Shape modelling reveals age-related knee bony shape changes in asymptomatic knees.

Osteoarthritis (OA) causes bony shape changes within the knee. Furthermore, the risk of developing OA increases with age. However, age alone does not cause OA. It is therefore important to understand the healthy age-related trajectories of knee shape before attributing these changes to OA. The aim of this study was to determine the association between bony knee shape and age using statistical-shape modelling (SSM). 96 participants received a CT scan of their knee. Three-dimensional models were created using manual segmentation. Separate SSM's for the distal femur and proximal tibia were created. Linear regression models were used to assess the association between age and femoral and tibial shape. Fourteen modes of the femoral and tibial SSM's captured 68% and 73% shape variation, respectively. Only femoral mode 3 and tibial mode 7 were associated with age. Increasing age was related to larger femoral bone volume and deepening of the femoral trochlear groove. Furthermore, increased age was associated with medial tibial plateau expansion. Aspects of bony femoral and tibial shape were significantly associated with aging, including femoral and tibial bone size, femoral trochlear groove, and medial tibial plateau area. Changes in knee morphology occur as a normal process of aging without osteoarthritis development. This may be a response to mechanical loading over time. Further research investigating the effect of these changes on loading in the knee may provide valuable information for knee health in older age.

EnderScope: a low-cost 3D printer-based scanning microscope for microplastic detection.

Low-cost and scalable technologies that allow people to measure microplastics in their local environment could facilitate a greater understanding of the global problem of marine microplastic pollution. A typical way to measure marine microplastic pollution involves imaging filtered seawater samples stained with a fluorescent dye to aid in the detection of microplastics. Although traditional fluorescence microscopy allows these particles to be manually counted and detected, this is a resource- and labour-intensive task. Here, we describe a novel, low-cost microscope for automated scanning and detection of microplastics in filtered seawater samples-the EnderScope. This microscope is based on the mechanics of a low-cost 3D printer (Creality Ender 3). The hotend of the printer is replaced with an optics module, allowing for the reliable and calibrated motion system of the 3D printer to be used for automated scanning over a large area (>20 × 20 cm). The EnderScope is capable of both reflected light and fluorescence imaging. In both configurations, we aimed to make the design as simple and cost-effective as possible, for example, by using low-cost LEDs for illumination and lighting gels as emission filters. We believe this tool is a cost-effective solution for microplastic measurement. This article is part of the Theo Murphy meeting issue 'Open, reproducible hardware for microscopy'.

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.

Team Behavior and Performance: An Exploration in the Context of Professional Rugby Union.

PURPOSE: To explore complex system behavior and subsequent team performance in professional rugby union. METHODS: Here, we present 2 studies. In the first, we used global positioning system technology to measure player clustering during stoppages in play in nearly 100 games of professional rugby union to explore team (complex system) behavior and performance. In the second, we measured stress hormones (cortisol and testosterone) prior to team meetings and analyzed these relative to amount of time and the frequency with which players looked at peer presenters, as well as subsequent training performance, to explain how stress may lead to behaviors observed in the first study and subsequent match performance. RESULTS: No link between player clustering during stoppages of play and performance was observed. When players (complex system agents) demonstrated greater levels of stress (as indicated by greater cortisol-awakening response and a greater decline in testosterone-to-cortisol ratio across the morning), they tended to look at peer presenters more; however, training quality declined (P = .02). Correlational analysis also showed that training quality was related to testosterone-to-cortisol ratio (P = .04). CONCLUSIONS: Team behavior is complex and can be unpredictable. It is possible that under stress, complex system agents (ie, rugby union players) look at (and cluster toward) their teammates more; however, meaningful interaction may not necessarily occur. Furthermore, while complex system (team) analysis may be valuable strategically in rugby union in the context of describing behavior, without understanding "how" or "why" intrateam/interagent behaviors emerge it may have little meaning.

A Two-Step Discrete Cosine Basis Oriented Motion Modeling Approach for Enhanced Motion Compensation.

Video coding algorithms attempt to minimize the significant commonality that exists within a video sequence. Each new video coding standard contains tools that can perform this task more efficiently compared to its predecessors. Modern video coding systems are block-based wherein commonality modeling is carried out only from the perspective of the block that need be coded next. In this work, we argue for a commonality modeling approach that can provide a seamless blending between global and local homogeneity information in terms of motion. For this purpose, at first a prediction of the current frame, the frame that need be coded, is generated by performing a two-step discrete cosine basis oriented (DCO) motion modeling. The DCO motion model is employed rather than traditional translational or affine motion model since it has the ability to efficiently model complex motion fields by providing a smooth and sparse representation. Moreover, the proposed two-step motion modeling approach can yield better motion compensation at a reduced computational complexity since an informed guess is designed for initializing the motion search procedure. After that the current frame is partitioned into rectangular regions and the conformance of these regions to the learned motion model is investigated. Depending on the non-conformance to the estimated global motion model, an additional DCO motion model is introduced to increase the local motion homogeneity. In this way, the proposed approach generates a motion compensated prediction of the current frame through the minimization of both global and local motion commonality. Experimental results show an improved rate-distortion performance of a reference high efficiency video coding (HEVC) encoder, specifically up to around 9% savings in bit rate, that employs the DCO prediction frame as a reference frame for encoding the current frame. When compared to the more recent video coding standard, the versatile video coding (VVC) encoder, a bit rate savings of 2.37% is reported.

Statistical shape modelling reveals differences in hamstring morphology between professional rugby players and sprinters.

Hamstring morphology may play an important role in understanding the aetiology of hamstring injury. Currently, the methods available to capture detailed morphological data such as muscle shape have not been utilized for the hamstring muscles. The aim of this study was to examine the utility of statistical shape modelling (SSM) for describing and comparing hamstring muscle shape in rugby and sprinting athletes. Magnetic resonance images of both thighs of nine elite male rugby players and nine track and field sprinters were analysed. Images were converted to three-dimensional models enabling generation of four statistical shape models. Principal components describing the shape variation in the cohort were derived and evaluated. Six principal components were sufficient to discriminate differences in the shape of the hamstring muscles of rugby and sprinting athletes with 89% classification accuracy. Distinct shape features distinguishing rugby players from sprinters included size, curvature and axial torsion. These data demonstrate that SSM is useful for understanding hamstring muscle shape and that meaningful variation can be identified within a small sample. This method can be used in future research to enhance the anatomical specificity of musculoskeletal modelling and to understand the relationship between hamstring shape and injury.

Hamstring musculotendon mechanics of prospectively injured elite rugby athletes.

The musculotendon mechanics of the hamstrings during high-speed running are thought to relate to injury but have rarely been examined in the context of prospectively occurring injury. This prospective study describes the hamstring musculotendon mechanics of two elite rugby players who sustained hamstring injuries during on-field running. Athletes undertook biomechanical analyses of high-speed running during a Super Rugby pre-season, prior to sustaining hamstring injuries during the subsequent competition season. The biceps femoris long head muscle experienced the greatest strain of all hamstring muscles during the late swing phase. When expressed relative to force capacity, biceps femoris long head also experienced the greatest musculotendon forces of all hamstring muscles. Musculotendon strain and force may both be key mechanisms for hamstring injury during the late swing phase of running.

Shape modelling of the oropharynx distinguishes associations with body morphology but not whiplash-associated disorder.

Characterization of the oropharynx, a subdivision of the pharynx between the soft palate and the epiglottis, is limited to simple measurements. Structural changes in the oropharynx in whiplash-associated disorder (WAD) cohorts have been quantified using two-dimensional (2D) and three-dimensional (3D) measures but the results are inconsistent. Statistical shape modelling (SSM) may be a more useful tool for systematically comparing morphometric features between cohorts. This technique has been used to quantify the variability in boney and soft tissue structures, but has not been used to examine a hollow cavity such as the oropharynx. The primary aim of this project was to examine the utility of SSM for comparing the oropharynx between WAD cohorts and control; and WAD severity cohorts. The secondary aim was to determine whether shape is associated with sex, height, weight and neck length. Magnetic resonance (MR) T1-weighted images were obtained from healthy control (n = 20), acute WAD (n = 14) and chronic WAD (n = 14) participants aged 18-39 years. Demographic, WAD severity (neck disability index) and body morphometry data were collected from each participant. Manual segmentation of the oropharynx was undertaken by blinded researchers between the top of the soft palate and tip of the epiglottis. Digital 3D oropharynx models were constructed from the segmented images and principal component (PC) analysis was performed with the PC weights normalized to z-scores for consistency. Statistical analyses were undertaken using multivariate linear models. In the first statistical model the independent variable was group (acute WAD, chronic WAD, control); and in the second model the independent variable was WAD severity (recovered/mild, moderate/severe). The covariates for both models included height, weight, average neck length and sex. Shape models were constructed to visualize the effect of perturbing these covariates for each relevant mode. The shape model revealed five modes which explained 90% of the variance: mode 1 explained 59% of the variance and primarily described differences in isometric size of the oropharynx, including elongation; mode 2 (13%) primarily described lateral (width) and AP (depth) dimensions; mode 3 (8%) described retroglossal AP dimension; mode 4 (6%) described lateral dimensions at the retropalatal-retroglossal junction and mode 5 (4%) described the lateral dimension at the inferior retroglossal region. There was no difference in shape (mode 1 p = 0.52; mode 2 p = 0.96; mode 3 p = 0.07; mode 4 p = 0.54; mode 5 p = 0.74) between control, acute WAD and chronic WAD groups. There were no statistical differences for any mode (mode 1 p = 0.12; mode 2 p = 0.29; mode 3 p = 0.56; mode 4 p = 0.99; mode 5 p = 0.96) between recovered/mild and moderate/severe WAD. Sex was not significant in any of the models but for mode 1 there was a significant association with height (p = 0.007), mode 2 neck length (p = 0.044) and in mode 3 weight (p = 0.027). Although SSM did not detect differences between WAD cohorts, it did detect associations with body morphology indicating that it may be a useful tool for examining differences in the oropharynx.

Arthroscopic Femoral and Acetabular Osteoplasties Alter the In Vivo Hip Kinematics of Patients With Femoroacetabular Impingement.

Purpose: Three-dimensional (3D)-two-dimensional (2D) fluoroscopic image registration was used to measure 3D hip kinematics before and after hip arthroscopy in patients with femoroacetabular impingement (FAI). Methods: In total, 24 subjects diagnosed with FAI (21 unilateral, 3 bilateral) were prospectively recruited. A clinical impingement test was performed on both hips while the patient was awake and then while anaesthetized, and in the operative hip after arthroscopic osteoplasties and labral repair. Fluoroscopy was used to image the hip during the impingement tests. Images were analyzed using 3D-2D image registration to calculate joint kinematics. The examiner's hand was instrumented with a glove to measure internal rotation torque applied to the hip during each test. Results: Internal rotation increased by 3.7° (standard error [SE] 0.95°) after surgery (P = .001). Maximum displacement of the femoral head out of the acetabulum was 4.0 mm (SE 0.5 mm) in the operative group before surgery and 1.8 mm (SE 0.3 mm) after surgery (P < .001). This was due to a decrease in lateral displacement by 1.3 mm (SE 0.4 mm, P = .002) and proximal displacement by 0.8 mm (SE 0.3 mm, P = .013). Internal rotation torque was greater in the operative hips when anaesthetized compared with when awake, by 5 Nm (SE 1.2 Nm, P < .001), and greater in the contralateral hips than the operative hips when awake by 8.4 Nm (SE 1.4 mm, P < .001). Conclusions: Arthroscopic osteoplasty and labral repair increased hip range of motion and reduced femoral head displacement from the acetabulum during the IR90 provocation test (i.e., hip flexion to 90°, maximum internal rotation) in patients with FAI. This suggests that the impinging acetabular rim acted as a fulcrum before surgery and may have caused edge loading that was reduced after surgery. Level of Evidence: Level IV case series, therapeutic study.

An efficient hybrid method for 3D to 2D medical image registration.

PURPOSE: The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement. METHODS: We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy. RESULTS: We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method. CONCLUSION: The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment.

Characterization of geometric variance in the epithelial nerve net of the ctenophore Pleurobrachia pileus.

Neuroscience lacks a diverse repertoire of model organisms, resulting in an incomplete understanding of the general principles of neural function. Ctenophores display many neurobiological and experimental features which make them a promising candidate to fill this gap. They possess a nerve net distributed across their body surface in the epithelial layer. There is a long-held assumption that nerve nets are "simple" and lack distinct organizational principles. We want to challenge this assumption and determine how stereotyped the structure of this network is. We estimated body surface area in Pleurobrachia pileus using custom optical projection tomography and light sheet morphometry imaging systems. Using an antibody against tyrosinated α-tubulin, we visualized the nerve net in situ and quantified the geometric properties using an automated segmentation approach. We characterized organizational rules of the epithelial nerve net in animals of different sizes and at different regions of the body. We found that specific morphological features within the nerve net are largely unchanged during growth. These properties must be essential to the functionality of the nervous system and therefore are maintained during a change in body size. We have also established the principles of organization of the network and showed that some of the geometric properties are variable across different parts of the body. This suggests that there may be different functions occurring in regions with different structural characteristics. This is the most comprehensive structural description of a ctenophore nerve net to date and demonstrates the amenability of P. pileus for whole organism network analysis.

Absence of monitoring in withdrawal of clinically-assisted nutrition and hydration (CANH) and other treatments: a cause for concern?

Since 2018, there has been no requirement to bring decisions about the withdrawal of clinically-assisted nutrition and hydration (CANH) in patients with persistent disorders of consciousness before the courts, providing that the requirements of the Mental Capacity Act 2005 (MCA) are fulfilled. Subsequent British Medical Association and Royal College of Physicians guidance on CANH withdrawal recommended standards of record keeping and internal and external audit to ensure local decision making was compliant with the MCA to safeguard patients. The scope of the guidance also included patients with stroke and neurodegenerative disorders.Freedom of Information requests made 2 years after the introduction of this guidance have shown that none of the NHS trusts or clinical commissioning groups who responded were undertaking any systematic monitoring of these decisions. Neither is the Care Quality Commission reviewing these decisions, as there is 'no statutory requirement' to do so. It appears there is a lack of organised scrutiny of these highly complex life-ending treatment decisions. This omission must surely be a cause for concern.

The influence of total knee arthroplasty design on kneeling kinematics: a prospective randomized clinical trial.

AIMS: Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs. METHODS: In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis. RESULTS: CR-FB designs had significantly lower maximal flexion (mean 116° (SD 2.1°)) compared to CR-RP (123° (SD 1.6°)) and PS-FB (125° (SD 2.1°)). The PS-FB design displayed a more posteriorly positioned femur throughout flexion. Furthermore, the CR-RP femur was more externally rotated throughout kneeling. Finally, individual patient kinematics showed high degrees of variability within all designs. CONCLUSION: The increased maximal flexion found in the PS-FB and CR-RP designs were likely achieved in different ways. The PS-FB design uses a cam-post to hold the femur more posteriorly preventing posterior impingement. The external rotation within the CR-RP design was surprising and hasn't previously been reported. It is likely due to the polyethylene bearing being decoupled from flexion. The findings of this study provide insights into the function of different knee arthroplasty designs in the context during deep kneeling and provide clinicians with a more kinematically informed choice for implant selection and may allow improved management of patients' functional expectations. Cite this article: Bone Joint J 2021;103-B(1):105-112.

Validation of a method to measure three-dimensional hip joint kinematics in subjects with femoroacetabular impingement.

INTRODUCTION: A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI). METHODS: 3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D-2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images. RESULTS: Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D-2D registration demonstrated maximums of 1.64° and 3.96°, respectively. However, if the single outlier was removed, bias and precision were 0.55° and 1.38°. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively. CONCLUSIONS: This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10° of rotation represent a clinically significant difference in hip kinematics, the method's accuracy of approximately 1 mm displacement and 1° rotation should enable detection of significant clinical differences.

The incubot: A 3D printer-based microscope for long-term live cell imaging within a tissue culture incubator.

Commercial live cell imaging systems represent a large financial burden to research groups, while current open source incubator microscopy systems lack adaptability and are sometimes inadequate for complex imaging experimentation. We present here a low-cost microscope designed for inclusion within a conventional tissue culture incubator. The build is constructed using an entry level 3D printer as the basis for the motion control system, with Raspberry Pi imaging and software integration, allowing for reflected, oblique, and fluorescence imaging of live cell monolayers. The open source nature of the design is aimed to facilitate adaptation by both the community at large and by individual researchers/groups. The development of an adaptable and easy-to-use graphic user interface (GUI) allows for the scientist to be at the core of experimental design through simple modifications of the base GUI code, or generation of an entirely purpose-built script. This adaptability will allow scientists to adapt this equipment for their experimental needs, as opposed to designing experiments to fit their current equipment. The build can be constructed for a cost of roughly €1000 and thus serves as a low-cost and adaptable addition to the open source microscopy community.

Cursive-Text: A Comprehensive Dataset for End-to-End Urdu Text Recognition in Natural Scene Images.

Reading text in natural scene images is an active research area in the fields of computer vision and pattern recognition as text detection, text recognition and script identification are required. In this data article, a comprehensive dataset for Urdu text detection and recognition in natural scene images is presented and analysed. To develop the dataset, more than 2500 natural scene images were captured using a digital camera and a built-in mobile phone camera. Three separate datasets for isolated Urdu character images, cropped word images and end-to-end text spotting were developed. The isolated Urdu character and cropped word images dataset contain a much larger number of samples than existing Arabic natural scene text datasets. The Urdu text spotting dataset contains images with Urdu, English and Sindhi text instances. However, the focus has been given to the Urdu text instances. The ground truths for each image in the isolated character, cropped word or text spotting datasets are provided separately. The proposed datasets can be used to perform Urdu text detection and recognition or end-to-end recognition in natural scenes. These datasets can also be helpful to develop Arabic and Persian natural scene text detection and recognition systems, as Urdu is a derived language of these scripts and has many similar letters. The datasets can also be helpful to develop multi-language translation systems, which can facilitate foreign tourists to read and translate multilingual text in natural scene images. To evaluate the datasets, state-of-the-art machine learning and deep neural networks were used to build the text detection and recognition models, where the best classification accuracies are achieved. To the best of the authors' knowledge, this is the first dataset proposed for Urdu text detection, recognition or end-to-end text recognition in natural scene images. The aim of this data article is to present a benchmark work in the field of document analysis and recognition. Computer Science Computer Vision and Pattern Recognition Tables Figures Images Text Files Using a digital camera with a 20 megapixels (MP) sensor, an iPhone with a 12 MP back camera and a Samsung mobile with a 16MP back camera. Raw Analyzed Environmental factors such as illuminations, blurring and lighting conditions were considered while capturing images. The focus was given to the text within an image. The images in the dataset were obtained from the advertisement banners, sign-boards along the road side and streets, shop name boards, text written on the passing vehicles and walls. The images provided in this dataset were collected in different cities of Sindh, Pakistan. Summarized data are hosted with the article. The datasets and their related files are hosted in a Mendeley public data repository. DOI: https://data.mendeley.com/datasets/k5fz57zd9z/1 URL: http://dx.doi.org/10.17632/k5fz57zd9z.1.

A biomimetic urethral model to evaluate urinary catheter lubricity and epithelial micro-trauma.

The standard method of evaluating the lubricity of intermittent urinary catheters with coefficient of friction (CoF) testing is not physiologically relevant, while there is also a dearth of published research on catheter-associated urethral micro-trauma. We developed a novel human urethral epithelial cell-seeded model of the urethra to replace the rubber counter-surface used in standard CoF testing. This cell-seeded model, in conjunction with a novel testing device, allows an investigation of catheter-associated epithelial micro-trauma in vitro for the first time. The CoF of four brands of commercially-available hydrophilic-coated intermittent catheters was measured using both the rubber and urethral model counter-surfaces. Post-catheterisation of the urethral model, the damage to the epithelial layer was analysed using standard cell imaging. The rubber counter-surface was shown to over-estimate the CoF of gel-coated catheters compared to our urethral model due to stick-slip behaviour caused by polymer-on-polymer interaction of the catheter base material on the rubber counter-surface. We identified no deleterious effect due to the presence or design of catheter eyelets to either the CoF measurements or the degree of epithelium damage in our model. Furthermore, the epithelial damage did not correlate with the measured CoF of the low friction catheters, suggesting a more nuanced pathogenesis of urethral irritation and casting doubt on the translatability of a solely mechanical assessment of lubricity of urinary catheters to a clinical effect.

The Flexiscope: a low cost, flexible, convertible and modular microscope with automated scanning and micromanipulation.

With technologies rapidly evolving, many research institutions are now opting to invest in costly, high-quality, specialized microscopes which are shared by many researchers. As a consequence, the user may not have the ability to adapt a microscope to their specific needs and limitations in experimental design are introduced. A flexible work-horse microscopy system is a valuable tool in any laboratory to meet the diverse needs of a research team and promote innovation in experimental design. We have developed the Flexiscope; a multi-functional, adaptable, efficient and high-performance microscopy/electrophysiology system for everyday applications in a neurobiology laboratory. The core optical components are relatively constant in the three configurations described here: an upright configuration, an inverted configuration and an upright/electrophysiology configuration. We have provided a comprehensive description of the Flexiscope. We show that this method is capable of oblique infrared illumination imaging, multi-channel fluorescent imaging and automated three-dimensional scanning of larger specimens. Image quality is conserved across the three configurations of the microscope, and conversion between configurations is possible quickly and easily, while the motion control system can be repurposed to allow sub-micrometre computer-controlled micromanipulation. The Flexiscope provides similar performance and usability to commercially available systems. However, as it can be easily reconfigured for multiple roles, it can remove the need to purchase multiple microscopes, giving significant cost savings. The modular reconfigurable nature allows the user to customize the system to their specific needs and adapt/upgrade the system as challenges arise, without requiring specialized technical skills.

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees.

Tibiofemoral shape influences knee kinematics but little is known about the effect of shape on deep knee flexion kinematics. The aim of this study was to examine the association between tibiofemoral joint shape and kinematics during deep kneeling in patients with and without osteoarthritis (OA). Sixty-one healthy participants and 58 patients with end-stage knee OA received a computed tomography (CT) of their knee. Participants completed full flexion kneeling while being imaged using single-plane fluoroscopy. Six-degree-of-freedom kinematics were measured by registering a three-dimensional (3D)-static CT onto 2D-dynamic fluoroscopic images. Statistical shape modeling and bivariate functional principal component analysis (bfPCA) were used to describe variability in knee shape and kinematics, respectively. Random-forest-regression models were created to test the ability of shape to predict kinematics controlling for body mass index, sex, and group. The first seven modes of the shape model up to three modes of the bfPCAs captured more than 90% of the variation. The ability of the random forest models to predict kinematics from shape was low, with no more than 50% of the variation being explained in any model. Furthermore, prediction errors were high, ranging between 24.2% and 29.4% of the data. Variations in the bony morphology of the tibiofemoral joint were weakly associated with the kinematics of deep knee flexion. The models only explained a small amount of variation in the data with high error rates indicating that additional predictors need to be identified. These results contribute to the clinical understanding of knee kinematics and potentially the expectations placed on high-flexion total knee replacement design.

Measurement of Quasi-Static 3-D Knee Joint Movement Based on the Registration From CT to US.

The measurement of quasi-static 3-D knee joint movement is an important basis for studying the mechanism of knee joint injury. Most of the existing measurement methods make use of computed tomography (CT) and nuclear magnetic resonance (MR) imaging technology and hence have the disadvantages of invasiveness, ionizing radiation, low accuracy, and high cost. To overcome those drawbacks, this article innovatively proposes a 3-D motion measurement system for the knee joint based on the registration of CT images to ultrasound (US) images. More specifically, the lower limbs of a subject were first scanned once to acquire the CT images. A portable handheld device was designed to control a US probe for mechanically scanning the subject's lower limbs in a linear trajectory. During the movement of the subject's lower limbs, the US scanning was performed quasi-statically. The acquired US images were then registered to the CT images, and the 3-D motions of the lower limb bones could be recreated with the bones scanned in CT images. To guarantee the registration accuracy and efficiency, we used the H-shaped multiview slice assembly as the structural image content for the registration process. The experimental results show that our approach can accurately measure the 3-D motion of the knee joint and meet the needs of 3-D motion analysis of knee joint in practice.