[The role of arthroscopy in diagnostics and treatment of arthritis of the ankle joint]. / Stellenwert der Arthroskopie in Diagnostik und Therapie der Sprunggelenkarthrose.

The arthroscopic treatment of arthritis of the ankle joint is very limited and is only indicated for early stages of arthritis with impingement, strictly localized forms and more for young patients. The most important aim of arthroscopy is to improve the range of motion (ROM) of the ankle by removal of bony projections (dorsal and ventral) and an extensive synovectomy with debridement. In cases of narrowing of the joint space to less than 2 mm and/or malalignment, the indications for arthroscopy should be considered very cautiously. This is independent of the localization of the narrowing, especially if the complete joint is affected. If necessary, arthroscopy can then be carried out as an additional intervention in cases of conversion osteotomy in order to improve the ROM.

KS(conf): A Light-Weight Test if a Multiclass Classifier Operates Outside of Its Specifications.

We study the problem of automatically detecting if a given multi-class classifier operates outside of its specifications (out-of-specs), i.e. on input data from a different distribution than what it was trained for. This is an important problem to solve on the road towards creating reliable computer vision systems for real-world applications, because the quality of a classifier's predictions cannot be guaranteed if it operates out-of-specs. Previously proposed methods for out-of-specs detection make decisions on the level of single inputs. This, however, is insufficient to achieve low false positive rate and high false negative rates at the same time. In this work, we describe a new procedure named KS(conf), based on statistical reasoning. Its main component is a classical Kolmogorov-Smirnov test that is applied to the set of predicted confidence values for batches of samples. Working with batches instead of single samples allows increasing the true positive rate without negatively affecting the false positive rate, thereby overcoming a crucial limitation of single sample tests. We show by extensive experiments using a variety of convolutional network architectures and datasets that KS(conf) reliably detects out-of-specs situations even under conditions where other tests fail. It furthermore has a number of properties that make it an excellent candidate for practical deployment: it is easy to implement, adds almost no overhead to the system, works with any classifier that outputs confidence scores, and requires no a priori knowledge about how the data distribution could change.

Clinical and radiological outcome at mean follow-up of 11 years after hip arthroscopy.

INTRODUCTION: The use of hip arthroscopy (HA) has substantially increased over the last decade. However, while the benefits of HA after 1 year in patients with femoroacetabular impingement (FAI) are well documented, long-term data on the progression of osteoarthritis (OA) or patient-reported outcomes (PROMs) are lacking. OBJECTIVES: To evaluate long-term clinical and radiological outcomes after HA. MATERIALS AND METHODS: Preoperative clinical records, operative notes, and radiographs from all patients who underwent HA at our hospital between 1998 and 2006 were reviewed. Exclusion criteria were previous hip surgery or diagnostic HA. Primary endpoints were subsequent total hip arthroplasty (THA) or other hip surgery. Secondary endpoints were OA progression and PROMs. RESULTS: HA was performed in 92 consecutive patients from 1998 to 2006. Indications for HA were FAI, labral lesions, early OA, and focal osteochondral defects. Mean follow-up was 11.2 years (SD 2.5, range 7.9-16). Data from 43 patients were available for analysis; 38 patients were excluded, and 11 were lost to follow-up. 20 patients had subsequent hip surgery, of which 11 patients required THA. 33 patients (77%) stated that they would undergo HA again under the same circumstances. Longitudinal radiological analysis showed no significant OA progression in patients without THA. The Forgotten Joint Score-12 was the only PROM to significantly differ between patients who had no further surgery and patients who had undergone revision (p = 0.037). CONCLUSION: There was no significant OA progression on plain radiography at an average of 11 years post-HA. Sound indication criteria is essential, as 45% of patients required subsequent surgery.

Zero-Shot Learning-A Comprehensive Evaluation of the Good, the Bad and the Ugly.

Due to the importance of zero-shot learning, i.e., classifying images where there is a lack of labeled training data, the number of proposed approaches has recently increased steadily. We argue that it is time to take a step back and to analyze the status quo of the area. The purpose of this paper is three-fold. First, given the fact that there is no agreed upon zero-shot learning benchmark, we first define a new benchmark by unifying both the evaluation protocols and data splits of publicly available datasets used for this task. This is an important contribution as published results are often not comparable and sometimes even flawed due to, e.g., pre-training on zero-shot test classes. Moreover, we propose a new zero-shot learning dataset, the Animals with Attributes 2 (AWA2) dataset which we make publicly available both in terms of image features and the images themselves. Second, we compare and analyze a significant number of the state-of-the-art methods in depth, both in the classic zero-shot setting but also in the more realistic generalized zero-shot setting. Finally, we discuss in detail the limitations of the current status of the area which can be taken as a basis for advancing it.

[Biologic Reconstruction of Full Sized Cartilage Defects of the Hip: A Guideline from the DGOU Group "Clinical Tissue Regeneration" and the Hip Committee of the AGA]. / Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft "Klinische Geweberegeneration" der DGOU und des Hüftkomitees der AGA.

Background Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Methods Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Results Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. Conclusions The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm2. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm2 the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

Attribute-based classification for zero-shot visual object categorization.

We study the problem of object recognition for categories for which we have no training examples, a task also called zero--data or zero-shot learning. This situation has hardly been studied in computer vision research, even though it occurs frequently; the world contains tens of thousands of different object classes, and image collections have been formed and suitably annotated for only a few of them. To tackle the problem, we introduce attribute-based classification: Objects are identified based on a high-level description that is phrased in terms of semantic attributes, such as the object's color or shape. Because the identification of each such property transcends the specific learning task at hand, the attribute classifiers can be prelearned independently, for example, from existing image data sets unrelated to the current task. Afterward, new classes can be detected based on their attribute representation, without the need for a new training phase. In this paper, we also introduce a new data set, Animals with Attributes, of over 30,000 images of 50 animal classes, annotated with 85 semantic attributes. Extensive experiments on this and two more data sets show that attribute-based classification indeed is able to categorize images without access to any training images of the target classes.

Cost comparison of wastewater treatment in Danubian countries.

This paper investigates the costs of wastewater treatment (including sludge management) within the Danube catchment countries A, CZ, SK, HU, SL, RO, BG and UA. TK is considered as well. Additionally, the paper compares the total costs of wastewater management (including sewage) with the incomes in the different countries. The annual costs of wastewater treatment in Austria are about 30 euro/p.e. y for large plants with nitrogen and phosphorus removal. In low income countries of the Danube and Black Sea catchment areas they are at a maximum 30% lower than in Austria. However, the incomes in countries like Bulgaria, Romania or Ukraine are 85% to 90% lower. The total annual costs for wastewater management (sewer development plus treatment) amount at least to 90 euro/p.e. y. Considering the level of income in those countries, financing of wastewater management completely by charges of the population equivalents connected is not feasible. Therefore other approaches for financing wastewater treatment are required.

Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study.

BACKGROUND: The role of the location and severity of the initial cartilage lesions associated with an ankle fracture in the development of posttraumatic osteoarthritis has not been established, to our knowledge. METHODS: We performed a long-term follow-up study of a consecutive, prospectively included cohort of 288 ankle fractures that were treated operatively between June 1993 and November 1997. Arthroscopy had been performed in all cases in order to classify the extent and location of cartilage damage. One hundred and nine patients (47%) were available for follow-up after a mean of 12.9 years. The main outcome parameters were the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score for clinical evaluation and a modified Kannus osteoarthritis score for radiographic assessment of the development of posttraumatic osteoarthritis. RESULTS: Cartilage damage anywhere in the ankle joint was associated with a suboptimal clinical outcome (odds ratio, 5.0 [95% confidence interval = 1.3 to 20.1]; p = 0.02) and with a suboptimal radiographic outcome (odds ratio = 3.4 [95% confidence interval = 1.0 to 11.2]; p = 0.04). An association was also found between the development of clinical signs of osteoarthritis and a deep lesion (>50% of the cartilage thickness) on the anterior aspect of the talus (odds ratio = 12.3 [95% confidence interval = 1.4 to 108.0]; p = 0.02) and a deep lesion on the lateral aspect of the talus (odds ratio = 5.4 [95% confidence interval = 1.2 to 23.5]; p = 0.02). A deep lesion on the medial malleolus was associated with the development of clinical signs of osteoarthritis (odds ratio = 5.2 [95% confidence interval = 1.9 to 14.6]; p < 0.01) and radiographic signs of osteoarthritis (odds ratio = 2.9 [95% confidence interval = 1.1 to 7.9]; p = 0.03) of osteoarthritis. There was no significant correlation between cartilage lesions on the fibula and the long-term outcome. CONCLUSIONS: Our findings show that initial cartilage damage seen arthroscopically following an ankle fracture is an independent predictor of the development of posttraumatic osteoarthritis. Specifically, lesions on the anterior and lateral aspects of the talus and on the medial malleolus correlate with an unfavorable clinical outcome.

Efficient subwindow search: a branch and bound framework for object localization.

Most successful object recognition systems rely on binary classification, deciding only if an object is present or not, but not providing information on the actual object location. To estimate the object's location, one can take a sliding window approach, but this strongly increases the computational cost because the classifier or similarity function has to be evaluated over a large set of candidate subwindows. In this paper, we propose a simple yet powerful branch and bound scheme that allows efficient maximization of a large class of quality functions over all possible subimages. It converges to a globally optimal solution typically in linear or even sublinear time, in contrast to the quadratic scaling of exhaustive or sliding window search. We show how our method is applicable to different object detection and image retrieval scenarios. The achieved speedup allows the use of classifiers for localization that formerly were considered too slow for this task, such as SVMs with a spatial pyramid kernel or nearest-neighbor classifiers based on the \chi;2 distance. We demonstrate state-of-the-art localization performance of the resulting systems on the UIUC Cars data set, the PASCAL VOC 2006 data set, and in the PASCAL VOC 2007 competition.

Pseudotumor of gout in the patella of a kidney transplant recipient.

BACKGROUND: A 33-year-old renal transplant recipient presented with painless swelling of the right knee. Physical examination revealed an impressive knee joint effusion with no signs of inflammation. The patient did not remember a recent trauma, but he mentioned a strain 3 years earlier; radiographic findings had been normal at that time. The patient had suffered from end-stage renal disease due to chronic glomerulonephritis and had previously undergone two transplantations. At presentation, his kidney function was stable under treatment with ciclosporin, azathioprine and steroids. INVESTIGATIONS: Conventional radiography revealed a tumor at the superolateral pole of the right patella. Extensive soft tissue invasion and bone destruction was seen on MRI. A knee arthroscopy with biopsy, performed to aid diagnosis, showed extensive chondrocalcinosis macroscopically; histologically, gouty tophi were found. DIAGNOSIS: Pseudotumor of gout in the patella. MANAGEMENT: Uric-acid-lowering therapy with benzbromarone was started immediately after diagnosis. A local arthroscopic debridement of the right knee joint was performed 4 months later, and the patient remained asymptomatic for the next 3 years.

An optimal nonorthogonal separation of the anisotropic Gaussian convolution filter.

We give an analytical and geometrical treatment of what it means to separate a Gaussian kernel along arbitrary axes in R(n), and we present a separation scheme that allows us to efficiently implement anisotropic Gaussian convolution filters for data of arbitrary dimensionality. Based on our previous analysis we show that this scheme is optimal with regard to the number of memory accesses and interpolation operations needed. The proposed method relies on nonorthogonal convolution axes and works completely in image space. Thus, it avoids the need for a fast Fourier transform (FFT)-subroutine. Depending on the accuracy and speed requirements, different interpolation schemes and methods to implement the one-dimensional Gaussian (finite impulse response and infinite impulse response) can be integrated. Special emphasis is put on analyzing the performance and accuracy of the new method. In particular, we show that without any special optimization of the source code, it can perform anisotropic Gaussian filtering faster than methods relying on the FFT.

Tumor-induced antibodies resemble the response to tissue damage.

Tumor-associated antibodies are frequently detected in cancer patients. To ask whether the recognized antigens are rejection antigens, we screened a cDNA expression library of the mouse TS/A tumor with TS/A-immune serum and isolated 8 IgG-reactive clones, representing self-antigens that were expressed in normal tissues and other tumor lines. Three of the antigens had previously been identified in the human system by this cloning strategy. None of the antigens revealed to be a rejection antigen in normal mice demonstrated by an otherwise effective plasmid immunization. For one of the identified antigens, alpha-catenin, it is shown that the induction of IgG antibodies by protein immunization does not correlate with tumor rejection. For another antigen, vimentin, it is shown that vimentin-deficient but not vimentin-competent mice reject vimentin-expressing tumors indicating T -cell tolerance despite the fact that tumor cell immunization induces antivimentin IgG antibodies. Tissue damage induced by adenovirus infection induced an antibody response similar to tumor cell immunization, exemplified with 2 of the antigens. We conclude that the tumor-induced antibodies mirror tissue damage and that the antibody-inducing antigens can serve as rejection antigens if they are recognized as foreign.