[Results from the German shoulder- and elbow arthroplasty register (SEPR) : Anatomic or reverse shoulder arthroplasty in B2-glenoids?] / Ergebnisse des deutschen Schulter- und Ellenbogenprothesenregisters (SEPR) : Anatomische oder inverse Prothese bei B2-Glenoid?

BACKGROUND: Anatomic shoulder arthroplasty in osteoarthritis with biconcave glenoid wear results in decreased functional results and a higher rate of early glenoid loosening. AIM: The aim of the data analysis of the German shoulder arthroplasty register was to clarify whether reverse shoulder arthroplasty can provide better functional results and a lower complication rate than anatomic arthroplasty in osteoarthritis with biconcave glenoid wear. METHODS: The analysis included 1052 completely documented primary implanted arthroplasties with a minimum follow-up of 2 years. In 119 cases, a B2-type glenoid was present. Out of these cases, 86 were treated with an anatomic shoulder arthroplasty, and in 33 cases a reverse shoulder arthroplasty was implanted. The mean follow-up was 47.6 months. RESULTS: The Constant score with its subcategories, as well as the active range of movement improved significantly after anatomic and after reverse shoulder arthroplasty. DISCUSSION: We observed no difference in functional results between both types of arthroplasty; however, reverse arthroplasty showed a significant higher revision rate (21.2%) (3% glenoid loosening, 6% prosthetic instability) than anatomic shoulder arthroplasty (12.8%) (11.6% glenoid loosening, 1.2% prosthetic instability), whereas anatomic shoulder arthroplasty showed a higher rate of glenoid loosening. Functional and radiographic results of both types of arthroplasty are comparable with the results reported in the literature, although our analysis represents results from an implant registry (data pertaining to medical care quality).

Combining Membrane Potential Imaging with Other Optical Techniques.

Membrane potential imaging using voltage-sensitive dyes can be combined with other optical techniques for a variety of applications. Combining voltage imaging with Ca2+ imaging allows correlating membrane potential changes with intracellular Ca2+ signals or with Ca2+ currents. Combining voltage imaging with uncaging techniques allows analyzing electrical signals elicited by photorelease of a particular molecule. This approach is also a useful tool to calibrate the change in fluorescence intensity in terms of membrane potential changes from different sites permitting spatial mapping of electrical activity. Finally, combining voltage imaging with optogenetics, in particular with channelrhodopsin stimulation, opens the gate to novel investigations of brain circuitries by allowing measurements of synaptic signals mediated by specific sets of neurons. Here we describe in detail the methods of membrane potential imaging in combination with other optical techniques and discus some important applications.

[Short stem shoulder prosthesis : concept and first results]. / Kurzschaftprothesen der Schulter : Konzept und erste Ergebnisse.

The trend in shoulder arthroplasty is moving away from long stemmed, cemented humeral components to cementless, stemless and metaphyseal fixed implants and to humeral resurfacing. The cementless short stem prosthesis presents a concept that combines the advantages of a bone-saving implantation with a straightforward revision option. Furthermore, the stem may serve as a carrier for a convertible anatomic and reversed modular system. The concept consists of a stabile proximal fixation of the prosthesis by compaction of metaphyseal cancellous bone. After 1 year follow-up the short stem prosthesis proved to be an implant with few complications and clinical results comparable to those of established prosthetic systems.

[Prostheses for fractures of the proximal humerus: presentation of current results of anatomical fracture shoulder prosthesis under consideration of alternative concepts]. / Prothetik bei proximalen Humerusfrakturen: Präsentation aktueller Ergebnisse der anatomischen Frakturschulterprothese unter Würdigung relevanter Alternativkonzepte.

BACKGROUND: The purpose of this present study was to review the functional and radiological results of patients with complex fractures of the proximal humerus who were treated with an anatomical shoulder prosthesis. PATIENTS AND METHODS: Between 1999 and 2005 a total of 61 patients were treated with an anatomical trauma prosthesis after an acute fracture. RESULTS: Thirty-eight patients (31 women and 7 men) with a mean age of 72 (range, 31-85) years could be followed-up. The absolute Constant score averaged 57.7 of 100 (range, 32-86) points by a mean of 86 (range, 60-129) months. Postoperative active elevation averaged 105 (range, 50-180)° and active abduction averaged 96 (50-180)°. Tuberosity resorption was found in 52% (20/38) at final follow-up. The outcome was significantly better in patients with healing of the tuberosities (p = 0.02). CONCLUSION: With the use of an anatomical trauma prosthesis the reduction of the pain level is excellent while the gain in function is only slight. The bony union of the tuberosities in an anatomical position is essential to achieve good results.

[Cementless humeral surface replacement arthroplasty in patients less than 55 years of age]. / Der zementfreie Oberflächenersatz des Humeruskopfes bei Patienten unter 55 Jahren.

BACKGROUND: Cementless humeral surface replacement arthroplasty is a viable treatment option for degenerative diseases of the shoulder joint. The aim of this prospective study was to analyse the results of this treatment option in patients younger than 55 years of age with different pathologies of the shoulder. PATIENTS AND METHODS: Twenty-three patients (26 implants) treated with cementless humeral surface replacement arthroplasty were included in this study. Mean follow-up was 2.5 years (1-6 years). Ten patients had posttraumatic osteoarthritis, seven had primary osteoarthritis, and six had osteonecrosis. Patients were evaluated using the Constant score, shoulder motion, and subjective satisfaction. RESULTS: The mean Constant score increased significantly from 33 points preoperatively (8-69 points) to 61 points postoperatively (25-83 points; p<0.0001), adjusted to age and gender from 38% (8-86%) to 70% (28-114%; p<0.0001). Significant improvement for the whole cohort was found regarding patients' pain, activity, mobility, shoulder flexion and abduction, and internal and external rotation (p<0.001). In one case, reoperation was necessary due to a superficial wound infection, and in another case, implant revision to a total shoulder replacement was performed because of glenoid erosion. CONCLUSION: Cementless humeral surface replacement arthroplasty is a viable bone-preserving treatment option for young and active patients. Later conversion to total shoulder replacement is possible. Good clinical results, a low complication rate, and high patient satisfaction were found in the short and mid term. Long-term investigations are necessary to confirm these observations.

Humeral head resurfacing for fixed anterior glenohumeral dislocation.

The purpose of this prospective study was to describe cementless humeral surface replacement arthroplasty (CHSRA) as a bone preserving treatment option for patients with fixed anterior glenohumeral dislocation. Ten patients with post-traumatic fixed anterior glenohumeral dislocation underwent CHSRA with a mean follow-up of 24 months. All patients were evaluated clinically using the Constant score and with radiographs in two planes. There were two reoperations: one patient developed glenoid erosion and was revised and in another case redislocation occurred. Clinical or radiographical signs of implant loosening were not found. The humeral head centred in the glenoid in nine out of ten cases radiographically. The Constant score increased from 20 points preoperatively to 61 points postoperatively (p < 0.007). CHSRA is a viable treatment option for elderly patients with fixed anterior glenohumeral dislocation and bone defects of the humeral head. Good clinical results and a moderate complication rate were found in the short term.

Total shoulder replacement in young and middle-aged patients with glenohumeral osteoarthritis.

Our aim in this prospective study was to evaluate the outcome of total shoulder replacement in the treatment of young and middle-aged active patients with primary glenohumeral osteoarthritis. We reviewed 21 patients (21 shoulders) with a mean age of 55 years (37 to 60). The mean follow-up was seven years (5 to 9). The same anatomical, third-generation, cemented implant had been used in all patients. All the patients were evaluated radiologically and clinically using the Constant and Murley score. No patients required revision. In one a tear of the supraspinatus tendon occurred. Overall, 20 patients (95%) were either very satisfied (n = 18) or satisfied (n = 2) with the outcome. Significant differences (p < 0.0001) were found for all categories of the Constant and Murley score pre- and post-operatively. The mean Constant and Murley score increased from 24.1 points (10 to 45) to 64.5 points (39 to 93), and the relative score from 30.4% (11% to 50%) to 83% (54% to 116%). No clinical or radiological signs of loosening of the implant were seen. For young and middle-aged patients with osteoarthritis, third-generation total shoulder replacement is a viable method of treatment with a low rate of complications and excellent results in the mid-term.

Mid-term results of anatomical total shoulder arthroplasty for primary osteoarthritis using a short-stemmed cementless humeral component.

Aims: The aim of this study was to evaluate the clinical and radiological outcome of using an anatomical short-stem shoulder prosthesis to treat primary osteoarthritis of the glenohumeral joint. Patients and Methods: A total of 66 patients (67 shoulders) with a mean age of 76 years (63 to 92) were available for clinical and radiological follow-up at two different timepoints (T1, mean 2.6 years, sd 0.5; T2, mean 5.3 years, sd 0.7). Postoperative radiographs were analyzed for stem angle, cortical contact, and filling ratio of the stem. Follow-up radiographs were analyzed for timing and location of bone adaptation (cortical bone narrowing, osteopenia, spot welds, and condensation lines). The bone adaptation was classified as low (between zero and three features of bone remodelling around the humeral stem) or high (four or more features). Results: The mean Constant score improved significantly from 28.5 (sd 11.6) preoperatively to 75.5 (sd 8.5) at T1 (p < 0.001) and remained stable over time (T2: 76.6, sd 10.2). No stem loosening was seen. High bone adaptation was present in 42% of shoulders at T1, with a slight decrease to 37% at T2. Cortical bone narrowing and osteopenia in the region of the calcar decreased from 76% to 66% between T1 and T2. Patients with high bone adaptation had a significantly higher mean filling ratio of the stem at the metaphysis (0.60, sd 0.05 vs 0.55, sd 0.06; p = 0.003) and at the diaphysis (0.65 sd 0.05 vs 0.60 sd 0.05; p = 0.007). Cortical contact of the stem was also associated with high bone adaptation (14/25 shoulders, p = 0.001). The clinical outcome was not influenced by the radiological changes. Conclusion: Total shoulder arthroplasty using a short-stem humeral component resulted in good clinical outcomes with no evidence of loosening. However, approximately 40% of the shoulders developed substantial bone loss in the proximal humerus at between four and seven years of follow-up. Cite this article: Bone Joint J 2018;100-B:603-9.

The medium- and long-term outcome of total shoulder arthroplasty for primary glenohumeral osteoarthritis in middle-aged patients.

AIMS: Promising medium-term results from total shoulder arthroplasty (TSA) have been reported for the treatment of primary osteoarthritis in young and middle-aged patients. The aim of this study was to evaluate the long-term functional and radiological outcome of TSA in the middle-aged patient. PATIENTS AND METHODS: The data of all patients from the previous medium-term study were available. At a mean follow-up of 13 years (8 to 17), we reviewed 21 patients (12 men, nine women, 21 shoulders) with a mean age of 55 years (37 to 60). The Constant-Murley score (CS) with its subgroups and subjective satisfaction were measured. Radiological signs of implant loosening were analysed. RESULTS: Two shoulders (two patients) were revised and in two shoulders of two different patients, revision surgery was recommended. The mean CS increased from 23.3 (10 to 45) pre-operatively to 56.5 (26 to 81; p < 0.0001), but with a decrease in CS from 62.8 (38 to 93) to 56.5 (26 to 81) between medium- and long-term follow-up (p = 0.01). Without revision surgery, 18 patients (95%) rated their result as good or very good. The mean radiolucent line score for the glenoid components increased from 1.8 (0 to 6) to 8.2 (2 to 18) between medium- and long-term follow-up (p < 0.001). CONCLUSION: TSA in young and middle-aged patients leads to improvement in clinical function and a relatively high satisfaction rate. However, clinical or radiological glenoid loosening worsens in the long term. Further studies are needed to optimise the treatment options in this patient population. Cite this article: Bone Joint J 2017;99-B:939-43.

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus.

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.

Discrimination of photon from proton irradiation using glow curve feature extraction and vector analysis.

Two types of thermoluminescence dosemeters (TLDs), the Harshaw LiF:Mg,Ti (TLD-100) and CaF(2):Tm (TLD-300) were investigated for their glow curve response to separate photon and proton irradiations. The TLDs were exposed to gamma irradiation from a (137)Cs source and proton irradiation using a positive ion accelerator. The glow curve peak structure for each individual TLD exposure was deconvolved to obtain peak height, width, and position. Simulated mixed-field glow curves were obtained by superposition of the experimentally obtained single field exposures. Feature vectors were composed of two kinds of features: those from deconvolution and those taken in the neighbourhood of several glow curve peaks. The inner product of the feature vectors was used to discriminate among the pure photon, pure proton and simulated mixed-field irradiations. In the pure cases, identification of radiation types is both straightforward and effective. Mixed-field discrimination did not succeed using deconvolution features, but the peak-neighbourhood features proved to discriminate reliably.

Threshold estimation in single photon emission computed tomography and planar imaging for clinical radioimmunotherapy.

Thresholding is the most widely used organ or tumor segmentation technique used in single photon emission computed tomography (SPECT) and planar imaging for monoclonal antibodies. Selecting the optimal threshold requires a priori knowledge (volumes from CT or magnetic resonance) for the size and contrast level of the organ in question. Failure to select an optimal threshold leads to overestimation or underestimation of the volume and, subsequently, the organ-absorbed dose value in radio-immunotherapy. To investigate this threshold selection problem, we performed a phantom experiment using six lucite spheres ranging from 1 to 117 ml and filled with a uniform activity of 1 microCi/ml Tc-99m. These spheres were placed at the center and off-center locations of a Jasczsak phantom and scanned with a three-headed gamma camera in SPECT and planar modes. Target-nontarget (T:NT) ratios were changed by adding the appropriate activity to the background. A threshold search algorithm with an interpolative background correction was applied to sphere images. This algorithm selects a threshold that minimizes the difference between the true and measured volumes (SPECT) or areas (planar). It was found that for spheres equal to or larger than 20 ml [diameter (D) > 38 mm] and T:NT ratios higher than 5:1, mean thresholds at 42% for SPECT and 38% for planar imaging yielded minimum image segmentation errors, which is in agreement with current literature. However, for small T:NT ratios (< 5:1), the threshold values as high as 71% for SPECT and 85% for planar imaging were substantially different than those fixed thresholds for large spheres (D > 38 mm). Hence, the use of fixed thresholds in low contrasts and with tumor and organ sizes of clinical interest (25 < or = D < or = 50 mm) may result in limited volume estimation accuracy. Therefore, we have provided the investigator a method to obtain the threshold values in which the proper threshold can be selected based on the organ and tumor size and image contrast. By measuring and calibrating the proper threshold value derived through machine-specific phantom measurements, a more accurate volume and activity quantitation can be performed. This, in turn, will provide tumor-absorbed dose optimization and greater accuracy in the measurement of potentially subacute, toxic absorbed doses to normal organs for patients undergoing radioimmunotherapy.

Three-dimensional simulations of multidetector point-focusing SPECT imaging.

We have applied an efficient algorithm for mathematically simulating the three-dimensional (3-D) response of a SPECT imaging system with a depth-dependent 3-D point spread function (3-DPSF). The input object whose reconstructed image is to be simulated is restricted to a binary map; more complex objects may be treated as linear combinations of binary maps. The 3-D convolution reduces to a sequence of additions of a 3-D line spread function (3-DLSF), appropriately translated, to the 3-D response. We have simulated the projection data from a multidetector SPECT system with point-focusing collimators. The simulated projection data were then reconstructed using the manufacturer's software. The objects simulated included simple geometrical solids such as spheres and cylinders, as well as the distribution of muscarinic cholinergic receptors in a realistic brain slice. The results of these simulations indicate the existence of significant qualitative and quantitative artifacts in reconstructed human brain images.

Analysis of the Harvey ras gene in cisplatin-initiated mouse skin tumors by polymerase chain reaction and direct DNA sequencing.

Cisplatin (cis-dichlorodiammineplatinum (II)) acts as a tumor initiator in the mouse skin model of carcinogenesis. DNA transfection studies suggested that skin tumors initiated by cisplatin contained dominant transforming activity. Since the Harvey-ras (H-ras) gene is known to be activated by point mutations in chemically initiated mouse skin tumors, we used polymerase chain reaction (PCR) and direct DNA sequencing to analyze the DNA sequence of the H-ras gene in twelve different cisplatin-initiated skin tumors. The results of these studies indicated that cisplatin-initiated skin tumors were normal (wild-type) at codons 12, 13, 61 and 117. Thus the transforming activity associated with cisplatin initiated mouse skin tumors was not due to a mutant H-ras gene and this suggests the involvement of other transforming genes during initiation of the mouse skin with cisplatin.

A clinical evaluation of contrast-detail analysis for ultrasound images.

We report on the reproducibility of human observers' vanishing detection thresholds for visual targets in contrast-detail (C/D) analysis of ultrasound B-mode images. The images used in this study contain visual targets which are circular cross sections of constant-contrast conical structures in the C/D phantom. The vanishing threshold diameters for these targets vary as a function of the perceived size of the imaged target, target-to-background contrast, image noise content, and reproducibility of the decision levels of human observers for repeated observations. Our study indicates that the determination of absolute vanishing threshold diameter values for several targets of different contrast by human observers yields a high degree of error that is not predicted by existing theoretical assumptions based on a static threshold detector. We find that systematic error is introduced by the observers during the course of the experiment and that the levels of sensitivity of the observers differ widely at all times, and increase the amount of total observer error. These results suggest that, due to the large total observer error, C/D analysis may be impractical in a clinical environment, unless there is access to a team of observers specifically and extensively trained in this task. We suggest that a computer-based observer may be more reliable for the objective performance of contrast-detail analysis as a method for evaluating ultrasound image quality and comparison of imaging systems.

Use of the fast Hartley transform for three-dimensional dose calculation in radionuclide therapy.

Effective radioimmunotherapy may depend on a priori knowledge of the radiation absorbed dose distribution obtained by trace imaging activities administered to a patient before treatment. A new, fast, and effective treatment planning approach is developed to deal with a heterogeneous activity distribution. Calculation of the three-dimensional absorbed dose distribution requires convolution of a cumulated activity distribution matrix with a point-source kernel; both are represented by large matrices (64 x 64 x 64). To reduce the computation time required for these calculations, an implementation of convolution using three-dimensional (3-D) fast Hartley transform (FHT) is realized. Using the 3-D FHT convolution, absorbed dose calculation time was reduced over 1000 times. With this system, fast and accurate absorbed dose calculations are possible in radioimmunotherapy. This approach was validated in simple geometries and then was used to calculate the absorbed dose distribution for a patient's tumor and a bone marrow sample.

Estimating fractal dimension with fractal interpolation function models.

Fractal dimension (fd) is a feature which is widely used to characterize medical images. Previously, researchers have shown that fd separates important classes of images and provides distinctive information about texture. We analyze limitations of two principal methods of estimating fd: box-counting (BC) and power spectrum (PS). BC is ineffective when applied to data-limited, low-resolution images; PS is based on a fractional Brownian motion (fBm) model-a model which is not universally applicable. We also present background information on the use of fractal interpolation function (FIF) models to estimate fd of data which can be represented in the form of a function. We present a new method of estimating fd in which multiple FIF models are constructed. The mean of the fd's of the FIF models is taken as the estimate of the fd of the original data. The standard deviation of the fd's of the FIF models is used as a confidence measure of the estimate. We demonstrate how the new method can be used to characterize fractal texture of medical images. In a pilot study, we generated plots of curvature values around the perimeters of images of red blood cells from normal and sickle cell subjects. The new method showed improved separation of the image classes when compared to BC and PS methods.

Objective analysis of ultrasound images by use of a computational observer.

The design, implementation, and testing of a computational observer method for objective evaluation of ultrasound images are presented. The method uses digitized ultrasound B-scan images of a test phantom (the contrast-detail phantom), and is able to calculate the detectability of a target (signal) from its background (background noise). A quantitative detectability index, based on the measured signal-to-noise ratio of the image data, that is measured for both the human and the computational observer on the same scale is generated. It is shown that the computational observer (CO) method may be a more useful, objective way of evaluating ulrasound images and imaging systems than methods that rely solely on human observers. It may also be applicable to other types (i.e. other than ultrasound) of imaging systems which produce noisy images. The relevance of the CO method when compared to human observer two-alternative-forced-choice (2AFC) readings of the same data by showing a high correlation between the CO detectability results and those of human observers for the same set of images. The method is (1) quantitative, (2) reproducible, (3) absolute, (4) takes into account, and can calculate the value of TPF and FPF for each target, for the given system, and (5) speeds up the evaluation of an image or imaging system (compared to using human observers), given the right conditions and equipment.

A methodology for modeling the distributions of medical images and their stochastic properties.

The probabilistic distribution properties of a set of medical images are studied. It is shown that the generalized Gaussian function provides a good approximation to the distribution of AP chest radiographs. Based on this result and a goodness-of-fit test, a generalized Gaussian autoregressive model (GGAR) is proposed. Its properties and limitations are also discussed. It is expected that the GGAR model will be useful in describing the stochastic characteristics of some classes of medical images and in image data compression and other applications.

A combined-transform coding (CTC) scheme for medical images.

A combined-transform coding (CTC) scheme is proposed to reduce the blocking artifact of conventional block transform coding and hence to improve the subjective performance. The proposed CTC scheme is described and its information-theoretic properties are investigated. Computer simulation results for a class of chest X-ray images are presented. A comparison between the CTC scheme and the conventional discrete cosine transform (DCT) and discrete Walsh-Hadamard transform (DWHT) demonstrates the performance improvement of the proposed scheme. In addition, combined coding can also be used in noiseless coding, yielding a slight improvement in the compression performance if it is used properly.