Clinical utility of markerless motion capture for kinematic evaluation of sit-to-stand during 30 s-CST at one year post total knee arthroplasty: a retrospective study

BACKGROUND

Although the importance of kinematic evaluation of the sit-to-stand (STS) test of total knee arthroplasty (TKA) patients is clear, there have been no reports analyzing STS during the 30-s chair sit-up test (30 s-CST) with a focus on kinematic characteristics. This study aimed to demonstrate the clinical utility of kinematic analysis of STS during the 30 s-CST by classifying STS into subgroups based on kinematic parameters, and to determine whether differences in movement strategies are expressed as differences in clinical outcomes.

METHODS

The subjects were all patients who underwent unilateral TKA due to osteoarthritis of the knee and were followed up for one year postoperatively. Forty-eight kinematic parameters were calculated using markerless motion capture by cutting STS in the 30 s-CST. The principal components of the kinematic parameters were extracted and grouped by kinematic characteristics based on the principal component scores. Clinical significance was examined by testing whether differences in patient-reported outcome measures (PROMs) were observed.

RESULTS

Five principal components were extracted from the 48 kinematic parameters of STS and classified into three subgroups (SGs) according to their kinematic characteristics. It was suggested that SG2, using a kinematic strategy similar to the momentum transfer strategy shown in previous studies, performed better in PROMs and, in particular, may be associated with achieving a "forgotten joint", which is considered the ultimate goal after TKA.

CONCLUSIONS

Clinical outcomes differed according to kinematic strategies used STS, suggesting that kinematic analysis of STS in 30 s-CST may be useful in clinical practice.

TRIAL REGISTRATION

This study was approved by the Medical Ethical Committee of the Tokyo Women's Medical University (approval number: 5628 on May 21, 2021).

Tetranuclear mixed-metal M(II)2Cu(II)2 complexes derived from a phenol-based macrocyclic ligand having two N(amine)2O2 and two N(imine)2O2 metal-binding sites

The reaction of N,N'-dimethyl-N,N'-ethylenebis(5-bromo-3-formyl-2-hydroxybenzylaminato)copper(II) with ethylenediamine in aqueous DMF with excess perchloric acid resulted in the [2:2] cyclic condensation of the constituents, providing the dinuclear Cu(II) complex [Cu2(H2R)](ClO4)2. It crystallizes in the monoclinic space group P2(1)/c, with a = 19.603(3) A, b = 13.370(2) A, c = 21.072(3) A, beta = 98.87(1) degrees, V = 5456(1) A3, and Z = 4. The ligand R4- has two N(amine)2O2 and two N(imine)2O2 metal-binding sites sharing two phenolic oxygens, and [Cu2(H2R)](ClO4)2 has the two Cu(II) ions in the N(imine)2O2 sites and two protons in the N(amine)2O2 sites. [Cu2(H2R)](ClO4)2 was converted by neutralization into [Cu2(R)], from which mixed-metal Cu(II)2M(II)2 complexes [Cu2M2(R)Cl4] (M = Co(II), Ni(II), Zn(II)) were derived. [Cu2Co2(R)Cl4]*2CHCl3*H2O crystallizes in the monoclinic space group C2/c, with a = 32.514(3) A, b = 12.246(3) A, c = 19.827(2) A, beta = 126.082(1) degrees, V = 6380(1) A3, and Z = 4. [Cu2Zn2(R)Cl4]*2CHCl3*H2O crystallizes in the monoclinic space group C2/c, with a = 32.53(1) A, b = 12.242(2) A, c = 19.729(9) A, beta = 126.03(3) degrees, V = 6354(4) A3, and Z = 4. The two complexes are isotructural and have a dimer-of-dimers structure with two separated Cu(II)M(II) units. In each dinuclear unit, the Cu(II) is bound to the N(imine)2O2 site and the M(II) is bonded to a phenolic oxygen and two nitrogens of the N(amine)2O2 site. The Cu(II) and M(II) ions are bridged by a phenolic oxygen and an exogenous chloride ion. The Cu(II)2Ni(II)2 complex has a defect double-cubane structure. Cryomagnetic studies for the Cu(II)2Co(II)2 complex indicate an antiferromagnetic spin-exchange interaction within each dinuclear Cu(II)Co(II) unit (J = -9.5 cm(-1) based on H = -2JS(Cu)S(Co)). The Cu(II)2Ni(II)2 complex shows a weak antiferromagnetic interaction between the adjacent Cu(II) and Ni(II) ions (-3.5 cm(-1)) and a weak ferromagnetic interaction between the two Ni(II) ions (+2.0 cm(-1)).

[Intraarterial chemotherapy for uterine cervical adenocarcinoma: evaluation of its efficacy as neoadjuvant therapy]

We performed preoperative intraarterial chemotherapy in twenty cases of uterine cervical adenocarcinoma (stage Ib: 2, II: 15, III: 3) and evaluated the efficacy of this therapy. The dosages used were 75-120 mg of CDDP, 10-20 mg of MMC and 30-60 mg of EPIR. These drugs were administered by intraarterial one-shot infusion twice every three weeks. In five cases, complete response (CR) of the primary lesion was confirmed by histologic examination. There were no cases of CR inpatients with well differentiated adenocarcinoma. Stage reduction was achieved in all cases except three. In all but one case, more than 50% volume reduction was recognized on MR images. These results were not significantly different from those in cases of uterine cervical squamous cell carcinoma in which we performed this therapy. Therefore, we concluded that intraarterial chemotherapy is highly effective and should be carried out as neoadjuvant therapy for advanced uterine cervical adenocarcinoma.

Intraductal mucin-producing tumor of the pancreas: diagnosis by MR cholangiopancreatography

PURPOSE

Our goal was to evaluate the usefulness of MR cholangiopancreatography (MRCP) for intraductal mucin-producing tumor of the pancreas (MPT).

METHOD

Eleven patients with intraductal MPTs (six main duct type; five branch duct type) underwent MRCP. The findings of MRCP were compared with those of endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS

In all of the cases, MRCP could disclose all dilated pancreatic ducts and cysts, some of which were not demonstrated by ERCP. MRCP did not show a signal void of mucin in any of the cases. In the two cases of the main duct type, ERCP showed filling defects of excrescent nodules, which were not seen by MRCP. In the two cases of the main duct type, nodules were seen more clearly by ERCP than by MRCP.

CONCLUSION

MRCP and ERCP are complementary imaging modalities for intraductal MPT.

[MR cholangiopancreatography (MRCP) for the mucin producing pancreatic tumor (MPT)]

MRCP was performed for 17 patients with MPT (main duct type; 7 and branch duct type; 10) using HASTE and single shot RARE with a body phased array coil on a 1.5 T unit. The findings of MRCP were compared with those of endoscopic retrograde cholangiopancreatography (ERCP). In all cases, MRCP completely disclosed all dilated ducts and cysts, some of which were not seen by ERCP due to mucinous accumulation. In five of seven patients with main duct type, an excrescent nodle was more clearly visualized by ERCP than by MRCP. Mucinous accumulation was not confirmed by MRCP in all cases except one case, in which the dilated branch duct was revealed as lower intensity compared with the main duct using single shot RARE. Therefore MRCP and ERCP are complementary methods in diagnosis for the mucin producing pancreatic tumor.

[Postgadolinium MR angiography of normal intradural veins of the thoracolumbar spine]

To evaluate the normal intradural spinal veins, we used postgadolinium three-dimensional time-of-flight MR angiography (MRA) at 1.5T in 7 subjects. MR images and MR angiograms[32/6/1 (TR/TE/NEX)] were obtained after a bolus injection of Gd-DTPA (0.15-0.2 mmol/kg). We reconstructed images using an equipped function, so-called multiplanar reconstruction. The anterior median veins in 2 patients and the posterior median veins were shown in 2. The great medullary veins were demonstrated in 2. We successed in obtaining venous angiograms by postgadolinium MRA. Disseminated tumors and abnormal enhanced cauda equina are often indistinguishable from normal intradural veins. This study suggests that it is useful to know the MR angiographic features of normal intradural veins in order to evaluate enhanced intradural components.

[CT findings of primary pulmonary cryptococcosis]

Ten cases of primary pulmonary cryptococcosis are presented. The patients' ages ranged from 19 to 71 years and all were males. All patients underwent chest X-ray, tomography and CT (two cases were in additional to HRCT). The most common radiographic findings were single masses (70%) which had to be differentiated from lung cancer or pulmonary tuberculosis. The second pattern of involvement was that of multiple nodules (20%) which may be mistaken for tuberculosis. The third was an infiltrative pneumonitis shadow (10%). By means of CT (HRCT), we revealed that most cryptococcosis lesions exist in the posterior segments (S2, S1, S6 and S1+2) and show cavity formation (30%). Therefore, CT, especially HRCT, may be useful for the differentiation of pulmonary cryptococcosis from neoplasm.

Potential usefulness of an artificial neural network for assessing ventricular size

An artificial neural network approach was applied to assess ventricular size from computed tomograms. Three layer, feed-forward neural networks with a back propagation algorithm were designed to distinguish between three degrees of enlargement of the ventricles on the basis of patient's age and six items of computed tomographic information. Data for training and testing the neural network were created with computed tomograms of the brains selected at random from daily examinations. Four radiologists decided by mutual consent subjectively based on their experience whether the ventricles were within normal limits, slightly enlarged, or enlarged for the patient's age. The data for training was obtained from 38 patients. The data for testing was obtained from 47 other patients. The performance of the neural network trained using the data for training was evaluated by the rate of correct answers to the data for testing. The valid solution ratio to response of the test data obtained from the trained neural networks was more than 90% for all conditions in this study. The solutions were completely valid in the neural networks with two or three units at the hidden layer with 2,200 learning iterations, and with two units at the hidden layer with 11,000 learning iterations. The squared error decreased remarkably in the range from 0 to 500 learning iterations, and was close to constant over two thousand learning iterations. The neural network with a hidden layer having two or three units showed high decision performance. The preliminary results strongly suggest that the neural network approach has potential utility in computer-aided estimation of enlargement of the ventricles.

[Selective segmental necrotizing therapy for hepatocellular carcinoma: an experimental study of an ethanol injection method]

Selective segmental necrotizing therapy (SSN), which necrotizes the hepatic segment by ethanol injection through the intrahepatic portal vein under balloon occlusion, is a new treatment for hepatocellular carcinoma. To better perform this therapy safely and completely, the author examined an ethanol injection method using rabbits. A discolored area immediately formed in the injected area following rapid injection (injection speed > or = 1.0 ml/s) of absolute ethanol. This area became larger with increasing ethanol volume until it reached a plateau. The author defined the minimal volume as the minimal ethanol volume needed to form the maximal discolored area. The minimal volume correlated with the portal branch diameter of the injected area. A discolored area also formed when 50% or 25% ethanol was given by slow injection (injection speed < or = 0.1 ml/s), similar to the case of using absolute ethanol by rapid injection. The area was recognized as a necrotic area on histological examinations 14 days after SSN. The blood ethanol level in the right atrium showed the slightest elevation when 25% ethanol was given by slow injection. GPT showed the highest elevation 1 day after SSN, but it returned to normal 7 days after SSN in all ethanol injection methods. From these results, the author concluded that SSN should be performed using 25% ethanol by slow injection.

[Arterial infusion chemotherapy with human tumor necrosis factor (TNF): an experimental study using rabbits bearing VX2 tumor]

To evaluate the direct effects of TNF on tumor vessels, three groups of Japanese white rabbits bearing VX2 tumor received 5000 U, 25000, U, and 5000 U of TNF respectively. Angiograms were obtained before, and at 1, 15 and 30 minutes after arterial TNF injection. At 1 minute after TNF injection, dilated tumor vessels and dense tumor stains, depending on the dose of TNF, were demonstrated. At 30 minutes after injection these findings had disappeared However, there were no changes in normal vessels. It is suggested that arterial TNF injection influenced tumor vessels without damaging on normal vessels, indicating that it is effective as cancer therapy.

[Embolization of varicocele with ethanol]

Embolization with ethanol was performed in 40 varicocele patients to prevent recurrence due to collateral formation. A prescribed amount of ethanol (0.5-4 ml) was injected slowly into the testicular vein with the catheter tip as close as possible to the inguinal region. Embolization with stainless steel coils was also performed in 15 of the 40 patients. Immediately after embolization, three varicoceles were reduced in size, and 37 disappeared. Recurrence was recognized in only two patients. These patients were embolized at a proximal site above lumbar vertebra IV. Spermatic data have improved for 13 patients but not for one azoospermatic patient. Serious complications were recognized in only one patient, who received an injection of 15 ml ethanol in one dose. Therefore, we conclude that embolization with ethanol is an useful treatment for varicocele.

[Intermittent intraarterial infusion chemotherapy using a subcutaneously implanted reservoir in patients with hepatoma]

Hepatocellular carcinomas that should not be treated with transarterial embolization (TAE) were treated with intermittent intraarterial infusion chemotherapy using a subcutaneously implanted reservoir. Among 37 patients, in whom objective evaluation of the initial response was possible, 3 cases of CR, 12 of PR, 10 of NC and 12 of PD were obtained. The response rate was 40.5%. Culminate 1 year survival rates were 80.0% for responders (CR + PR), 4.5% for non-responders (NC + PD) and 35.1% as an average for all patients. The survival in responder patients was better than in non-responders (p < 0.001). To determine the role of this therapy we divided the cases into two groups by anamnesis of TAE and investigated the initial response and prognosis based on the grade of portal vein invasion in each group. In one group of 18 patients, who had not been treated with TAE, there were no relationships between the grade of portal vein invasion and the initial response and between the grade of portal vein invasion and the prognosis. In this group the initial response was better in patients whose one shot infusion chemotherapy immediately before intermittent intraarterial infusion chemotherapy had been effective than in the others. In the other group of 19 patients, who had been treated with TAE, the initial response and prognosis were better in patients with lower grades of portal vein invasion (Vp0-2) than in those with the highest grade (Vp3).

Hepatic angiomyolipoma pre-operatively diagnosed by imaging

An asymptomatic patient with pre-operatively diagnosed solitary angiomyolipoma is reported. The tumour was a well defined, fat density mass on computerized tomography (CT) and magnetic resonance imaging (MRI), and a hyperechoic nodule with a sharp margin on ultrasonography (US). The lesion was hypervascular on arteriography and CT during hepatic angiography. Chemical shift MRI confirmed the fat component within the lesion. Although a review of the literature shows this tumour to be rare and difficult to differentiate from a malignant lesion pre-operatively, the pre-operative diagnosis of angiomyolipoma is considered feasible when the characteristic findings as described here are present.

[Percutaneous arterial prostheses of femoro-femoral bypass: using a new method of Modified Seldinger technique]

An experimental study of percutaneous arterial prostheses of femoro-femoral bypass was performed in 3 dogs using Modified Seldinger technique. Modified Seldinger technique with an arc needle was a newly designed method to penetrate the arterial wall due to introduce a bypass graft into the artery percutaneously. In all dogs, the bypass graft was successfully placed and proved to be effective in excellent blood flow. No significant complication was encountered. It is concluded that this method is feasible in the dog model.

Clinical evaluation of interventional radiology for renal cell carcinoma in 100 patients

One hundred of 160 patients with renal cell carcinoma (RCC) were treated by interventional radiology (IVR) in the period from 1978 to 1989. The number and kind of interventions done each year were classified retrospectively. More than half of the patients underwent therapeutic arterial embolization or intraarterial infusion of anticancer drugs during the first half of the period. More recently, about half of the patients have had nephrectomies without IVR. One patient with advanced RCC by IVR 18 times lived 8 years and three months after diagnosis, but that was exceptionally long. IVR has been more effective against hepatocellular carcinoma than RCC, for several reasons.

[Gd-DTPA-enhanced MR imaging of the normal facial nerve]

We performed a prospective imaging study of the normal facial nerve within the temporal bone before and after injection of Gd-DTPA. The study included 29 patients using a 1.5T superconducting unit and 40 nerves (right: 21; left: 19) were available for analysis. There was no enhancement of the facial nerve within the internal auditory canal in the entire series. However, the enhancement at the labyrinthine segment was observed in one nerve (3%); at the geniculate ganglion in seven (18%); at the tympanic segment in 18 (45%) and at the mastoid segment in 28 nerves (70%). Our results indicate that enhancement of the facial nerve in normal subjects is not a rare condition.

[MR imaging of the thymoma--differentiation of invasive thymoma from noninvasive thymoma]

Magnetic resonance imaging (MRI) findings were reviewed in nine patients with histologically confirmed thymoma. The morphologic findings obtained by MRI were useful in distinguishing invasive from noninvasive thymoma. Invasive thymomas (2 cases) showed irregular contours and broad obliteration of the fatty plane between the mass and great vessels on T1-weighted coronary images. Perivascular infiltration shadow was considered to be characteristic of invasive thymoma. Noninvasive thymomas (7 cases) were round or oval in shape and showed slight obliteration of the fatty plane. In conclusion, MRI was helpful in differentiating invasive from noninvasive thymoma and defining the extent of thymoma.

[Two routes chemotherapy by CDDP and STS against liver tumor]

Nine (eight males, one female) patients with unresectable liver tumor (seven HCC and two metastasis) were treated by two-routes chemotherapy using cis-diamminedichloroplatinum (CDDP) and sodium thiosulfate (STS). In these patients, 50-100 mg/body of CDDP was administered through the proper hepatic artery or right hepatic artery by one shot infusion or the balloon-occluded arterial infusion (BOAI) at 10 mg/min, and during administration, intra-inferior vena cava injection of STS (4 g/body) was given. None of 9 patients suffered nausea and vomiting during the treatment, 3 of 9 patients suffered nausea and vomiting to a mild degree after the treatment, none of 9 patients showed significant side effects, such as bone marrow suppression and/or renal disfunction. In conclusion, this study demonstrated the protection effect of STS injected in inferior vena cava against the toxicity of CDDP were well indicated.

[Ethanol injection for embolization of varicocele]

Five patients were treated for varicocele by embolization with the use of ethanol, which has not been used before. The ethanol was injected into the spermatic vein involved in the varicocele by the technique of spermatic venography. Embolization was successful in all five patients. During the follow-up period, the varicocele became smaller or disappeared in four of the five patients. In one patient, catheterization was difficult, and the effect of ethanol was unsatisfactory because of the location of its release. The varicocele appeared again 13 months after embolization. Serious side effects were not found in all patients. Embolization therapy with ethanol is easily performed and is considered to be a safe and effective method.

[Selective segmental sclerotherapy of the liver by transportal ethanol injection--a complete remission case of hepatocellular carcinoma]

Selective segmental sclerotherapy of the liver by transportal ethanol injection (SSS) was devised and evaluated in a case of hepatocellular carcinoma. The patient was a 72-year-old man suffering from unresectable hepatoma. Injected ethanol with an amount of 20 ml into the portal branch under occluding the portal flow by balloon catheter produced complete necrosis of the liver proportional to the injected liver segment including the tumor on CT. Because of ethanol perfusion into sinusoid level by wedge injection, its cytotoxicity maybe affected liver cells directly. In this case, there has been no evidence of inadvertent liver damage and a significant rise in the blood ethanol level. The present technique of SSS in this clinical case and our past animal experience seemed to yield the same condition as resection without surgical disadvantages and be apparently a safe method, which is suggested for clinical use for several hepatic tumors.

[Adrenal arterial embolization and radiotherapy of a case with metastatic adrenal tumor and its tumor thrombus in inferior vena cava from hepatocellular carcinoma]

Right adrenal arterial embolization and radiotherapy were performed in a patient to treat the metastatic tumor and its tumor thrombus in inferior vena cava from hepatocellular carcinoma. This case developed no complication following the embolization and radiotherapy. This therapy necrosed the metastatic tumor and made inferior vena cava recanalization. Adrenal arterial embolization and radiotherapy were effective treatment for the metastatic adrenal tumor and its tumor thrombus.

[Transvenous biopsy of tumor thrombi in the vena cava]

Percutaneous transvenous tumor biopsy was performed in three patients with tumor thrombi in the vena cava. In one case, we tried three kinds of equipment, an endobronchial brush, an aspiration needle and a cystoscopic forceps, for the biopsy, and found the forceps most useful. So, we used only forceps in the other cases and obtained satisfactory results. The biopsy could be obtained easily at the time of angiography, and there were no complications. This technique was helpful in making a histologic diagnosis of intravenous tumors.

Two cases of venous aneurysm of the intrahepatic portal vein branch: MR demonstration

Two cases are reported of congenital intrahepatic portal vein aneurysm in women who had chronic hepatitis. Ultrasound (US) and computed tomography (CT) investigations revealed vascular communication between intrahepatic portal vein and venous aneurysms in both cases. These portal vein aneurysms were fusiform in shape and two and one centimeter in diameter in each case. On angiography portal-hepatic venous shunt was observed in one case. The MR image of two cases were presented. We believe this is the first report of MR image of portal vein aneurysm.

[Experimental and clinical studies on degradable starch microspheres (DSM) in the treatment of hepatic neoplasms]

To evaluate the effect of hepatic arterial chemotherapy combined with DSM, experimental and clinical studies were performed. Experimental study: Hemodynamic and histological changes induced by intra-arterial administration of DSM were investigated in the kidneys of rabbits. The degree of blockade of arterial blood flow was correlated with the dosage of DSM, and estimated by the angiographic change. Histological changes also depended on the dosage of DSM. Although administration of less than 6 mg DSM induced little or no histological changes, more than 15 mg of DSM induced extensive necrosis of renal tubules. Clinical study: The hepatic arterial chemotherapy combined with DSM was performed in 63 patients (hepatomas in 45 and metastatic tumors in 18). Fourteen patients (30%) showed partial or complete response. Patients with a higher degree of blockade of arterial blood flow tended to have a better response. Analysis of CT images suggested that DSM not only enhance the chemotherapeutic agents but also the ischemic effect. In conclusion, degree of blockade of arterial blood flow is controlled by the change in DSM dosage, and DSM administration combined with chemotherapeutic agents may have the potential to improve the therapeutic effect.