Une nouvelle méthode pour estimer la torsion géométrique en scoliose idiopathique de l’adolescent

La scoliose idiopathique de l’adolescent (SIA) est une déformation tridimensionnelle (3D) de la colonne vertébrale. Pour la plupart des patients atteints de SIA, aucun traitement chirurgical n’est nécessaire. Lorsque la déformation devient sévère, un traitement chirurgical visant à réduire la déformation est recommandé. Pour déterminer la sévérité de la SIA, l’imagerie la plus utilisée est une radiographie postéroantérieure (PA) ou antéro-postérieure (AP) du rachis. Plusieurs indices sont disponibles à partir de cette modalité d’imagerie afin de quantifier la déformation de la SIA, dont l’angle de Cobb. La conduite thérapeutique est généralement basée sur cet indice. Cependant, les indices disponibles à cette modalité d’imagerie sont de nature bidimensionnelle (2D). Celles-ci ne décrivent donc pas entièrement la déformation dans la SIA dû à sa nature tridimensionnelle (3D). Conséquemment, les classifications basées sur les indices 2D souffrent des mêmes limitations. Dans le but décrire la SIA en 3D, la torsion géométrique a été étudiée et proposée par Poncet et al. Celle-ci mesure la tendance d’une courbe tridimensionnelle à changer de direction. Cependant, la méthode proposée est susceptible aux erreurs de reconstructions 3D et elle est calculée localement au niveau vertébral. L’objectif de cette étude est d’évaluer une nouvelle méthode d’estimation de la torsion géométrique par l’approximation de longueurs d’arcs locaux et par paramétrisation de courbes dans la SIA. Une première étude visera à étudier la sensibilité de la nouvelle méthode présentée face aux erreurs de reconstructions 3D du rachis. Par la suite, deux études cliniques vont présenter la iv torsion géométrique comme indice global et viseront à démontrer l’existence de sous-groupes non-identifiés dans les classifications actuelles et que ceux-ci ont une pertinence clinique. La première étude a évalué la robustesse de la nouvelle méthode d’estimation de la torsion géométrique chez un groupe de patient atteint de la SIA. Elle a démontré que la nouvelle technique est robuste face aux erreurs de reconstructions 3D du rachis. La deuxième étude a évalué la torsion géométrique utilisant cette nouvelle méthode dans une cohorte de patient avec des déformations de type Lenke 1. Elle a démontré qu’il existe deux sous-groupes, une avec des valeurs de torsion élevées et l’autre avec des valeurs basses. Ces deux sous-groupes possèdent des différences statistiquement significatives, notamment au niveau du rachis lombaire avec le groupe de torsion élevée ayant des valeurs d’orientation des plans de déformation maximales (PMC) en thoraco-lombaire (TLL) plus élevées. La dernière étude a évalué les résultats chirurgicaux de patients ayant une déformation Lenke 1 sous-classifiées selon les valeurs de torsion préalablement. Cette étude a pu démontrer des différences au niveau du PMC au niveau thoraco-lombaire avec des valeurs plus élevées en postopératoire chez les patients ayant une haute torsion. Ces études présentent une nouvelle méthode d’estimation de la torsion géométrique et présentent cet indice quantitativement. Elles ont démontré l’existence de sous-groupes 3D basés sur cet indice ayant une pertinence clinique dans la SIA, qui n’étaient pas identifiés auparavant. Ce projet contribue dans la tendance actuelle vers le développement d’indices 3D et de classifications 3D pour la scoliose idiopathique de l’adolescent.

Scoliosis Follow-Up Using Noninvasive Trunk Surface Acquisition

Adolescent idiopathic scoliosis (AIS) is a musculoskeletal pathology. It is a complex spinal curvature in a 3-D space that also affects the appearance of the trunk. The clinical follow-up of AIS is decisive for its management. Currently, the Cobb angle, which is measured from full spine radiography, is the most common indicator of the scoliosis progression. However, cumulative exposure to X-rays radiation increases the risk for certain cancers. Thus, a noninvasive method for the identification of the scoliosis progression from trunk shape analysis would be helpful. In this study, a statistical model is built from a set of healthy subjects using independent component analysis and genetic algorithm. Based on this model, a representation of each scoliotic trunk from a set of AIS patients is computed and the difference between two successive acquisitions is used to determine if the scoliosis has progressed or not. This study was conducted on 58 subjects comprising 28 healthy subjects and 30 AIS patients who had trunk surface acquisitions in upright standing posture. The model detects 93% of the progressive cases and 80% of the nonprogressive cases. Thus, the rate of false negatives, representing the proportion of undetected progressions, is very low, only 7%. This study shows that it is possible to perform a scoliotic patient's follow-up using 3-D trunk image analysis, which is based on a noninvasive acquisition technique.

Validity of a Quantitative Clinical Measurement Tool of Trunk Posture in Idiopathic Scoliosis

STUDY DESIGN: Concurrent validity between postural indices obtained from digital photographs (two-dimensional [2D]), surface topography imaging (three-dimensional [3D]), and radiographs. OBJECTIVE: To assess the validity of a quantitative clinical postural assessment tool of the trunk based on photographs (2D) as compared to a surface topography system (3D) as well as indices calculated from radiographs. SUMMARY OF BACKGROUND DATA: To monitor progression of scoliosis or change in posture over time in young persons with idiopathic scoliosis (IS), noninvasive and nonionizing methods are recommended. In a clinical setting, posture can be quite easily assessed by calculating key postural indices from photographs. METHODS: Quantitative postural indices of 70 subjects aged 10 to 20 years old with IS (Cobb angle, 15 degrees -60 degrees) were measured from photographs and from 3D trunk surface images taken in the standing position. Shoulder, scapula, trunk list, pelvis, scoliosis, and waist angles indices were calculated with specially designed software. Frontal and sagittal Cobb angles and trunk list were also calculated on radiographs. The Pearson correlation coefficients (r) was used to estimate concurrent validity of the 2D clinical postural tool of the trunk with indices extracted from the 3D system and with those obtained from radiographs. RESULTS: The correlation between 2D and 3D indices was good to excellent for shoulder, pelvis, trunk list, and thoracic scoliosis (0.81>r<0.97; P<0.01) but fair to moderate for thoracic kyphosis, lumbar lordosis, and thoracolumbar or lumbar scoliosis (0.30>r<0.56; P<0.05). The correlation between 2D and radiograph spinal indices was fair to good (-0.33 to -0.80 with Cobb angles and 0.76 for trunk list; P<0.05). CONCLUSION: This tool will facilitate clinical practice by monitoring trunk posture among persons with IS. Further, it may contribute to a reduction in the use of radiographs to monitor scoliosis progression.

Semiautomatic Detection of Scoliotic Rib Borders From Posteroanterior Chest Radiographs

3-D assessment of scoliotic deformities relies on an accurate 3-D reconstruction of bone structures from biplanar X-rays, which requires a precise detection and matching of anatomical structures in both views. In this paper, we propose a novel semiautomated technique for detecting complete scoliotic rib borders from PA-0° and PA-20° chest radiographs, by using an edge-following approach with multiple-path branching and oriented filtering. Edge-following processes are initiated from user starting points along upper and lower rib edges and the final rib border is obtained by finding the most parallel pair among detected edges. The method is based on a perceptual analysis leading to the assumption that no matter how bent a scoliotic rib is, it will always present relatively parallel upper and lower edges. The proposed method was tested on 44 chest radiographs of scoliotic patients and was validated by comparing pixels from all detected rib borders against their reference locations taken from the associated manually delineated rib borders. The overall 2-D detection accuracy was 2.64 ± 1.21 pixels. Comparing this accuracy level to reported results in the literature shows that the proposed method is very well suited for precisely detecting borders of scoliotic ribs from PA-0° and PA-20° chest radiographs.

Changes in Trunk Appearance After Scoliosis Spinal Surgery and Their Relation to Changes in Spinal Measurements

Study Design Retrospective study of surgical outcome. Objectives To evaluate quantitatively the changes in trunk surface deformities after scoliosis spinal surgery in Lenke 1A adolescent idiopathic scoliosis (AIS) patients and to compare it with changes in spinal measurements. Summary of Background Data Most studies documenting scoliosis surgical outcome used either radiographs to evaluate changes in the spinal curve or questionnaires to assess patients health-related quality of life. Because improving trunk appearance is a major reason for patients and their parents to seek treatment, this study focuses on postoperative changes in trunk surface deformities. Recently, a novel approach to quantify trunk deformities in a reliable, automatic, and noninvasive way has been proposed. Methods Forty-nine adolescents with Lenke 1A idiopathic scoliosis treated surgically were included. The back surface rotation and trunk lateral shift were computed on trunk surface acquisitions before and at least 6 months after surgery. We analyzed the effect of age, height, weight, curve severity, and flexibility before surgery, length of follow-up, and the surgical technique. For 25 patients with available three-dimensional (3D) spinal reconstructions, we compared changes in trunk deformities with changes in two-dimensional (2D) and 3D spinal measurements. Results The mean correction rates for the back surface rotation and the trunk lateral shift are 18% and 50%, respectively. Only the surgical technique had a significant effect on the correction rate of the back surface rotation. Direct vertebral derotation and reduction by spine translation provide a better correction of the rib hump (22% and 31% respectively) than the classic rod rotation technique (8%). The reductions of the lumbar Cobb angle and the apical vertebrae transverse rotation explain, respectively, up to 17% and 16% the reduction of the back surface rotation. Conclusions Current surgical techniques perform well in realigning the trunk; however, the correction of the deformity in the transverse plane proves to be more challenging. More analysis on the positive effect of vertebral derotation on the rib hump correction is needed. Level of evidence III.

Time-resolved studies of neutral and ionized Na_n clusters with femtosecond light pulses

The real-time dynamics of Na_n (n=3-21) cluster multiphoton ionization and fragmentation has been studied in beam experiments applying femtosecond pump-probe techniques in combination with ion and electron spectroscopy. Three dimensional wave packet motions in the trimer Na_3 ground state X and excited state B have been observed. We report the first study of cluster properties (energy, bandwidth and lifetime of intermediate resonances Na_n^*) with femtosecond laser pulses. The observation of four absorption resonances for the cluster Na_8 with different energy widths and different decay patterns is more difficult to interpret by surface plasmon like resonances than by molecular structure and dynamics. Timeresolved fragmentation of cluster ions Na_n^+ indicates that direct photo-induced fragmentation processes are more important at short times than the statistical unimolecular decay.

Fundamental interactions of molecules (Na_2, Na_3) with intense femtosecond laser pulses

The real-time dynamics of multiphoton ionization and fragmentation of molecules Na_2 and Na_3 has been studied in molecular beam experiments employing ion and electron spectroscopy together with femtosecond pump-probe techniques. Experiments with Na_2 and Na_3 reveal unexpected features of the dynamics of the absorption of several photons as seen in the one- and three-dimensional vibrational wave packet motion in different potential surfaces and in high laser fields: In Na_2 a second major resonance-enhanced multiphoton ionization (REMPI) process is observed, involving the excitation of two electrons and subsequent electronic autoionization. The possibility of controlling a reaction by controlling the duration of propagation of a wave packet on an electronically-excited surface is demonstrated. In high laser fields, the contributions from direct photoionization and from the second REMPI process to the total ion yield change, due to different populations in the electronic states participating in the multiphoton ionization (MPI) processes. In addition, a vibrational wave packet motion in the electronic ground state is induced through stimulated emission pumping by the pump laser. The 4^1 \summe^+_g shelf state of Na_2 is given as an example for performing frequency spectroscopy of highlying electronic states in the time domain. Pure wave packet effects, such as the spreading and the revival of a vibrational wave packet, are investigated. The three-dimensional wave packet motion in the Na_3 reflects the normal modes in the X and B states, and shows in addition the pseudorotational motion in the B state in real time.

How are Three-Deminsional Objects Represented in the Brain?

We discuss a variety of object recognition experiments in which human subjects were presented with realistically rendered images of computer-generated three-dimensional objects, with tight control over stimulus shape, surface properties, illumination, and viewpoint, as well as subjects' prior exposure to the stimulus objects. In all experiments recognition performance was: (1) consistently viewpoint dependent; (2) only partially aided by binocular stereo and other depth information, (3) specific to viewpoints that were familiar; (4) systematically disrupted by rotation in depth more than by deforming the two-dimensional images of the stimuli. These results are consistent with recently advanced computational theories of recognition based on view interpolation.

Concordancia interobservador entre ortopedistas de urgencias y cirujanos de codo en fracturas de cúpula radial

El trauma de codo y la fractura de cúpula radial resultan ser un motivo de consulta frecuente en nuestro medio. Es común en nuestro medio que a pesar de tener radiografías de codo en las que se evidencia fractura de cúpula radial se solicite un TAC de codo. Consideramos que el TAC es una herramienta útil en algunos casos de fracturas de la cúpula radial, es decir, no se debe tomar de forma rutinaria el TAC de codo en los pacientes con fracturas de cúpula radial como es usual en nuestro medio. Existen pocos estudios que comparan la concordancia inter observador de las clasificaciones utilizadas para las fracturas de cúpula radial, pero, no existe en la literatura mundial un estudio que evalué las diferencias entre la clasificación de la fractura en base a radiografías y tomografía entre un grupo ortopedistas traumatólogos y sub-especialistas de miembro superior. La realización de este estudio permite elaborar guías de manejo de pacientes con fractura de cúpula radial en la que se racionalizara el uso del TAC de codo.

¿La tomografía de codo cambia la conducta tomada previamente con radiografía en fracturas de cúpula radial? un estudio de concordancia

Las fracturas de la cúpula radial corresponden a un tercio de todas las fracturas del codo en adultos (1), por lo que se toman radiografías o tomografías, sin embargo no existe literatura que soporte la realización de la tomografía como estudio complementario, por lo que preguntamos ¿La tomografía de codo cambia la conducta tomada previamente con radiografía en fracturas de cúpula radial? Se propone un estudio de concordancia, donde se evalúan las radiografías y tomografías por parte de dos cirujanos de codo, de pacientes con diagnóstico de fractura de cúpula radial valorados en urgencias de dos hospitales de tercer nivel de Bogotá desde enero 2011 a enero 2013. Se revisaron 116 historias, 99 cumplieron los criterios, las radiografías fueron revisadas por dos ortopedistas de codo quienes realizaron clasificación de Mason obteniendo un κ 1 (p˂ 0,00), propuesta de tratamiento postradiografía κ 0,934 (p˂ 0,000 IC95% 0.85, 1). Tratamiento post-tomografía de codo κ 0.949 (p˂ 0,00 IC95% 0.867,1). Concordancia intra-ortopedista de la conducta pre y post-tomografía hay cambio en la conducta del ortopedista 1 en 32.6% (κ 0.674 p˂ 0,00 IC95% 0.52, 0.818) y del ortopedista 2 en 36% (κ 0.64 p˂ 0,00 IC95% 0.452, 0.792). Se dividieron los pacientes en Mason I, II, III con concordancia considerable en los pacientes Mason I y III, mientras que en Mason II fue una concordancia aceptable lo que significa que el uso de tomografía de codo cambia la conducta en general pero sobretodo en pacientes clasificados Masson II.

Cambios ocurridos a nivel de flexibilidad y actitud postural a través de la aplicación del método pilates en una muestra de cinco pacientes entre los 30 y 50 años de edad durante 15 sesiones

En los últimos años, no se ha podido precisar con exactitud la cantidad de personas que se encuentran sometidas a problemas de origen muscular, debido a factores como el trabajo, la violencia, la cultura y otras circunstancias que terminan en desórdenes crónicos reflejados en su actitud postural y más grave aún, dolores incapacitantes que llevan a ausentismo laboral y social. Es por esto, que el propósito del siguiente trabajo de grado es identificar los cambios obtenidos a nivel de flexibilidad y actitud postural con la aplicación del Método Pilates durante quince sesiones, con el fin de analizar los resultados obtenidos en una muestra especifica.

How may tropical cyclones change in a warmer climate?

Tropical Cyclones (TC) under different climate conditions in the Northern Hemisphere have been investigated with the Max Planck Institute (MPI) coupled (ECHAM5/MPIOM) and atmosphere (ECHAM5) climate models. The intensity and size of the TC depend crucially on resolution with higher wind speed and smaller scales at the higher resolutions. The typical size of the TC is reduced by a factor of 2.3 from T63 to T319 using the distance of the maximum wind speed from the centre of the storm as a measure. The full three dimensional structure of the storms becomes increasingly more realistic as the resolution is increased. For the T63 resolution, three ensemble runs are explored for the period 1860 until 2100 using the IPCC SRES scenario A1B and evaluated for three 30 year periods at the end of the 19th, 20th and 21st century, respectively. While there is no significant change between the 19th and the 20th century, there is a considerable reduction in the number of the TC by some 20% in the 21st century, but no change in the number of the more intense storms. Reduction in the number of storms occurs in all regions. A single additional experiment at T213 resolution was run for the two latter 30-year periods. The T213 is an atmospheric only experiment using the transient Sea Surface Temperatures (SST) of the T63 resolution experiment. Also in this case, there is a reduction by some 10% in the number of simulated TC in the 21st century compared to the 20th century but a marked increase in the number of intense storms. The number of storms with maximum wind speeds greater than 50ms-1 increases by a third. Most of the intensification takes place in 2 the Eastern Pacific and in the Atlantic where also the number of storms more or less stays the same. We identify two competing processes effecting TC in a warmer climate. First, the increase in the static stability and the reduced vertical circulation is suggested to contribute to the reduction in the number of storms. Second, the increase in temperature and water vapor provide more energy for the storms so that when favorable conditions occur, the higher SST and higher specific humidity will contribute to more intense storms. As the maximum intensity depends crucially on resolution, this will require higher resolution to have its full effect. The distribution of storms between different regions does not, at first approximation, depend on the temperature itself but on the distribution of the SST anomalies and their influence on the atmospheric circulation. Two additional transient experiments at T319 resolution where run for 20 years at the end of the 20th and 21st century, respectively using the same conditions as in the T213 experiments. The results are consistent with the T213 study. The total number of tropical cyclones were similar to the T213 experiment but were generally more intense. The change from the 20th to the 21st century was also similar with fewer TC in total but with more intense cyclones.

Efficient evaluation of highly oscillatory acoustic scattering surface integrals

We consider the approximation of some highly oscillatory weakly singular surface integrals, arising from boundary integral methods with smooth global basis functions for solving problems of high frequency acoustic scattering by three-dimensional convex obstacles, described globally in spherical coordinates. As the frequency of the incident wave increases, the performance of standard quadrature schemes deteriorates. Naive application of asymptotic schemes also fails due to the weak singularity. We propose here a new scheme based on a combination of an asymptotic approach and exact treatment of singularities in an appropriate coordinate system. For the case of a spherical scatterer we demonstrate via error analysis and numerical results that, provided the observation point is sufficiently far from the shadow boundary, a high level of accuracy can be achieved with a minimal computational cost.

Measuring root traits in barley (Hordeum vulgare ssp vulgare and ssp spontaneum) seedlings using gel chambers, soil sacs and X-ray microtomography

Root characteristics of seedlings of five different barley genotypes were analysed in 2D using gel chambers, and in 3D using soil sacs that were destructively harvested and pots of soil that were assessed non-invasively using X-ray microtomography. After 5 days, Chime produced the greatest number of root axes (similar to 6) and Mehola significantly less (similar to 4) in all growing methods. Total root length was longest in GSH01915 and shortest in Mehola for all methods, but both total length and average root diameter were significantly larger for plants grown in gel chambers than those grown in soil. The ranking of particular growth traits (root number, root angular spread) of plants grown in gel plates, soil sacs and X-ray pots was similar, but plants grown in the gel chambers had a different order of ranking for root length to the soil-grown plants. Analysis of angles in soil-grown plants showed that Tadmore had the most even spread of individual roots and Chime had a propensity for non-uniform distribution and root clumping. The roots of Mehola were less well spread than the barley cultivars supporting the suggestion that wild and landrace barleys tend to have a narrower angular spread than modern cultivars. The three dimensional analysis of root systems carried out in this study provides insights into the limitations of screening methods for root traits and useful data for modelling root architecture.

Effects of metal pollution on soil macroinvertebrate burrow systems

A reduction in the numbers of macroinvertebrates present in soil may have a negative effect on soil structure, infiltration rates, and gas exchanges. Soil pollution by metal is known to have a detrimental effect on soil macrofauna. The aim of the present study was to evaluate (1) direct and indirect effects of soil pollution on soil macroinvertebrate bioturbation and (2) effects of the two macroinvertebrate communities found in a polluted and a nonpolluted area (one supposed sensitive, the other tolerant to metals) on burrow systems parameters. Macroinvertebrate porosity was studied using X-ray tomography. Three-dimensional reconstructions and characterisation of the burrow system were obtained using image analysis. Results showed that metal pollution principally affected the spatial distribution of macropores (more macropores were found near the soil surface) and the shape of the burrow system (branching rate was higher in the polluted soil), whereas soil macroinvertebrate composition principally affects burrow density parameters (the number of burrows was higher for the sensitive macroinvertebrate community).