Methodological improvement of 3D fluoroscopic analysis for the robust quantification of 3D kinematics of human joints

3D video-fluoroscopy is an accurate but cumbersome technique to estimate natural or prosthetic human joint kinematics. This dissertation proposes innovative methodologies to improve the 3D fluoroscopic analysis reliability and usability. Being based on direct radiographic imaging of the joint, and avoiding soft tissue artefact that limits the accuracy of skin marker based techniques, the fluoroscopic analysis has a potential accuracy of the order of mm/deg or better. It can provide fundamental informations for clinical and methodological applications, but, notwithstanding the number of methodological protocols proposed in the literature, time consuming user interaction is exploited to obtain consistent results. The user-dependency prevented a reliable quantification of the actual accuracy and precision of the methods, and, consequently, slowed down the translation to the clinical practice. The objective of the present work was to speed up this process introducing methodological improvements in the analysis. In the thesis, the fluoroscopic analysis was characterized in depth, in order to evaluate its pros and cons, and to provide reliable solutions to overcome its limitations. To this aim, an analytical approach was followed. The major sources of error were isolated with in-silico preliminary studies as: (a) geometric distortion and calibration errors, (b) 2D images and 3D models resolutions, (c) incorrect contour extraction, (d) bone model symmetries, (e) optimization algorithm limitations, (f) user errors. The effect of each criticality was quantified, and verified with an in-vivo preliminary study on the elbow joint. The dominant source of error was identified in the limited extent of the convergence domain for the local optimization algorithms, which forced the user to manually specify the starting pose for the estimating process. To solve this problem, two different approaches were followed: to increase the optimal pose convergence basin, the local approach used sequential alignments of the 6 degrees of freedom in order of sensitivity, or a geometrical feature-based estimation of the initial conditions for the optimization; the global approach used an unsupervised memetic algorithm to optimally explore the search domain. The performances of the technique were evaluated with a series of in-silico studies and validated in-vitro with a phantom based comparison with a radiostereometric gold-standard. The accuracy of the method is joint-dependent, and for the intact knee joint, the new unsupervised algorithm guaranteed a maximum error lower than 0.5 mm for in-plane translations, 10 mm for out-of-plane translation, and of 3 deg for rotations in a mono-planar setup; and lower than 0.5 mm for translations and 1 deg for rotations in a bi-planar setups. The bi-planar setup is best suited when accurate results are needed, such as for methodological research studies. The mono-planar analysis may be enough for clinical application when the analysis time and cost may be an issue. A further reduction of the user interaction was obtained for prosthetic joints kinematics. A mixed region-growing and level-set segmentation method was proposed and halved the analysis time, delegating the computational burden to the machine. In-silico and in-vivo studies demonstrated that the reliability of the new semiautomatic method was comparable to a user defined manual gold-standard. The improved fluoroscopic analysis was finally applied to a first in-vivo methodological study on the foot kinematics. Preliminary evaluations showed that the presented methodology represents a feasible gold-standard for the validation of skin marker based foot kinematics protocols.

Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction

A standard rheumatoid forefoot reconstruction consists of arthrodesis of the first metatarsophalangeal (MTP) joint and resection arthroplasty of the lesser metatarsal heads. However, preservation of the metatarsal heads has gained renewed interest since the medical treatment of rheumatoid arthritis has improved dramatically.

ANKLE IMPEDANCE AND ANKLE ANGLES DURING STEP TURN AND STRAIGHT WALK: IMPLICATIONS FOR THE DESIGN OF A STEERABLE ANKLE-FOOT PROSTHETIC ROBOT

During locomotion, turning is a common and recurring event which is largely neglected in the current state-of-the-art ankle-foot prostheses, forcing amputees to use different steering mechanisms for turning, compared to non-amputees. A better understanding of the complexities surrounding lower limb prostheses will lead to increased health and well-being of amputees. The aim of this research is to develop a steerable ankle-foot prosthesis that mimics the human ankle mechanical properties. Experiments were developed to estimate the mechanical impedance of the ankle and the ankles angles during straight walk and step turn. Next, this information was used in the design of a prototype, powered steerable ankle-foot prosthesis with two controllable degrees of freedom. One of the possible approaches in design of the prosthetic robots is to use the human joints’ parameters, especially their impedance. A series of experiments were conducted to estimate the stochastic mechanical impedance of the human ankle when muscles were fully relaxed and co-contracting antagonistically. A rehabilitation robot for the ankle, Anklebot, was employed to provide torque perturbations to the ankle. The experiments were performed in two different configurations, one with relaxed muscles, and one with 10% of maximum voluntary contraction (MVC). Surface electromyography (sEMG) was used to monitor muscle activation levels and these sEMG signals were displayed to subjects who attempted to maintain them constant. Time histories of ankle torques and angles in the lateral/medial (LM) directions, inversion-eversion (IE), and dorsiflexionplantarflexion (DP) were recorded. Linear time-invariant transfer functions between the measured torques and angles were estimated providing an estimate of ankle mechanical impedance. High coherence was observed over a frequency range up to 30 Hz. The main effect of muscle activation was to increase the magnitude of ankle mechanical impedance in all degrees of freedom of the ankle. Another experiment compared the three-dimensional angles of the ankle during step turn and straight walking. These angles were measured to be used for developing the control strategy of the ankle-foot prosthesis. An infrared camera system was used to track the trajectories and angles of the foot and leg. The combined phases of heel strike and loading response, mid stance, and terminal stance and pre-swing were determined and used to measure the average angles at each combined phase. The Range of motion (ROM) in IE increased during turning while ML rotation decreased and DP changed the least. During the turning step, ankle displacement in DP started with similar angles to straight walk and progressively showed less plantarflexion. In IE, the ankle showed increased inversion leaning the body toward the inside of the turn. ML rotation initiated with an increased medial rotation during the step turn relative to the straight walk transitioning to increased lateral rotation at the toe off. A prototype ankle-foot prosthesis capable of controlling both DP and IE using a cable driven mechanism was developed and assessed as part of a feasibility study. The design is capable of reproducing the angles required for straight walk and step turn; generates 712N of lifting force in plantarflexion, and shows passive stiffness comparable to a nonload bearing ankle impedance. To evaluate the performance of the ankle-foot prosthesis, a circular treadmill was developed to mimic human gait during steering. Preliminary results show that the device can appropriately simulate human gait with loading and unloading the ankle joint during the gait in circular paths.

Observations of Joints Present in the Lawton Clay Member of the Vashon Stade, Exposed at a Coastal Bluff in Discovery Park, Seattle, Washington

The southwest-facing coastal bluff present at Discovery Park, Seattle, Washington, displays distinctive joints throughout the exposed Lawton Clay Member. Exhibiting a characteristic local stratigraphy of permeable advance outwash over the impermeable proglacial lacustrine clay, this bluff is located in an area of Seattle at high risk from landslides. This project addressed the relationship between the joints observed at this coastal bluff and the coherency of the bluff as a whole, through remote sensing and field measurements. Aerial drone photography taken of the bluff was processed through a photogrammetry software to produce a 3-dimensional Structure from Motion model, allowing for a digital manipulation and broad examination of the bluff not possible by foot. Stereonet plots produced from these measurements provided insight into patterns of varying joint strike along a horizontal transect of the observed bluff face. Taken together, these two visualizations provided a better picture of the possible chicken-and-egg interaction of the joints and bluff topography; they demonstrated the likelihood that the joint formation at the bluff was most likely to be primarily influenced by the local topography of the bluff over other sources of possible tensional stress in the immediate area.

Analise cinematica da movimentação dos membros superiores e inferiores, tronco e cabeça durante a marcha de hemipareticos

Universidade Estadual de Campinas . Faculdade de Educação Física

Proposição e avaliação de um modelo de representação dos membros superiores e escapula durante a marcha humana

Universidade Estadual de Campinas . Faculdade de Educação Física

Spatial clustering analysis of the foot-and-mouth disease outbreaks in Mato Grosso do Sul state, Brazil - 2005

In the southern region of Mato Grosso do Sul state, Brazil, a foot-and-mouth disease (FMD) epidemic started in September 2005. A total of 33 outbreaks were detected and 33,741 FMD-susceptible animals were slaughtered and destroyed. There were no reports of FMD cases in other species than bovines. Based on the data of this epidemic, it was carried out an analysis using the K-function and it was observed spatial clustering of outbreaks within a range of 25km. This observation may be related to the dynamics of foot-and-mouth disease spread and to the measures undertaken to control the disease dissemination. The control measures were effective once the disease did not spread to farms more than 47 km apart from the initial outbreaks.

The effectiveness of educational practice in diabetic foot: a view from Brazil

Background: The aim of the present study was to evaluate the prevention and self-inspection behavior of diabetic subjects with foot at ulcer risk, no previous episode, who participated in the routine visits and standardized education provided by the service and who received prescribed footwear. This evaluation was carried out using a questionnaire scoring from 0-10 (high scores reflect worse practice compliance). Results: 60 patients were studied (30 of each sex); mean age was 62 years, mean duration of the disease was 17 years. As for compliance, 90% showed a total score <= 5, only 8.7% regularly wore the footwear supplied; self foot inspection 65%, 28,3% with additional familiar inspection; creaming 77%; proper washing and drying 88%; proper cutting of toe nails 83%; no cuticle cutting 83%; routine shoe inspection 77%; no use of pumice stones or similar abrasive 70%; no barefoot walking 95%. Conclusion: the planned and multidisciplinary educational approach enabled high compliance of the ulcer prevention care needed in diabetic patients at risk for complications. In contrast, compliance observed for the use of footwear provided was extremely low, demonstrating that the issue of its acceptability should be further and carefully addressed. In countries of such vast dimensions as Brazil multidisciplinary educational approaches can and should be performed by the services providing care for patients with foot at risk for complications according to the reality of local scenarios. Furthermore, every educational program should assess the learning, results obtained and efficacy in the target population by use of an adequate evaluation system.

Comparison of three-dimensional lower extremity running kinematics of young adult and elderly runners

The objective of this study was to compare the three-dimensional lower extremity running kinematics of young adult runners and elderly runners. Seventeen elderly adults (age 67-73 years) and 17 young adults (age 26-36 years) ran at 3.1ms-1 on a treadmill while the movements of the lower extremity during the stance phase were recorded at 120Hz using three-dimensional video. The three-dimensional kinematics of the lower limb segments and of the ankle and knee joints were determined, and selected variables were calculated to describe the movement. Our results suggest that elderly runners have a different movement pattern of the lower extremity from that of young adults during the stance phase of running. Compared with the young adults, the elderly runners had a substantial decrease in stride length (1.97 vs. 2.23m; P=0.01), an increase in stride frequency (1.58 vs. 1.37Hz; P=0.002), less knee flexion/extension range of motion (26 vs. 33; P=0.002), less tibial internal/external rotation range of motion (9 vs. 12; P0.001), larger external rotation angle of the foot segment (toe-out angle) at the heel strike (-5.8 vs. -1.0; P=0.009), and greater asynchronies between the ankle and knee movements during running. These results may help to explain why elderly individuals could be more susceptible to running-related injuries.

Incidence of injuries to the lower limbs joints in kung fu athletes

Background and Study Aim: This study evaluated the influence of competitive practice and training aspects on incidence of injuries to the lower limbs joints in formalized (taolu) and combat (sanshou) kung fu athletes. Material/Methods: One hundred and twenty-seven kung fu athletes (taolu, n=82; sanshou, n=45) were interviewed about kung fu practice (practice time, competition time and competition level), training volume (days of training per week and hours per training session) and injury profiles (incidence and type). Continuous variables were compared by non-parametric Kolmogorov-Smirnov test (disciplines and competition levels as grouping variables). The effects of categorical variables (kung fu practice) on injury profiles were analyzed using the Pearson`s chi-square test. The level of significance was set at p<0.05. Results: Our data exhibited large frequency of injury reports (70.1%) and significantly differences on injury profiles between disciplines and competition levels. Taolu athletes, despite the lower practice/competition time (-51.5 and -41.8%, respectively), presented frequency of injury reports twofold greater, longer daily training volume (23.3%) and higher incidence of lower limbs joints injuries than sanshou athletes (35.4% and 11.8%, respectively). Conclusions: Our results suggest a link between injury profiles (incidence and type) and specific characteristics of kung fu disciplines.

Evaluation of Electrical Properties of Lap Joints for BSCCO and YBCO Tapes

The joint process between tapes of coated conductors is a critical issue for the most of the applications of high temperature superconductors (HTS). Using different fabrication techniques joints of YBCO coated superconductors were prepared and characterized through electrical measurements. For soldering material low melting point eutectic alloys, such as In-Sn (m.p. 116 degrees C) and Sn-Pb (m. p. 189 degrees C) were selected to prepare lap joints with effective length between 1 to 20 cm. The splice resistance and the critical current of the joints were evaluated by I-V curve measurements with the maximum current strength above the critical current, in order to evaluate the degree of degradation for each joint method. Pressed lap joints prepared with tapes without external reinforcement presented low resistance lap joint nevertheless some critical current degradation occurs when strong pressing is applied. When mechanical pressure is applied during the soldering process we can reduce the thickness of the solder alloy and a residual resistance arises from contributions of high resistivity matrix and external reinforcement. The lap joints for reinforced tape were prepared using two methods: the first, using ""as-supplied"" tape and the other after reinforcement-removal; in the latter case, the tapes were resoldered using Sn-Pb alloy. The results using several joint geometries, distinct surface preparation processes and different soldering materials are presented and analysed. The solder alloy with lower melting point and the longer joint length presented the smallest joint resistance.

Microstructure and mechanical properties of laser-welded joints of TWIP and TRIP steels

With the aim of investigating a laser-welded dissimilar joint of TWIP and TRIP steel sheets, the microstructure was characterized by means of OM, SEM, and EBSD to differentiate the fusion zone, heat-affected zone, and the base material. OIM was used to differentiate between ferritic, bainitic, and martensitic structures. Compositions were measured by means of optical emission spectrometry and EDX to evaluate the effect of manganese segregation. Microhardness measurements and tensile tests were performed to evaluate the mechanical properties of the joint. Residual stresses and XRD phase quantification were used to characterize the weld. Grain coarsening and martensitic areas were found in the fusion zone, and they had significant effects on the mechanical properties of the weld. The heat-affected zone of the TRIP steel and the corresponding base material showed considerable differences in the microstructure and properties. (C) 2009 Elsevier B.V. All rights reserved.

Digital versus Conventional Radiography for Imaging Fatigue Cracks in Riveted Lap Joints of Hybrid Glass Reinforced Fiber/Metal Laminate

A round robin program zoos conducted to assess the ability of three different X-radiographic systems for imaging internal fatigue cracks in riveted lap joints of composite glass reinforced fiber/metal laminate. From an engineering perspective, conventional film radiography and direct radiography have produced the best results, identifying and characterizing in detail internal damage on metallic faying surfaces of fastened glass reinforced fiber/metal laminate joints. On the other hand, computed radiographic images presented large projected geometric distortions and feature shifts due to the angular incident radiation beam, disclosing only partial internal cracking patterns.

A Dynamic Model of Hand-and-Foot Syndrome in Patients Receiving Capecitabine

For the purpose of developing a longitudinal model to predict hand-and-foot syndrome (HFS) dynamics in patients receiving capecitabine, data from two large phase III studies were used. Of 595 patients in the capecitabine arms, 400 patients were randomly selected to build the model, and the other 195 were assigned for model validation. A score for risk of developing HFS was modeled using the proportional odds model, a sigmoidal maximum effect model driven by capecitabine accumulation as estimated through a kinetic-pharmacodynamic model and a Markov process. The lower the calculated creatinine clearance value at inclusion, the higher was the risk of HFS. Model validation was performed by visual and statistical predictive checks. The predictive dynamic model of HFS in patients receiving capecitabine allows the prediction of toxicity risk based on cumulative capecitabine dose and previous HFS grade. This dose-toxicity model will be useful in developing Bayesian individual treatment adaptations and may be of use in the clinic.