Three-Dimensional Segmentation of Equine Paranasal Sinuses in Multidetector Computed Tomography Datasets: Preliminary Morphometric Assessment Assisted with Clustering Analysis.

The paranasal sinuses, a bilaterally symmetrical system of eight air-filled cavities, represent one of the most complex parts of the equine body. This study aimed to extract morphometric measures from computed tomography (CT) images of the equine head and to implement a clustering analysis for the computer-aided identification of age-related variations. Heads of 18 cadaver horses, aged 2-25 years, were CT-imaged and segmented to extract their volume, surface area, and relative density from the frontal sinus (FS), dorsal conchal sinus (DCS), ventral conchal sinus (VCS), rostral maxillary sinus (RMS), caudal maxillary sinus (CMS), sphenoid sinus (SS), palatine sinus (PS), and middle conchal sinus (MCS). Data were grouped into young, middle-aged, and old horse groups and clustered using the K-means clustering algorithm. Morphometric measurements varied according to the sinus position and age of the horses but not the body side. The volume and surface area of the VCS, RMS, and CMS increased with the age of the horses. With accuracy values of 0.72 for RMS, 0.67 for CMS, and 0.31 for VCS, the possibility of the age-related clustering of CT-based 3D images of equine paranasal sinuses was confirmed for RMS and CMS but disproved for VCS.

Study of foot support during gait in healthy children from neighbouring countries.

BACKGROUND: Healthy children's gait support patterns play a critical role in their development and overall well-being. Therefore, in order to develop a correct gait, it is necessary to constantly update knowledge. OBJECTIVE: To identify differences in gait support among children in neighbouring countries. METHODS: 44 healthy children from Poland and Lithuania (4-11 years old) participated in the study. The spatiotemporal and plantar pressure parameters of 88 neutrally aligned feet were analysed and compared. RESULTS: Statistically significant differences between stance, single-limb support, double support, swing duration, cadence, and velocity, max. force and pressure in the forefoot, as well as in the times of occurrence of max. forces in all three zones. Defined that age is related (p< 0.05) to cadence (R= 0.32), swing phase (R= 0.53), max. force under the midfoot (R= 0.35) and the heel (R= 0.47), max. pressure under the forefoot (R=-0.52), midfoot (R=-0.63) and heel (R=-0.47). CONCLUSION: The results can help caregivers, as well as clinicians and researchers, understand how gait mechanics change with development and the growth course of the children of that country. Also, the results are important for the analysis and comparison of children's gait, as control reference data from the same country.

Three-Dimensional Segmentation Assisted with Clustering Analysis for Surface and Volume Measurements of Equine Incisor in Multidetector Computed Tomography Data Sets.

Dental diagnostic imaging has progressed towards the use of advanced technologies such as 3D image processing. Since multidetector computed tomography (CT) is widely available in equine clinics, CT-based anatomical 3D models, segmentations, and measurements have become clinically applicable. This study aimed to use a 3D segmentation of CT images and volumetric measurements to investigate differences in the surface area and volume of equine incisors. The 3D Slicer was used to segment single incisors of 50 horses' heads and to extract volumetric features. Axial vertical symmetry, but not horizontal, of the incisors was evidenced. The surface area and volume differed significantly between temporary and permanent incisors, allowing for easy eruption-related clustering of the CT-based 3D images with an accuracy of >0.75. The volumetric features differed partially between center, intermediate, and corner incisors, allowing for moderate location-related clustering with an accuracy of >0.69. The volumetric features of mandibular incisors' equine odontoclastic tooth resorption and hypercementosis (EOTRH) degrees were more than those for maxillary incisors; thus, the accuracy of EOTRH degree-related clustering was >0.72 for the mandibula and >0.33 for the maxilla. The CT-based 3D images of equine incisors can be successfully segmented using the routinely achieved multidetector CT data sets and the proposed data-processing approaches.

What Influences Proprioceptive Impairments in Patients with Rheumatic Diseases? Analysis of Different Factors.

Rheumatic diseases lead to postural problems, which increase the risk of falls and lead to greater disability. The aim of the present work is to evaluate posture disorders in patients with osteoarthritis (OA) and rheumatoid arthritis (RA), as well as to evaluate the influence of other factors. A total of 71 subjects were enrolled in this study. Joint position sense (JPS) and the functional assessment of proprioception on a balance platform for both lower limbs were examined. The Average Trace Error (ATE), test time (t), and Average Platform Force Variation (AFV) were calculated. Additionally, an equilibrium test was carried out in the one-legged standing position (Single Leg Stance-SLS). The results were compared in several ways and revealed the following: (1) A JPS of 10° plantar flexion in RA obtained significantly worse results when repeating the movement than OA; the ATEs were significantly lower in RA; and RA needed more support during SLS assessment. (2) RA patients with higher DAS28 had statistically significantly higher values in JPS, with 5° plantar flexion and 10° dorsal flexion, SLS assessment, and stabilometric rates. A statistically significant correlation between DAS28 and RA was found in a JPS of 10° plantar flexion. The VAS ruler demonstrated a significant moderate correlation with t. (3) Patients who experienced at least one fall demonstrated higher JPS and t. Our study shows that proprioception is the most influenced by the nature of the disease and the level of disease activity. We can see that the stability and balance functions are also greatly influenced by the patient's falling experience and the level of pain. These findings may be useful in designing an optimal proprioception-enhancing movement training plan.

A computational method to differentiate rheumatoid arthritis patients using thermography data.

BACKGROUND: The traditional rheumatoid arthritis (RA) diagnosis is very complicated because it uses many clinical and image data. Therefore, there is a need to develop a new method for diagnosing RA using a consolidated set of blood analysis and thermography data. OBJECTIVE: The following issues related to RA are discussed: 1) Which clinical data are significant in the primary diagnosis of RA? 2) What parameters from thermograms should be used to differentiate patients with RA from the healthy? 3) Can artificial neural networks (ANN) differentiate patients with RA from the healthy? METHODS: The dataset was composed of clinical and thermal data from 65 randomly selected patients with RA and 104 healthy subjects. Firstly, the univariate logistic regression model was proposed in order to find significant predictors. Next, the feedforward neural network model was used. The dataset was divided into the training set (75% of data) and the test set (25% of data). The Broyden-Fletcher-Goldfarb-Shanno (BFGS) and non-linear logistic function to transformation nodes in the output layer were used for training. Finally, the 10 fold Cross-Validation was used to assess the predictive performance of the ANN model and to judge how it performs. RESULT: The training set consisted of the temperature of all fingers, patient age, BMI, erythrocyte sedimentation rate, C-reactive protein and White Blood Cells (10 parameters in total). High level of sensitivity and specificity was obtained at 81.25% and 100%, respectively. The accuracy was 92.86%. CONCLUSIONS: This methodology suggests that the thermography data can be considered in addition to the currently available tools for screening, diagnosis, monitoring of disease progression.

An effect of spinal and ankle-foot orthoses on gait of spastic diplegic child: A case report.

BACKGROUND: In children with spastic cerebral palsy (CP), the most common motor dysfunction is pathological gait. OBJECTIVE: To evaluate the effectiveness of measures for an individual CP case. METHODS: The case of one spastic diplegia child has been analyzed. Both lower extremities and spine were examined under three gait conditions: 1) barefoot, 2) with ankle-foot orthoses (AFOs) and thoracolumbosacral spinal orthosis (TLSO), and 3) with TLSO only. Spatiotemporal gait and kinematic parameters of the pelvic, hip, knee, ankle joints, and spine were obtained using Vicon Plug-in-Gait model. The difference (Δ) between the measured values and normative ranges was calculated to determine the efficiency of the orthoses. RESULTS: Significant differences were found in kinematic and spatiotemporal parameters comparing results between conditions and body sides. The effectiveness of the measures was confirmed by the smallest Δ values in the double and single support time with the AFOs/TLSO and in the stride and stance time with TLSO. CONCLUSIONS: Based on the study results, the best stability of the spine, ankle plantarflexion, and knee hyperextension is achieved with the AFOs/TLSO; therefore, this combination of measures was considered the most effective. However, not only quantitative parameters should be taken into account, but also the child's willingness and comfort.

Quantitative parameters of gait imbalance in multiple sclerosis patients.

PURPOSE: The purpose is to identify objective quantitative parameters for a more accurate evaluation of gait imbalance and relate it to Body Mass Index and age. METHODS: 25 multiple sclerosis (MS) and 30 healthy people (CG) aged between 22 and 66 years old (50.4 ± 9.5) were examined in static and dynamic tasks. The demographic data were as follows: body mass (72.4 ± 18.4 kg in CG vs. 66.8 ± 11.5 kg in MS); body height (1.78 ± 0.15 m in CG vs. 1.70 ± 0.11 m in MS); BMI (24.7 ± 4.5 kg/m2 in CG vs. 23.5 ± 3.0 kg/m2 in MS). First, all individuals remained static for baropodometric, pulse and saturation evaluation. Later on, a 6-minute walk and timed up and go tests were performed and additionally included quantitative measurements by barometry and pulse oximeter. RESULTS: The dynamic condition revealed meaningful differences in the foot surface and hindfoot loading, in addition to foot max. loading between study groups. TUG disclosed significantly different results between groups in time and the number of steps. For MS in statics, the moderate positive correlations between BMI and the right forefoot and right hindfoot, and in MS statics, the correlation of the age vs. maximal left foot loading, forefoot loading and hindfoot loading was observed. In the dynamic, the age and plantar angle of the foot had weak relation. CONCLUSIONS: Quantitative parameters defining balance deviations of MS are related to BMI and age in statics and dynamics, therefore should be taken into account during MS imbalance assessment.

EMG Based Analysis of Gait Symmetry in Healthy Children.

The purpose of this study was to examine the changes in muscular activity between the left and right lower legs during gait in healthy children throughout temporal parameters of EMG and symmetry index (SI). A total of 17 healthy children (age: 8.06 ± 1.92 years) participated in this study. Five muscles on both legs were examined via the Vicon 8-camera motion analysis system synchronized with a Trigno EMG Wireless system and a Bertec force plate; onset-offset intervals were analyzed. The highest occurrence frequency of the primary activation modality was found in the stance phase. In the swing phase, onset-offset showed only a few meaningful signs of side asymmetry. The knee flexors demonstrated significant differences between the sides (p < 0.05) in terms of onset-offset intervals: biceps femoris in stance, single support, and pre-swing phases, with SI values = -6.45%, -14.29%, and -17.14%, respectively; semitendinosus in single support phase, with SI = -12.90%; lateral gastrocnemius in swing phase, with SI = -13.33%; and medial gastrocnemius in stance and single support phases, with SI = -13.33% and -23.53%, respectively. The study outcomes supply information about intra-subject variability, which is very important in follow-up examinations and comparison with other target groups of children.

Mechanisms of Gait Adaptation in Overweight Pregnant Women.

BACKGROUND: Pregnancy is a period when a woman's body undergoes changes. The purpose of this study was to analyze the mechanisms of gait adaptation in overweight pregnant women regarding spatiotemporal gait parameters, ground reaction forces, and plantar pressure distribution. METHODS: The tests were performed in 29 normal-weight pregnant women and 26 pregnant women who were overweight before pregnancy. The measurements included spatiotemporal gait parameters, in-shoe plantar pressure distribution, and ground reaction forces during gestation. RESULTS: The results indicate that both normal-weight and overweight pregnant women make use of the same spatiotemporal gait parameters to increase body stability and safety of movement during pregnancy. The double-step duration in the third trimester of pregnancy was higher in normal-weight and overweight pregnant women compared with in the first trimester (P < .05). A significant change in pressure amplitude was found under all anatomical parts of the foot in the third trimester (P < .05). The results also suggest a higher increase in the maximum amplitude of force in overweight pregnant women in the third trimester compared with the normal-weight group. CONCLUSIONS: This study suggests that both normal-weight and overweight pregnant women use different mechanisms of gait adaptation during pregnancy. In practice, understanding the biomechanical changes in women's gait can protect the musculoskeletal system during gestation.

Nanomechanical Properties of Articular Cartilage Due to the PRP Injection in Experimental Osteoarthritis in Rabbits.

The purpose of this study was twofold. Firstly, we proposed a measurement protocol for the atomic force microscopy (AFM) method to determine the nanomechanical properties of articular cartilage in experimental osteoarthritis in rabbits. Then, we verified if mechanical properties can be evaluated with AFM shortly after platelet-rich plasma (PRP) injection. We hypothesized that the modulus determined by AFM indentation experiments could be utilized as a progressive disease marker during the treatment of osteoarthritis. The rabbits were equally divided into three groups of six: control (group 1); injections of saline (0.5 mL) and 10% surgical talc (Talcum Pharmaceutical®, Minsk, Belarus) were delivered into the right knee under the patella (group 2 and 3); and PRP was injected into the right knee (group 3). In group 2, the arithmetic average of absolute values (Ra) change was a 25% increase; the maximum peak height (Rp) increased by over 102%, while the mean spacing between local peaks (S) increased by 28% (p < 0.05). In group 3, Ra increased by 14% and Rp increased by 32%, while S decreased by 75% (p < 0.05). The Young's modulus of the surface layers decreased by 18% as a result of induced model of osteoarthritis (IMO) (p < 0.05), and it increased by 9% (p < 0.05) as a result of PRP therapy, which means that the mechanical properties of cartilage were partially recovered. This research demonstrates that Young's modulus utilized on a nanometer scale has potential to be a progressive disease marker during the treatment of osteoarthritis.

A portable plantar pressure system: Specifications, design, and preliminary results.

BACKGROUND: In recent years, there has been an increasing interest in developing in-shoe foot plantar pressure systems. Although such devices are not novel, devising insole devices for gait analysis is still an important issue. OBJECTIVE: The goal of this study is to develop a new portable system for plantar pressure distribution measurement based on a three-axis accelerometer. METHODS: The portable system includes: PJRC Teensy 3.6 microcontroller with 32-bit ARM Cortex-M4 microprocessor with a clock speed of 180 MHz; HC-11 radio modules (transmitter and receiver); a battery; a fixing band; pressure sensors; MPU-9150 inertial navigation module; and FFC tape. The pressure insole is leather-based and consists of seven layers. It is divided into 16 areas and the outcome of the system is data concerning plantar pressure distribution under foot during gait. The system was tested on 22 healthy volunteer subjects, and the data was compared with a commercially available system: Medilogic. RESULT: The SNR value for the proposed sensor is 28.27 dB. For a range of pressure of 30-100 N, the sensitivity is 0.0066 V/N while the linearity error is 0.05. The difference in plantar pressure from both the portable plantar pressure system and Medilogic is not statistically significant. CONCLUSION: The proposed system could be recommended for research applications both inside and outside of a typical gait laboratory.

AFM-Based Method for Measurement of Normal and Osteoarthritic Human Articular Cartilage Surface Roughness.

In osteoarthrosis, pathological features of articular cartilage are associated with degeneration and nanomechanical changes. The aim of this paper is to show that indentation-atomic force microscopy can monitor wear-related biomechanical changes in the hip joint of patients with osteoarthritis. Fifty patients (N = 50), aged 40 to 65, were included in the study. The mechanical properties and the submicron surface morphology of hyaline cartilage were investigated using atomic force microscopy. Measurements of the roughness parameters of cartilage surfaces were performed, including the arithmetic average of absolute values (Ra), the maximum peak height (Rp), and the mean spacing between local peaks (S). The arithmetic mean of the absolute values of the height of healthy cartilage was 86 nm, while wear began at Ra = 73 nm. The maximum changes of values of the roughness parameters differed from the healthy ones by 71%, 80%, and 51% for Ra, Rp, and S, respectively. Young's modulus for healthy cartilage surfaces ranged from 1.7 to 0.5 MPa. For the three stages of cartilage wear, Young's modulus increased, and then it approached the maximum value and decreased. AFM seems to be a powerful tool for surface analysis of biological samples as it enables indentation measurements in addition to imaging.

Infrared Thermography Sensor for Disease Activity Detection in Rheumatoid Arthritis Patients.

A recent review of thermography studies in rheumatoid arthritis shows limited data about disease activity and mostly focuses on differences between the thermography of rheumatoid arthritis patients and typical subjects. A retrospective study compared patients with high disease activity (n = 50), moderate disease activity (n = 16), and healthy participants (n = 42), taking into account demographic, clinical, laboratory, and thermography parameters. We applied an infrared thermography sensor and a fingers examination protocol. Outcomes included the mean temperature of five fingers of a hand: In static, post-cooling, post-rewarming, the total change in mean temperature of fingers due to cold provocation, the total change in mean temperature of fingers due to rewarming, the area under the cooling curve, the area under the heating curve, the difference between the area under the rewarming and the cooling curve, and temperature intensity distribution maps. For patients with high disease activity, a lower area under the heating curve and a lower difference between the area under the rewarming curve and the cooling curve were observed, as well as a smaller total change in mean temperature due to rewarming, compared to patients with moderate disease activity (p < 0.05). Our study findings could be helpful in patients with an equivocal clinical examination.

Correction of Planovalgus Deformity Through Rotational Reinsertion of the Lateral Layers of the Achilles Tendons in Ambulatory Children With Cerebral Palsy.

Symptomatic planovalgus deformity is a condition commonly seen in patients with cerebral palsy. The authors propose a new procedure for the management of this deformity through rotational reinsertion of the lateral layers of the Achilles tendon, and then they assess its benefit by comparing plantar pressure distribution patterns in children preoperatively and at 6- and 12-month intervals postoperatively. Pedobarographic measurements, range of motion of the ankle, and radiographic indexes were used to assess the outcome of the surgery. The functional abilities of the patients were assessed based on the Gross Motor Function Classification System. A total of 37 feet (22 patients) were included, with a mean ± standard deviation age at surgery of 11.8 ± 2.7 (range 9.1 to 14.5) years. All feet were managed through rotational reinsertion of the lateral layers of the Achilles tendon. Surgical correction of planovalgus has good outcomes. Significant changes were observed with statistical significance at the 5% (p ≤ .05) level in plantar pressure distribution in children preoperatively and at 6- and 12-month intervals postoperatively. The results show that the proposed method of surgery is effective in the correction of planovalgus in ambulatory children with cerebral palsy.

Estimation of ground reaction forces and joint moments on the basis on plantar pressure insoles and wearable sensors for joint angle measurement.

BACKGROUND: Gait analysis is a useful tool medical staff use to support clinical decision making. There is still an urgent need to develop low-cost and unobtrusive mobile health monitoring systems. OBJECTIVE: The goal of this study was twofold. Firstly, a wearable sensor system composed of plantar pressure insoles and wearable sensors for joint angle measurement was developed. Secondly, the accuracy of the system in the measurement of ground reaction forces and joint moments was examined. METHODS: The measurements included joint angles and plantar pressure distribution. To validate the wearable sensor system and examine the effectiveness of the proposed method for gait analysis, an experimental study on ten volunteer subjects was conducted. The accuracy of measurement of ground reaction forces and joint moments was validated against the results obtained from a reference motion capture system. RESULTS: Ground reaction forces and joint moments measured by the wearable sensor system showed a root mean square error of 1% for min. GRF and 27.3% for knee extension moment. The correlation coefficient was over 0.9, in comparison with the stationary motion capture system. CONCLUSIONS: The study suggests that the wearable sensor system could be recommended both for research and clinical applications outside a typical gait laboratory.

Quantitative assessment of upper extremities motor function in multiple sclerosis.

BACKGROUND: Upper extremity (UE) motor function deficits are commonly noted in multiple sclerosis (MS) patients and assessing it is challenging because of the lack of consensus regarding its definition. Instrumented biomechanical analysis of upper extremity movements can quantify coordination with different spatiotemporal measures and facilitate disability rating in MS patients. OBJECTIVE: To identify objective quantitative parameters for more accurate evaluation of UE disability and relate it to existing clinical scores. METHODS: Thirty-four MS patients and 24 healthy controls (CG) performed a finger-to-nose test as fast as possible and, in addition, clinical evaluation kinematic parameters of UE were measured by using inertial sensors. RESULTS: Generally, a higher disability score was associated with an increase of several temporal parameters, like slower task performance. The time taken to touch their nose was longer when the task was fulfilled with eyes closed. Time to peak angular velocity significantly changed in MS patients (EDSS > 5.0). The inter-joint coordination significantly decreases in MS patients (EDSS 3.0-5.5). Spatial parameters indicated that maximal ROM changes were in elbow flexion. CONCLUSIONS: Our findings have revealed that spatiotemporal parameters are related to the UE motor function and MS disability level. Moreover, they facilitate clinical rating by supporting clinical decisions with quantitative data.

The impact of body mass on spine alterations in pregnant women: A preliminary study.

BACKGROUND: Weight gain is the most significant change during pregnancy. The lack of consensus among scientists as far as significant spine alterations are concerned requires basic knowledge to be increased. OBJECTIVE: The aim of the paper is to determine changes in spine parameters occurring during pregnancy accompanying the increasing body gain. METHODS: Twelve pregnant women were included in this study. Winspine Pointer, a three-dimensional motion analysis system, was applied for the tests. The output measurements were: pelvic torsion, pelvic obliquity, pelvic/shoulder obliquity, thoracic kyphosis angle, lumbar lordosis angle, and sacral angle. The correlation between the BMI index and the spine parameters was investigated using Spearman's correlation coefficient. RESULTS: Differences between women in the 2nd and 3rd trimester of pregnancy were found for thoracic kyphosis angle and lumbar lordosis angle (P< 0.05). A statistically significant relationship was revealed between the BMI and the thoracic kyphosis in the 3rd trimester of pregnancy (R = 0.50, p= 0.005). With the increase of the BMI, the measured parameter also increased. CONCLUSIONS: Understanding the changes in spine parameters during pregnancy is important as far as prevention and treatment are concerned.

Novel techniques for a wireless motion capture system for the monitoring and rehabilitation of disabled persons for application in smart buildings.

BACKGROUND: Due to the problem of aging societies, there is a need for smart buildings to monitor and support people with various disabilities, including rheumatoid arthritis. OBJECTIVE: The aim of this paper is to elaborate on novel techniques for wireless motion capture systems for the monitoring and rehabilitation of disabled people for application in smart buildings. METHODS: The proposed techniques are based on cross-verification of distance measurements between markers and transponders in an environment with highly variable parameters. To their verification, algorithms that enable comprehensive investigation of a system with different numbers of transponders and varying ambient parameters (temperature and noise) were developed. In the estimation of the real positions of markers, various linear and nonlinear filters were used. Several thousand tests were carried out for various system parameters and different marker locations. RESULTS: The results show that localization error may be reduced by as much as 90%. It was observed that repetition of measurements reduces localization error by as much as one order of magnitude. CONCLUSIONS: The proposed system, based on wireless techniques, offers a high commercial potential. However, it requires extensive cooperation between teams, including hardware and software design, system modelling, and architectural design.

Research of the spatial-temporal gait parameters and pressure characteristic in spastic diplegia children.

PURPOSE: Spastic diplegia is the most common form of cerebral palsy. It presents with symmetric involvement of the lower limbs and upper limbs. Children with spastic diplegia frequently experience problems with motor control, spasticity, and balance which lead to gait abnormalities. The aim of this study is twofold. Firstly, to determine the differences in spatial-temporal gait parameters and magnitude of plantar pressure distribution between children with spastic diplegia (CP) and typical children. Secondly, to compare and evaluate main changes of plantar pressure and spatial-temporal gait parameters instead of data between spastic diplegia children with prescribed ankle - solid foot orthosis (AFOs) and without using AFOs. METHODS: The evaluation was carried out on 20 spastic diplegia children and 10 agematched children as a control group aged 6-15 years. Twenty children with spastic diplegia CP were divided into two groups: ten subjects with prescribed AFOs and ten subjects without use of assistive device. Patients used the AFOs orthosis for one year. Measurements included in-shoe plantar pressure distribution and spatial-temporal gait parameters. RESULTS: Spatial-temporal gait parameters showed meaningful difference between study groups in velocity, stride length, step length and cadence ( p < 0.05). However no significant differences between patients with and without AFOs were found ( p > 0.05). Significant differences between typical and spastic diplegia children with AFOs were observed in the magnitude of plantar pressure under the toes, the metatarsal heads, the medial arch, and the heel ( p < 0.05). For typical subjects, the highest pressure amplitudes were found under the heel and the metatarsal heads, while the lowest pressure distribution was under the medial arch. In CP patients the lateral arch was strongly unloaded. The peak pressure under heel was shifted inside. CONCLUSIONS: Collected data and calculated scores present a state of the gait in test groups, showed the difference and could be valuable for physicians in decision making by choosing qualitative therapy. Furthermore, it allows predicting probability of further possible changes in gait of spastic diplegia patients with AFOs and without it. In conclusion, our current results showed that the use of AFOs, prescribed on a clinical basis by doctors improves gait patterns and gait stability in children with spastic cerebral palsy.