Pre‐Clinical Testing of Microwave Radiometer and a Pilot Study on the Screening Inflammation of Knee Joints

This article presents the pre‐clinical evaluation of our custom‐built, single‐band microwave radiometer centered at 1.3 GHz for deep tissue thermometry, and a pilot study on volunteers for passive detection of inflammation in knee joints. The electromagnetic (EM) compatibility of the battery‐operated radiometer for clinical use was assessed as per International Special Committee on Radio Interference (CISPR) 22 standard. The ability to detect inflammation in knee joints was assessed using a substrate integrated waveguide antenna connected to the radiometer. EM compatibility tests carried out in the laboratory indicated device immunity to intentional radiated interference up to ?20 dBm injected power in the global system for mobile communication frequency band, and pre‐compliance to CISPR 22 standard. Radiometer temperature measurements recorded at the lateral and medial aspects of both knees of 41 volunteers indicated mean temperature greater than 33°C for the diseased sites compared with the mean temperature of 28°C measured for the healthy sites. One‐way analysis of variance statistics indicated significantly (P < 0.005) higher radiometer temperature at the diseased sites unlike the healthy sites. Thus, the EM pre‐compliance of the device and the potential to measure deep tissue inflammation were demonstrated. Bioelectromagnetics. 2019;40:402–411. © 2019 Bioelectromagnetics Society.     

Image based weighted center of proximity versus directly measured knee contact location during simulated gait

To understand the mechanical consequences of knee injury requires a detailed analysis of the effect of that injury on joint contact mechanics during activities of daily living. Three-dimensional (3D) knee joint geometric models have been combined with knee joint kinematics to dynamically estimate the location of joint contact during physiological activities—using a weighted center of proximity (WCoP) method. However, the relationship between the estimated WCoP and the actual location of contact has not been defined. The objective of this study was to assess the relationship between knee joint contact location as estimated using the image-based WCoP method, and a directly measured weighted center of contact (WCoC) method during simulated walking. To achieve this goal, we created knee specific models of six human cadaveric knees from magnetic resonance imaging. All knees were then subjected to physiological loads on a knee simulator intended to mimic gait. Knee joint motion was captured using a motion capture system. Knee joint contact stresses were synchronously recorded using a thin electronic sensor throughout gait, and used to compute WCoC for the medial and lateral plateaus of each knee. WCoP was calculated by combining knee kinematics with the MRI-based knee specific model. Both metrics were compared throughout gait using linear regression. The anteroposterior (AP) location of WCoP was significantly correlated with that of WCoC on both tibial plateaus in all specimens (p<0.01, 95% confidence interval of Pearson?s coefficient r>0), but the correlation was not significant in the mediolateral (ML) direction for 4/6 knees (p>0.05). Our study demonstrates that while the location of joint contact obtained from 3D knee joint contact model, using the WCoP method, is significantly correlated with the location of actual contact stresses in the AP direction, that relationship is less certain in the ML direction.     

The effect of patient positioning on the precision of model-based radiostereometric analysis

A repeatable method for in vivo and in vitro measurement of polyethylene wear in total knee replacement (TKA) is needed. This research examines the model-based radiostereometric analysis’ (MBRSA) in vitro precision under different patient-radiograph orientations and flexion angles of the knee using a TKA phantom. Anterior–posterior and medial–lateral imaging orientations showed the highest precision; better than 0.036 mm (3-dimensional translation) and 0.089° (3-dimensional rotation). Flexion of the knee did not affect MBRSA precision. Medial–lateral imaging is advantageous as it allows for flexion of the knee joint during an RSA examination, thus providing greater information for wear measurement.     

An augmented Lagrangian finite element formulation for 3D contact of biphasic tissues

Biphasic contact analysis is essential to obtain a complete understanding of soft tissue biomechanics, and the importance of physiological structure on the joint biomechanics has long been recognised; however, up to date, there are no successful developments of biphasic finite element contact analysis for three-dimensional (3D) geometries of physiological joints. The aim of this study was to develop a finite element formulation for biphasic contact of 3D physiological joints. The augmented Lagrangian method was used to enforce the continuity of contact traction and fluid pressure across the contact interface. The biphasic contact method was implemented in the commercial software COMSOL Multiphysics 4.2^® (COMSOL, Inc., Burlington, MA). The accuracy of the implementation was verified using 3D biphasic contact problems, including indentation with a flat-ended indenter and contact of glenohumeral cartilage layers. The ability of the method to model multibody biphasic contact of physiological joints was proved by a 3D knee model. The 3D biphasic finite element contact method developed in this study can be used to study the biphasic behaviours of the physiological joints.     

Biomechanical behaviour of ankle ligaments: constitutive formulation and numerical modelling

This study was aimed at the definition of a constitutive formulation of ankle ligaments and of a procedure for the constitutive parameters evaluation, for the biomechanical analysis by means of numerical models. To interpret the typical features of ligaments mechanical response, as anisotropic configuration, geometric non-linearity, non-linear elasticity and time-dependent behaviour, a specific fibre-reinforced visco-hyperelastic model is provided. The identification of constitutive parameters is performed by a stochastic–deterministic procedure that minimises the discrepancy between experimental and computational results. A preliminary evaluation of parameters is performed by analytical models in order to define reference values. Afterwards, solid models are developed to consider the complex histo-morphometric configuration of samples as a basis for the definition of numerical models. The results obtained are adopted for upgrading parameter values by comparison with specific mechanical tests. Assuming the new parameters set, the final numerical results are compared with the overall set of experimental data, to assess the reliability and efficacy of the analysis developed for the interpretation of the mechanical response of ankle ligaments.     

Multi-body optimization with subject-specific knee models: performance at high knee flexion angles

When estimating knee kinematics from skin markers and stereophotogrammetry, multi-body optimization (MBO) has provided promising results for reducing soft tissue artefacts (STA), but can still be improved. The goal of this study was to assess the performance of MBO with subject-specific knee models at high knee flexion angles (up to 110°) against knee joint kinematics measured by magnetic resonance imaging. Eight subjects were recruited. MBO with subject-specific knee models was more effective in compensating STA compared to no kinematic and spherical constraints, in particular for joint displacements. Moreover, it seems to be more reliable over large ranges of knee flexion angle. The ranges of root mean square errors for knee rotations/displacements were 3.0°–9.2°/1.3–3.5 mm for subject-specific knee models, 6.8°–8.7°/6.0–12.4 mm without kinematic constraint and 7.1°–9.8°/4.9–12.5 mm for spherical constraints.     

Application of a semi-automatic cartilage segmentation method for biomechanical modeling of the knee joint

Manual segmentation of articular cartilage from knee joint 3D magnetic resonance images (MRI) is a time consuming and laborious task. Thus, automatic methods are needed for faster and reproducible segmentations. In the present study, we developed a semi-automatic segmentation method based on radial intensity profiles to generate 3D geometries of knee joint cartilage which were then used in computational biomechanical models of the knee joint. Six healthy volunteers were imaged with a 3T MRI device and their knee cartilages were segmented both manually and semi-automatically. The values of cartilage thicknesses and volumes produced by these two methods were compared. Furthermore, the influences of possible geometrical differences on cartilage stresses and strains in the knee were evaluated with finite element modeling. The semi-automatic segmentation and 3D geometry construction of one knee joint (menisci, femoral and tibial cartilages) was approximately two times faster than with manual segmentation. Differences in cartilage thicknesses, volumes, contact pressures, stresses, and strains between segmentation methods in femoral and tibial cartilage were mostly insignificant (p > 0.05) and random, i.e. there were no systematic differences between the methods. In conclusion, the devised semi-automatic segmentation method is a quick and accurate way to determine cartilage geometries; it may become a valuable tool for biomechanical modeling applications with large patient groups.     

高水位条件下池杉根系的生态适应机制和膝根的呼吸特性

  池杉(Taxodium ascendens)属于典型的耐水树种, 掌握其根系对淹水环境的生态适应机制对于研究林木耐水机理十分重要。通过对江苏省里下河低湿地17年生池杉在高水位(6～10月淹水, 全年平均地下水位-5 cm)、中水位(8～9月淹水, 全年平均地下水位-18 cm)和低水位(常年不淹水, 全年平均地下水位-41 cm)条件下的根系进行调查, 结果表明, 池杉在高水位条件下形成细长的气生根, 气生根依附于树干北侧或潜伏于树干外表皮内侧和纵裂的树皮缝隙中; 中水位池杉能形成直径(7.9±2.2) cm、高(7.7±2.7) cm的膝根, 每株立木拥有膝根数(5.8±1.7)个; 低水位池杉也能形成膝根, 但个体小、数量少。林木地下和地上生物量均呈现出明显的高水位<中水位<低水位的趋势, 但是地下/地上生物量的比值却呈相反趋势, 表明池杉耐水性虽然很强, 长期处于较高水位时生长会明显受抑, 尤其是地上生物量生长受抑更显著。高、中和低水位池杉的地径/胸径之比分别是2.66±0.11、2.08±0.10和1.75±0.08, 说明水位较高的环境能促进树干基部的相对粗生长。长期淹水导致地下根的容重降低, 但是气生根和膝根的容重却明显大于地下根。高、中水位池杉细根的Fe和Mn浓度显著高于低水位, 其中Fe的浓度相差10倍以上, 但是叶的Fe、Mn浓度在不同水位之间没有显著差异。膝根的呼吸具有明显的季节差异, 8月和9月平均每个膝根的呼吸速率为2.1～2.5 mgCO₂&#8226;h^–1, 6月和11月为0.7～0.9 mgCO₂&#8226;h^–1, 3月为0.4 mgCO₂&#8226;h^–1; 膝根吸收O₂的摩尔数是释放CO₂摩尔数的4.6倍, 说明膝根吸收的O₂除了供自身呼吸, 大部分是提供给地下根利用。池杉之所以具有较强的耐水性, 与其在缺氧环境中能形成气生根和膝根、树干基部膨大和根系容重降低等有利于改善根系通气条件的生态适应机制密切相关。     

Perioperative Opioid Counseling Reduces Opioid Use Following Primary Total Joint Arthroplasty

BackgroundPreoperative counseling may reduce postoperative opioid requirements; however, there is a paucity of randomized controlled trials (RCTs) demonstrating efficacy. The purpose of this study was to perform an interventional, telehealth-based RCT evaluating the effect of peri-operative counseling on quantity and duration of opioid consumption following primary total joint arthroplasty (TJA).MethodsParticipants were randomized into three groups: 1. Control group, no perioperative counseling; 2. Intervention group, preoperative educational video; 3. Intervention group, preoperative educational video and postoperative acceptance and commitment therapy (ACT). Opioid consumption was evaluated daily for 14 days and at 6 weeks postoperatively. Best-case and worse-case intention to treat analyses were performed to account for non-responses. Bonferroni corrections were applied.Results183 participants were analyzed (63 in Group 1, 55 in Group 2, and 65 in Group 3). At 2 weeks postoperatively, there was no difference in opioid consumption between Groups 1, 2, and 3 (p>0.05 for all). At 6 weeks postoperatively, Groups 2 and 3 had consumed significantly less opioids than Group 1 (p=0.04, p<0.001) (