Virtual Hand with Ambiguous Movement between the Self and Other Origin: Sense of Ownership and 'Other-Produced' Agency.

The feeling that a body part is one's own body (sense of ownership; SoO) and the feeling based on the causal relationship between one's will and action (sense of agency; SoA) have been recognized as the basis of our bodily self-consciousness. Previously, the illusory SoO over a fake body part (e.g., rubber hand) was introduced as the rubber hand illusion (RHI). Furthermore, it was determined that one could also evoke a SoA over an object with movements linked to the one's prior intention. On the other hand, the postdictivity of our spontaneity implies that it is essentially inseparable whether actions originate from self or others. In other words, our SoA or daily experiences are obtained in such as inseparable scenario. Previous research, however, has maintained the premise that self- and other-origin movements are perceptually distinguishable. Here, we implement a protocol to make these aspects ambiguous for the participants and to estimate whether they can feel SoO and/or SoA and how. To this end, we employ an experiment using virtual reality, under which participants observe virtual fingers moving very slowly (or quickly or not moving) while their own fingers do not move. For evaluation of the illusory SoO, measurements of skin conductance responses against a knife threat are adopted. Additionally, we introduce face-to-face interviews to determine whether the feelings regarding the slow movement match the conventional SoA definition. Our representative results suggest that the SoO is evoked over the hand, and various attitudes to accept its movement as the participant's own with awareness that they did not originate it are reported by the majority. As the results show, the novelty of this protocol is discovering that in such a situation, the SoO cooperates with an externally produced SoA to establish one's own bodily experience rather than the independence of the SoO and SoA.

The Effect of Posterior Tibial Slope on Joint Gap and Range of Knee Motion in Mobile-Bearing Unicompartmental Knee Arthroplasty.

BACKGROUND: It is widely known that the posterior tibial slope (PTS) has an influence on the clinical outcome of arthroplasty. However, the influence of PTS on unicompartmental knee arthroplasty (UKA) is still not fully clear. The objective of this study is to reveal the effect PTS has on knee flexion and extension joint gap and the postoperative range of motion in mobile-bearing UKA. Moreover, we investigated an adequate PTS angle in mobile-bearing UKA. METHODS: Oxford UKA was performed so that the flexion gap would be equal to the extension gap. Correlation between the gap value difference from 90° to 120° of the knee flexion and the PTS was evaluated. Correlation between postoperative range of motion and the PTS was also evaluated to find whether a small degree of PTS would cause knee flexion restriction. RESULTS: The PTS had a moderate positive correlation with the flexion gap difference. However, the PTS had no correlation with the knee flexion angle both postoperative and 1 year after surgery. CONCLUSION: It was suggested that the degree of the PTS should not be so large to avoid joint looseness throughout every knee angle. Increasing the degree of the PTS had the potential to dislocate the bearing. Since a small degree of the PTS does not have an influence on the clinical outcome, surgeons should aim to cut the tibia with a posterior slope of less than 7°.

Free will in Bayesian and inverse Bayesian inference-driven endo-consciousness.

How can we link challenging issues related to consciousness and/or qualia with natural science? The introduction of endo-perspective, instead of exo-perspective, as proposed by Matsuno, Rössler, and Gunji, is considered one of the most promising candidate approaches. Here, we distinguish the endo-from the exo-perspective in terms of whether the external is or is not directly operated. In the endo-perspective, the external can be neither perceived nor recognized directly; rather, one can only indirectly summon something outside of the perspective, which can be illustrated by a causation-reversal pair. On one hand, causation logically proceeds from the cause to the effect. On the other hand, a reversal from the effect to the cause is non-logical and is equipped with a metaphorical structure. We argue that the differences in exo- and endo-perspectives result not from the difference between Western and Eastern cultures, but from differences between modernism and animism. Here, a causation-reversal pair described using a pair of upward (from premise to consequence) and downward (from consequence to premise) causation and a pair of Bayesian and inverse Bayesian inference (BIB inference). Accordingly, the notion of endo-consciousness is proposed as an agent equipped with BIB inference. We also argue that BIB inference can yield both highly efficient computations through Bayesian interference and robust computations through inverse Bayesian inference. By adapting a logical model of the free will theorem to the BIB inference, we show that endo-consciousness can explain free will as a regression of the controllability of voluntary action.

Teriparatide Treatment Improved Loosening of Cementless Total Knee Arthroplasty: A Case Report.

INTRODUCTION: Along with the increase of osteoporotic patients in an aging society, complications in surgeries associated with osteoporosis are also increasing. In cementless total knee arthroplasty (TKA), poor primary stability and subsequent initial loosening of the implant may be seen. CASE REPORT: The patient, a 75-year-old Asian woman with a history of osteoporosis, underwent cementless TKA. Knee radiography at 5 weeks postoperatively showed radiolucent lines outlined beneath the tibial tray and around the stem. The tibial component was considered unstable due to loosening. A 56.5 µg weekly dose of teriparatide (rh [1-34] parathyroid hormone) was administered. After 2 months of treatment, knee pain and knee swelling had disappeared. Tomosynthesis taken after 6 months of treatment confirmed complete ingrowth of the component to the bone. CONCLUSION: This case showed that a weekly teriparatide administration of 56.5 µg improved initial loosening of the tibial implant in cementless TKA. Administration of teriparatide in cases of the osteoporotic patient who has loosening in cementless TKA may be a useful adjuvant to achieve bone ingrowth again.

Evaluation of spacer block technique using tensor device in unicompartmental knee arthroplasty.

INTRODUCTION: Mobile-bearing unicompartmental knee arthroplasty (UKA) was designed so that flexion and extension gap adjustments could achieve isometric function of the ligaments throughout ROM to prevent complications. However, achieving accurate knee balancing using a spacer block technique remains difficult since determination of the thickness of the spacer block is determined according to the feeling of the individual surgeon's hand. The objective of the study was to investigate flexion and extension medial unicompartmental knee gap kinematics in mobile-bearing UKA and to reveal the accuracy of spacer block measurement technique using a gap tensor device. MATERIALS AND METHODS: Mobile-bearing UKA was performed in 40 knees of 31 subjects using generally accepted spacer block technique so that the extension gap was made equal to the flexion gap. The extension and flexion gaps of the medial knee compartment were measured using the tensor device with 25, 50, 75, 100, 125, and 150 N of joint distraction force. The interplay gap was calculated by subtracting the thickness of the tibial prosthesis and the thickness of the selected size of bearing from the measured extension and flexion gaps. Medial compartmental joint interplay gap differences were compared among flexion and extension gaps. RESULTS: The mean flexion interplay gap was 25 N: 0.5 mm, 50 N: 1.5 mm, 75 N: 2.4 mm, 100 N: 3.1 mm, 125 N: 3.6 mm, 150 N: 4.0 mm. The mean extension interplay gap was 25 N: -0.2 mm, 50 N: 0.81 mm, 75 N: 1.7 mm, 100 N: 2.5 mm, 125 N: 3.1 mm, 150 N: 3.5 mm. The measured extension gap was shown to be significantly smaller compared with the flexion gap at every joint distraction force (P < 0.01). CONCLUSIONS: These results suggest that gap measurement using a spacer block in UKA has the potential risk that the resulting extension gap may be smaller than the flexion gap. Surgeons should adjust the flexion and extension gaps with caution to achieve good ligament function when performing mobile-bearing UKA.

Efficacy of interdisciplinary treatment for chronic nonmalignant pain patients in Japan.

OBJECTIVES: The implementation of interdisciplinary pain management is a relatively new concept in Japan. Although there are more than 4200 pain specialists in Japan at present, no multidisciplinary pain center has yet to be established. This prospective study is, to our knowledge, the first published evaluation of the effectiveness of multidisciplinary/interdisciplinary pain treatment in Japanese patients with chronic noncancer pain. METHODS: Ninety-nine patients with chronic noncancer pain were treated by an interdisciplinary approach in a Japanese outpatient pain clinic. Treatment was on the basis of the biopsychosocial model of pain and consisted of the following components: (1) education; (2) exercise and stretch; (3) long-term and short-term goal setting; (4) medication management; and (5) cognitive and behavioral techniques for problem solving and changing maladaptive behaviors. Each treatment session was 30 minutes and was held once every 1 to 3 weeks for 8 to 12 times according to the patients' progress and availability. The patients were assessed before and 2 to 4 weeks after the treatment. RESULTS: Results showed (1) 68.9% of patients reported a significant decrease in pain, (2) 92.0% stopped using inappropriate medication including nonsteroidal anti-inflammation drugs, benzodiazepines and muscle relaxants, (3) 51.4% underwent their usual daily activities without being disturbed by pain, and (4) 75.0% who had been unemployed because of pain returned to work. Overall, the treatment succeeded in 56.8% of the patients. CONCLUSIONS: Our results suggest that an interdisciplinary treatment based upon the biopsychosocial model of pain was associated with significant improvement in multiple outcomes in this sample of Japanese patients with chronic pain.