS

Twelve MDM implants of one design with a mean in situ duration of 26 months (range, 1-57 months) were evaluated. Six implants (50%) were from primary THAs and 6 (50%) from revision THAs. The taper region of the liner at risk of damage was qualitatively graded using modified Goldberg criteria while quantitative dimensional assessment was performed with a validated coordinate measurement machine.

RESULTS

Among the retrieved implants, 2 (17%) demonstrated severe grade 4 corrosion, 5 (42%) moderate grade 3 corrosion, 4 (33%) mild grade 2 corrosion, and 1 (8%) grade 1 (no visible corrosion). Mean maximum linear corrosion depth at the taper interface measured 35.5 microns (range, 8.4-176.2 microns). All implants had a maximum linear corrosion depth >7 microns, a threshold suggestive of potentially clinically significant material loss. Three corrosion patterns were identified: generalized corrosion, a stripe of corrosion about the middle of the taper region, and focal areas of corrosion at the portion of the taper closest to the joint surface.

CONCLUSION

Visual and dimensional analysis of all 12 retrieved MDM implants demonstrated identifiable corrosion/wear of the cobalt-chromium metal liner taper of varying severity. These implants should be used judiciously until larger series with clinical correlation can be completed.

Bilateral Femoral Component Fractures After Primary Total Knee Arthroplasty With Cruciate-Retaining Femoral Component

A 69-year-old male presented with atraumatic bilateral femoral component fractures at different time intervals after simultaneous bilateral total knee arthroplasty using the cemented Biomet Ascent Knee System. The right and left knee implant fractures occurred 12 and 17 years after primary arthroplasty, respectively. This patient was notably tall (190.5 cm, 98th percentile) and maintained an active lifestyle before implant fractures. Sequential, bilateral knee implant fractures in a system with a previously acceptable track record suggest that biomechanics, patient characteristics, and surgical factors can significantly influence the risks for fracture of an implant.

Assessing Shoulder Biomechanics of Healthy Elderly Individuals During Activities of Daily Living Using Inertial Measurement Units: High Maximum Elevation Is Achievable but Rarely Used

Current shoulder clinical range of motion (ROM) assessments (e.g., goniometric ROM) may not adequately represent shoulder function beyond controlled clinical settings. Relative inertial measurement unit (IMU) motion quantifies ROM precisely and can be used outside of clinic settings capturing "real-world" shoulder function. A novel IMU-based shoulder elevation quantification method was developed via IMUs affixed to the sternum/humerus, respectively. This system was then compared to in-laboratory motion capture (MOCAP) during prescribed motions (flexion, abduction, scaption, and internal/external rotation). MOCAP/IMU elevation were equivalent during flexion (R2 = 0.96, μError = 1.7 deg), abduction (R2 = 0.96, μError = 2.9 deg), scaption (R2 = 0.98, μError = -0.3 deg), and internal/external rotation (R2 = 0.90, μError = 0.4 deg). When combined across movements, MOCAP/IMU elevation were equal (R2 = 0.98, μError = 1.4 deg). Following validation, the IMU-based system was deployed prospectively capturing continuous shoulder elevation in 10 healthy individuals (4 M, 69 ± 20 years) without shoulder pathology for seven consecutive days (13.5 ± 2.9 h/day). Elevation was calculated continuously daily and outcome metrics included percent spent in discrete ROM (e.g., 0-5 deg and 5-10 deg), repeated maximum elevation (i.e., >10 occurrences), and maximum/average elevation. Average elevation was 40 ± 6 deg. Maximum with >10 occurrences and maximum were on average 145-150 deg and 169 ± 8 deg, respectively. Subjects spent the vast majority of the day (97%) below 90 deg of elevation, with the most time spent in the 25-30 deg range (9.7%). This study demonstrates that individuals have the ability to achieve large ROMs but do not frequently do so. These results are consistent with the previously established lab-based measures. Moreover, they further inform how healthy individuals utilize their shoulders and may provide clinicians a reference for postsurgical ROM.

Higher offset cross-linked polyethylene acetabular liners: is wear a significant clinical concern?

INTRODUCTION

Total hip arthroplasty (THA) is the 2nd most common total joint replacement surgery in the United States. However, not all THA devices perform well and need revised for several reasons including dislocation. Higher offset acetabular liners reduce this problem by creating a more anatomically/biomechanically natural hip joint, increasing soft-tissue tension, and accommodating larger femoral heads in smaller acetabular cups via increased polyethylene thickness. To our knowledge, however, in vivo wear (another failure mode) performance of offset acetabular liners remains unknown.

METHODS

2 cohorts of 40 individuals (0-mm, 4-mm offset acetabular liners, respectively) from a single surgeon's consecutive caseload were assessed. 6-week/5-year post-op radiographs were compared using a validated method using SolidWorks software to assess in vivo linear and volumetric wear rates. Resultant surgical offset was also quantified using this method.

RESULTS

Linear wear rate for 0-mm and 4-mm offset cohorts were 0.01 ± 0.09 mm/year and 0.08 ± 0.12 mm/year, respectively. Volumetric wear rate for 0-mm and 4-mm offset cohorts were 30.4 ± 20.4 mm³/year and 61.6 ± 42.1 mm³/year, respectively. Both of these were statistically significant. Neither linear nor volumetric wear rate was correlated with resultant surgical offset.

DISCUSSION

To our knowledge, this is the 1st study to compare in vivo wear performance of 0-mm and 4-mm offset acetabular liners. Although linear and volumetric wear rates were different between cohorts, neither reached previously established osteolysis thresholds. Moreover, wear rates were not correlated with resultant surgical offset. Finally, no patients in either cohort showed signs of osteolysis nor needed revision. As such, the clinical relevance of the wear rate differences is potentially less significant.

Continuously monitoring shoulder motion after total shoulder arthroplasty: maximum elevation and time spent above 90° of elevation are critical metrics to monitor

BACKGROUND

Traditional clinical shoulder range-of-motion (ROM) measurement methods (ie, goniometry) have limitations assessing ROM in total shoulder arthroplasty (TSA) patients. Inertial measurement units (IMUs) are superior; however, further work is needed using IMUs to longitudinally assess shoulder ROM before TSA and throughout post-TSA rehabilitation. Accordingly, the study aims were to prospectively capture shoulder elevation in TSA patients and to compare the results with healthy controls. We hypothesized that patients would have reduced maximum elevation before TSA compared with controls but would have improved ROM after TSA.

METHODS

A validated IMU-based shoulder elevation quantification method was used to continuously monitor 10 healthy individuals (4 men and 6 women; mean age, 69 ± 20 years) without shoulder pathology and 10 TSA patients (6 men and 4 women; mean age, 70 ± 8 years). Controls wore IMUs for 1 week. Patients wore IMUs for 1 week before TSA, for 6 weeks at 3 months after TSA, and for 1 week at 1 year after TSA. Shoulder elevation was calculated continuously, broken into 5° angle "bins" (0°-5°, 5°-10°, and so on), and converted to percentages. The main outcome measures were binned movement percentage, maximum elevation, and average elevation. Patient-reported outcome measures and goniometric ROM were also captured.

RESULTS

No demographic differences were noted between the cohorts. Average elevation was not different between the cohorts at any time. Control maximum elevation was greater than pre-TSA and post-TSA week 1 and week 2 values. Time under 30° and time above 90° were equal between the cohorts before TSA. After TSA, patients showed decreased time under 30° and increased time above 90°.

DISCUSSION

This study demonstrates that acute and chronic recovery after TSA can be assessed via maximum elevation and time above 90°, respectively. These results inform how healthy individuals and patients use their shoulders before and after TSA.

Stance and swing phase knee flexion recover at different rates following total knee arthroplasty: An inertial measurement unit study

Total knee arthroplasty (TKA) is the most common joint replacement in the United States. Range of motion (ROM) monitoring includes idealized clinic measures (e.g. goniometry during passive ROM) that may not accurately represent knee function. Accordingly, a novel, portable, inertial measurement unit (IMU) based ROM measurement method was developed, validated, and implemented. Knee flexion was computed via relative motion between two IMUs and validated via optical motion capture (p > 0.05). Prospective analyses of 10 healthy individuals (5M, 50 ± 19 years) and 20 patients undergoing TKA (3 lost to follow up, 10M, 65 ± 6 years) were completed. Controls wore IMUs for 1-week. Patients wore IMUs for 1-week pre-TKA, 6-weeks immediately post-TKA, and 1-week at 1-year post-TKA. Flexion was computed continuously each day (8-12 h). Metrics included daily maximum flexion and flexion during stance/swing phases of gait. Maximum flexion was equal between cohorts at all time points. Contrastingly, patient stance and swing flexion were reduced pre-TKA, yet improved post-TKA. Specifically, patient stance and swing flexion were reduced below control/pre-TKA values during post-TKA week 1. Stance flexion exceeded pre-TKA and equaled control levels after week 2. However, swing flexion only exceeded pre-TKA and equaled control levels at 1-year post-TKA. This novel method improves upon the accuracy/portability of current methods (e.g. goniometry). Interestingly, surgery did not impact maximum ROM, yet improved the ability to flex during gait allowing more efficient and safe ambulation. This is the first study continuously monitoring long-term flexion before/after TKA. The results offer richer information than clinical measures about expected TKA rehabilitation.

Differences in hip-knee joint coupling during gait after anterior cruciate ligament reconstruction

BACKGROUND

After anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging.

METHODS

Thirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal-knee frontal planes, hip frontal-knee sagittal, hip frontal-knee transverse, hip sagittal-knee frontal, hip sagittal-knee transverse, and hip transverse-knee frontal planes.

FINDINGS

The hip sagittal-knee frontal and hip sagittal-knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal-knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal-knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking.

INTERPRETATION

The increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls.

Evaluation of a new effect-site controlled, patient-maintained sedation system in dental patients

We have designed a new effect-site controlled, patient-maintained sedation system for delivering propofol. In the previous systems we developed, the patients retained the use of the handset throughout the procedure and were able to increase the level of sedation. However, it was found that this could potentially lead to oversedation. In the present system, the patients were able to increase their level of sedation until a level was reached that was judged by the patients as being adequate to allow them to tolerate the injection of dental local anaesthetic. The handset was then taken from the patients and the effect site concentration of propofol was maintained at that level for the remainder of the procedure. To assess its safety and efficacy, the system was used to sedate 40 patients presenting for dental procedures under sedation. The system was used successfully and treatment was completed in 39 patients. The system was found to be safe. Both surgeon and patient approval scores were high. Although this study demonstrates the efficacy of effect-site controlled, patient-maintained propofol sedation in this group of patients, further work is required to confirm its safety.

Dysregulation of cyclin dependent kinase 6 expression in splenic marginal zone lymphoma through chromosome 7q translocations

The increased or inappropriate expression of genes with oncogenic properties through specific chromosome translocations is an important event in the pathogenesis of B-cell lymphoproliferative diseases. Recent studies have found deletions or translocations of chromosome 7q to be the most common cytogenetic abnormality observed in SLVL, a leukemic variant of SMZL, with the q21-q22 region being most frequently affected. In three patients with translocations between chromosomes 2 and 7, the cloning of the breakpoints at 7q21 revealed that each was located within a small region of DNA 3.6 kb upstream of the transcription start site of cyclin dependent kinase 6 (CDK6). In each case the translocation event was consistent with aberrant VJ recombination between the immunoglobulin light chain region (Ig kappa) on chromosome 2p12 and DNA sequences at 7q21, resembling the heptamer recombination site. The t(7;21) breakpoint in an additional patient with splenic marginal zone lymphoma (SMZL), resided 66 kb telomeric to the t(2;7) breakpoints juxtaposing CDK6 to an uncharacterized transcript. In two of the SLVL patient samples, the CDK6 protein was found to be markedly over expressed. These results suggest that dysregulation of CDK6 gene expression contributes to the pathogenesis of SLVL and SMZL.

Detailed molecular delineation of 13q14.3 loss in B-cell chronic lymphocytic leukemia

A region of chromosome 13q14.3, telomeric to the Retinoblastoma gene RB-1 is frequently deleted in patients with B-cell chronic lymphocytic leukemia (B-CLL). A cosmid and P1-derived artificial chromosome (PAC) contig spanning over 600 kb has been constructed, which encompasses this locus. The contig clones have been used to order a number of markers along the minimally deleted region and to localize a series of CpG islands corresponding to possible candidate genes. A novel polymorphic dinucleotide repeat, 6E3.2, present in one of the ordered cosmid clones has been isolated for use in deletion mapping studies of patient DNA. Leukemic samples from 229 CLL patients have been screened for loss of heterozygosity using microsatellite markers and analyzed for hemizygous and homozygous deletions by Southern blot techniques using genomic probes selected from cosmids across the region. Hemizygous deletions were found in 31% of cases with an additional 10% showing homozygous loss. The use of these probes has defined the commonly deleted area to less than 130 kb, centromeric to the locus D13S272.

Absolute pitch and sex effect event-related potential activity for a melodic interval discrimination task

Absolute pitch is a special ability which allows for special perceptual/cognitive strategies. Studies have shown differences in event-related scalp potentials between absolute-pitch (AP) and relative-pitch (RP) subjects of equal musical training. In this study, highly trained musicians (15 females/15 males) performed a melodic interval discrimination task, using intervals on-pitch in equal-tempered tuning (A4 = 440 Hz) and tuned a half-semitone sharp. Subjects identified target intervals (probability 0.2) in a series of 400 randomly transposed intervals. AP subjects were expected to perform differently across intonation conditions, whereas RP subjects were not. Event-related potentials (ERPs) were recorded from three midline sites and two lateral sites. ERPs were analyzed by principal component analysis of variance. Sex was also considered as an independent subject variable. Performance was not significantly different either by absolute pitch or sex. Reaction times did not reveal any significant interactions involving AP or sex, but showed a significant effect by response type (target/nontarget). Strong P3 activity appeared to the target melodic intervals regardless of subject group or intonation. PCA factors with maxima at 352, 511, and 709 ms were sensitive to task relevance. Males showed greater positivity than females along the midline. A significant intonation by response type by sex interaction indicated a greater spread of values for females than males, and greater similarity in response by sex for the sharp than the on-pitch intervals. AP subjects showed reduced P3 activity along the midline, but increased over lateral sites. In a difficult musical task, the ERPs were sensitive to the sex of the listeners, as well as to whether they had absolute pitch.

PCR analysis of polymorphisms at the D13S25 locus

Evidence that the D13S25 locus lies close to a potential tumour suppressor gene implicated in the pathogenesis of B-CLL has been based on detection of LOH and bi-allelic loss using the pH2-42 probe. The SspI polymorphism detected by this probe has been identified by sequencing adjacent clones and a polymorphic (TA)n repeat has been found. Amplification of the region encompassing both polymorphic markers by PCR increases the informativity to 80%.

Sex differences in memory for timbre: an event-related potential study

Although female/male cognitive differences have been studied for some time, little is known about such differences relative to music. Highly-trained musicians (15 females and 15 males) performed a memory task for musical timbre modeled after the missing-displaced visual object test known to favor female performance. Subjects were tested on memory for a timbre missing from a previously presented set of synthesized instrumental timbres, and a control series of white noise bursts at two different intensity levels. Subjects were given the missing-displaced visual object test and ERPs were recorded from three midline sites and two lateral sites. Waveforms were subjected to a principal component analysis and analysis of variance. Females and males performed equally well on both of the auditory series and the visual object test. Both auditory series elicited several ERP components: a strong early peak to the white noise, and both early (P3a) and late (P3b) peaks to the timbre series. PCA factor, maximum at 675 ms (P3b), showed a main effect for sex across both series with males > females. PCA factor, maximum at 336 ms (P3a), showed larger Fz to Pz differential for females than males for both auditory series. Females show a greater differentiation between targets and nontargets in the white noise series, suggesting greater sensitivity to changes in intensity. Interactions involving absolute pitch also appeared in the sensory processing time frames. Although the behavioral measures did not show significant sex differences, the ERP measures did show reliable task-related sex differences.

EP component identification and measurement by principal components analysis

Between the acquisition of Evoked Potential (EP) data and their interpretation lies a major problem: What to measure? An approach to this kind of problem is outlined here in terms of Principal Components Analysis (PCA). An important second theme is that experimental manipulation is important to functional interpretation. It would be desirable to have a system of EP measurement with the following characteristics: (1) represent the data in a concise, parsimonous way; (2) determine EP components from the data without assuming in advance any particular waveforms for the components; (3) extract components which are independent of each other; (4) measure the amounts (contributions) of various components in observed EPs; (5) use measures that have greater reliability than measures at any single time point or peak; and (6) identify and measure components that overlap in time. PCA has these desirable characteristics. Simulations are illustrated. PCA's beauty also has some warts that are discussed. In addition to discussing the usual two-mode model of PCA, an extension of PCA to a three-mode model is described that provides separate parameters for (1) waveforms over time, (2) coefficients for spatial distribution, and (3) scores telling the amount of each component in each EP. PCA is compared with more traditional approaches. Some biophysical considerations are briefly discussed. Choices to be made in applying PCA are considered. Other issues include misallocation of variance, overlapping components, validation, and latency changes.

Frequent homozygous deletions of the D13S25 locus in chromosome region 13q14 defines the location of a gene critical in leukaemogenesis in chronic B-cell lymphocytic leukaemia

Cytogenetic studies of B-cell chronic lymphocytic leukaemia show structural abnormalities involving the 13q14 chromosome region as the only karyotypic change in a significant proportion of tumours. This observation suggests the location of a gene important in leukaemogenesis. A series of 68 BCLL tumours have been analysed for allele loss using a series of probes from 13q14. Using intragenic polymorphic markers from the retinoblastoma predisposition gene LOH was observed in 25% of tumours including 3/6 showing cytogenetically obvious deletions of the 13q14 region and 3/6 showing translocations involving 13q14. However, three deletions with proximal breakpoints in 13q14 did not show allele loss, demonstrating that the breakpoint lay distal to RB1. Using the D13S25 locus, which lies 1.6 cM distal to RB1, allele loss was seen in 90% of tumours with structural rearrangements of 13q14 and 75% of tumours with an apparently normal karyotype. 50% of these tumours showed homozygous loss of D13S25, suggesting that a 'tumour suppressor gene' lies in this region. The more distal D13S31 locus, 1 cM distal to D13S25, was infrequently involved in allele loss demonstrating that the minimum region of overlap for homozygous deletions is approximately 1 Mbp around the D13S25 locus.

Methylation analysis by means of PCR SSCP: application to clonality studies

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Word meaningfulness and event-related potentials during phrase processing

Evoked Potentials (EP) were recorded to visual presentation of words in phrases. Three EP components, P250, N400, P560, and their dependence on the role that each word plays in the phrase were studied. Subjects were requested to perform a congruity/incongruity task after the presentation of short phrases of two-types that differed in the position of meaningful keywords. We show how these keywords contribute substantially to N400 and possibly to P560 but do not reliably affect P250.

Neuromagnetic topography of photoconvulsive response in man

The neuromagnetic method was applied to the study of photoconvulsive responses. The identification of specific magnetic field distributions over the scalp was achieved by; (a) a stimulation paradigm consisting of series of trains of flicker stimuli randomly presented to the epileptic patient, after eye closure, to get epileptic responses while avoiding seizures; (b) a novel procedure for data analysis, to select consistent responses. These patterns, when sufficiently stable in time and dipolar in shape, were used for source localization in the usual biomagnetic framework of the equivalent current dipole source representation. The results of this approach suggest that different specific cortical areas are repeatedly and randomly activated, involving mainly the frontal, occipital and temporal areas, often with a hemispheric prevalence.

A simple method for 3-dimensional localization of epileptic activity recorded by simultaneous EEG and MEG

A simple method is presented to average target patterns in the magnetoencephalographic trace of epileptic activity by finding markers in an EEG channel. This method proves to be useful even in cases of low magnetic signal-to-noise ratio. After simultaneously recording electric and magnetic activity the user chooses in the electric trace a template of interest and determines within the same trace all the time points at which the EEG pattern is highly correlated with the chosen template. The magnetic trace portions recorded at those times are averaged together, extracting in this way the magnetic signal from the noise. The MEG results are applied to localize in the brain the active sources that contribute to the recorded signals.

Selective localization of alpha brain activity with neuromagnetic measurements

A method of localizing brain activity by a new combination of magnetic and electrical recording, relative covariance, is described. The successful application of this method to alpha EEG is reported. Spontaneous human brain activity was recorded simultaneously with fixed scalp electrodes and a movable magnetometer. The analysis was restricted to the alpha rhythm, which was selected by a narrow bandpass filter centered at the observed alpha frequency. For each magnetometer location, the ratio of the covariance of the magnetic and electric signals to the electric variance was calculated, producing a map reflecting the magnetic field pattern. Clear maxima of opposite polarity over the left and right parietotemporal areas indicate bilateral current source areas near the midline, in the vicinity of the calcarine fissure, at a depth of 4-6 cm from the scalp. This relative covariance method may prove generally useful in localizing bioelectrical sources such as spontaneous brain rhythms.

Testicular dysfunction in untreated Hodgkin's disease

Gonadal function was examined in 19 young men with Hodgkin's disease before therapy and compared with that of 11 men with other malignancies, 13 men with primary testicular failure, and 19 normal men of similar age. Total (p less than 0.01) and free (p less than 0.05) testosterone levels were decreased in Hodgkin's disease. In those with advanced (stage III + IV) and symptomatic (B), Hodgkin's disease serum testosterone levels were indistinguishable from those in primary testicular failure, yet serum levels of luteinizing hormone were normal. Moreover, the acute response of serum testosterone to exogenous human chorionic gonadotropin (HCG) was significantly greater in Hodgkin's disease than in primary testicular failure (p less than 0.03). These data and the finding that basal serum follicle-stimulating hormone levels are significantly lower than normal in Hodgkin's disease (p less than 0.05) suggest that the cause of pretreatment hypogonadism in Hodgkin's disease is not simple primary testicular failure. Total sperm count was decreased in 40 percent of men with Hodgkin's disease but in none of the men with other malignancies (p less than 0.05), suggesting specific seminiferous tubular dysfunction in Hodgkin's disease. However, motility was abnormal in 69 percent of men with Hodgkin's disease and 60 percent of those with other malignancies, suggesting that this is a nonspecific effect of cancer. Serum prolactin levels were significantly higher than normal in Hodgkin's disease (p less than 0.05) but not in other malignancies. Our findings suggests that the cause of testicular dysfunction that is present before treatment of Hodgkin's disease is complex, perhaps involving both pituitary and gonadal abnormalities.

Effect of cytotoxic therapy on sexuality and gonadal function

Many chemotherapeutic agents have been shown to cause variable degrees of gonadal dysfunction in both sexes and in all age groups. The severity of the dysfunction depends on the total drug dose and the age at time of therapy. In general, cytotoxic agents produce gonadal dysfunction in men while they produce premature gonadal failure in women. Men develop azoospermia and compensated Leydig-cell function; women sustain ovarian damage causing impaired fertility in the short term and early ovarian failure later. This dysfunction is associated with sexual and emotional difficulties in many patients. In order to discover these problems the physician must sympathetically ask patients and families about their sexual and emotional health. Endocrine and psychologic evaluation help the physician identify the problem. Appropriate counseling and hormone replacement therapy may ameliorate most symptoms and help the patient emotionally adjust to illness and infertility. Prevention of gonadal damage during cytotoxic therapy may be possible in the future. For those young people who retain fertility after cytotoxic therapy, prognosis should be taken into account when counseling about parenthood is given. There is no evidence of genetic abnormalities in the offspring of people previously treated with chemotherapy or irradiation.

Protection of ovarian function by oral contraceptives in women receiving chemotherapy for Hodgkin's disease

It has been reported by us and by others that after chemotherapy for Hodgkin's disease the ovary contains fewer than 5 primordial and primary follicles per 5 x 5 mm biopsy section. In young women this is associated with premature menopause. We report here that before treatment the tissue contains 18--55 such follicles per biopsy section. When women took combination oral contraceptives throughout the course of MVPP therapy, the posttreatment ovarian biopsy tissue had more than 20 follicles per histologic section. Normal menses were established in the five women who discontinued oral contraceptives at the end of MVPP therapy, and one of them is now pregnant.

Male gonadal dysfunction in Hodgkin's disease. A prospective study

Forty-seven men (median age, 31.5 years) were studied prospectively to assess the effect of Hodgkin's disease and subsequent chemotherapy on gonadal function. Before therapy, 16 (43%) of 37 men were functionally subfertile, as assessed by impotence (four of 37) and "inadequate" sperm counts (12 of 37). Histological abnormalities were noted in eight of nine pretreatment testicular biopsy specimens. Additionally, changes were noted in blood hormone levels and libido. After completion of only two cycles of chemotherapy, 14 of 14 men became persistently azoospermic, with blood follicle-stimulating hormone levels four to five times normal. Posttreatment testicular biopsy specimens confirmed germ cell aplasia. During therapy 17 (81%) of 21 men had mild or no libido; irritability in 16 (84%) of 19 and violence in four (18%) of 22 caused additional family distress. While it is clear that cytotoxic therapy induces infertility, these data further indicate that a proportion of men have gonadal dysfunction prior to treatment.

Principal components analysis of sources of variability in retinal ganglion cell responses

An approach to the functional organization of retinal ganglion cell processing in terms of correlation matrices (Levine and Shefner, 1975; 1977a, b; Shefner and Levine, 1979) is extended by applying Principal Components Analysis. This analysis reduces each correlation matrix to a few components which are implicit in the data. The component loadings describe properties of the system in terms of loadings (correlations) of time bins on the underlying components. Each component is identified by the experimental conditions associated with the highest loadings. Mixed conditions are quantitatively interpreted as weighted contributions from the various identified components. This has led to new interpretations of existing data. Several properties of ganglion cell inputs are analyzed in this manner, including ON and OFF processes, center and surround mechanisms, rod and cone inputs, and spatially distinct areas within the receptive field center. Although the details vary, generally one of the components is highly associated with ON processes and the other with OFF and/or MAINTAINED processes. several advantages may be realized through the use of Principal Components Analysis: (1) all of the data contribute to the analysis, (2) the number and relative importance of contributing processes may be assessed, (3) the relative contribution of underlying processes to mixed responses may be assessed, and (4) the most parsimonious representation of the data is obtained.

Cytotoxic-induced ovarian failure in women with Hodgkin's disease. I. Hormone function

Forty-one women with advanced Hodgkin's disease were studied to determine the effect of combination chemotherapy on fertility and ovarian function. Histories and pretreatment ovarian biopsy specimens indicated normal fertility before therapy, thus implying no adverse effect of Hodgkin's diseases on female gonadal function. Ovarian activity was assessed after therapy by menstrual history, serial basal body temperatures, and hormonal levels. Each case was assigned to one of three categories: primary ovarian failure (failed ovary), irregular ovarian activity (failing ovary), and normal cyclic ovarian activity (functioning ovary). After therapy, 20 of 41 patients (49%) were categorized as failed, 14 (34%) as failing, and only 7 (17%) as functioning. In 16 months of further observation, progressive loss of ovarian function occurred that was clearly age related but not statistically dose related. Induction of premature, irreversible menopause presents a need for effective hormonal replacement and patient counseling.

Cytotoxic-induced ovarian failure in Hodgkin's disease. II. Effects on sexual function

Chemotheraphy for Hodgkin's disease produces ovarian failure in young women. The consequences of this are emotional distress, sexual dysfunction, and the disruption of families and friendships. These previously unappreciated side effects of cytotoxic therapy had developed in 25 of 41 patients, among whom we conducted a retrospective study.

Cyclical combination chemotherapy and gonadal function. Retrospective study in males

The effect of cyclical chemotherapy on fertility and gonadal function was investigated in seventy-four male patients who had been treated for advanced Hodgkin's disease. All patients were azoospermic after therapy, and, with a median follow-up period of 27 months (range 1--62 months), only four patients have regained spermatogenesis. Testicular biopsy showed an absence of germinal epithelium without other gross architectural changes. Despite this high degree of infertility, 60% of patients were practising contraception. A decline in libido and sexual performance with frequent long periods of sexual inactivity was noted by most men during therapy. Although some recovery was apparent once therapy was stopped, this was incomplete in approximately half of the patients. Follicle-stimulating-hormone levels were consistently raised after therapy at all periods of study. Median luteinising-hormone levels were at, or just above, the upper limit of normal, and median testosterone levels were normal. Increased prolactin levels were noted in 42% of patients, of whom about a half had an identifiable cause for hyperprolactinaemia. Return of spermatogenesis could not be predicted by serial hormone assessment. Because of the guaranteed infertility and the low frequency and unpredictability of recovery of spermatogenesis, sperm storage should be available for male patients undergoing cytotoxic therapy, since most of these patients may enjoy prolonged survival. Hormone-replacement therapy will usually be unnecessary. However, the probability of major changes in libido and sexual performance should be discussed with patients so that additional stress can be avoided. Contraceptive advice should be available to those who require it.

Short-term memory: the "storage" component of human brain responses predicts recall

An evoked potential component with a poststimulus peak at about 250 milliseconds is related to the storage of information in short-term memory. This storage component was found in an investigation of brain potentials in relation to a number and letter comparison task. In replications of this experiment at three different light intensities spaced 1.0 log unit apart, the component had essentially the same waveform and pattern of scores. The memory storage interpretation was confirmed in a behavioral experiment that probed short-term memory. Recall was predicted by the magnitude of the storage component.

Immune neutropenia

A patient with hyperthyroidism and severe neutropenia had a clinical course and family history that suggested an immune cause. Neutrophil-binding IgG was demonstrated in serum using the Fab-anti Fab assay. The antineutrophil factor bound specifically to either homologous or autologous neutrophils and could be adsorbed by the target neutrophils. The quantity of IgG required to saturate the neutrophil-binding sites (175 000 molecules per neutrophil) and the serum concentration (1.3 mug/ml) were determined. It was estimated that at the time that blood and marrow neutrophils were markedly reduced, serum contained sufficient neutrophil-binding IgG to saturate the binding sites of 1.2 times the total blood neutrophil pool.

Alpha and kappa electroencephalogram activity in eyeless subjects

Several reports have cast doubt on the cerebral origin of alpha and kappa electroencephalogram activity by charging that they are artifacts related to eye activity. Data are cited which eliminate the corneoretinal potential of the eyeball, tremor of the extraocular muscles, eye position, accommodation, and eye flutter as sources of alpha and kappa electroencephalogram activity. A subject with both eyes removed showed normal alpha and kappa electroencephalogram activity. Marked left-right differences in alpha activity were not found in one-eyed subjects whose eyes and extraocular muscles were completely removed on one side.