Maximum flexion and lateral rollback revealed better patient satisfaction after total knee arthroplasty.

INTRODUCTION: Patient satisfaction is an important outcome of total knee arthroplasty (TKA). However, we cannot predict how and why patients are satisfied or dissatisfied with TKA. The hypothesis of this study was that patient-reported outcomes (PROs) correlate with in vivo kinematics after TKA. MATERIALS AND METHODS: One hundred knees were analyzed after TKA. The in vivo kinematics of deep knee bending motion were estimated from single-plane fluoroscopy using a two-to-three-dimensional registration technique. Active knee flexion, femoral rotation and rollback were evaluated. The PROs were obtained after surgery using the 2011 Knee Society Scoring System (KSS), and their relationship with in vivo kinematics was determined. RESULTS: The average minimum and maximum flexion were -2.4 ± 7.3° and 113.2 ± 13.6°, respectively. The average femoral rotation was 7.4 ± 3.4°, and the average medial and lateral rollback were 2.4 ± 4.8 mm and 7.2 ± 5.6 mm, respectively. The multiple regression analysis revealed that the maximum flexion angle significantly contributed to symptoms and satisfaction. In addition, lateral rollback was also a significant factor affecting patient satisfaction. Lateral rollback and lateral Anterior-Posterior (AP) position at maximum flexion were correlated with the maximum flexion angle, whereas femoral rotation did not correlate with flexion angles. CONCLUSIONS: Maximum flexion and lateral rollback are important for better patient satisfaction after TKA. To obtain the maximum flexion angle, it was necessary to perform the normal kinematic pattern with a large amount of lateral rollback.

Chemoradiation induces upregulation of immunogenic cell death-related molecules together with increased expression of PD-L1 and galectin-9 in gastric cancer.

Surgery alone or combined with chemo- and/or radiation therapy remains the primary treatment for gastric cancer (GC) to date and immunotherapeutic tools such as monoclonal antibodies are only slowly being implemented. This is partly due to the fact that the immune microenvironment in GC during chemoradiation and other treatment modalities is still poorly understood. 7 gastric cancer (GC) cell lines were tested for their response to chemoradiation using 5-FU in combination with X-ray irradiation. We conducted flow cytometric analysis to determine the cells' ability to undergo immunogenic cell death (ICD) and their expression of the two immunosuppressive proteins programmed death-ligand 1 (PD-L1) and galectin-9 (Gal-9). We evaluated the overall immunogenicity of two cell lines (MKN7, MKN74) in co-culture experiments with human monocyte-derived dendritic cells (Mo-DCs). Chemoradiation induces distinct responses in different GC cell lines. We observe ICD in vitro in all tested GC cell lines in the form of calreticulin (CRT) translocation to the plasma membrane. As a resistance mechanism, these cells also upregulated Gal-9 and PD-L1. Mo-DC maturation experiments showed that GCs provoked the maturation of Mo-DCs after chemoradiation in vitro. The addition of α-PD-L1 blocking antibody further enhanced the immunogenicity of these cells while improving DC viability. Blocking Tim-3, as the main receptor for Gal-9, had no such effect. Our findings suggest that the benefits of chemoradiation can substantially depend on tumor subtype and these benefits can be offset by induced immune evasion in GC. Combination treatment using checkpoint inhibitors could potentially lead to enhanced immune responses and yield better patient outcomes.

Surgical results of Hybrid Mita method to idiopathic scoliosis: minimum two years follow-up.

Hybrid Mita (Suzuki) method is a newly developed technique of scoliosis surgery. This concept consists of three components: rib mobilization, rod rotation maneuver and hook rotation maneuver, which does not require intra-operative CT scan with lower risk of screw malposition. The aim of this study is to evaluate the efficacies of this method for correction in scoliosis. : This is a retrospective observational study, consist of eighty-nine idiopathic scoliosis patients who underwent this method between 2009 and 2016 with minimum 2-years follow-up. The curve pattern, Cobb angle, hump height and angle, peri-operative events and complications were analyzed. The mean pre- and post-operative Cobb angle was 50.9° and 10.1°, respectively. The average correction rate was 80.5%. Hump height was reduced from 20.2 mm to 9.8 mm and hump angle reduced from 13.1° to 6.1° in average. The correction loss at the final follow-up was 0.3° in average. There were two local superficial infection cases, but there was no instrumentation failure such as malposition or dislodgement, or pseudarthrosis. This novel method is promising to provide excellent clinical correction to idiopathic scoliosis, which is no less than all pedicle screw constructs. The technique of the skillful utilization of hooks in spinal surgery should not perish from the stage.

Dynamics of the Vortex-Particle Complexes Bound to the Free Surface of Superfluid Helium.

We present an experimental and theoretical study of the 2D dynamics of electrically charged nanoparticles trapped under a free surface of superfluid helium in a static vertical electric field. We focus on the dynamics of particles driven by the interaction with quantized vortices terminating at the free surface. We identify two types of particle trajectories and the associated vortex structures: vertical linear vortices pinned at the bottom of the container and half-ring vortices traveling along the free surface of the liquid.

Role of the Inferior Alveolar Nerve in Rodent Lower Incisor Stem Cells.

In developing teeth, the sequential and reciprocal interactions between epithelial and mesenchymal tissues promote stem/progenitor cell differentiation. However, the origin of the stem/progenitor cells has been the subject of considerable debate. According to recent studies, mesenchymal stem cells originate from periarterial cells and are regulated by neurons in various organs. The present study examined the role of innervation in tooth development and rodent incisor stem/progenitor cell homeostasis. Rodent incisors continuously grow throughout their lives, and the lower incisors are innervated by the inferior alveolar nerve (IAN). In this study, we resected the IAN in adult rats, and the intact contralateral side served as a nonsurgical control. Sham control rats received the same treatment as the resected rats, except for the resection process. The extent of incisor eruption was measured, and both mesenchymal and epithelial stem/progenitor cells were visualized and compared between the IAN-resected and sham-operated groups. One week after surgery, the IAN-resected incisors exhibited a chalky consistency, and the eruption rate was decreased. Micro-computed tomography and histological analyses performed 4 wk after surgery revealed osteodentin formation, disorganized ameloblast layers, and reduced enamel thickness in the IAN-resected incisors. Immunohistochemical analysis revealed a reduction in the CD90- and LRIG1-positive mesenchymal cell ratio in the IAN-resected incisors. However, the p40-positive epithelial stem/progenitor cell ratio was comparable between the 2 groups. Thus, mesenchymal stem/progenitor cell homeostasis is more related to IAN innervation than to epithelial stem/progenitor cells. Furthermore, sensory nerve innervation influences subsequent incisor growth and formation.

In vivo three-dimensional kinematics of normal knees during different high-flexion activities.

AIMS: In Asia and the Middle-East, people often flex their knees deeply in order to perform activities of daily living. The purpose of this study was to investigate the 3D kinematics of normal knees during high-flexion activities. Our hypothesis was that the femorotibial rotation, varus-valgus angle, translations, and kinematic pathway of normal knees during high-flexion activities, varied according to activity. MATERIALS AND METHODS: We investigated the in vivo kinematics of eight normal knees in four male volunteers (mean age 41.8 years; 37 to 53) using 2D and 3D registration technique, and modelled the knees with a computer aided design program. Each subject squatted, kneeled, and sat cross-legged. We evaluated the femoral rotation and varus-valgus angle relative to the tibia and anteroposterior translation of the medial and lateral side, using the transepicodylar axis as our femoral reference relative to the perpendicular projection on to the tibial plateau. This method evaluates the femur medially from what has elsewhere been described as the extension facet centre, and differs from the method classically applied. RESULTS: During squatting and kneeling, the knees displayed femoral external rotation. When sitting cross-legged, femurs displayed internal rotation from 10° to 100°. From 100°, femoral external rotation was observed. No significant difference in varus-valgus angle was seen between squatting and kneeling, whereas a varus position was observed from 140° when sitting cross-legged. The measure kinematic pathway using our methodology found during squatting a medial pivoting pattern from 0° to 40° and bicondylar rollback from 40° to 150°. During kneeling, a medial pivot pattern was evident. When sitting cross-legged, a lateral pivot pattern was seen from 0° to 100°, and a medial pivot pattern beyond 100°. CONCLUSION: The kinematics of normal knees during high flexion are variable according to activity. Nevertheless, our study was limited to a small number of male patients using a different technique to report the kinematics than previous publications. Accordingly, caution should be observed in generalizing our findings. Cite this article: Bone Joint J 2018;100-B:50-5.

Taylor cone and electrospraying at a free surface of superfluid helium charged from below.

Electrically charged metallic micro- and nanoparticles are trapped under a free surface of superfluid He in a vertical static electric field. We observe a static deformation of the charged liquid surface in the form of a Taylor cone and the emission of a charged liquid helium jet (electrospray). Our numeric calculations reproduce the static shape of the cone.

Ripplonic Lamb Shift for Electrons on Liquid Helium.

We study the shift of the energy levels of electrons on a helium surface due to the coupling to the quantum field of surface vibrations. As in quantum electrodynamics, the coupling is known, and it is known to lead to an ultraviolet divergence of the level shifts. We show that there are diverging terms of different nature and use the Bethe-type approach to show that they cancel each other, to leading order. This resolves the long-standing theoretical controversy and explains the existing experiments. The results allow us to study the temperature dependence of the level shift. The predictions are in good agreement with the experimental data, with no adjustable parameters.

Metallic nanowires and mesoscopic networks on a free surface of superfluid helium and charge-shuttling across the liquid-gas interface.

We investigate the motion of electrically charged metallic nano- and microparticles produced by laser ablation in He gas and injected into superfluid helium. In the presence of a vertical static electric field, the particles either perform a repetitive shuttle-like motion transporting the charge across the liquid-gas interface or become trapped under the free surface of liquid He and coalesce into long filaments and complex two-dimensional mesoscopic networks. A classical electrohydrodynamic model is used to describe the motion of charged microparticles in superfluid He. The resulting filaments and networks are analyzed using electron microscopy. It is demonstrated that each filament is in fact composed of a large number of nanowires with a characteristic diameter of order of 10 nm and extremely large aspect ratios.

Critical Behavior of Alternately Pumped Nuclear Spins in Quantum Dots.

Nuclear spins in a spin-blocked quantum dot can be pumped and eventually polarized in either of two opposite directions that are selected by applying two different source-drain voltages. Applying a square pulse train as the source-drain voltage can continuously switch the pumping direction alternately. We propose and demonstrate a critical behavior in the polarization after alternate pumping, where the final polarization is sensitive to the initial polarization and pulse conditions. This sensitivity leads to stochastic behavior in the final polarization under nominally the same pumping conditions.

Computed tomography of the thorax for gastric cancer staging: Is it necessary?

BACKGROUND: The utility of computed tomography scans of the thorax, abdomen, and pelvis for gastric cancer staging has been recommended in many countries. However, the validity of the use of computed tomography thorax in gastric cancer staging has not been challenged. METHODS: A retrospective review was conducted on our gastric cancer registry from 1998 till 2012 in the National University Hospital, Singapore. We performed computed tomography thorax only in selected cases. We defined isolated lung metastasis as the presence of suspicious findings on computed tomography thorax in the absence of metastasis elsewhere. RESULTS: A total of 808 gastric cancer cases were reviewed. The mean age of the patients was 66 years (standard deviation 13.53), and 67% were male. In all, 238 patients (30%) had metastatic disease at presentation, and 1 (0.42%) had isolated lung metastasis. The most common site of metastasis was intra-abdominal (73.8%). Among the patients who underwent surgery, the overall distant recurrence rate was 30%, of which only 83 (30%) patients had lung metastasis and all had concurrent metastasis in an intra-abdominal site. CONCLUSION: The rarity of isolated lung metastasis in gastric cancer suggests the limited value of computed tomography thorax as a routine staging tool for gastric cancers.

The Computational Fluid Dynamics Rupture Challenge 2013­Phase I: prediction of rupture status in intracranial aneurysms.

BACKGROUND AND PURPOSE: Rupture risk assessment for intracranial aneurysms remains challenging, and risk factors, including wall shear stress, are discussed controversially. The primary purpose of the presented challenge was to determine how consistently aneurysm rupture status and rupture site could be identified on the basis of computational fluid dynamics. MATERIALS AND METHODS: Two geometrically similar MCA aneurysms were selected, 1 ruptured, 1 unruptured. Participating computational fluid dynamics groups were blinded as to which case was ruptured. Participants were provided with digitally segmented lumen geometries and, for this phase of the challenge, were free to choose their own flow rates, blood rheologies, and so forth. Participants were asked to report which case had ruptured and the likely site of rupture. In parallel, lumen geometries were provided to a group of neurosurgeons for their predictions of rupture status and site. RESULTS: Of 26 participating computational fluid dynamics groups, 21 (81%) correctly identified the ruptured case. Although the known rupture site was associated with low and oscillatory wall shear stress, most groups identified other sites, some of which also experienced low and oscillatory shear. Of the 43 participating neurosurgeons, 39 (91%) identified the ruptured case. None correctly identified the rupture site. CONCLUSIONS: Geometric or hemodynamic considerations favor identification of rupture status; however, retrospective identification of the rupture site remains a challenge for both engineers and clinicians. A more precise understanding of the hemodynamic factors involved in aneurysm wall pathology is likely required for computational fluid dynamics to add value to current clinical decision-making regarding rupture risk.

Current status of cancer immunotherapy.

To prove clinical benefits of cancer vaccine is currently difficult, except for one phase III trial has documented improved overall survival with the vaccine, Sipuleucel-T, although induction of anti-tumor immune responses through cancer vaccine is theoretically promising and would be straightforward. In contrast, immune checkpoint blockade with anti-CTLA4 mAb and anti-PD-1 mAb has demonstrated clear evidence of objective responses including improved overall survival and tumor shrinkage, driving renewed enthusiasm for cancer immunotherapy in multiple cancer types. In addition, there is a promising novel cancer immunotherapy, CAR therapy-a personalized treatment that involves genetically modifying a patient's T-cells to make them target tumor cells. We are now facing new era of cancer immunotherapy.

Chiral symmetry breaking in superfluid 3He-A.

Spontaneous symmetry breaking is an important concept in many branches of physics. In helium-3 ((3)He), the breaking of symmetry leads to the orbital chirality in the superfluid phase known as (3)He-A. Chirality is a fundamental property of (3)He-A, but its direct detection has been challenging. We report direct detection of chirality by transport measurements of electrons trapped below a free surface of (3)He-A. In particular, we observed the so-called intrinsic Magnus force experienced by a moving electron; the direction of the force directly reflected the chirality. We further showed that, at the superfluid transition, the system selected either right- or left-handed chirality. The observation of such selection directly demonstrates chiral symmetry breaking.

A possible solution for charge sensing in vertical double quantum dots.

We report the observation of a peculiar charge stability diagram of a vertical double quantum dot, where the conventional Coulomb diamond edges have a sawtooth-like shape. This feature could be understood if we assume the formation of a third quantum dot in the semiconductor volume which is supposed to be a part of the source in the standard quantum dot measurement circuit. The size of this additional dot is larger compared to the size of the original ones, thus the charging energy is smaller, but it still exceeds the thermal energy and affects the electron transport through the structure. Since the big dot is coupled to small ones, the observed effect could be utilized for charge detection, which has always been a problem in the case of vertical quantum dots.

Immunogenic tumor cell death induced by chemoradiotherapy: molecular mechanisms and a clinical translation.

Chemoradiotherapy can induce immunogenic cell death, triggering danger signals such as high-mobility group box 1 protein, and resulting in T-cell immunity. This concept can potentially be harnessed for clinical therapy to enhance tumor-specific immunity. There is however limited information to translate this theory directly in a clinical setting. In this review, we will discuss and summarize molecular and cellular mechanisms underlying immunogenic tumor cell death induced by chemoradiotherapy, with emphasis on a clinical translation.

Hemodynamics of 8 different configurations of stenting for bifurcation aneurysms.

BACKGROUND AND PURPOSE: SACE is performed for complex aneurysms. There are several configurations of stent placement for bifurcation aneurysms. We investigated hemodynamics among 8 different configurations of stent placement, which may relate to the recanalization rate. MATERIALS AND METHODS: We created a silicone block model of a patient-specific asymmetric bifurcation aneurysm. Enterprise closed-cell stents were deployed in the model as various configurations. 3D images of these stents were obtained by micro-CT. We performed CFD simulations for a no-stent model and 8 stent models: a single stent from a proximal vessel to a right or left distal vessel, a horizontal stent, a kissing-Y stent with a uniformly narrowed structure, a nonoverlapping-Y stent, a virtual-Y stent with no narrowed structure (fusion of 2 single stents), and 2 different crossing-Y stents with a focally narrowed structure. Hemodynamic parameters were evaluated. RESULTS: Cycle-averaged velocity and WSS in the aneurysm were reduced because of stent placement in the following order: single stent (19% reduction in cycle-averaged velocity) < nonoverlapping-Y stent (29%) < virtual-Y stent (32%) < horizontal stent (39%) < kissing-Y stent (48%) < crossing-Y stent (54%). Kissing- and crossing-Y stents redirected impingement flow into the distal vessels because of lowered porosity of stents due to narrowed structures. CONCLUSIONS: Among 8 different configurations of stent placement, kissing- and crossing-Y stents showed the strongest reduction in flow velocity in the aneurysm because of lowered porosity of stents and redirection of impingement flow. This may be a desirable reconstruction of flow hemodynamics and may decrease recanalization rates in SACE.

Commensurability-dependent transport of a Wigner crystal in a nanoconstriction.

We present the first transport measurements of a classical Wigner crystal through a constriction formed by a split-gate electrode. The Wigner crystal is formed on the surface of superfluid helium confined in a microchannel. At low temperatures, the current is periodically suppressed with increasing split-gate voltage, resulting in peaklike transport features. We also present the results of molecular dynamics simulations that reproduce this phenomenon. We demonstrate that, at the split-gate voltages for which the current is suppressed, the electron lattice is arranged such that the stability of particle positions against thermal fluctuations is enhanced. In these configurations, the suppression of transport due to interelectron Coulomb forces becomes important.

Staircaselike suppression of supersolidity under rotation.

There are a number of distinct signatures of superfluids, one of which is the appearance of quantized vortices. There have been some attempts to understand the putative supersolid 4He in the vortex framework, but no conclusive evidence that supports the existence of the vortices has been reported. Here, we investigate the rotation velocity dependence of the torsional oscillation of solid 4He at various temperatures. The velocity sweep reveals intriguing periodic staircaselike features below about 300 mK. The staircase patterns show remarkable periodicity, and we interpret these patterns as a consequence of vortex injection. However, there are some features that cannot be accounted for with simple injection of vortices into superfluid, and further investigation is required.

A retrospective analysis of endometrial carcinoma cases surgically treated with or without para-aortic lymph node dissection followed by adjuvant chemotherapy.

PURPOSE: To analyze the efficacies of para-aortic node (PAN) dissection for patients undergoing surgery and adjuvant chemotherapy for endometrial carcinomas. METHODS: At the Osaka University Hospital and the Kaizuka City Hospital in Osaka, Japan, either pelvic lymph nodes (PLN) plus para-aortic lymph nodes (PAN) or PLN-only dissections were performed for endometrial carcinomas. An adjuvant chemotherapy using paclitaxel, epirubicin, and carboplatin was conducted for all such patients. A retrospective comparison of the efficacy of PAN dissection was conducted. RESULTS: Disease-free and overall survivals and frequency of PAN involvement at the first recurrence did not exhibit a statistically significant difference between the PLN-only group and the PLN + PAN group. Operation time was significantly longer in the PLN + PAN group than the PLN-only group, and the total blood loss was also significantly greater in the PLN+PAN group. CONCLUSION: PAN dissection may be omitted, without adverse effect on prognosis, for endometrial carcinoma patients with recurrence risks who undergo adjuvant chemotherapy using platinum, anthracycline and taxane derivatives.